No abstract available.
Arteries* ; Humans ; Intracranial Aneurysm* ; Single Parent*

BACKGROUND: Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. METHODS: We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3℃, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. RESULTS: Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). CONCLUSIONS: AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.
Acalculous Cholecystitis ; Aneurysm* ; Aspartame ; Body Temperature ; C-Reactive Protein ; Cerebrovascular Disorders ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Diagnosis ; Fasting ; Fever* ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Leukocyte Count ; Prognosis ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage* ; Urinary Bladder ; Vital Signs

No abstract available.
Gliosarcoma*

PURPOSE: To assess the efficacy of three-dimensional CT angiography (3D-CTA) using multi-detector row computed tomography (MDCT) in the evaluation of intracranial aneurysms in patients with non-traumatic acute subarachnoid hemorrhage and to describe those aneurysms which were not found 3D-CTA. MATERIALS AND METHODS: 3D-CTA was done in 40 patients with non-traumatic subarachnoid hemorrhage by using a 16-slice MDCT; conventional digital subtraction angiography (DSA) was done in 36 of those patients within 12 hours. The CT and DSA images were reviewed by two radiologists and the site, size and neck of the aneurysms were evaluated. The results from these two modalities were then compared with the operative findings. We calculated the detection rates by 3D-CTA and DSA and evaluated the size differences of aneurysms dignosed with 3D-CTA and those found at surgery. We also analyzed the locations and sizes of aneurysms missed by 3D-CTA and attempted to explain these false negatives. RESULTS: A total of 55 aneurysms were surgically confirmed in 40 patients. 48 of these were detected pre-operatively by 3D-CTA. Thus, the detection rate by 3D-CTA was 87%. The size difference of aneurysms as calculated by 3-D CTA and found operatively was as follows: less than 1 mm in 17 cases, within 1-2 mm in 15 cases, and more than 2 mm in 16 cases. Seven aneurysms were not detected by 3D-CTA. The major cause of these missed aneurysms was their small size. The undetected aneurysms were less than 2 mm in size, except for 2 instances of PCoA aneurysms. One case was not detected due to difficult image evaluation. A possible explanation of the one remaining missed aneurysm was the filling of the aneurismal sac by thrombosis. CONCLUSION: Though there were some limitations in the detection of aneurysms, 3D-CTA using 16-channel MDCT may provide sufficient pre-operative information for the management of patients with intracranial aneurysms in cases of emergency operations or DSA-failure.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Emergencies ; Humans ; Intracranial Aneurysm* ; Neck ; Subarachnoid Hemorrhage ; Thrombosis

Traumatic intracranial aneurysms are rare, compromising less than 1% of intracranial aneurysms. The case of 20-year-old man suffered from delayed frontal intracerebral hematoma, subarachnoid hemorrhage and intraventricular hemorrhage from traumatic pericallosal aneurysm 12 days after head injury is presented. Traumatic pericallosal artery aneurysm is always near the falcine edge, is unrelated to arterial branching point. Sudden movement of brain and artery causes vessel wall injury against the stationary edge of the falx. Because of high mortality rate of ruptured traumatic aneurysm, clinical suspicion must be focused on the prompt diagnostic work-up and early treatment.
Aneurysm* ; Arteries* ; Brain ; Craniocerebral Trauma ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Mortality ; Subarachnoid Hemorrhage ; Young Adult

Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and/or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients.
Adult ; Angiography ; Anterior Cerebral Artery ; Asian Continental Ancestry Group ; Autopsy ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Angiography ; Cerebral Hemorrhage ; Child ; Constriction, Pathologic ; Early Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Intracranial Hemorrhages ; Ischemia ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Spectroscopy ; Middle Cerebral Artery ; Moyamoya Disease ; Positron-Emission Tomography ; Stroke ; Tomography, Emission-Computed, Single-Photon

We report a case of clear cell meningioma in the petroclival area, occurring in a 39-year old woman. She complained of dizziness, right facial pain and ataxia. Magnetic resonance imaging performed after first operation in other hospital showed a 6x8x8cm sized slightly enhancing mass in the right petroclival area. The tumor was totally removed with petrosal approach. The clinical, radiological, histopathological, and surgical points of view are discussed.
Adult ; Ataxia ; Dizziness ; Facial Pain ; Female ; Glycogen ; Humans ; Magnetic Resonance Imaging ; Meningioma*

The authors analyzed 38 consecutive cases with an occipital arteriovenous malformation(AVM) in regard to visual field defect. The incidence of occipital AVM was 10.4% among 367 patients with a cerebral AVM treated between 1975 and 1994 in our institute. Bleeding rate of occipital AVM in this series was 86.8%(EE cases) and it was significantly higher than that of AVM in other locations. Of 38cases, 15 patients(39.5%) had a visual field defect on admission and all of them were accompanied by intracerebral hematomas caused by the rupture of AVMs. The presence of visual field defect did not correlate with angioarchitecture in reference to pattern of nidus, feeding artery, and draining vein. Of 15 patients with visual field defect. 10 patients showed homonymous hemianopsia and five patients, homonymous quadrantanopsia. The size and location of intracerebral hematoma correlated well with hemispheric approach : 11, parietooccipital approach : 10, with six preoperative embolization and 1 postoperative gamma knife surgery. Fifteen patients underwent gamma knife surgery with five preoperative embolization. One patient underwent embolization only. The results of treatment were as follows : There were no mortality and morbidity except for visual field defect. We confirmed complete resection or obliteration of malformed vessels in 25 patients and reduction of the nidus size in eight patients. Five patients were not followed. After gamma knife surgery, two patients showed rebleeding during the follow up period. Among 23 patients who had no visual field defect before treatment, three patients showed visual field defect after treatment(one after microsurgical resection using occipital interhemispheric approach, two after preoperative embolization). In 15 patients with visual field defect before treatment, four patients showed improvement in their visual field defect after treatment(three after microsurgical resection using occipital interhemispheric approach, one after gamma knife surgery). The parietooccipital approach did not change the status of visual field in any of the ten parients. In occipital AVM, visual field defect was the most srious morbidity. Ruptured occipital AVM had a higher incidence of hemorrhage causing a visual field defect and had a higher indication of direct surgical approach than AVM of other location. In planning surgery of occipital AVM, one has to count microsurgical anatomy based on the visual pathway as well as clinical findings such as the angioarchitecture, location of intracerebral hematoma, and preopeative visual field.
Arteries ; Arteriovenous Malformations* ; Follow-Up Studies ; Hematoma ; Hemianopsia ; Hemorrhage ; Humans ; Incidence ; Mortality ; Occipital Lobe ; Rupture ; Veins ; Visual Fields* ; Visual Pathways

OBJECTIVE: Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA) aneurysm. We present the best diagnostic tool to determine the approaches. METHODS: We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. RESULTS: Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the 11th cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. CONCLUSION: The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach, craniocervical instability can be avoided.
Aneurysm ; Angiography ; Arteries ; Brain Stem ; Cranial Nerves ; Humans ; Paralysis ; Pica ; Veins ; Vertebral Artery

Vestibular schwannoma (VS) usually present the widening of internal auditory canal (IAC), and these bony changes are typically limited to IAC, not extend to temporal bone. Temporal bone invasion by VS is extremely rare. We report 51-year-old man who revealed temporal bone destruction beyond IAC by unilateral VS. The bony destruction extended anteriorly to the carotid canal and inferiorly to the jugular foramen. On histopathologic examination, the tumor showed typical benign schwannoma and did not show any unusual vascularity or malignant feature. Facial nerve was severely compressed and distorted by tumor, which unevenly eroded temporal bone in surgical field. Vestibular schwannoma with atypical invasion of temporal bone can be successfully treated with combined translabyrinthine and lateral suboccipiral approach without facial nerve dysfunction. Early detection and careful dissection of facial nerve with intraoperative monitoring should be considered during operation due to severe adhesion and distortion of facial nerve by tumor and eroded temporal bone.
Cytochrome P-450 CYP1A1 ; Facial Nerve ; Humans ; Middle Aged ; Monitoring, Intraoperative ; Neurilemmoma ; Neuroma, Acoustic* ; Temporal Bone*