No abstract available.
Intracranial Aneurysm*

No abstract available.

No abstract available.
Aneurysm*

Recently the cause of hemifacial spasm and trigeminel neuralgia is known to be vascular compression-distortion in the root exit and entry zone of each nerve. The microvascular decompression of the 5th and 7th cranial nerves is a method of refined and non-traumatic surgical treatment of these disabling diseases. 33 patients with intractable hemifacial spasm and 7 patients with trigeminal neuralgia were treated by microvascular decompression and the follow-up results were evaluated. The surgical results in 33 cases of hemifacial spasm were as follow: Excellent-18, Good-7, Fair-6, Poor-2. Disturbance of hearing as a complication appeared in 6 cases, but improved gradually except one case. The surgical finding and results in 7 cases of trigeminal neuralgia were as follow: In 6 cases the causative vessel was SCA and in one case SCV indented the nerve root. All 7 patients with trigeminal neuralgia were relieved from facial pain after surgery.
Cranial Nerves ; Facial Nerve* ; Facial Pain ; Follow-Up Studies ; Hearing ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery* ; Neuralgia ; Trigeminal Neuralgia

Middle cerebral artery aneuryms account for aporoximately 20 percent of all intracranial aneurysms. The majority are located at the bbifurcation of M1 segment insylvian fissure. Incidence of formation of intracerebral hematoma with ruptured aneurysm and giant and infectious aneurysms are more common than with aneurysm in other locations. Clinical presentation of the MCA aneurysms are associated with symptoms of subarachnoid hemorrhage and mass effect. Symptoms of subarachnoid hemorrhage such as headache are indistinguishable from that associated with SAH from rupture of an aneurysm in any other location. But mass effect of large aneurysm, temporal lobe epilepsy and transient ischemic attack occur more frequently with aneurysms of the MCA. Complications of MCA aneurysm surgery can be divided into two group, one related to subarachnoid hemorrhage with aneurysmal rupture and the other to surgical procedure. Vasospasm is major cause of morbiduty and medical complications such as hypertension, cardiac arrhythmia, pneumonia and GI bleeding are frequently encountered. Operative complications include occlusion of MCA branch by improperly placed clip, retraction injury, intraoperative rupture.
Aneurysm ; Aneurysm, Ruptured ; Arrhythmias, Cardiac ; Epilepsy, Temporal Lobe ; Headache ; Hematoma ; Hemorrhage ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Ischemic Attack, Transient ; Middle Cerebral Artery* ; Pneumonia ; Rupture ; Subarachnoid Hemorrhage

Pterional, trans-sylvian approach is a basic and most popular neurosurgical procedure used in surgical treatment of various vascular, tumor and other lesions located in and around the sellar and parasellar region. It has several benefits such as a shorter working distance, anatomical familiarity, lesser need for brain retraction with wide sylvian dissection, ability of extension with some modification. All anterior circulation aneurysm except pericallosal origin aneurysm and some aneurysm of posterior circulation can be approached with pterional, trans-sylvian method. The authors discribe the procedure of pterional trans-sylvian approach.
Aneurysm* ; Brain ; Neurosurgical Procedures ; Recognition (Psychology)

OBJECTIVE: Direct revascularization surgery is regarded as the most effective method of treatment of adults with moyamoya disease. These patients, however, have a higher risk of perioperative ischemic complications than do patients with atherosclerotic stroke, and are at risk for ischemic complications in the hemisphere contralateral to the one operated on. We investigated the incidence and risk factors for ischemic stroke in the contralateral hemisphere after surgical treatment of adults with moyamoya disease. METHODS: We retrospectively reviewed the medical records and results of neuroimaging studies on 79 hemispheres of 73 consecutive patients with adult moyamoya disease (mean+/-SD age, 37.96+/-11.27 years; range, 18-62 years) who underwent direct bypass surgery over 6 years. RESULTS: Ischemic complications occurred in 4 of 79 (5.1%) contralateral hemispheres, one with Suzuki stage 3 and three with Suzuki stage 4. Three patients showed posterior cerebral artery (PCA) involvement by moyamoya vessels. Advanced stage of moyamoya disease (Suzuki stages 4/5/6; p=0.001), PCA involvement (p=0.001) and postoperative hypotension (mean arterial blood pressure <80% of preoperative mean arterial blood pressure) on the first (p<0.0001) and second (p=0.003) days after surgery were significantly correlated with postoperative contralateral ischemic complications. CONCLUSION: In patients with advanced moyamoya disease and involvement of the PCA, intentional hypotension can result in ischemic stroke in the hemisphere contralateral to the one operated on. Careful control of perioperative blood pressure is crucial for good surgical results.
Adult ; Arterial Pressure ; Blood Pressure ; Cerebral Revascularization ; Humans ; Hypotension ; Incidence ; Medical Records ; Moyamoya Disease ; Neuroimaging ; Passive Cutaneous Anaphylaxis ; Perioperative Period ; Posterior Cerebral Artery ; Retrospective Studies ; Risk Factors ; Stroke

The morbidity and mortality rates of the patients who survive initial aneurysm rupture were disconcertingly high. So the best results of treating intracranial aneurysms can be achieved with treating aneurysm before they rupture. But, the natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still arguable. This review article included risks of bleeding of the unruptured aneurysm and risk of the surgery.
Aneurysm ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Mortality ; Natural History ; Rupture

OBJECTIVE: This study was undertaken to demonstrate the usefulness of endovascular technique in treatment of vertebral artery dissecting aneurysms. METHODS: The clinical characteristics of vertebral artery dissecting aneurysms were reviewed in 11 patients with particular focus on clinical presentation, angiographic feature and outcome. RESULTS: All patients underwent the GDC embolization. One of them was managed with surgical trapping after failure of GDC embolization and the other with GDC embolization after failure of stent insertion. Nine patients were recovered with intact neurological feature, one patient died as result of sepsis and ARDS, and one patient was suffered from cerebellar infarction. CONCLUSION: Although the timing of the procedure and site of occlusion remain controversial, proximal GDC occlusion of vertebral artery appears to be a safe and effective therapy for patients with vertebral artery dissecting aneurysm. This procedure provides an important, less invasive alternative for this condition.
Aneurysm, Dissecting* ; Endovascular Procedures ; Humans ; Infarction ; Sepsis ; Stents ; Vertebral Artery*

The treatment of stroke is undergoing a revolution, which is reflected in the wide spread use of the term "Brain Attack". Our understanding of the pathophysiology of cerebral ischemia, and our ability to effectively intervene in the clinical setting have changed the way patients at risk of or suffering from a stroke are managed.
Brain Ischemia ; Brain* ; Humans ; Stroke