[Giant intracranial aneurysm visualized by prolonged injection angiography--case report (author's transl)]

A case of giant intracranial aneurysm which almost completely occluded the internal carotid artery and was diagnosed angiographically by prolonged injection technique was reported. A 62-year-old house-wife was admitted to the Department of Neurosurgery of The Asahi General Hospital, complaining of headache, nausea, and left ptosis. Neurological examination revealed left IInd, IIIrd, IVth, and VIth cranial nerve palsy. Films and laminagrams of the skull demonstrated the double floor of the sella trucica. Plain CT scan showed an oval high density area without surrounding low density area in the left middle cranial fossa. A left carotid angiogram revealed almost complete occlusion of the internal carotid artery at the foramen lacerum. Good cross filling through the anterior communicating artery was seen in the right carotid angiogram. Pre-operative diagnosis was pituitary tumor which extended to the middle cranial fossa. Left fronto-temporal craniotomy was performed and the tumor was suspected to be a giant intracranial aneurysm. Post-operative carotid angiogram by prolonged injection technique also showed a blood channel in the aneurysm and a part of the aneurysm. Left carotid ligation was carried out following intracranial surgery and her symptoms were remarkably improved. Apart from left VIth cranial nerve palsy she showed no abnormal neurological findings at discharge. Usefulness of the prolonged injection technique for differential diagnosis of the parasellar tumor was stressed.