No abstract available.
Aneurysm* ; Hydrocephalus*

The decision of proper time for operation on ruptured aneurysm is a very important tactic of treatment, because of the following major complications after subarachnoid hemorrhage. Recently it is widely accepted opinion that the ruptured aneurysm should receive an early operation for lower mortality and morbidity by preventing possible complications after subarachnoid hemorrhage such as rebleeding, symptomatic vasospasm and even hydrocephalus. Since 1985, we applied early to emergency surgery to the clinically deteriorating or non improving patients after aneurysm rupture and delayed surgery to the ameliorating patients who were placed under close observation. The early to emergency surgery on poor risk patient was performed within 48 hours after recent subarachnoid hemorrhage and delayed surgery was done after 2 weeks. Of the selective 95 poor-condition patients admitted to Kyungpook National University Hospital over the past 4 years from 1984, 60 got early surgeries and 35 delayed surgeries. Among the 60 patients in the early group, 22 patients with considerable intracranial hemorrhage were exempted from this comparative study. A few cases of vertebrobasilar aneurysms were not included in this paper for a little value in significance. In this prospective study, we evaluated the results of early and delayed surgeries of poor risk patients through clinical analyses and comparison, and we could gain better results from early surgeries.
Aneurysm* ; Aneurysm, Ruptured ; Emergencies* ; Gyeongsangbuk-do ; Humans ; Hydrocephalus ; Intracranial Hemorrhages ; Mortality ; Prospective Studies ; Rupture ; Subarachnoid Hemorrhage

There are many intracranial lesions causing spontaneous intracerebral hemorrhage, including hypertension, aneurysm, arteriovenous malformation, bleeding tumor, coagulopathy, amyloid angiopathy. In fact, the management of spontaneous intracerebral hemorrhage remains still a complex problem. The patient's age and consciousness, general condition, the hematoma location, as well as the cause combine to affect the management outcome. In general, mortality and morbidity is increasing with greater patient's age and hematoma size, deeper hematoma location. The emergent care and management usually are needed in almost all the patients with medical and surgical treatments. Acute medical management is required to control increased intracranial pressure, to stablize cardiorespiratory system, and prevent further compication such as brain edema, hematoma expansion, seizure. Emergent surgical treatment should be considered when surgical removal of hematoma would be benefit the patient's condition by decreasing mass effect and protecting the secondary injury to the surrounding normal brain.
Amyloid ; Arteriovenous Fistula ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Consciousness ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Intracranial Pressure ; Mortality ; Seizures

The authors report a very unusual case of ruptured aneurysm by direct vessel invasion of anaplastic oligodendroglioma (WHO grade III) confirmed by histopathological examinations. As local invasion is the hallmark of malignant gliomas, malignant glial tumors invade neighboring structure and often cause microscopic endothelial proliferation, telangiectasias in small arteriols, but direct arterial invasion by glioma is very rare. Possible mechanisms of intracranial aneurysm development by glioma are thought to be related to the close proximity to the tumor, perivascular basement membrane breakage due to high tumor pressure and increased regional blood flow through the feeding artery of tumor. The aneurysm and tumor were treated in a single operation simultaneously.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery* ; Arteries ; Basement Membrane ; Glioma ; Intracranial Aneurysm* ; Oligodendroglioma* ; Regional Blood Flow ; Rupture* ; Telangiectasis

The authors have clinically analysed the patients who required the reoperations after the aneurysmal clippings with intention to decrease the rate of reoperation as predicting the risk factors causing the postoperative complications or sequelae of subarachnoid hemorrhage. Between 1991 and 1996, we have performed total operation on 691 patients with aneurysmal subarachnoid hemorrhage. Among these, 72 patients(10.4% of total) required to be reoperated due to various causes. The shunt for hydrocephalus which was the most common cause of reoperation, performed in 57 patients(79.2% of the reoperated), and next, trephination for the subdural hygroma in 12 cases (16.7%), removal of the intracranial hematoma on the operated site in 7 cases(9.7%), reclipping of aneurysms for the regrowing of aneurysm rest or undiscovered aneurysm preoperatively in 5 cases(7%), and decompressive surgery for postoperative brain swelling and vasospasm in 2 cases(2.8%). The authors suggest that the perfect aneurysmal clipping and the detailed evaluation to decrease these complications of aneurysmal surgery, and careful attention should be given to find out the hidden or regrowing of aneurysmal rest are needed on pre-, postoperatively, and during the operation procedure.
Aneurysm* ; Brain Edema ; Hematoma ; Humans ; Hydrocephalus ; Intention ; Postoperative Complications ; Reoperation ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion ; Trephining

Saccular aneurysms of the subarachnoid segment of the internal carotid artery(ICA) are among the most common aneurysms encountered by neurosurgeons. Surgical strategy and techniques to deal with such aneurysms arising from the ophthalmic artery to the ICA bifurcation are described. Intimate understanding of the anatomy and proper surgical technique improve surgical result.
Aneurysm* ; Carotid Artery, Internal* ; Ophthalmic Artery

The authors studied and analyzed microscopically the structure, length and diameter of each part of Willis circle in 264 cerebral hemispheres of 182 autopsied patients in the Taegu area from 1984 to 1990. The mean length of each A1 was 14.1mm and diameter at distal A1 was 2.25mm. The most common anatomical anomaly of the ACA part was A1 that of hypoplasia which appeared in 7.5% of the cases. The origin of the Heuner a. was accounted for the highest incidence of AcoA(82.5%). The length of AcoA. Noted 3.5mm with the incidence of duplication and triplication in 38.6%. The inner diameter of ICA noted 3.9mm at the communicating segment in ICA, and the average length of C4 was 12.5m. Except 5 hemispheres of undetectable origin at ICA, all the anterior choroidal a. originated from ICA, and the double stump of which noted 15.5%. Fetal type PcoA. Showed 6.6% of all and average length of the a. was 13.5mm. The inner diameter of MCA was 3.1mm and the mean length of M1 noted 15.5mm. The length of each P1 noted 6.95mm and the inner diameter of basilar a. at 1cm below the bifurcation was 3.3mm. The mean circumference of willis circle including both side of A1, P1, PcoA. AcoA. And choroidal and communicating segment of ICA was 88.6mm. Incidental finding of unruptured aneurysm noted 5.3% and junctional dilatation of PcoA. Showed 11.4% of all the cases.
Aneurysm ; Cerebrum ; Choroid ; Circle of Willis* ; Daegu ; Dilatation ; Humans ; Incidence ; Incidental Findings

OBJECTIVE: The authors investigated the role of transcranial Doppler ultrasound (TCD) in clinical decision making about vasospasm due to subarachnoid hemorrhage (SAH). METHODS: In this retrospective study, a total of 383 patients, admitted to our hospital between January 2001 to December 2004 and treated surgically with the diagnosis of aneurysmal SAH, were examined by TCD. RESULTS: Blood flow velocity (BFV) was significantly lower in older patients than in younger patients (p<0.01). BFV in the hypertensive patients were not significantly lower than in the normotensive individuals (p=0.93). The amount of blood clots in the computed tomography after SAH was significantly correlated with BFV (p<0.01). However, there was no statistically significant difference between Hunt-Hess Grade and BFV (p=0.54). The maximum mean flow velocity was greater in 54 patients who developed a delayed ischemic neurological deficit(DIND, 144.1 cm/sec) than in 221 patients who did not develop DIND (94.3 cm/sec, p=0.04). A maximum velocity increase of 40.6 cm/sec/24hr was recorded higher in patients with DIND, compared to that of 22.6 cm/sec/24 hr in patients without DIND (p<0.01). Lindegaard's index (LI) was higher in patients with DIND (4.6) than in those without DIND (2.8, p<0.01). Peak velocity, maximum velocity increase, and LI can thus assist in diagnosis of DIND, however, when those readings made before onset of DIND were considered, there was only significant difference in LI between the groups. CONCLUSION: Serial TCD studies after SAH are of value to detect cerebral vasospasm, especially, LI is significantly correlated with identifying patients who later develop DIND.
Aneurysm* ; Blood Flow Velocity ; Decision Making ; Diagnosis ; Humans ; Intracranial Aneurysm ; Reading ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ultrasonography ; Vasospasm, Intracranial*

This study was conducted on 60 metastatic brain parenchymal tumor patients admitted at this hospital between January of 1987 and July of 1993. The mean age of the patients was 54, the youngest 26 and the oldest, 78. The ratio of male v.s. female was 1:2,3,50 were single metastatic and 10 were multiple. The following are the results of the analyses of the factors affecting the prognosis of metastatic brain parenchymal tumor patients: The group operated on showed a significantly prolonged life-span as compared with the group without operation, which was also phenomenal among the single metastatic patients. Among the primary tumors, breast cancer had the longest median survival period, 20 months, and the shortest survival period was one month with the gasrointestinal tumor. As for clinical grade and survival span, those above the karnofsky scale of 80 survived a median of six months, and those below 50 survived for 2 months. The group with favorable clinical conditions before operation resulted in a significantly long life span, Especially in the group with 80 or above of the Karnofsky scale, the operated group showed a far more excellent prognosis as compared to the non operated group. The median survival time was 20 months in the group with more than 12months as an interval between diagnoses of primary tumor and metastasis, wherease it was 3 months for the group with an interval of less than6 months. Thus, the longer the interval, the better the prognosis, This fact was statistically significant Among the patients with an interval of 12 months or more, the operated group also showed better prognosis than the nonoperated group. The mean six months survival rate was 33.3%, the one-year rate was 23.3%, the two-year rate was 10.0% in all cases. The longest survival time was 36 months. The whole body metastasis was the most common cause of death accounting for 64.2%.
Brain* ; Breast Neoplasms ; Cause of Death ; Diagnosis ; Female ; Humans ; Karnofsky Performance Status ; Male ; Neoplasm Metastasis ; Prognosis ; Survival Rate

OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.
Aneurysm* ; Arteries ; Carotid Artery, Internal* ; Cranial Nerves ; Humans ; Intracranial Aneurysm ; Neck ; Thrombosis