With the development of devices and techniques, including complex shape coils, balloons, multiple catheter techniques, and intracranial stents, endosaccular treatment of ruptured or unruptured wide-necked cerebral aneurysms has advanced rapidly with respect to indications and outcomes. In contrast to other options, stent-assisted aneurysm embolization has a distinct feature in which the stent is permanently implanted in the cerebral vessels. Therefore, we must consider the short-term effect of stent-assisted aneurysm embolization in the prevention of coil migration and adverse thrombogenicity, but also the permanent mechanical, hemodynamic, and biological influence on the parent vessels and the aneurysm. We have reviewed the current experimental and clinical data on stent-assisted coil embolization of cerebral aneurysms.
Aneurysm ; Catheters ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Parents ; Stents

PURPOSE: To report a case of proptosis occurring during a Valsalva maneuver in a neurofibromatosis patient with an arachnoid cyst. CASE SUMMARY: A 42-year-old man diagnosed with type I neurofibromatosis visited our hospital with a 20-year history of enophthalmos in the left eye. The patient also complained of exophthalmos during the abdominal straining. On exophthalmometry, a 4 mm enophthalmos was found. The patient also presented with a limited motion to the superior and lateral direction. There was an ocular pulsation corresponding to the heart rate. During the Valsalva maneuver, a marked exophthalmos of the left eye occurred. The patient had light brown spots on the skin of the face and body trunk. Following an orbital computed tomography (CT), defects of the left sphenoid bone were present. Posteriorly, an arachnoid cyst was found; however, there was a lack of varix. The archnoid cyst was also observed to expand into the orbit during the Valsalva maneuver and forward the globe. CONCLUSIONS: To date, cases of proptosis occurring during a Valsalva maneuver by causes other than orbital varix are rare. Herein, the authors report a case with a review of literature.
Adult ; Arachnoid ; Enophthalmos ; Exophthalmos ; Eye ; Heart Rate ; Humans ; Light ; Neurofibromatoses ; Orbit ; Skin ; Sphenoid Bone ; Sprains and Strains ; Valsalva Maneuver ; Varicose Veins

Simultaneous occurrence of remote intracerebral hemorrhage (ICH) and intracranial aneurysmal subarachnoid hemorrhage is very rare. We report on a case of concurrent hypertensive ICH at the left thalamus and rupture of an intracranial aneurysm at the bifurcation of the single A2 segment of the anterior cerebral artery in a 64-year-old woman, which was clipped previously, with review of the literature. To our knowledge, this is the first case report demonstrating bleeding of previously clipped aneurysm with simultaneous hypertensive ICH. Hypertensive crisis following ICH seems to have provoked rupture of the residual aneurysm.
Aneurysm ; Anterior Cerebral Artery ; Cerebral Hemorrhage ; Female ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Rupture ; Subarachnoid Hemorrhage ; Thalamus

Meningiomas are usually benign neoplasms in which extracranial metastases occur very rarely. We report a case of multiple extracranial metastases of an atypical meningioma following a local recurrence. A 68-year-old man presented with left-side motor weakness and dysarthria for two weeks. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed an intraventricular tumor. We performed a total mass removal, and the histopathologic findings were consistent with benign meningioma. Eight months later, the meningioma recurred. We performed a reoperation and whole brain radiation therapy postoperatively. The histopathologic findings showed atypical meningioma. Six months later, CT and MRI revealed metastases to multiple vertebrae, lung, ribs and perirenal soft tissue so a decompressive laminectomy with mass removal was performed. The histopathologic findings of the spinal tumors showed atypical meningioma. The results from perirenal biopsies were consistent with metastatic meningioma. In conclusion, extracranial metastasis as well as local recurrence must be considered in atypical or anaplastic meningioma. There must be regular follow-ups. Finally, an evaluation of the chest, abdomen and bone is necessary, especially when related symptoms or signs develop.
Abdomen ; Aged ; Biopsy ; Brain ; Dysarthria ; Follow-Up Studies ; Humans ; Laminectomy ; Lung ; Magnetic Resonance Imaging ; Meningioma ; Neoplasm Metastasis ; Recurrence ; Reoperation ; Ribs ; Spine ; Thorax

Intracaval neoplastic extension of renal cell carcinoma to the right atrium has been reported in 14-39% of the patients with carcinoma involving the vena cava. We report a case of 44-year-old woman hospitalized with intermittent vomiting and presented with evidence of renal cell carcinoma extending into the inferior vena cava and right atrium on CF and MRI. We successfully managed renal cell carcinoma surgically extending into the right atrium using hypothermia and circulatory arrest.
Adult ; Carcinoma, Renal Cell* ; Female ; Heart Atria* ; Humans ; Hypothermia* ; Magnetic Resonance Imaging ; Vena Cava, Inferior* ; Vomiting

The authors describe a case of 17-year-old male with anaplastic astrocytoma in the basal ganglia and brain stem 11 years after surgical excision and local irradiation(5480cGy) for craniopharyngioma. There is no recurrence at the primary tumor site. Because of a geometric coincidence between the tumor location and the radiation field, radiation therapy is strongly implicated as a cause of this anaplastic astrocytoma.
Adolescent ; Astrocytoma* ; Basal Ganglia ; Brain Stem ; Craniopharyngioma* ; Humans ; Male ; Neoplasms, Radiation-Induced ; Radiotherapy* ; Recurrence

Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.
Arm ; Catheters ; Humans ; Laminectomy ; Magnetic Resonance Spectroscopy ; Middle Aged ; Peritoneal Cavity ; Proprioception ; Spinal Cord Injuries ; Spine ; Subarachnoid Space ; Syringomyelia

OBJECTIVE: Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI. METHODS: We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery). RESULTS: Among all the 2617 THI patients, total number of pediatric patients was 256. The average age of the subjects was 9.07 (standard deviation±6.3) years old. The male-to female ratio was 1.87 to 1 and male dominance increases with age. The most common cause for trauma were falls and traffic accidents. Age (p=0.007), surgery (p<0.001), mechanism of trauma (p=0.016), subdural hemorrhage (SDH) (p<0.001), diffuse axonal injury (DAI) (p<0.001) were statistically significant associated with severe brain injury. CONCLUSION: Falls were the most common cause of trauma, and age, surgery, mechanism of trauma, SDH, DAI increased with injury severity. There is a critical need for effective fall and traffic accidents prevention strategies for children, and we should give attention to these predicting factors for more effective care.
Accidental Falls ; Accidents, Traffic ; Brain Injuries* ; Cause of Death ; Child ; Craniocerebral Trauma ; Developed Countries ; Diffuse Axonal Injury ; Epidemiology* ; Female ; Glasgow Coma Scale ; Hematoma, Subdural ; Hospitals, University ; Humans ; Korea ; Male ; Mortality* ; Pediatrics ; Republic of Korea ; Trauma Centers

OBJECTIVE: Detection of intracranial multiple aneurysms, including mirror-image aneurysms, have recently been increasing with the development of diagnostic techniques. However, studies of mirror-image aneurysms have been rare in South Korea. Thus, we intend to report our hospital's experience with mirror-image aneurysms during the past 20 years along with a review of relevant literature. METHODS: We analyzed medical records and image data from patients with cerebral aneurysms who had been admitted to our institution from January 1988 to June 2007. We divided the patients into three groups and investigated the clinical patterns of mirror-image aneurysms (Group 1). We then compared them with patients exhibiting non-mirror multiple aneurysms (Group 2) and the patients with solitary aneurysms (Group 3). We also statistically analyzed the age, sex, smoking habits, medical histories, and prognoses of the patients. RESULTS: Mirror-image aneurysms were found in 62 (5.1%) of the 1,209 patients admitted for cerebral aneurysms over the past 20 years. Of the mirror-image aneurysms, 48% were located in the posterior communicating artery (PcoA), and 40% were in the middle cerebral artery (MCA). Ruptures of aneurysms occurred slightly more frequently on the right side and when the aneurysm was larger and its shape was more irregular. Women, particularly menopausal women aged 50 and older, were shown to be at higher risk. Smoking was also a risk factor. However, there were no significant differences in prognoses among the three groups. CONCLUSION: We should pay attention to the possibility of mirror-image or multiple aneurysms when diagnosing and treating menopausal women and smokers, particularly if the cerebral aneurysm is located in the MCA or PcoA.
Aged ; Aneurysm ; Arteries ; Female ; Humans ; Intracranial Aneurysm ; Medical Records ; Middle Cerebral Artery ; Prognosis ; Republic of Korea ; Risk Factors ; Rupture ; Smoke ; Smoking

OBJECTIVE: The authors analyzed the postoperative radiological changes in chronic subdural hematoma (CSDH) after operation and its relation to the recurrence. METHODS: After reviewing the postoperative imagings of CSDH patients (90 cases, 70 patients), we classified them into 4 types according to the radiological changes in the hematoma area and calculated the prevalence of recurrence respectively. We also reviewed the preoperative images of the same patients and classified them into 4 types according to hematoma density and internal structure and investigated the prevalence of recurrence after operation respectively. RESULTS: The low density area in postoperative computerized tomography (CT) showed the same Hounsfield unit and signal intensity in magnetic resonance imaging (MRI) with the CSF in ventricles. The recurrence of CSDH was lower if the hematoma was totally replaced with CSF (Type III) or the brain re-expanded completely with total hematoma drainage (Type IV) on postoperative imagings (p<0.05). The location of catheter tip can be used as a valuable indicator of the boundary of newly collected CSF and residual hematoma. CONCLUSION: The low-density area found on postoperative CT medial to the residual hematoma in CSDH is filled with CSF and it can be a helpful factor in reducing the recurrence. The catheter tip location can be used as a good index and we can remove the catheter immediately after confirming the tip location on the inner surface of the skull.
Brain ; Catheters ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Recurrence* ; Skull