PURPOSE: To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy. MATERIALS AND METHODS: From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26–37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated. RESULTS: Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam. CONCLUSION PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.

OBJECTIVE: Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively. METHODS: From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes. RESULTS: The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment. CONCLUSION: IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.
Consciousness ; Craniocerebral Trauma ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Headache ; Hematoma, Subdural* ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Symptom Assessment

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections that lie within the dura. Intraosseous DAVFs involving diploic venous system are extremely rare. A 46-year-old woman presented with headache and right pulsatile tinnitus for three weeks. The tinnitus started after yelling. Digital subtraction angiography revealed DAVF within the basal portion of right parietal bone along the middle meningeal artery (MMA) groove. The fistula was fed by frontal branch of right MMA and drained into right transverse sigmoid sinus junction through dilated middle meningeal vein. The intraosseous DAVF involving diploic vein was successfully obliterated with Onyx embolization via transarterial route.
Angiography, Digital Subtraction ; Central Nervous System Vascular Malformations* ; Colon, Sigmoid ; Female ; Fistula ; Headache ; Humans ; Meningeal Arteries ; Middle Aged ; Parietal Bone ; Tinnitus ; Veins*

PURPOSE: We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. MATERIAL AND METHODS: We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. RESULTS: Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common lilac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. CONCLUSION: Although medical therapy is preferred in management of DeBakey type Ill aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches.
Acute Kidney Injury ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortography ; Arteries ; Back Pain ; Bronchi ; Deglutition Disorders ; Dyspnea ; Esophagus ; Hemoptysis ; Hoarseness ; Humans ; Magnetic Resonance Imaging ; Paraplegia ; Pericardial Effusion ; Renal Artery ; Retrospective Studies ; Rupture ; Thorax

Retro-rectal cystic hamartoma (tailgut cyst), is an uncommon congenital developmental lesion, generally located in the retro-rectal space. Its diagnosis and approach is challenging because the retropelvic space is not familiar. We report a 51-year-old woman who presented with paresthesia and pain in perianal area. The magnetic resonance image showed high signal intensity on the T1-weighted image and iso to high signal intensity on the T2-weighted image of the retropelvic space and CT showed sacral bony defect. We chose the posterior approach for removal of the tailgut cyst. Histopathology exam of the retropelvic cyst revealed a multiloculated cyst containing abundant mucoid material lined by both squamous and glandular mucinous epithelium. The patient has recovered nicely with no recurrence. Tailgut cyst needs complete surgical excision for good prognosis. So, a preoperative high-resolution image and co-operation between neurosurgen and general surgeon would help to make safe and feasible diagnosis and surgical access.
Diagnosis ; Epithelium ; Female ; Hamartoma ; Humans ; Middle Aged ; Mucins ; Paresthesia ; Prognosis ; Recurrence

OBJECTIVE: The purpose of this study was to determine the clinical significance of intraventricular hemorrhage (IVH) in patients with ruptured aneurysms. METHODS: Of 1034 patients who were admitted to our hospital with ruptured aneurysms between 1994 and 2007, 128 (12.4%) had IVHs. The clinical, radiologic characteristics, and surgical outcomes in the IVH group were compared with the no-IVH group. RESULTS: The IVH group had a shorter time interval to admission. The incidence of IVH was significantly higher in patients > 70 years of age (p=0.021), males (p=0.000), alcohol abusers (p=0.039), patients with a Glagow Coma Scale (GCS) < or =8 (p=0.000), and patients with a Hunt and Hess grade of 4-5 (p=0.000). IVH was more common in patients with ruptured posterior circulation aneurysms (p=0.000) and anterior communicating artery aneurysms (p=0.036). The incidence of thick, diffuse subarachnoid hemorrhage (SAH; p=0.004), intracerebral hemorrhage (ICH) >10 cc (p=0.006), rebleeding (p=0.010), and shunt-dependant hydrocephalus (p=0.000) was significantly higher in the IVH group than the no-IVH group. The mortality rate in the IVH group was significantly higher than the no-IVH group (48.4% versus 22.1%). The amount of IVH had an influence on the mortality; IVH involving all of the ventricles (59.7%) and IVH only involving some of the ventricles (33.9%) was associated with a 6.6- and 2.3-fold higher mortality than the no-IVH group, respectively. IVH was significantly associated with a poor surgical outcome; however, this association was not significant in patients with a GCS < or =8, or histories of rebleeding or seizures. CONCLUSIONS: In patients with ruptured aneurysms, IVH reflects the clinical severity of SAH. IVH has a negative influence on surgical outcome, except in patients with a poor clinical status pre-operatively.
Aneurysm ; Aneurysm, Ruptured ; Cerebral Hemorrhage ; Coma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm ; Male ; Seizures ; Subarachnoid Hemorrhage

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.
Aged, 80 and over ; Aneurysm ; Angiography ; Brain ; Brain Stem Infarctions ; Catheters ; Dizziness ; Female ; Headache ; Humans ; Middle Aged ; Neck ; Posterior Cerebral Artery ; Stents ; Subarachnoid Hemorrhage

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.
Aged, 80 and over ; Aneurysm ; Angiography ; Brain ; Brain Stem Infarctions ; Catheters ; Dizziness ; Female ; Headache ; Humans ; Middle Aged ; Neck ; Posterior Cerebral Artery ; Stents ; Subarachnoid Hemorrhage

We report a rare case of scalp arteriovenous malformation(AVM). A 55-year-old woman presented with a pulsatile palpable mass on her left temporo-parietal scalp. She complained of insomnia because of bruit, which was audible when she lay on her left side. Computed tomography angiography(CTA) for the scalp vessel showed AVM on the left temporo-parietal region. Multiple enlarged arteries, such as the superficial temporal artery, posterior auricular artery, and occipital artery, were directly connected to the elongated dilated superficial temporal vein. Digital subtraction angiography also showed similar results. Fistulous portions were clearly delineated on both modalities. Surgical excision of the malformations, including feeding arteries and the draining vein, resulted in immediate relief of the symptoms. Usefulness of CTA in the diagnosis of vascular lesions on the scalp was emphasized.
Angiography* ; Angiography, Digital Subtraction ; Arteries ; Arteriovenous Malformations* ; Diagnosis ; Female ; Humans ; Middle Aged ; Scalp* ; Sleep Initiation and Maintenance Disorders ; Temporal Arteries ; Veins

OBJECTIVE: Chronic subdural hematoma (CSDH) is a condition mostly present in older people. Men are more commonly affected than women. Several theories about male predominance could not enough to explain the reason for male predominance on CSDH. The purpose of this study is to find out whether there were any differences in the anatomy of cranium, which may contribute the pathogenesis or risk factors of CSDH. METHODS: The study population was consisted of 87 patients with CSDH and 100 patients with transient ischemic attack (TIA) from 2006 to 2013. We classified into four groups; group A (CSDH male 47), group B (CSDH female 40), group C (TIA male 50), and group D (TIA female 50). We measured the size of the cranium in the computed tomography scans, retrospectively. We define the difference of cranium (Dc), which is difference between the right and left radiuses. RESULTS: The Dc was significantly higher in patients with CSDH (group A and B)(p=0.03). The mean Dc was 3.49 mm in CSDH group (group A and B) and 2.14 mm in TIA group (group C and D). The mean Dc of CSDH group was significantly larger than that of TIA group (by t-test, p<0.01). CONCLUSION: Size and asymmetry of the cranium may be a risk factor of CSDH. Gender differences in the anatomy of cranium may contribute pathogenesis of CSDH.
Craniocerebral Trauma ; Female ; Hematoma, Subdural, Chronic* ; Humans ; Ischemic Attack, Transient ; Male ; Radius ; Retrospective Studies ; Risk Factors ; Skull