A case of multiple intracranial aneurysms with undetermined source of subarachnoid hemorrhage successfully managed by combined surgical and endovascular treatment

We report a case of multiple intracranial aneurysms located at the left posterior cerebral (P1), left anterior cerebral (A1-A2), basilar fenestration (fBA) and left middle cerebral (MCA) arteries. A 58-year-old woman presented with subarachnoid hemorrhage, the source of which could not be determined from the preoperative images. The left P1, left A1-A2 and left MCA aneurysms were managed surgically through cranio-orbito-zygomatic approach ; they were found to be unruptured. Because the remaining fBA aneurysm was strongly suspected to have ruptured, we decided to treat it by endovascular route without delay. Postoperative course was uneventful.