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

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

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

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 compare the lesion detectability and conspicuity in traumatic brain injury on T-2 FFE , FLAIR and diffusion weighted imaging (DWI) sequences. MATERIALS AND METHODS: Thirty-three patients who underwent MR brain imaging after traumatic brain injury were reviewed. T-2 FFE, FLAIR and diffusion-weighted MR sequences were obtained and were compared in terms of the detectability and conspicuity of intra- and extra- axial lesions which showed abnormal signal intensities. RESULTS: Among 33 patients, a total of 108 lesions were found. T-2 FFE sequences detected 88(81%) of these, FLAIR sequences 91(84%), and diffusion-weighted sequences 57(52%). In the case of petechial hemorrhagic lesions, 16 were detected by T-2 FFE imaging but only one by FLAIR and one by DWI. Sixteen extra-axial lesions (73%) were detected by T-2 FFE, 21 (95%) by FLAIR, and 11(50%) by DWI. Lesion conspicuity on FLAIR images was judged superior to that on T-2 FFE and diffusion-weighted images in 42 lesions (75%). Eleven extra- axial Lesions (92%) were more conspicuous on FLAIR than on T-2 FFE and DWI. CONCLUSION: For detecting traumatic brain lesions and determining their conspicuity, FLAIR imaging was more useful than T-2 FFE and diffusion weighting, while T-2 FFE imaging was more sensitive for the detection of petechial hemorrhage. Although diffusion-weighted imaging was generally inferior to both FLAIR and T-2 FFE in terms of lesion detection and conspicuity, for some lesions it was superior. The results suggest that images obtained at each pulse sequence can be used as complementary imaging sequences, and that in traumatic brain injury, the acquisition of FLAIR, T-2 FFE and diffusion-weighted images is useful.
Brain ; Brain Injuries* ; Diffusion ; Hemorrhage ; Humans ; Neuroimaging

OBJECTIVE: The purpose of this study is to evaluate the findings of magnetic resonance(MR) perfusion study and relation with the prognosis in patients of head trauma. METHODS: Forty-two consecutive patients with head trauma were evaluated and the findings of brain computed tomography(CT) and MR image were compared with MR perfusion study. We classified perfusion MR findings into 5 categories and correlated with the prognosis. RESULTS: In all 42 patients with head trauma, 38 cases(90.5%) showed new lesions of abnormal perfusion pattern in MR perfusion study compared to CT and conventional MR image. Causes of the trauma were motor vehicle accident(73.8%) falling(16.7%), and blows to the head(7.1%) in order of frequency. The cumulative prevalent sites of focal abnormalities were frontal lobe in 11 cases(39.3%), basal ganglia and thalamus 9 cases(32.1%), temporal lobe 3 cases(10.7%) and parietal lobe 3 cases(10.7%) and occipital lobe 1 case(3.6%) and cerebellum 1 case(3.6%). The pattern of abnormalities in MR perfusion study were focal type in 18 cases(42.8%), diffuse type 18 cases(42.8%), mixed type 4 cases(9.5%). MR perfusion findings showed statistically significant correlation with initial Glasgow Coma Scale score and Glasgow Outcome Scale score(p<0.05). CONCLUSION: The patterns of perfusion MR abnormality show significant correlation with the prognosis. Further study is mandatory to define the meaning of perfusion defect area and clinical significance.
Basal Ganglia ; Brain* ; Cerebellum ; Craniocerebral Trauma* ; Frontal Lobe ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head* ; Humans ; Motor Vehicles ; Occipital Lobe ; Parietal Lobe ; Perfusion* ; Prognosis ; Temporal Lobe ; Thalamus

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

Third cranial nerve palsy may indicate the presence of an intracranial aneurysm, most commonly in the posterior communicating artery. The effect of endovascular management of posterior communicating artery aneurysms on recovery from third cranial nerve palsy is not well documented. We report two patients with third cranial nerve palsy caused by posterior communicating artery aneurysms. Endovascular treatment resulted in subsiding of ptosis within two weeks. Resolution of extraocular muscle function occurred within one to three months after treatment. Endovascular treatment, which has recently been introduced into neurosurgical practice, is effective in preventing aneurysmal rupture, and in eliminating manifestations due to mass effects.
Aneurysm ; Arteries ; Humans ; Intracranial Aneurysm* ; Oculomotor Nerve* ; Paralysis* ; Rupture