A 45-year-old woman presented with severe headache for three hours. Non-contrast brain
CT revealed subarachnoid hemorrhage, mostly in the prepontine cistern ( [Figure] A). A catheter-based angiogram showed a heart-shaped aneurysm arising from the junction
of the basilar artery and the left superior cerebellar artery ( [Figures] B and C), which was then coiled uneventfully ( [Figure] D).
Figure (A) Non-contrast head CT shows subarachnoid hemorrhage in the prepontine cistern.
(B-C) Catheter-based angiogram shows a heart-shaped saccular aneurysm (arrows) originating
from the bifurcation of the basilar artery and the left superior cerebellar artery.
(D) Postoperative angiogram shows the aneurysm (arrow) coiled successfully.
Cerebral aneurysm with a heart-shaped configuration is interesting and extremely rare,
which is usually associated with vessel-wall degeneration under hemodynamic stress
[1] . Surgical clipping is challenging because of the complex anatomic environment and
fragile aneurysmal wall; while an endovascular procedure, as a straightforward option,
seems to be feasible and effective [2],[3] .
