No abstract available.
Aneurysm* ; Hydrocephalus*

The authors studied and analyzed microscopically the structure, length and diameter of each part of Willis circle in 264 cerebral hemispheres of 182 autopsied patients in the Taegu area from 1984 to 1990. The mean length of each A1 was 14.1mm and diameter at distal A1 was 2.25mm. The most common anatomical anomaly of the ACA part was A1 that of hypoplasia which appeared in 7.5% of the cases. The origin of the Heuner a. was accounted for the highest incidence of AcoA(82.5%). The length of AcoA. Noted 3.5mm with the incidence of duplication and triplication in 38.6%. The inner diameter of ICA noted 3.9mm at the communicating segment in ICA, and the average length of C4 was 12.5m. Except 5 hemispheres of undetectable origin at ICA, all the anterior choroidal a. originated from ICA, and the double stump of which noted 15.5%. Fetal type PcoA. Showed 6.6% of all and average length of the a. was 13.5mm. The inner diameter of MCA was 3.1mm and the mean length of M1 noted 15.5mm. The length of each P1 noted 6.95mm and the inner diameter of basilar a. at 1cm below the bifurcation was 3.3mm. The mean circumference of willis circle including both side of A1, P1, PcoA. AcoA. And choroidal and communicating segment of ICA was 88.6mm. Incidental finding of unruptured aneurysm noted 5.3% and junctional dilatation of PcoA. Showed 11.4% of all the cases.
Aneurysm ; Cerebrum ; Choroid ; Circle of Willis* ; Daegu ; Dilatation ; Humans ; Incidence ; Incidental Findings

The authors have clinically analysed the patients who required the reoperations after the aneurysmal clippings with intention to decrease the rate of reoperation as predicting the risk factors causing the postoperative complications or sequelae of subarachnoid hemorrhage. Between 1991 and 1996, we have performed total operation on 691 patients with aneurysmal subarachnoid hemorrhage. Among these, 72 patients(10.4% of total) required to be reoperated due to various causes. The shunt for hydrocephalus which was the most common cause of reoperation, performed in 57 patients(79.2% of the reoperated), and next, trephination for the subdural hygroma in 12 cases (16.7%), removal of the intracranial hematoma on the operated site in 7 cases(9.7%), reclipping of aneurysms for the regrowing of aneurysm rest or undiscovered aneurysm preoperatively in 5 cases(7%), and decompressive surgery for postoperative brain swelling and vasospasm in 2 cases(2.8%). The authors suggest that the perfect aneurysmal clipping and the detailed evaluation to decrease these complications of aneurysmal surgery, and careful attention should be given to find out the hidden or regrowing of aneurysmal rest are needed on pre-, postoperatively, and during the operation procedure.
Aneurysm* ; Brain Edema ; Hematoma ; Humans ; Hydrocephalus ; Intention ; Postoperative Complications ; Reoperation ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion ; Trephining

The authors report a very unusual case of ruptured aneurysm by direct vessel invasion of anaplastic oligodendroglioma (WHO grade III) confirmed by histopathological examinations. As local invasion is the hallmark of malignant gliomas, malignant glial tumors invade neighboring structure and often cause microscopic endothelial proliferation, telangiectasias in small arteriols, but direct arterial invasion by glioma is very rare. Possible mechanisms of intracranial aneurysm development by glioma are thought to be related to the close proximity to the tumor, perivascular basement membrane breakage due to high tumor pressure and increased regional blood flow through the feeding artery of tumor. The aneurysm and tumor were treated in a single operation simultaneously.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery* ; Arteries ; Basement Membrane ; Glioma ; Intracranial Aneurysm* ; Oligodendroglioma* ; Regional Blood Flow ; Rupture* ; Telangiectasis

Saccular aneurysms of the subarachnoid segment of the internal carotid artery(ICA) are among the most common aneurysms encountered by neurosurgeons. Surgical strategy and techniques to deal with such aneurysms arising from the ophthalmic artery to the ICA bifurcation are described. Intimate understanding of the anatomy and proper surgical technique improve surgical result.
Aneurysm* ; Carotid Artery, Internal* ; Ophthalmic Artery

The decision of proper time for operation on ruptured aneurysm is a very important tactic of treatment, because of the following major complications after subarachnoid hemorrhage. Recently it is widely accepted opinion that the ruptured aneurysm should receive an early operation for lower mortality and morbidity by preventing possible complications after subarachnoid hemorrhage such as rebleeding, symptomatic vasospasm and even hydrocephalus. Since 1985, we applied early to emergency surgery to the clinically deteriorating or non improving patients after aneurysm rupture and delayed surgery to the ameliorating patients who were placed under close observation. The early to emergency surgery on poor risk patient was performed within 48 hours after recent subarachnoid hemorrhage and delayed surgery was done after 2 weeks. Of the selective 95 poor-condition patients admitted to Kyungpook National University Hospital over the past 4 years from 1984, 60 got early surgeries and 35 delayed surgeries. Among the 60 patients in the early group, 22 patients with considerable intracranial hemorrhage were exempted from this comparative study. A few cases of vertebrobasilar aneurysms were not included in this paper for a little value in significance. In this prospective study, we evaluated the results of early and delayed surgeries of poor risk patients through clinical analyses and comparison, and we could gain better results from early surgeries.
Aneurysm* ; Aneurysm, Ruptured ; Emergencies* ; Gyeongsangbuk-do ; Humans ; Hydrocephalus ; Intracranial Hemorrhages ; Mortality ; Prospective Studies ; Rupture ; Subarachnoid Hemorrhage

There are many intracranial lesions causing spontaneous intracerebral hemorrhage, including hypertension, aneurysm, arteriovenous malformation, bleeding tumor, coagulopathy, amyloid angiopathy. In fact, the management of spontaneous intracerebral hemorrhage remains still a complex problem. The patient's age and consciousness, general condition, the hematoma location, as well as the cause combine to affect the management outcome. In general, mortality and morbidity is increasing with greater patient's age and hematoma size, deeper hematoma location. The emergent care and management usually are needed in almost all the patients with medical and surgical treatments. Acute medical management is required to control increased intracranial pressure, to stablize cardiorespiratory system, and prevent further compication such as brain edema, hematoma expansion, seizure. Emergent surgical treatment should be considered when surgical removal of hematoma would be benefit the patient's condition by decreasing mass effect and protecting the secondary injury to the surrounding normal brain.
Amyloid ; Arteriovenous Fistula ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Consciousness ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Intracranial Pressure ; Mortality ; Seizures

OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.
Aneurysm* ; Arteries ; Carotid Artery, Internal* ; Cranial Nerves ; Humans ; Intracranial Aneurysm ; Neck ; Thrombosis

The redundant nerve root syndrome is not common and demonstrates a large, elongated, and tortuous nerve roots of cauda equina. Usually, the diagnosis of this syndrome is not difficult with the radiological finding and clinical symptom. The authors report a case of the redundant nerve root syndrome mimicking intradural spinal tumor in view of the symptom and radiological findings. Magnetic resonance imaging revealed a globular intradural mass just above canal stenosis. Decompressive laminectomy and durotomy improved back pain and radicular pain. From the experience of this case, the relief of nerve root compression is recommended as early as possible in the redundant nerve root syndrome.
Back Pain ; Cauda Equina ; Constriction, Pathologic ; Diagnosis ; Laminectomy ; Magnetic Resonance Imaging ; Radiculopathy

No abstract available.
Aneurysm* ; Humans ; Hydrocephalus*