23 years Female Reason: Aneurysm coiling, History: 5.5mm right paraclinoid aneurysm extending into the pituitary fossa as well as two aneurysms versus ophthalmic artery infundibulae at the left (2.5mm) right (1.5mm) ophthalmic artery origins OPERATORS: Greg Christoforidis, Brandyn CastroFLUOROSCOPY TIME: 40.8 minutesFrontal: 1331.46 mGyLateral: 1466.52 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 4) 3-D reconstructions of intracranial left internal carotid artery Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There was reflux into the PCOMAs bilaterally. The PCOMAs are small. There was transient reflux into the distal RVA which is slightly smaller in diameter relative to the LVA. The left PICA origin is extracranial. A posterior meningeal artery originates distal to the PICA.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There was reflux into the PCOMAs bilaterally. The PCOMAs are small. The right PICA is very small. The right PICA origin is extracranial. A posterior meningeal artery originates distal to the PICA. The right AICA is dominant. The anterior spinal artery originates from the RVA.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. The ACOMA is medium sized.There is a 2.5mm left ICA opthalmic artery origin aneurysm present. It is directed superiorly and medially.There is a 1.5 mm right ICA paraclinoid ICA aneurysm present. It is directed inferiorly, posteriorly and medially. It is associated with adjacent bone remodeling.Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. The ACOMA is medium sized.There is a 1 mm dilation/blister aneurysm at the right ICA opthalmic artery origin. It is directed superiorly and medially.There is a 5.5 mm left ICA paraclinoid ICA aneurysm present. It is directed inferiorly, posteriorly and medially. It is associated with adjacent bone remodeling.Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula.Intra-aneurysmal arteriogramIntra-aneurysmal arteriogram demonstrates no perforating arteries originating from the aneurysm.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure. There were no thromboembolic events noted.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the parent vessels and no thromboembolic events.Right common iliac artery: The puncture site is adjacent to the right CFA bifurcation.
1.Bilateral paraclinoid and ophthalmic origin aneurysms.2.Embolic coil occlusion of a right ICA paraclinoid intracranial aneurysm using MRI compatible (up to 3T) coils.3.Findings were communicated to Drs Awad and Goldenberg at the end of the procedure.