جستجوی مقالات مرتبط با کلیدواژه « intracranial aneurysm » در نشریات گروه « پزشکی »

We report the first case demonstrating the viability of the trans-cell approach as a salvage strategy in situations where Flow Redirection Endoluminal Devices (FREDs) fail to open.

A 64-year-old woman was admitted to our facility after a motorcycle accident. During her examination, an arteriovenous malformation (AVM) in the right temporal lobe was incidentally discovered. The AVM was associated with large flow-related aneurysms in the bilateral supraclinoid internal carotid artery (ICA), as revealed by computed tomography and magnetic resonance imaging. The AVM was surgically removed, and the aneurysm was treated endovascularly using a FRED. However, the middle section of the FRED failed to open post-deployment. We successfully carried out a salvage therapy using the stent strut technique with a Headway Duo microcatheter for coiling.

The trans-cell technique utilizing aHeadwayDuo156 microcatheter can beaneffective salvage treatment forunopened FRED stents used in brain aneurysm cases.

Aneurysmal subarachnoid hemorrhage (SAH) constitutes a life-threatening condition, and identifyingthe ruptured aneurysm is essential for further therapy. This study aimed to evaluate the diagnostic accuracy of hypo-attenuating berry sign (HBS) observed on computed tomography (CT) scan in distinguishing ruptured aneurysms.

In this diagnostic accuracy study, patients who had SAH and underwent non-enhanced brain CT scan wererecruited. The HBS was defined as a hypo-attenuating area with an identifiable border in the blood-filled hyper-densesubarachnoid space. The screening performance characteristics of HBS in identifying ruptured aneurysms were calcu-lated considering the digital subtraction angiography (DSA) as the gold standard.

A total of 129 aneurysms in131 patients were analyzed. The overall sensitivity and specificity of HBS in the diagnosis of aneurysms were determinedto be 78.7% (95%CI: 73.1% - 83.4%) and 70.7% (95%CI: 54.3% - 83.4%), respectively. Notably, the sensitivity increased to90.9% (95%CI: 84.3% - 95.0%) for aneurysms larger than 5mm. The level of inter-observer agreement for assessing thepresence of HBS was found to be substantial (kappa=0.734). The diagnostic accuracy of HBS in individuals exhibitedenhanced specificity, sensitivity, and reliability when evaluating patients with a solitary aneurysm or assessing rup-tured aneurysms. The multivariate logistic regression analysis revealed a statistically significant relationship betweenaneurysm size and the presence of HBS (odds ratios of 1.667 (95%CI: 1.238 - 2.244; p < 0.001) and 1.696 (95%CI: 1.231- 2.335; p = 0.001) for reader 1 and reader 2, respectively).

The HBS can serve as a simple and easy-to-useindicator for identifying a ruptured aneurysm and estimating its size in SAH patients.

The high incidence of intracranial aneurysms and the high mortality rate after rupture highlight the requirement and importance for early and accurate visualization of the aneurysm profile for subsequent patient treatment. Here we report a patient with an intracranial aneurysm who underwent digital subtraction angiography (DSA), zero echo time MRA (ZTE-MRA), and three-dimensional time-of-flight MRA (3D-TOF-MRA) on admission and after operation. The imaging quality and accuracies of ZTE-MRA and 3D-TOF-MRA were compared with DSA, the gold standard, in pre-operative and post-operative evaluation of intracranial aneurysms. Comparison of the two MRAs, ZTE-MRA has greater advantages in imaging.

Aneurysmal subarachnoid hemorrhage is a relatively rare cause of stroke, carrying a bad prognosis of mortality and disability. The current standard procedure, neurosurgical clipping, has failed to achieve satisfactory outcomes. Therefore, endovascular detachable coils have been tested as an alternative. This meta‑analysis was aimed to compare the outcomes of surgical clipping and endovascular coiling in aneurysmal subarachnoid hemorrhage.

Relevant randomized trials up to June 2018 were identified from Medline, Central, and Web of Science. Data for poor outcomes (Modified Rankin Scale [mRS] scores 3 to 6) at 2–3 months, 1 year, and 3–5 years were extracted and analyzed as odds ratios (ORs) with 95% confidence intervals (CIs), using RevMan software.

Five studies (2780: 1393 and 1387 patients in the coiling and clipping arms, respectively) were included in the current analysis. The overall effect estimate favored endovascular coiling over surgical clipping in terms of reducing poor outcomes (death or dependency, mRS > 2) at 1 year (OR = 0.67, 95% CI: 0.57–0.79) and 3–5 years (OR = 0.8, 95% CI: 0.67–0.96). Moreover, coiling was associated with a significantly lower rate of cerebral ischemia (OR = 0.37, 95% CI: 0.16–0.86). Postprocedural mortality (OR = 0.79, 95% CI: 0.6–1.05) and rebleeding (OR = 1.15, 95% CI: 0.75–1.78) rates were comparable between the two groups. However, technical failure was significantly more common with coiling interventions than with clipping surgeries (OR = 2.84, 95% CI: 1.86–4.34).

Our analysis suggests that coiling can be a better alternative to clipping in terms of surgical outcomes. Further improvements in the coiling technique and training may improve the outcomes of this procedure.

We aimed to investigate whether the polymorphisms of gene heparan sulfate proteoglycan 2 (HSPG2) and chondroitin sulfate proteoglycan 2 (CSPG2) are associated with increased risk of intracranial aneurysms (IAs) susceptibility.

The Cochrane Library, Medline, PubMed, and Embase databases were carefully searched for potential researches before Mar 30, 2018. The title, abstract, and full text were assessed to determine whether the paper was suitable for inclusion. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were presented to assess the associations between CSPG2 and HSPG2 polymorphisms and IAs susceptibility.

We enrolled 7 papers, 4 matched single nucleotide polymorphisms (SNPs) of CSPG2 (rs173686, rs251124) or HSPG2 (rs173686, rs251124), and a total of 8651 participations (3674 with IAs and 4977 for control). For the rs251124 polymorphism of CSPG2, the quantitative synthesis from 5 studies showed significant difference in the gene allele comparison of T vs. C (OR, 1.129; 95% CI, 1.029, 1.238; P=0.01). Similar results were found for rs3767137 of HSPG2 (A vs. G, OR, 0.842, 95% CI=0.759-0.935, P=0.001). However, for the rs173686 polymorphism of CSPG2 and rs7556412 polymorphism of HSPG2, no significant difference was found (P=0.259 and P=0.474, respectively)

The SNPs rs251124 of CSPG2 and rs3767137 of HSPG2 had statistically significant associations with IAs susceptibility. The minor allele T of rs251124 demonstrated a harmful effect but the minor allele A of rs3767137 demonstrated a protective role with regard to the risk of IAs. However, no such associations were found in the SNPs rs173686 of CSPG2 and rs7556412 of HSPG2.

Ventriculostomy-Related Infections (VRIs) are reported in 3%–29% of patients with Subarachnoid Hemorrhage (SAH), and is strongly associated with the placement of Cerebrospinal Fluid (CSF) catheters. Considering the risk of placement of a metal clip in an infected environment, the timing of clipping in these patients is a challenging issue. To treat the patients with a ruptured aneurysm that simultaneously had infection induced by External Ventricular Drainage (EVD).
Materials & This study was carried out from January 2016 to December 2018 in an academic hospital in the north of Iran. A total of 42 consecutive patients with spontaneous SAH treated with EVD were enrolled in this study. The results of laboratory tests of CSF (proven or suspected ventriculitis) and timing from ictus to aneurysm surgical clipping, length of VRIs, and patients’ outcomes were reviewed. Analysis of the obtained data was performed by ANOVA, Fisher exact test and the Chi-square test in SPSS 20. P values less than 0.05 were considered significant. Among non-infected patients, the best time of clipping is less than 3 days that resulted in the least complications (P=0.047). Among the infected patients, the rate of death in patients undergone surgery 4-14 days later was more than the patients  undergone surgery after 2 weeks and the rate of severe complications was even more after 2 weeks. If there is simultaneous brain aneurysm and infection induced by EVD, aneurysm clipping is better to be done in less than 3 day that reduces the vasospasm too, otherwise the clipping is better to be done after treatment of the infection i.e. 2-3 weeks later.

Themaintenance of hemodynamic stability in brain aneurysm surgery has paramount clinical significance in order to prevent vasospasm in the patients with aneurysmal subarachnoid hemorrhage. Regarding this, the present study was conducted to assess the role of magnesium sulfate in preventing vasospasm and maintaining hemodynamic stability during endovascular coiling procedure for brain aneurysm. This double-blind clinical trial was conducted on 60 patients who were candidates for undergoing endovascular coiling for brain aneurysm. The patients were subjected to angiography through femoral artery catheterization. Then, they were randomly assigned into two treatment groups of case receiving magnesium sulfate and control administered normal saline. The vasospasm and hemodynamic status were measured and recorded during and following the surgery. According to the results, no significant difference was observed between the two groups in terms of heart rate (p=0.98) and mean arterial pressure =p) 0.89( one hour post-surgery. Furthermore, there was no statistical difference between the two groups regarding the use of nimodipine ( p=0.11). Nevertheless, the frequency of vasospasm was significantly lower in the patients receiving magnesium sulfate, during surgery (p=0.037) and after surgery (p=0.02), compared to those administered normal saline. As the findings indicated, magnesium sulfate could lower the incidence of vasospasm during and following the endovascular coiling procedure for brain aneurysm. Moreover, it resulted in no adverse effects on the hemodynamic status of the patients

Autosomal recessive polycystic kidney disease (ARPKD)is an autosomal recessive inherited developmental kidney disorder characterized by bilateral cystic dilatation of renal collecting ducts. The liver is always affected, with various degrees of biliary dysgenesis and periportal fibrosis. Intracranial aneurysms (ICA) can be associated with autosomal dominant polycystic kidney disease (ADPKD) in 5-10% of the cases, but extremely rarely with ARPKD. We described a full-term male infant with ARPKD born with an extremely distended abdomen and anuria. Bilateral nephrectomy and open liver biopsy were performed during the first month of hospitalization, as well as the insertion of a peritoneal dialysis catheter. On the 59th day of life, the baby`s condition abruptly deteriorated and he showed a decreased level of consciousness, coma (GCS=3), and severe anemia. Head ultrasound and head CT scan revealed large hemorrhage in the left cerebral hemisphere. Hemostasis parameters, as well as clinical and laboratory signs of infection, were in referral ranges at the time of neurological deterioration. MRI showed large hemorrhages in the left ventricle and left cerebral hemisphere but a preexisting intracranial aneurism (ICA) in the site of hemorrhage could not be diagnosed for sure. The baby died on the 66th day of life.

PurposeTo describe a case of endovascular occlusion of an unruptured anterior communicating artery aneurysm presenting with acute altitudinal visual field defect is presented here.
MethodsA 52-year-old man was evaluated and treated for altitudinal visual field defect in the right eye.
ResultsIn ophthalmic and neuro-imaging, an accompanying anterior communication artery aneurysm was detected as a cause of visual field defect. He underwent endovascular procedure, yielding excellent outcome as full recovery of visual field defect was observed one month following the procedure and sustained when followed at month 24.
ConclusionsVisual dysfunction is a rare presentation of unruptured anterior communication artery aneurysm. Endovascular procedure may be a safe treatment in these cases.

The existence of residual aneurysm after intracranial aneurysm clipping bears the risk of re-bleeding, which worsens with the passage of time. Digital subtraction angiography (DSA) is accepted as the gold standard for evaluation of residual aneurysm, but it is invasive, costly, and serious complications are possible.
The aim of this study was to compare DSA to 64-slice CT angiography for assessing residual aneurysm.
Patients and Forty patients with 43 clipped aneurysms from which 36 were torn, were evaluated by DSA after improvement in clinical status, and after a month they were evaluated by 64-slice CT angiography. The pictures were assessed by two neuroradiologists separately, in terms of quality, artifact due to the clips, and the completion of aneurysm closing.
In multislice computed tomographic angiography (MSCT) analysis, 36 pictures (90%) had good quality and four pictures (10%) had poor quality. In case of good quality pictures in MSCT and angiography, the 2- and 3-millimeter residual aneurysms were approved for two patients based on which, sensitivity, feature and positive/negative predictive value for diagnosis of residual aneurysm was 100 for good-quality pictures by MSCT. The level of agreement between the two neuroradiologists was 1 for diagnosing residual aneurysm and 0.86 for vasospasm. The average time for doing MSCT was 12 minutes compared to 45 minutes for DSA angiography, which was cost effective.
CT angiography is a less invasive method with high sensitivity and capabilities for diagnosing residual aneurysm. It is cheaper, quicker and can be accomplished for critical patients. Therefore, it can be taken as the first choice and a replacement for DSA in post-surgery evaluation of patients with clipped brain aneurysm.

Intracranial aneurysms (IAs) are focal pathologic dilation of cerebral vasculature, which mostly affect the anterior circulation of brain. Carotid body tumors (CBTs) are the most common head and neck parasympathetic paragangliomas. These slow growing neoplasms may cause hypertension along with catecholamine release symptoms, mostly in patients in their fourth decade. This is the second reported case of simultaneous presentation of CBT and IA in a male patient.
A 54-year-old male with positive history of hypertension presented with isolated acute weakness of right upper extremity. Bilateral Doppler ultrasound of carotid arteries showed a mass at left carotid bifurcation, which was confirmed by vessels computed tomography (CT) – angiography. CT scan also demonstrated anterior communicating artery (A-Com) aneurysm. Digital subtraction angiography (DSA) confirmed a right sided A-com artery aneurysm. Aneurismal repair was performed prior to CBT removal.
Although multifactorial etiologies, such as hypertension, atherosclerosis and congenital predisposition with vascular abnormalities exists; this case raises the possibility of etiologic relationship between hypertension and hypertensive crises due to catecholamine release and aneurismal development and rupture. Avoidance of possible life threatening complications of aneurismal rupture necessitates preoperative evaluation for CBT in patients with established diagnosis of IA.

Cost-effectiveness of medical intervention is becoming increasingly important in healthcare delivery. Treatment in neurosurgery is extremely expensive and there have been very few publications on neurosurgical health economics and comparative effectiveness analysis of neurosurgical procedures. Previous studies which had compared the costs of clipping and coiling were held out in European centers with data specifically from the ISAT study conducted in Europe. No significant differences were seen in the total cost of coiling when compared to clipping in a time period of one year.
A systematic literature search was conducted using electronic databases including MEDLINE and EMBASE. The inclusion criteria included the literature search limited to the last 10 years (2006-2016), studies on adult human patients, and papers published in English. All editorials, comments and correspondences were excluded from this study.
Systematic literature search yielded 5784 studies. After removing duplicates and non-relevant studies, finally five studies had specifically analyzed cost economics of coiling and clipping of intracranial aneurysm. Overall, coiling was more expensive than clipping in three studies. The study which was conducted by Wolsteholme et al. showed no significant differences between the two procedures in terms of their costs.
Cost evaluations of intracranial aneurysm showed that surgical clipping results to reduced re-operation rate when compared to endovascular coiling, associated with increased complications, longer hospital stays and ultimately greater hospital costs.

Due to advancements in technology, endovascular techniques (EVT) are considered a mainstay of treatment for intracranial aneurysms. However, for patients with anatomically complex aneurysms, associated intracranial hematomas requiring evacuation still need an open surgical clipping as the first line of treatment. Microsurgical clipping is an alternative for patients who cannot afford the high cost of EVT treatment.
This paper presents our experience in surgical clipping of symptomatic intracranial aneurysms performed in our hospital from Jan 2010 to Dec 2013 on 170 patients. Based on the data, this study recommends microsurgical clipping as a viable and cost effective option for symptomatic intracranial aneurysms.
Patients and This study was a retrospective analysis of case records of patients who had been treated for symptomatic intracranial aneurysms, including both ruptured and unruptured intracranial aneurysms, at Krishna institute of medical sciences from January 2010 to December 2013. A total of 230 patients, who had clinical and radiological evidence of symptomatic intracranial aneurysms, were admitted into the study. Of the total number of patients, 170 had been managed with microsurgical clipping. The patient’s demographics, the features of the aneurysms, clinical grades, cost effectiveness, and outcomes were analyzed. Excluded from the study were 60 patients who had been treated with the endovascular technique.
Of a total of 170 patients who underwent surgical clipping, 158 (93%) patients had an aneurysm in the anterior circulation and 12 (7%) in the posterior circulation. In the study group, 160 (94%) patients survived and 10 (6%) patients expired. One patient (0.58%) in the clipping group had a rebleed, and 4 (6.6%) patients from the coiling group eventually underwent clipping due to failed coiling. The average duration of hospital stay for the study group was 13 days and the cost for the treatment was Rs 2, 89, 238. The reasons for clipping in our patients were complex aneurysmal anatomy, difficulty accessing the aneurysm and MCA location in 60 (35%) patients, cost factor in 72 (42%) patients, non-availability of endovascular operator and hardware in 17 (10%) patients, associated hematoma requiring evacuation in 17 (10%) patients, and failure of the endovascular technique in 4 (2.5%) patients. Regarding outcomes, 83% of patients experienced a good outcome and 17% experienced a bad outcome.
These observations suggested that microsurgical clipping is a viable and cost effective alternative in the management of intracranial aneurysms in this endovascular era.

Induction of anaesthesia and its associated spikes in blood pressure can cause rupture of an aneurysm during intracranial surgery. Lidocaine can reportedly provide hemodynamic stability when applied before endotracheal intubation. Rapid injection of large doses of lidocaine can cause unconsciousness.. Lidocaine was applied as the sole anaesthetic for induction and maintenance during aneurysm surgery in four patients undergoing intracranial aneurysm surgery. Blood pressure alteration after induction and during surgery, bleeding, brain laxity, intracranial pressure and extubation time were acceptable.. Although propofol remains a standard agent for such types of surgeries, lidocaine proved equally effective and coupled with its low cost, minimal side effects and omission of other hypnotic agents was a plausible induction agent and a maintenance drug in the selected cases..

Ruptured cerebral aneurysms (ICAs) are the most common non-traumatic cause of subarachnoid hemorrhage (SAH) that is associated with life threatening complications such as Vasospasm, Infarction, and Hydrocephalus (HCP). The active participation of macrophage/monocyte-mediated inflammatory response in the pathogenesis of cerebral aneurysm as labeled with Monocyte Chemoattractant Protein-1 (MCP-1) is suggested. To measure the serum level of MCP-1 in ruptured CAs in different time intervals. We measured the serum levels of MCP-1 in SAH patients who had CAs and compared it with that of MCP-1 in two control groups: including patients with SAH without CAs, and the normal population of blood donors. We also measured the MCP-1 levels in patients with CAs one week afterward to evaluate the effect of treatment. Serum level of MCP-1 was measured by a commercial ELISA assay. Mean serum MCP-1 level in patients with SAH and CAs was 188.2168 Pg/ml and 331.3982 Pg/ml in the normal population. There was no statistically significant difference between serum levels of MCP-1 on the first (mean=188.2168 Pg/ml) and 7th days after SAH onset (mean=171.8450 Pg/ml) (p=0.739). Serum level of MCP-1 increased significantly as Glasgow Coma Scale decreased (p=0.078) and Hunt and Hess score increased (p=0.089). Our results did not show an increasing MCP-1 serum level in patients with aneurysmal SAH. There was a relationship between poor clinical grade and MCP-1 levels in patients with CAs. MCP-1 may be a local inflammatory marker for cerebral aneurysms without systemic manifestation. Rahmanian A, et al. Iran J Immunol. 2015; 12(4):302-310.

Rupture of the intracranial aneurysms is associated with a high risk of bleeding and a high incidence of mortality if left untreated.

The aim of this study is to report our experience in managing intracranial aneurysms using coil embolization and to report the 6-month follow-up outcome of the patients.

From January 2010 to December 2012, a series of 90 nonrandomized consecutive patients (mean age: 44.6 ± 14.9 years) with intracranial aneurysms underwent endovascular coil embolization in our center. We excluded patients with dissecting, blood blister-like, or false aneurysms. All patients were evaluated by four-vessel angiography to determine the shape, size, number and location of the aneurysms. We recommended a six-month follow-up control angiography. However, only 38 of them participated in this follow-up imaging. The data were analyzed by chi-square, fisher exact and t-tests and alpha was considered lower than 5%.

Immediately after the procedure, the total occlusion was seen in 76 (86.4%), subtotal occlusion in six (6.8%), and partial occlusion in six patients (6.8%). There was no significant relationship between the aneurysm size, aneurysm neck size, and location of the aneurysm with total or subtotal occlusions. Eleven patients (12.5%) experienced some complication during the procedure including two tears, three focal neurological signs, three vision disturbances, and three bleedings in the aneurysm. Major complications were significantly higher in the posterior aneurysm compared to the anterior ones (55.6% versus 44.4% of the major complications; P value = 0.015). Among patients who underwent control angiography, 34 patients (89.4%) had no change, two (5.3%) had new growth and two (5.3%) had widening of the neck after 6 months follow-up. Although aneurysms that remained unchanged after six months follow-up angiography had total occlusion after the procedure, it was 50% for aneurysms that had any changes in 6 months follow-up angiography (P value = 0.01).

Coil embolization showed successful outcomes in the treatment of intracranial aneurysms with a low complication rate.

Cerebral aneurysms are the major cause of subarachnoid hemorrhage. Common ascribed etiologies are hemodynamic factors such as atherosclerosis, hypertension, infection, trauma, polycyctic kidney disease, connective tissue disorders like Ehlers-Danlos disease, Marfan syndrome, and familial predisposition. However, its association with ankylosing spondylitis (AS) is not clear. Here, we report 2 patients with AS who presented with subarachnoid hemorrhage which was finally confirmed to be due to cerebral aneurysms, one in posterior communicating artery and the other in basilar artery tip). The patients had no history of hypertension or any other disease. Our data may not strongly suggest that vascular changes due to AS are etiological factors for developing intracranial aneurysm, but this report may show the possibility for existence of an association between these diseases, which has to be confirmed by more genetic and pathologic studies.

The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm.. The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms..Patients and Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data.. Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 88.2%, respectively; the specificity was calculated as 100% and 91.6%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms.. BSCTA is easily accessible, less time consuming, and most importantly, a non-invasive technique for detecting intracranial aneurysms. It is also suitable for patients who have been referred to emergency services. Therefore, it can be used in emergency conditions and as a first-line diagnostic method in patients with non-traumatic SAH..

Localization and delineation of the extent of lesions are critical for safe management of brain tumors and vascular abnormalities. Neuronavigation systems have been developed for image-guided neurosurgery to aid accurate localization and better visualization of these lesions. Navigation has been mainly used in brain biopsy and tumor resection. There have been a few reports on its use in vascular surgery and they suggest that neuronvigation could be helpful.. A 53-year-old man developed a severe sudden headache 2 days before admission. He did not have any specific medical problems. On inspection of neurological status, he was alert and his motor power was normal in all extremities. CT scan on admission showed diffuse blood in sylvian fissures and basal cisterns. Angiography revealed an aneurysmal dilatation where the posterior communicating artery arises from the right internal carotid artery (ICA). MRI scan with appropriate protocol for neuronavigation was performed and demonstrated, on Gadolinium (Gd) enhanced images, a small round hyperintense lesion in parasellar region on the right side. We prepared the navigation based on CT scan and MRI for surgery of the aneurysm. Right frontotemporal craniotomy was performed, brain retracted and arachnoid membranes were opened under the guidance of navigation-MRI. The neck was dissected and a clip was applied to the aneurysm. Neurological status of the patient was unchanged postoperatively and control CT scan was unremarkable.. According to the reports and our case we suggest that MRI based neuronavigation results in accurate localization of the aneurysm, increases visualization of the lesion, decreases normal parenchymal and vascular injury and is useful for the treatment of ruptured intracranial aneurysms in special cases..