{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:13Z","timestamp":1790729713371,"version":"4.1.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Ruptured thrombosed aneurysms may transiently disappear on angiography and later reappear after partial recanalization. The authors report a ruptured nonbranching M2 aneurysm with delayed angiographic visualization and pathological\/hemodynamic correlation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 43-year-old man presented with diffuse subarachnoid hemorrhage (SAH). Initial CT angiography and digital subtraction angiography failed to identify the bleeding source. Serial follow-up imaging subsequently demonstrated delayed visualization of a small (3.5 mm) distal nonbranching M2 lesion on day 11 of angiography. Microsurgical reconstruction was performed with evacuation of organized thrombus, direct closure of the aneurysmal orifice, and preservation of parent artery flow. Histopathological examination demonstrated organized thrombosis with disruption of elastic fibers. Intraoperative indocyanine green videoangiography demonstrated preserved parent artery flow without apparent intra-aneurysmal flow despite angiographic visualization on the preceding day. Computational fluid dynamics analysis demonstrated disturbed local flow with focal stagnation and localized oscillatory flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Negative angiographic findings do not necessarily indicate lesion stability after aneurysmal SAH. The authors propose the term \u201csmall ghost aneurysm\u201d to describe thrombosed ruptured aneurysms showing transient angiographic disappearance followed by unstable reappearance after partial recanalization.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26515\">https:\/\/thejns.org\/doi\/10.3171\/CASE26515<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26515","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:03:56Z","timestamp":1790121836000},"source":"Crossref","is-referenced-by-count":0,"title":["\u201cSmall ghost aneurysm\u201d: delayed visualization of a ruptured thrombosed nonbranching M2 aneurysm with pathological and hemodynamic correlation. Illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2531-0577","authenticated-orcid":true,"given":"Narihide","family":"Shinoda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Higashino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2635-513X","authenticated-orcid":true,"given":"Tsuyoshi","family":"Katsube","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsugu","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyoshi","family":"Korosue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Kanoko Hospital, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shogo","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Kose","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kosei Hospital, Hyogo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"J Neurosurg","first-page":"450","article-title":"Spontaneous healing of intracranial aneurysms after subarachnoid hemorrhage. Case report","volume":"48","author":"Edner","year":"1978","unstructured":"Edner GForster DMSteiner LBergvall U.Spontaneous healing of intracranial aneurysms after subarachnoid hemorrhage. Case report. J Neurosurg. 1978;48(3):450-454. doi:10.3171\/jns.1978.48.3.0450"},{"issue":"6","key":"bib2","series-title":"J Neurosurg","first-page":"984","article-title":"Observations on the relationship between the volume and the size of the orifice of experimental aneurysms","volume":"17","author":"Black","year":"1960","unstructured":"Black SPGerman WJ.Observations on the relationship between the volume and the size of the orifice of experimental aneurysms. J Neurosurg. 1960;17(6):984-990. doi:10.3171\/jns.1960.17.6.0984"},{"issue":"10","key":"bib3","series-title":"Stroke","first-page":"1945","article-title":"Spontaneous thrombosis of an unruptured anterior communicating artery aneurysm. An unusual cause of ischemic stroke","volume":"26","author":"Brownlee","year":"1995","unstructured":"Brownlee RDTranmer BISevick RJKarmy GCurry BJ.Spontaneous thrombosis of an unruptured anterior communicating artery aneurysm. An unusual cause of ischemic stroke. Stroke. 1995;26(10):1945-1949. doi:10.1161\/01.STR.26.10.1945"},{"issue":"4","key":"bib4","series-title":"J Neurosurg","first-page":"508","article-title":"Disappearance and reappearance of cerebral aneurysm in serial arteriograms. Case report","volume":"41","author":"Spetzler","year":"1974","unstructured":"Spetzler RFWinestock DNewton HTBoldrey EB.Disappearance and reappearance of cerebral aneurysm in serial arteriograms. Case report. J Neurosurg. 1974;41(4):508-510. doi:10.3171\/jns.1974.41.4.0508"},{"key":"bib5","series-title":"Surg Neurol Int","article-title":"Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage","volume":"5","author":"Chohan","year":"2014","unstructured":"Chohan MOWesthout FDTaylor CL.Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 2014;5:42. doi:10.4103\/2152-7806.129615"},{"issue":"4","key":"bib6","series-title":"J Korean Neurosurg Soc","first-page":"354","article-title":"Recanalization of completely thrombosed non-giant saccular aneurysm mimicking as de novo aneurysm","volume":"48","author":"Choi","year":"2010","unstructured":"Choi YSKim DWJang SJKang SD.Recanalization of completely thrombosed non-giant saccular aneurysm mimicking as de novo aneurysm. J Korean Neurosurg Soc. 2010;48(4):354-356. doi:10.3340\/jkns.2010.48.4.354"},{"issue":"2","key":"bib7","series-title":"Surg Neurol","first-page":"186","article-title":"Disappearance and reappearance of a cerebral aneurysm: a case report","volume":"67","author":"Greenberg","year":"2007","unstructured":"Greenberg EJanardhan VKatz JMRiina HZimmerman RGobin YP.Disappearance and reappearance of a cerebral aneurysm: a case report. Surg Neurol. 2007;67(2):186-189. doi:10.1016\/j.surneu.2006.04.017"},{"issue":"5","key":"bib8","series-title":"J Korean Neurosurg Soc","first-page":"280","article-title":"Thrombosis and recanalization of small saccular cerebral aneurysm: two case reports and a suggestion for possible mechanism","volume":"55","author":"Kim","year":"2014","unstructured":"Kim HJKim JHKim DRKang HI.Thrombosis and recanalization of small saccular cerebral aneurysm: two case reports and a suggestion for possible mechanism. J Korean Neurosurg Soc. 2014;55(5):280-283. doi:10.3340\/jkns.2014.55.5.280"},{"issue":"3","key":"bib9","series-title":"J Neurosurg","first-page":"384","article-title":"Ruptured distal middle cerebral artery aneurysm","volume":"100","author":"Horiuchi","year":"2004","unstructured":"Horiuchi TTanaka YTakasawa HMurata TYako THongo K.Ruptured distal middle cerebral artery aneurysm. J Neurosurg. 2004;100(3):384-388. doi:10.3171\/jns.2004.100.3.0384"},{"issue":"6","key":"bib10","series-title":"Neurol Res","first-page":"583","article-title":"Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography","volume":"22","author":"Nakajima","year":"2000","unstructured":"Nakajima YYoshimine TMori HSpontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography. Neurol Res. 2000;22(6):583-587. doi:10.1080\/01616412.2000.11740723"},{"issue":"8","key":"bib11","series-title":"J Clin Neurosci","first-page":"1077","article-title":"Acute thrombosis and recanalization of a ruptured anterior communicating artery aneurysm","volume":"16","author":"Su","year":"2009","unstructured":"Su TMHsu SWChen WFLee TCCheng CH.Acute thrombosis and recanalization of a ruptured anterior communicating artery aneurysm. J Clin Neurosci. 2009;16(8):1077-1079. doi:10.1016\/j.jocn.2008.08.013"},{"issue":"4","key":"bib12","series-title":"J Neurosurg Pediatr","first-page":"346","article-title":"Thrombosis and subsequent recanalization of a ruptured intracranial aneurysm in 2 children, demonstrating the value of repeating catheter angiography after an initial negative study","volume":"5","author":"Valle","year":"2010","unstructured":"Valle EPTamargo RJGailloud P.Thrombosis and subsequent recanalization of a ruptured intracranial aneurysm in 2 children, demonstrating the value of repeating catheter angiography after an initial negative study. J Neurosurg Pediatr. 2010;5(4):346-349. doi:10.3171\/2009.10.PEDS0966"},{"issue":"3","key":"bib13","series-title":"Surg Neurol","first-page":"269","article-title":"How does spontaneous hemostasis occur in ruptured cerebral aneurysms? Preliminary investigation on 247 clipping surgeries","volume":"66","author":"Ishikawa","year":"2006","unstructured":"Ishikawa TNakayama NYoshimoto THow does spontaneous hemostasis occur in ruptured cerebral aneurysms? Preliminary investigation on 247 clipping surgeries. Surg Neurol. 2006;66(3):269-276. doi:10.1016\/j.surneu.2006.03.030"},{"issue":"11","key":"bib14","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1040","article-title":"Spontaneous thrombosis in giant intracranial aneurysms","volume":"45","author":"Whittle","year":"1982","unstructured":"Whittle IRDorsch NWCBesser M.Spontaneous thrombosis in giant intracranial aneurysms. J Neurol Neurosurg Psychiatry. 1982;45(11):1040-1047. doi:10.1136\/jnnp.45.11.1040"},{"issue":"3","key":"bib15","series-title":"Interv Neuroradiol","first-page":"247","article-title":"Disappearing saccular intracranial aneurysms: do they really disappear?","volume":"13","author":"Jayakumar","year":"2007","unstructured":"Jayakumar PNRavishankar SBalasubramaya KSChavan RGoyal G.Disappearing saccular intracranial aneurysms: do they really disappear? Interv Neuroradiol. 2007;13(3):247-254. doi:10.1177\/159101990701300304"},{"issue":"3","key":"bib16","series-title":"J Neuroradiol","first-page":"153","article-title":"Spontaneous thrombosis of a recurrent clipped intracranial aneurysm","volume":"36","author":"Hassan","year":"2009","unstructured":"Hassan FTaschner CAThines LLejeune JPPruvo JPLeclerc X.Spontaneous thrombosis of a recurrent clipped intracranial aneurysm. J Neuroradiol. 2009;36(3):153-157. doi:10.1016\/j.neurad.2008.11.004"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26515.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26515.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26515.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:43Z","timestamp":1790726443000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26515.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":16,"journal-issue":{"issue":"13"},"URL":"https:\/\/doi.org\/10.3171\/case26515","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}