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Figure 3: 13 year old female with left sided hemiparesis since one day. Plain and contrast (a and b) axial CT sections shows a giant partially thrombosed basilar aneurysm. Left VA angiogram (c and d) shows both PCAs arising from the aneurysm. Endovascular treatment was planned in the form of BTO followed by flow reversal. Roadmap image of left VA angiogram in Towne's view (e) shows balloon inflation in the BA proximal to the anterior inferior cerebellar arteries (AICAs). Right ICA angiogram (f and g) with BTO shows good retrograde reformation of the BA through the PCoA upto the AICAs. Plain skull radiograph (h) shows occlusion of the VAs with detachable balloons and free platinum and detachable coils. Post-occlusion right (i) and left (j) VA angiograms show complete occlusion of both the VAs. Post-occlusion right ICA angiogram (k,l and m) shows good reformation of the BA up to the AICAs with stasis within the aneurysm. Left ICA angiogram in lateral view shows good reformation through good caliber PCoA. Post-procedure axial CT section (n) reveals thrombosed aneurysm. Patient was extubated after 48 hrs with quadriparesis. Control MRI (o) reveals acute brainstem and bilateral cerebellar ischemia on axial diffusion weighted images

Figure 3: 13 year old female with left sided hemiparesis since one day. Plain and contrast (a and b) axial CT sections shows a giant partially thrombosed basilar aneurysm. Left VA angiogram (c and d) shows both PCAs arising from the aneurysm. Endovascular treatment was planned in the form of BTO followed by flow reversal. Roadmap image of left VA angiogram in Towne's view (e) shows balloon inflation in the BA proximal to the anterior inferior cerebellar arteries (AICAs). Right ICA angiogram (f and g) with BTO shows good retrograde reformation of the BA through the PCoA upto the AICAs. Plain skull radiograph (h) shows occlusion of the VAs with detachable balloons and free platinum and detachable coils. Post-occlusion right (i) and left (j) VA angiograms show complete occlusion of both the VAs. Post-occlusion right ICA angiogram (k,l and m) shows good reformation of the BA up to the AICAs with stasis within the aneurysm. Left ICA angiogram in lateral view shows good reformation through good caliber PCoA. Post-procedure axial CT section (n) reveals thrombosed aneurysm. Patient was extubated after 48 hrs with quadriparesis. Control MRI (o) reveals acute brainstem and bilateral cerebellar ischemia on axial diffusion weighted images