At 10 o’clock one morning in March 2006, a 69-year-old woman in Slippery County, Henan Province, was at home doing household chores as usual when she suddenly felt an unprecedented headache and suddenly fell to the ground, and then she didn’t know what happened. 2 hours later, her family came home and found her on the ground, unable to move her right limb, unable to speak, and in a coma, and rushed her to the county people’s hospital. sent to the county people’s hospital. After CT examination, it was found that there was about 70 ml of bruising in the brain. Combined with Mrs. Li’s usual history of hypertension, the county people’s hospital initially diagnosed her with “hypertensive cerebral hemorrhage” and prepared to perform craniotomy to remove the hematoma. However, the careful brain surgeon found that although Mrs. Li’s hemorrhage was located in the basal ganglia, a good site for hypertensive cerebral hemorrhage, there was also more hemorrhage in the subarachnoid space, so the possibility of a ruptured intracranial aneurysm could not be ruled out. At 3:00 p.m., the county people’s hospital dialed the first affiliated hospital neurosurgery department. Deputy director Zhou Guosheng immediately arrived for consultation and concluded that the possibility of intracranial aneurysm rupture and hemorrhage was so great that cerebral angiography was needed to confirm the diagnosis. Deputy Director Zhou Guosheng immediately contacted the interventional center and requested emergency cerebral angiography. At 5:00 p.m., the ambulance arrived at the First Affiliated Hospital with the critically ill old lady, and went directly to the interventional center for a whole brain angiogram. Under local anesthesia, a soft and thin catheter was sent from the femoral artery at the root of the thigh to the cranium, and then contrast was pushed in to take pictures. The pictures showed that there was an aneurysm in each of the left internal carotid artery and middle cerebral artery, and the culprit of the brain hemorrhage was found. Because of the huge amount of intracranial hemorrhage, Mrs. Li was in a coma and time was of the essence. Only emergency surgery was possible to save the patient’s life. Although Deputy Director Zhou Guosheng already had some experience in the surgical treatment of intracranial aneurysms, he had never encountered a patient as critical as Mrs. Li with two aneurysms at the same time, and it was an emergency operation, which was not only extremely difficult, but also had a high risk of intraoperative hemorrhage leading to the patient’s death. Facing the challenge, Vice Director Zhou Guosheng made a decisive decision: emergency surgery to remove the hematoma and at the same time to clamp the intracranial aneurysm as much as possible. At 9:00 pm, the patient lay on the operating table; at 10:00 pm, the patient’s cranial cavity was opened, and the atmosphere was so tense that the operating room was silent. Under the operating microscope, Deputy Director Zhou Guosheng operated patiently and meticulously. First, he released part of the hematoma and cerebrospinal fluid, then separated the internal carotid artery and middle cerebral artery, found the aneurysm and safely clamped it. At this point, all of them breathed a sigh of relief. Subsequently, the intracranial hematoma was aspirated and then the skull was closed. By this time, it was 2:00 am. The patient was taken to the ward and closely monitored. After a series of post-operative treatments, a week later Mrs. Li opened her eyes, recognized her family, and shook hands with the doctors to express her gratitude. Three weeks later, Mrs. Li basically returned to normal and the family was happily discharged from the hospital. Zhou Guosheng, a neurosurgeon at the First Affiliated Hospital of Zhengzhou University, said that an intracranial aneurysm is a localized bulge in a weak point of the cerebral artery formed by the impact of blood flow, which usually has no manifestation, but is known as an “intracranial unscheduled bomb” by the neurosurgical community and may “explode” anytime and anywhere. “The subarachnoid hemorrhage can cause headache and hemiparesis in mild cases and life-threatening in severe cases. In the past, the medical profession did not know enough about this disease, and generally gave conservative treatment according to “subarachnoid hemorrhage” without in-depth examination, resulting in repeated bleeding until death. Intracranial aneurysms can only be diagnosed by cerebral angiography, which is a safe and reliable test that is far less risky than waiting for rebleeding and should be performed as soon as possible after the first bleed. Once an intracranial aneurysm is diagnosed, early steps should be taken to treat it and prevent rebleeding. Although interventional embolization techniques are largely mature and minimally invasive, the high cost, often $50,000 to $100,000, limits the popularity of this technique. Surgical clamping of intracranial aneurysms is a traditional method that has been quite reliable, with a success rate of more than 90% under current microscopic techniques and a low cost, generally between 20,000 and 30,000 RMB. Neurosurgery Department of the First Affiliated Hospital of Xinxiang Medical College has been carrying out microscopic neurosurgery since 2001. Over the past few years, the technology has developed rapidly, and now more than 150 cases of intracranial aneurysm clamping are carried out every year, and the quantity and quality are at an advanced level in Henan Province. Photo caption: The upper picture shows the preoperative CT, which shows the intracranial hematoma and subarachnoid blood accumulation; the lower picture shows the preoperative imaging, which shows 2 aneurysms.