A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.
Accidents, Traffic ; Adult ; Aneurysm, False ; Aorta, Thoracic/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Cerebral Hemorrhage/radiography/surgery ; Endovascular Procedures/*methods ; Humans ; Male ; Subclavian Artery/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds, Nonpenetrating/radiography/surgery

We have had 37 patients with cerebral arteriovenous malformation and subarachnoid hemorrhage, who were admitted to the Department of Neurosurgery, Yonsei Medical Center from 1964 to 1976. All of the cerebral arteriovenous malformations were proved by cerebral angiography. Since the site of the lesions were considered to have a close relation to the neurologic deficit and the results of surgery, various analysis of clinical manifestations and of the cerebral angiographic findings were attempted. Out of 37 patients, surgery was performed in 28 and the results were analysed according to the various type of surgical procedure.
Adolescent ; Adult ; Cerebral Angiography ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Intracranial Arteriovenous Malformations/radiography ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Methods ; Middle Age ; Subarachnoid Hemorrhage/radiography ; Subarachnoid Hemorrhage/surgery

OBJECTIVETo simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) and assess the value of 3D-CTA in early microneurosurgery for ruptured intracranial aneurysms.

METHODSForty-eight patients with spontaneous subarachnoid hemorrhage due to ruptured intracranial aneurysm were confirmed by early operation. All the patients were classified according to Hunt-Hess, including 11 of grade I, 29 of grade II, and 8 of grade III. CTA was performed before the operation and surgical simulation was conducted. The preoperative findings on CTA and the intraoperative findings were compared and the clinical value of cerebral 3D-CTA was analyzed.

RESULTSPre-operative 3D-CTA clearly displayed the location, size and shape of the aneurysms, the axis direction of the aneurysm apex and the width of aneurysm neck. The spatial relation between the parent aneutysm artery, the aneurysm, the peripheral vessels and the bony structures were also demonstrated. These findings were basically consistent with the intraoperative findings. The Glasgow outcome score was 5 in 41 patients, 4 in 4 patients, 3 in 2 patients, and 2 in 1 patient upon discharge from the hospital.

CONCLUSIONSPreoperative 3D-CTA examination can simulate the surgery for ruptured aneurysms to help improve the surgical success rate.

Adult ; Aged ; Aneurysm, Ruptured ; diagnostic imaging ; surgery ; Cerebral Angiography ; methods ; Computer Simulation ; Female ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography, Interventional ; Subarachnoid Hemorrhage ; diagnostic imaging ; etiology ; surgery ; Tomography, Spiral Computed