OBJECTIVE: Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. METHODS: We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16–173). The mean interval between the prior treatment and second surgery was 26 months (range : 7–123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. RESULTS: Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. CONCLUSION: Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.
Cerebrospinal Fluid Rhinorrhea ; Follow-Up Studies ; Glycerol ; Hematoma, Subdural ; Humans ; Microvascular Decompression Surgery ; Postoperative Complications ; Radiosurgery ; Retrospective Studies ; Rhizotomy ; Trigeminal Neuralgia*

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

A 66-year-old man presented with typical trigeminal neuralgia (TN). Magnetic resonance angiography (MRA) revealed a primitive trigeminal artery (PTA) that came into contact with the trigeminal nerve. Based on MRA, we performed microvascular decompression (MVD). In the operational field, we confirmed the PTA location and performed MVD successfully. Postoperatively, the patient's pain subsided without any complications.
Aged ; Arteries* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Trigeminal Nerve ; Trigeminal Neuralgia*

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH. METHODS: The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups. RESULTS: Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B). CONCLUSION: There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.
Aged ; Consciousness ; Drainage ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Pneumonia ; Retrospective Studies

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.
Brain Injuries ; Cerebral Infarction* ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Stroke ; Warfarin

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.
Brain Injuries ; Cerebral Infarction* ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Stroke ; Warfarin

Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.
Aneurysm ; Arteries ; Decompression ; Facial Nerve ; Hemifacial Spasm ; Hemodynamics ; Humans ; Intracranial Hemorrhages ; Ligation ; Magnetic Resonance Angiography ; Male ; Microvascular Decompression Surgery ; Middle Aged ; Neuroimaging ; Pons ; Spasm ; Vertebral Artery

OBJECTIVE: In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes. METHODS: Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> 10 cm3 in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus. RESULTS: Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group (10-15 cm3 size), and 25% (2/8) in the larger nidus group (over 15 cm3 size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was 17.1 cm3 (10.1-38.4 cm3), in contrast with the mean estimated volume of 20.9 cm3 (12.0-45.0 cm3). CONCLUSION: The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.
Arteries ; Arteriovenous Malformations ; Brain Edema ; Cerebral Hemorrhage ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations ; Radiosurgery ; Retrospective Studies ; Treatment Outcome ; Veins

OBJECTIVES: Aneurysms of the anterior cerebral circulation are usually found on the anterior communicating artery (ACoA) or peripheral portion (A2) of the anterior cerebral artery (ACA). Infrequently, they are found on proximal segment (A1) of the ACA. These are presented 0.88-2.1% of all intracranial aneurysm cases. There are few describing a series of patient with A1 aneurysms. In this report, we present our surgical experience of the 27 A1 aneurysms. MATERIAL AND METHODS: 27 patients with aneurysm of proximal segment of anterior cerebral artery were operated on between January 1983 and September 2004. Retrospective analysis of clinical characteristics, radiologic findings, operation method, clinical outcomes and complications were performed. RESULTS: 27 patients with aneurysm of proximal segment of anterior cerebral artery, male was 11 cases, female was 16 cases. Relatively, predominantly occurred in female. In preoperative Hunt-Hess grade (H-H grade) of the patient, H-H grade I was 10, gradeII in 13, grade III in 3, grade IV in 1 case. In CT findings, 23 cases presented only SAH, SAH and ICH in 4, accompanying hydrocephalus in 3 cases. In angiographics and surgical findings, according to aneurysm site, proximal type was 9 cases, middle type in 8, distal type in 10 cases, and compared with each clinical outcomes. In 9 patients, aneurysms was found in right side and 7 patients of these had favorable outcomes. In left side, 12 of 18 patients had favorable outcomes. Postoperative complication occurred in 8 cases, postoperative infarction in 3 case. vasospasm in 4 cases, hydrocephalus, meningitis in 4 cases. 5 patients had multiple aneurysms. In 2 cases of these, A1 aneurysm was ruptured. In 3 cases, other aneurysm was ruptured and A1 aneurysm was incidental finding. In total 27 patients, 19 patients had favorable outcomes and unfavorable outcomes in 8. CONCLUSION: Aneurysms of proximal segment (A1) of the anterior cerebral artery occur very infrequently and in this report, These are presented 3.9% (27 out of 680) in anterior cerebral artery aneurysms. 19 patients underwent direct surgery had good outcomes after the surgery. As causes of unfavorable outcomes, poor preoperative general condition, injury of perforating artery during operation and vasospasm. Comparison with other aneurysms, relative good outcomes can be obtained by direct surgery.
Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Arteries ; Female ; Humans ; Hydrocephalus ; Incidental Findings ; Infarction ; Intracranial Aneurysm ; Male ; Meningitis ; Postoperative Complications ; Retrospective Studies

OBJECTIVES: Aneurysms of the anterior cerebral circulation are usually found on the anterior communicating artery (ACoA) or peripheral portion (A2) of the anterior cerebral artery (ACA). Infrequently, they are found on proximal segment (A1) of the ACA. These are presented 0.88-2.1% of all intracranial aneurysm cases. There are few describing a series of patient with A1 aneurysms. In this report, we present our surgical experience of the 27 A1 aneurysms. MATERIAL AND METHODS: 27 patients with aneurysm of proximal segment of anterior cerebral artery were operated on between January 1983 and September 2004. Retrospective analysis of clinical characteristics, radiologic findings, operation method, clinical outcomes and complications were performed. RESULTS: 27 patients with aneurysm of proximal segment of anterior cerebral artery, male was 11 cases, female was 16 cases. Relatively, predominantly occurred in female. In preoperative Hunt-Hess grade (H-H grade) of the patient, H-H grade I was 10, gradeII in 13, grade III in 3, grade IV in 1 case. In CT findings, 23 cases presented only SAH, SAH and ICH in 4, accompanying hydrocephalus in 3 cases. In angiographics and surgical findings, according to aneurysm site, proximal type was 9 cases, middle type in 8, distal type in 10 cases, and compared with each clinical outcomes. In 9 patients, aneurysms was found in right side and 7 patients of these had favorable outcomes. In left side, 12 of 18 patients had favorable outcomes. Postoperative complication occurred in 8 cases, postoperative infarction in 3 case. vasospasm in 4 cases, hydrocephalus, meningitis in 4 cases. 5 patients had multiple aneurysms. In 2 cases of these, A1 aneurysm was ruptured. In 3 cases, other aneurysm was ruptured and A1 aneurysm was incidental finding. In total 27 patients, 19 patients had favorable outcomes and unfavorable outcomes in 8. CONCLUSION: Aneurysms of proximal segment (A1) of the anterior cerebral artery occur very infrequently and in this report, These are presented 3.9% (27 out of 680) in anterior cerebral artery aneurysms. 19 patients underwent direct surgery had good outcomes after the surgery. As causes of unfavorable outcomes, poor preoperative general condition, injury of perforating artery during operation and vasospasm. Comparison with other aneurysms, relative good outcomes can be obtained by direct surgery.
Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Arteries ; Female ; Humans ; Hydrocephalus ; Incidental Findings ; Infarction ; Intracranial Aneurysm ; Male ; Meningitis ; Postoperative Complications ; Retrospective Studies