Five patients aged 55 to 73 years (mean 63 years) underwent one-stage clipping for unruptured aneurysms in the bilateral middle cerebral arteries (mean size 4.5 mm, range 2 to 7 mm) via the bilateral pterional keyhole approach in our institute. Important points are as follows: the head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; a 5-cm curvilinear skin incision is made inside the hairline and pterional keyhole craniotomy is made bilaterally using 2 burr holes; the whole operating table is rotated 15 degrees to one side to facilitate the microsurgical trans-sylvian approach and aneurysm clipping; the operating table is rotated to the other side for the contralateral procedure; and particular care is taken to avoid bilateral brain injury. This approach provided minimum but sufficient working space required for trans-sylvian dissection. Aneurysm neck clipping was safely performed in a mean operation time of 5 hours 17 minutes. No complications occurred and satisfactory cosmetic results were obtained in all patients. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimum consequences of brain retraction. One-stage clipping via the pterional keyhole approach is a safe and effective therapeutic option for small bilateral aneurysms.

Purpose:This study aimed to evaluate the characteristics of pseudoaneurysms and aneurysms following gastrointestinal surgery treated with endovascular management (i.e., transcatheter arterial embolization or stent-graft placement). Methods:This retrospective study included 17 patients with pseudoaneurysms and 1 patient with an aneurysm following gastrointestinal surgery in a tertiary care hospital between 2011 and 2021. There were 15 men and 3 women aged 37-85 years, with an average age of 67 years. All patients underwent endovascular management. We retrospectively analyzed their angiographic features and clinical outcomes. Results:Arterial embolization was performed in 11 patients, and stent-graft placement was performed in 7 patients. Additional arterial embolization was necessary for another bleeding lesion in 2 patients, while 1 patient died of multiple organ failure. Stent-graft occlusion occurred after a few days in 3 out of 7 patients without any antithrombotic drugs. Extravascular migration of the occluded stentgrafts was observed in 3 out of 7 patients, wherein these stent-grafts migrated to the intestine and eventually disappeared in 2 patients. There were no clinical symptoms related to the occlusion or migration of the stent-grafts. Conclusion:Both arterial embolization and stent-graft place-ment are effective in the management of postoperative pseudoaneurysms and aneurysms. Stent-graft placement is suitable for cases with poor collateral flow because it preserves arterial patency. The use of antithrombotic treatment and the risk of stent-grafts migration should be taken into consideration.

Summary:Background: Aneurysmal rupture accompanies intraventricular hemorrhage (IVH) in 13% to 28% of cases and can occur with no or slight subarachnoid hemorrhage. Clinical characteristics of such patients as well as their optimal management remain unclear.Methods: We performed direct surgery for 197 patients with ruptured cerebral aneurysms in the past four years at our institute. Among them, we studied nine patients (5%) presenting mainly with IVH. The patient age ranged from 44 to 83 years (mean 64 years). They comprised of five men and four women. We retrospectively analyzed the method of treatment and clinical results.

A 71-year-old woman presented disturbance of consciousness due to subarachnoid hemorrhage (SAH). A computed tomography (CT) on admission revealed diffuse thick SAH and intracerebral hematoma in the right frontal lobe. Conventional angiography and three-dimensional CT angiography showed symmetrical aneurysms located on the bilateral pericallosal arteries at bifurca

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