• 61-year-old man who presented with severe headache and somnolence.

CT scan of patient’s brain shown subarachnoid hemorrhage.





MRA on the top CTA on the bottom show a left PICA (Posterior Inferior Cerebral Angiography)




Cerebral angiography shows a PICA aneurysm. Further he lacks a right vertebral artery.

• He underwent left far lateral craniectomy with micro-clipping of this aneurysm utilizing intra-operative neurophysiological monitoring and stereotaxy.

Computer navigation and stereotaxy was utilized to precisely model and map the aneurysm for surgical planning. The aneurysm is shown under the hairpin, and marked red in the right lower model of the skull.

• Post op cerebral angiography shows complete treatment of this aneurysm

On post bleeding day #11 while being monitored in the ICU he developed weakness in right side. Cerebral angiography showed sever vasospasm (as the result of subarachnoid hemorrhage)

• This vasospasm was aggressively treated medically in the ICU with HHH therapy (Hypertensive, Hypervolemic, and Hemodilution). He responded to this treatment and was discharged out of hospital.
• He has since returned to normal function and remains free of any aneurysm.

On discharge his CT showed clearance of subarachnoid hemorrhage.