Image 15. The cerebral angiogram shows the same aneurysm seen in Image 14. It is now undergoing coiling. You can see the thin microcoil (green arrowheads) being fed through the catheter in the internal carotid artery and anterior communicating artery. Coils are now present in the dome of the aneurysm (red arrow), but the neck of the aneurysm (yellow arrow) could not be coiled despite multiple best attempts.

Image 16. At the end of the coiling procedure depicted in Image 15, the aneurysm dome is well filled with microcoils (red arrow) as seen in this angriogram image. However, the neck of the aneurysm (yellow arrow) has not been obliterated. A neurosurgeon was therefore consulted.

Image 17. This is an intraoperative photograph of the same aneurysm seen in Images 14-16. Here, you can see the metallic coils (red arrows) through the thin aneurysm wall. The residual uncoiled neck of the aneurysm is seen (greeen arrowheads). Also note the presence of an aneurysm daughter sac (D).

Image 18. This is an intraoperative photograph of the same aneurysm seen in Images 14-17. Here, you can still see the metallic coils (red arrow) through the thin aneurysm wall. The residual uncoiled neck of the aneurysm has now been definitively clipped by the surgeon. The green arrowheads show the jaws of the clip (C) firmly around the aneurysm neck. The daughter sac (D) has now also been taken care of by the same clip.

Image 19. This is a postoperative cerebral angiogram image of the same aneurysm shown in Images 14-18. Here, you can a craniotomy has recently been carried out (the titanium snowflake-shaped plates are seen on the left of this image, forming a bridge between the skull and the restored bone flap). A row of staples on the skin surface is also seen. The previously coiled and now clipped aneurysm is shown (red arrow), the clip is marked by the green arrowheads.

Images 20 and 21. These are magnetic resonance angiogram (MRA) images of the same aneurysm seen in Images 14-19. The left image shows the previously coiled aneurysm before clipping, and the right image shows the same aneurysm after clipping. In the left image, the residual neck is marked by the green arrowheads, and the coiled dome is shown by the red arrow. In the right image, the clip is seen placed across the neck of the aneurysm (green arrowheads), and no residual neck is seen. In both images, the parent artery, in this case the anterior communicating artery, is shown (P).