There are so many differences between the elderly patients and the younger patients in the aspects of a causes and the clinical course of spontaneous intracerebral hemorrage (ICH). As the mean life-time of a general population goes longer, the incidence of spontaneous ICH increases but the aggressive support in ICH is withdrawn more commonly and a prognosis of ICH becomes poor. Therefore, a prevention of ICH and a strict control of hypertension is very very important.
Aged ; Cerebral Hemorrhage* ; Humans ; Hypertension ; Incidence ; Mortality ; Prognosis

As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

Hypertension is a very common disorder in the aged persons. There exist several hemodynamic characteristics associated with hypertension in the geriatric population, - decreased elasticity of arterioles due to fibrosis, decreased renin activity, and decreased cardiac output and renal blood flow. Clinically, isolated systolic hypertension, blood pressure variation within a day, and white coat hypertension, are more common in the aged population. Furthermore, aged persons have more chances to suffer other diseases, diabetes, COPD, and renal dysfunction, for example. These characteristics need tailored approaches in diagnosing and managing hypertension in the aged. In the current literature, detailed characteristics of 'geriatric hypertension', are described, including definition, grade of hypertension, importance of treatment of hypertension, complications of hypertension, drug or non-drug treatment, and principles of drug treatment especially in the specific age group.
Arterioles ; Blood Pressure ; Cardiac Output ; Elasticity ; Fibrosis ; Geriatrics* ; Hemodynamics ; Humans ; Hypertension* ; Pulmonary Disease, Chronic Obstructive ; Renal Circulation ; Renin ; White Coat Hypertension

The stereotactic radiosurgery for arteriovenous malformation (AVM) began in the early 1970s. Nowadays, by 2000 world-wide, more than 27,500 patients have undergone Gamma Knife radiosurgery for cerebrovascular disease (CVD). New concepts, consisting of obliteration rate, postradiosurgical hemorrhagic risk, dose selection for treatment, and radiosurgery for pediatric AVM, medium-to-large sized AVM, cavernous malformation, venous angioma, so on, have been established. Gamma Knife radiosurgery has been considered as an effective management stratege with relatively few side effects for AVM. However, recently delayed radiation-induced complications were reported in 3.2 to 12.5% in range. Therefore, the long-term follow-up is thought to be mandatory even after treatment goal, complete obliteration, is confirmed.
Arteriovenous Malformations ; Follow-Up Studies ; Hemangioma ; Humans ; Patient Selection ; Radiosurgery*

These days, a less invasive surgery is stressed. One current thought is that the endovascular surgery itself is the less invasive and safer surgery for a cerebral aneurysm, and not the microsurgery. Is this true? We have evaluated the merits and demerits of each method. Our conclusion is as follows. Endovascular Surgery should be considered as an alternative, only for the specific patients. Microsurgery itself retains its position of the first treatment of choice for a cerebral aneurysm. "Less invasive" cannot be equated with "less dangerous". We will show the above reasons using slides and videotapes of several patients.
Humans ; Intracranial Aneurysm ; Microsurgery ; Videotape Recording

Vertebral artery(VA) and posterior inferior cerebellar artery(PICA) have complex and variable anatomic configuration of origin and running course in its exctracranial and intracranial pathway. VA has four main segments: the first portion from their origin to the entry into the foramen transversarium of C6, V1; the second portion from the C6 foramen to the C1 foramen, V2; the third portion from the exit from the C1 foramen to their entry through the atlanto-occipital membrane, V3; and the fourth portion from the entry through the dura to the vertebrobasilar junction, V4 after usual origin from proximal subclavian artery. Anatomic variations including aplasia, hypoplasia, duplication, and fenestration have been reported and careful consideration and examination must be needed because these variations tend to have another vascular anomalies such as arteriorvenous malformation or aneurysm. Tortuosity of VA is not a unusual finding especially in the aged people and the branches of VA are composed of meningeal, spinal, muscular, and radicular artery. PICA is most prominent artery from VA and its trunk is divided into five segments: anterior medullary, lateral medullary, tonsilomedullary, telovellotonsillar, and cortical. The running pathway of this vessel is pretty various in each person. The branches of this vessel are composed of perforating, terminal (cortical), choroidal, and meningeal artery. The extradural origin of PICA is infrequent; however, awareness of the presence of such an anatomic variation may be a helpful adjunct to avoid injury to this vessel. Around the vertebrobasilar junction (VBJ), the anatomy of the main arteries was variable. In contrast, the perforators penetrated the adjoining brain stem at specific locations regardless of caliber of the main artery. The four major point of entry to brain stem are the lateral medullary area just caudal to the posterior olivary sulcus (Group I), the posterior olivary sulcus(Group II), the small lateral fossa at the superior olivary groove(Group III), and the foramen caecum(Group IV). Despite a small VA or its major branches, the perforators penetrating the brain stem are very important and may effect the outcomes of operation or neurointerventional procedure of VBJ unless careful manipulation and consideration was performed.
Anatomic Variation ; Aneurysm ; Arteries* ; Brain Stem ; Choroid ; Humans ; Membranes ; Meningeal Arteries ; Pica ; Running ; Subclavian Artery ; Vertebral Artery

The detailed knowledge of the microvascular anatomy and the recognition of the anatomical variations of the middle cerebral artery (MCA) are very important for neurosurgeons to construct a better and safer microdissection plan and to prevent postoperative neurological deficits. This paper mainly reviewed segments, perforators, cortical arteries, branching patterns, anomalies, and regional anatomy relating various neurovascular surgery such as vascular anastomosis and the management of aneurysms and arteriovenous malformations of the MCA.
Anatomy, Regional ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Microdissection ; Middle Cerebral Artery*

The microsurgical anatomical characteristics of the anterior cerebral artery(ACA) are described. Inequality of horizontal segment of ACA has been reported. The majority of anterior communicating artery (ACoA) aneurysms occur in association with dominance of one A1 and hypoplasia of the other. ACoA has variation such as dimple, fenestration duplication, string, median artery of the corpus callosum and azygos anterior cerebral artery. ACoA gives rise to the perforating branches which feed subcallosal, hypothalamic area and optic chiasm. The recurrent artery of Heubner arises at A1-A2 junction, proximal A2 or distal A1. The distal ACA gives origin to many cortical branches, but there is the large variety of their origin. The aneurysm arising from A1 could be clipped through the pterional route, and those of distal ACA throuph the interhemispheric approach. ACo aneurysm could be approached through pterional or interhemspheric route. Essential points in ACo aneurysm surgery through any approach are to confirm H complex and to clip aneurysmal neck precisely without compromising feeding arteries or perforating branches.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Corpus Callosum ; Neck ; Optic Chiasm ; Socioeconomic Factors

As the internal carotid artery(ICA) spans the cavernous sinus and supraclinoid segments, it assumes an S-shaped configuration on lateral view that is referred as the carotid siphon. The supraclinoid carotid artery begins where the artery emerges through the dural ring from the clinoidal segment, thereby forming the distal half of the siphon. The artery enters the subarachnoid space medial to the anterior clinoid process, just inferior to the optic nerve, and then pass posteriorly, and laterally to the side of the optic chiasm. The vessel then angles forward as it nears the anterior perforated substance at the medial end of Sylvian fissure, where it bifurcates into the anterior and middle cerebral arteries. The supraclinoid portion of the ICA can be divided into three segments: ophthalmic, communicating, and choroidal, based on the site of origin of the ophthalmic, posterior communicating, and anterior choroidal arteries, respectively.
Arteries ; Carotid Arteries ; Carotid Artery, Internal* ; Cavernous Sinus ; Choroid ; Middle Cerebral Artery ; Olfactory Pathways ; Optic Chiasm ; Optic Nerve ; Subarachnoid Space

Although lacking of unanimously accepted nomenclature and numbering system of the internal carotid artery (ICA) segments, recently adopted system may be applicable in terms of its simplicity and practical purposes. According to this seven-tier system, we briefly summarized the normal microvascualr anatomy of the ICA from the extracranial cervical (C1) segment to the clinoid (C5) segment of the ICA and surrounding structures with relevant schematic drawings. Also we presented a spectrum of normal variants and congenital anomalies with respect to the normal anatomy.
Carotid Artery, Internal