Aneurysm of the left anterior communicating branch (RCA)CT angiography, coronary reconstructionsagital reconstructionangiographyParticularly the connection of the aneurysm to the neighboring structures can be displayed well in CT angiography, which is useful for planning the right approach for a surgical procedure. Because of the surrounding bony structures, there can unfortunately be lots of artifacts that corrupt the image. The amount of contrast agent used in CT angiography is lower than for conventional angiography. This can lead to lack of representation of small but potentially functional important vessels on the image. It is essential to see if that's the case before treatment is begun. Due to artifacts it can also look like the caliber of the arteries varies, which can be misdiagnosed as vasospasm. Despite many contrary opinions, I think digital subtraction angiography (DSA) is still indispensable.One recognizes here a typical aneurysm of about 7 mm in size. In addition to age, condition and wishes of the patient, situation, size and form of the aneurysm are crucial factors that influence treatment options.Essentially there are three possibilities:1. Surgical treatment after craniotomy and clipping of the aneurysm,2. Embolization (coiling) by platinum coils (GDC coils) via a percutaneous endoluminal catheter technique3. No treatment but observation with follow-ups.It should be noted, however, that observation without treatment is dangerous because of the risk of suffering a subarachnoid hemorrhage due to rupture of the aneurysm. In general, intracranial aneurysms, depending on the prognostic factors (like previous history of SAH, age and condition of the patient, treatment risks) should be are always treated, because the risk of a rupture is so high and a rupture is often fatal or associated with severe neurological deficits.This aneurysm was successfully treated by percutaneous embolization.Another example: Giant aneurysm of the right middle cerebral artery, which was initially closed by embolization, but later, due to increasing size and reperfusion, had to be clipped and resected (see here)
