The introduction of detachable coils in treating cerebral aneurysm patients has revolutionized the management of this disease in the past 15 years. The advancement of imaging resolution and the use of three dimensional imaging not only with catheterized conventional angiography, but also with CTA and MRA have enabled a more thorough evaluation and accurate diagnosis of cerebral aneurysms prior to intervention and has also aided in the treatment process. Therefore, it is essential to organize past studies and create an up to date general diagnostic guideline.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Catheters ; Diagnosis ; Humans ; Intracranial Aneurysm

Anterior choroidal artery (AChA) syndrome is widely known to be composed of a triad of hemiparesis, hemisensory loss and homonymous hemianopia. AChA syndrome is an unusual complication of aneurysmal treatment. This report documents two cases of AChA syndrome that occurred after an endovascular aneurysmal coiling procedure. Both cases showed complete recovery of the neurologic deficit at the time of discharge. To avoid this complication, meticulous caution is required to preserve the posterior communicating artery, the AChA and the various perforators during an endovascular procedure. When AChA syndrome occurs, immediate treatment is necessary, including vasodilators, thrombolytics and close observation of the patient's clinical status.
Adenosine ; Aneurysm ; Arteries ; Cerebral Infarction ; Choroid ; Endovascular Procedures ; Hemianopsia ; Intracranial Aneurysm ; Neurologic Manifestations ; Paresis ; Radiology, Interventional ; Vasodilator Agents

PURPOSE: The purpose of this study was to develop PC-based perfusion software using Microsoft Windows. This software was developed to reformat perfusion maps including CBV (Cerebral Blood Volume), MTT (Mean Transit Time), and CBF (Cerebral Blood Flow) maps and to analyze perfusion quantitatively. MATERIALS AND METHODS: Windows-based perfusion software was developed using IDL (Interactive Data Language) as the development tool. The perfusion software was written to load the source image from dynamic first-pass cerebral perfusion CT and to reformat perfusion maps. Mean perfusion values in gray matter and white matter were calculated and compared to previously calculated data reported in literature. RESULTS: This software reformatted first pass perfusion maps in a user-friendly PC and calculated CBV, MTT, and CBF values. The values were within the normal range of the mean values when compared to previous studies. CONCLUSION: CT perfusion maps and perfusion values can be obtained by using the newly developed PC-based perfusion software. Further study is needed to achieve more precise values. However, we believe that in the future, this program may be used in various clinical settings.
Perfusion* ; Reference Values

Malignant rhabdoid tumor (MRT) is a rare but distinctive neoplasm of unknown histogenesis, occurring primarily in children. It has a characteristic histologic pattern and aggressive clinical behavior, and was originally thought to be a malignant sarcomatous variant of Wilms tumor; numerous cases of MRT arising from extrarenal sites have, however, been reported. We describe the radiologic findings of two cases of malignant extrarenal rhabdoid tumor that arose in the pelvic paravertebral region of two children. Both were confirmed by surgical excision and pathologic examination.
Child ; Humans ; Rhabdoid Tumor* ; Wilms Tumor

In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Vascular Surgical Procedures/*adverse effects ; Treatment Outcome ; Male ; Incidental Findings ; Humans ; Craniocerebral Trauma/*complications ; Carotid-Cavernous Sinus Fistula/etiology/*radiography/*surgery ; Carotid Artery Thrombosis/*etiology/*radiography ; Adult

OBJECTIVE: This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment. METHODS: Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale. RESULTS: Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway. CONCLUSION: Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.
Aneurysm ; Cerebral Hemorrhage ; Frontal Lobe ; Glasgow Coma Scale ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Prognosis ; Retrospective Studies ; Surgical Instruments ; Survival Rate ; Temporal Lobe

PURPOSE: To evaluate the merits of this technique and to provide a standard for comparison with futuretreatment alternatives. MATERIALS AND METHODS: We retrospectively reviewed the records of 52 patients withdirect CCF treated at the Yonsei Medical Center between 1983 and 1997 by transarterial or transvenous embolizationusing detachable balloon(s) and/or coils. RESULTS: Among the 52 cases, 51 were traumatic in origin, while onlyone was the result of a ruptured aneurysm. The three most common presentations were chemosis, bruit, andpulsatile proptosis. Forty-five patients were successfully treated with detachable balloon(s) and/or coils andinternal carotid blood flow was preserved in 35. When coils were used (1993-7), the ICA preservation rate washigher than when they were not used (1983-92). To confirm statistical significance, however, more studies areneeded. Four patients who initially presented with incomplete occlusion showed spontaneous occlusion on follow upangiography. In two patients, surgical ligation was performed because embolization failed and there was incompleteocclusion of the fistula. We experienced complications such as transient 3rd and 6th cranial nerve palsy,migration of deflated balloons and coils to the lung, and loss of vision. CONCLUSION: Transarterial andtransvenous embolization with detachable balloon(s) and/or coils provides a high rate of fistula obliteration withlow morbidity. In particular, the use of coils led to an increased rate of ICA preservation, thus and isconsidered as a good treatment modality for CCF obliteration.
Aneurysm, Ruptured ; Cranial Nerves ; Exophthalmos ; Fistula* ; Humans ; Ligation ; Lung ; Retrospective Studies

OBJECTIVE: The purpose of this study is to evaluate complications in 70 patients who had underwent endovascular treatment to occlude cerebral aneurysms. METHODS: From May 1999 to December 2002, we treated 70 patients by endovascular treatment or by combination of endovascular treatment and surgery. Complications have been developed in fifteen patients. Twelve patients had anterior circulation aneurysms: 4 posterior commmuncating artery ; 2 anterior communicating artery ; 2 paraclinoid artery ; 2 anterior choroidal artery ; 1 distal internal carotid artery ; 1 middle cerebral artery ; 1 pericallosal artery and three patients had posterior circulation aneurysms: 3 basilar artery tip. RESULTS: The complications related to the coil embolization were the thromboembolic event in 9 cases, rupture of the aneurysm in 3 cases, coil prolapse in 3 cases and coil migration in 1 case. CONCLUSION: The coil embolization can be a alternative good modality in the treatment of cerebral aneurysms. But careful attention should be required to reduce the various complications of procedures and to improve the prognosis of aneurysmal treatment. Effort to overcome the technical problem and to develop more comfortable device are needed for the better results of endovascular treatment.
Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Choroid ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prognosis ; Prolapse ; Rupture

We report on two cases of microguidewire breakage that occurred during endovascular treatment of intracranial aneurysms. The microguidewire can be broken when a part of the wire is stuck due to vascular tortuosity, and, subsequently, application of excessive rotational movement. The mechanical and physical properties of a microguidewire are also important factors in microguidewire breakage. We also suggest technical tips for avoidance of this problem.
Aged ; *Catheters ; Device Removal ; Embolization, Therapeutic/*instrumentation ; *Equipment Failure ; Female ; Humans ; Intracranial Aneurysm/*therapy ; Middle Aged ; Radiography, Interventional/*instrumentation

Extracranial carotid artery aneurysm is a rare disease. A 72-year-old man was admitted with a painful neck mass for 5 days. Neck CT angiography and carotid duplex ultrasonography revealed a fusiform aneurysm of the left carotid bifurcation with a thrombus. His symptoms improved after anticoagulation therapy. The thrombus decreased in size and ultimately disappeared, as evidenced by serial duplex examinations. Carotid duplex ultrasonography is a simple and useful tool for diagnosis and follow-up.
Aged ; Aneurysm ; Angiography ; Carotid Arteries ; Carotid Artery Diseases ; Follow-Up Studies ; Humans ; Neck ; Rare Diseases ; Thrombosis ; Ultrasonography, Doppler, Duplex