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In spite of technical advances in neuroradiology, neuroanesthesiology, and microneurosurgery, the treatment of giant aneurysms remains problematic. Between 1983 and 1995, the authors encountered 42 consecutive cases of giant aneurysms, and this study focuses on their clinical manifestations, management, and outcome. The patients' ages ranged from 5 to 73 years, with peak incidence in the sixth decade ; the male to female ratio was 12 : 30. The follow-up period was from 2 to 110(mean, 36) months. The most common presenting symptom was a mass effect found in 22 patients(52%), followed by subarachnoid hemorrhage in 16(38%). Thirty patients underwent a surgical or interventional radiological procedure, comprising direct neck clipping(n=13), proximal clipping(n=7), detachable balloon occlusion(n=4), wrapping(n=3), trapping(n=1), and partial clipping with thrombectomy(n=2). The mortality rate was 16.7% and the morbidity rate, 40% ; the most common postoperative complication was distal cerebral infarction. At the last follow-up, 22 patients(73%) were able to perform daily activities without assistance. In this clinical study, the authors reviewed general aspects of the treatment of giant aneurysms. In conclusion, treatment of giant aneurysms should-for best results-be tailored to patients' individual requirements, determined after thorough examination. Despite advanced neurosurgical techniques, morbidity and mortality rates remain high.
Aneurysm* ; Cerebral Infarction ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Neck ; Postoperative Complications ; Subarachnoid Hemorrhage

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. During the past 10 years, the senior author(DH Han) operated upon 64 posterior circulation aneurysms. The number of the basilar bifurcation aneurysms(BBAA) were 31(48%), the posterior cerebral artery aneurysms(PCEAA) 7, the superior cerebellar artery aneurysms(SCAA) 10, the anterior inferior cerebellar aneurysms(AICAA) 3, the vertebro-basilar junction aneurysms(VBJA) 2, the vertebral artery aneurysms(VAA) 5 and the posterior inferior cerebellar artery aneurysms(PICAA) 6. The surgical approaches for BBAA, SCAA and PCEAA(proxinal to P4) were pterional route in 41 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms(AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The authors achieved aneurysmal neck clipping in the 48(75%) aneurysms, wrapping in other 8 and proximal clipping in the other 8. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent(38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.
Aneurysm* ; Arteries ; Hand ; Infarction ; Mortality ; Neck ; Paralysis ; Paresis ; Posterior Cerebral Artery ; Status Epilepticus ; Vertebral Artery

To settle the controversy over the optimum management strategy for patients with poor-grade(Hunt-Hess grade IV and V) aneurysmal subarachnoid hemorrhage, the medical records of 50 patients admitted in poor Hunt-Hess grade have been examined retrospectively with literature review. Twelve patients underwent early surgery for aneurysmal neck clipping, and for the other patients, initial conservative management was done followed by delayed operation for 19 patients who showed stabilization or improvement of neurologic status. All patients were managed by active treatment(hypertensive, hypervolemic and hemodilutional therapy) after aneurysmal neck clipping. Initial findings such as better neurological condition(Hunt-Hess grade IV) and presence of intracerebral hemorrhage were indicators of good prognosis. Patients with intraventricular hemorrhage and uncontrollably increased intracranial pressure(>40 cm H20 after extraventricular drainage) resulted in severe morbidity or mortality. Regarding the timing of surgery, early intervention led to a better outcome with less morbidity(8% vs. 26%) compared with delaying operation, because of the lower incidence of rebleeding, reduced vasospasm and more effective management of delayed ischemia after surgery. The incidence of intraoperative premature rupture and mortality were not significantly influenced by the timing of surgery. It is concluded that, for poor-grade aneurysm patients without a definite evidence of irreversibility such as brainstem failure signs or uncontrollably increased intracranial pressure, early surgery followed by aggressive treatment to prevent cerebral vasospasm is the treatment of choice.
Aneurysm ; Brain Stem ; Cerebral Hemorrhage ; Early Intervention (Education) ; Hemorrhage ; Humans ; Incidence ; Intracranial Pressure ; Ischemia ; Medical Records ; Mortality ; Neck ; Prognosis ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. Patients with intracranial aneurysms operated on from January 1984 to January 2003 have been reviewed retrospectively. During that period 104 patients with 110 posterior circulation aneurysms underwent operation in our institute. Among them 47 patients had 49 aneurysms at the basilar bifurcation. The posterior cerebral artery aneurysms (PCEAA) 11, the superior cerebellar artery aneurysms (SCAA) 18, the anterior inferior cerebellar aneurysms (AICAA) 6, the vertebral artery aneurysms (VAA) 8 and the posterior inferior cerebellar artery aneurysms (PICAA) 18. The surgical approaches for BBAA, SCAA and PCEAA (proximal to P4) were pterional route in 70 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms (AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The author achieved aneurysmal neck clipping in the 82 (73%) aneurysms, wrapping in other 15 and proximal clipping in the other 13. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent (38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.
Aneurysm* ; Arteries ; Hand ; Humans ; Infarction ; Intracranial Aneurysm ; Mortality ; Neck ; Paralysis ; Paresis ; Retrospective Studies ; Status Epilepticus ; Vertebral Artery

No abstract available.
Diagnosis* ; Moyamoya Disease* ; Neuroimaging*

No abstract available.
Intracranial Arteriovenous Malformations* ; Risk Factors*

No abstract available.
Pyloric Stenosis, Hypertrophic*

No abstract available.
Child* ; Humans ; Tuberculosis, Meningeal*

This study was intended to investigate the pre-and postoperative profile of seizures in the patients with cerebral arteriovenous malformatins(AVM's), and to evaluate various preoperative factors to predict the postoperative occurrence of seizures. The patients consisted of 46 consecutive cases with supratentorial AVM's operated on from May 1987 to May 1993. Their mean follow-up duration was 40 months. The pre- and postoperative seizure profiles were similar to each other. The overall incidence of patients experiencing seizure were 50% preoperatively and 52% postoperatively, and the incidence of intractable seizure was 15%, which was the same in both the pre-and postoperatively period. The presence of preoperative seizure and large size of AVM were significant indicators of high incidence of postoperative seizures(P<0.05), while other factors such as preoperative intracerebral hemorrhage or embolization showed no significant influence on the occurrence of postoperative seizures. About 70% of the patients with preoperative seizures also had postoperative seizures, while those without preoperative seizures developed new ones only in 35% of the cases postoperatively. The mean size of the AVM's in the group, with postoperative seizures was larger than that of the group without postoperative seizures(4.56 vs. 3.02 cm). Regarding postoperative intractable seizures, 57% of the group with preoperative intractable seizures remained intractable postoperatively and groups with preoperatively controlled and groups without seizures demonstrated postoperative intractablity only in 13% and 4% respectively. In conclusion, surgery of AVM's did not change the overall incidence of seizures, both controlled and intractable, and patients with preoperative and large sized AVM's and significantly higher possibility of postoperative seizures. Patients with preoperative intractable seizures resulted in control of seizures in 43% after removal of AVM, while 57% remained intractable. Extirpation of epileptic focl, after localization with preoperative study, seems to be needed to improve the outcome of the postoperative seizures.
Cerebral Hemorrhage ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Arteriovenous Malformations* ; Seizures*