Ruptured "occult" aneurysm disclosed by three-dimensional angiographic reconstructions

Area of Science:

• Neurosurgery
• Radiology
• Vascular Imaging

Background:

• Rotational angiography and 3D reconstructions significantly enhance angiographic diagnostics, particularly for brain aneurysms.
• These techniques accurately depict aneurysm morphology, wall irregularities, and arterial origins, aiding in precise measurements.

Purpose of the Study:

• To highlight the diagnostic utility of 3D rotational angiography in identifying complex and occult brain aneurysms.
• To present a case where 3D rotational angiography revealed an aneurysm missed by standard imaging techniques.

Main Methods:

• Utilized rotational angiographic sequences and their three-dimensional reconstructions for detailed aneurysm analysis.
• Employed a diagnostic strategy including rotational angiography for suspected subarachnoid hemorrhage when standard views were inconclusive.

Main Results:

• 3D reconstructions accurately visualized aneurysm morphology and spatial relationships.
• An occult left carotid artery siphon aneurysm, masked by the posterior communicating artery, was successfully identified.
• Rotational angiography disclosed ruptured and intact aneurysms not visible on digital subtraction angiography.

Conclusions:

• 3D angiographic reconstructions are invaluable for characterizing brain aneurysms.
• This technique is essential for detecting occult ruptured aneurysms and associated lesions.
• A systematic diagnostic approach incorporating rotational angiography improves detection rates for complex cerebrovascular pathologies.