No abstract available.
Diagnosis* ; Ischemia* ; Subarachnoid Hemorrhage*

No abstract available.
Latex* ; Polystyrenes* ; Potassium Channels* ; Potassium* ; Vasospasm, Intracranial*

No abstract available.
Bacteremia* ; Staphylococcus aureus* ; Staphylococcus*

The authors recently reported that over the years, the outcome of aneurysm surgery improved, and that surgical complications importantly affected this change. The present study was conducted to determine whether the incidence of symptomatic vasospasm in fact changed during the period under review, and the factors contributing to any changes. Between 1990 and 1995, 219 Hunt-Hess grade I to III patients with ruptured intracranial aneurysm underwent surgery within 3 days of subarachnoid hemorrhage ; all operations were performed by the same surgeon. Age, Hunt-Hess grade on admission, Fisher grade, hypertension, and hydrocephalus were analyzed to determine which factors were significant for syptomatic vasospasm, and for the periods 1990 to 1993, and 1994 to 1995, the distribution of each significant factor was then examined. Syptomatic vasospasm decreased significantly (p<0.05), but was seen in 28 of 124 patients(22.6%) treated beween 1990 and 1993 and 11 of 95(11.6%) treated between 1994 and 1995 ; no significant reduction of syptomatic vasospasm as a cause of mortality and morbidity (irreversible vasospasm) was seen, however, Fisher grade(p<0.05) and Hunt-Hess grade(p<0.05) significantly contributed to the development of symptomatic vasospasm, though the distribution of these two biologically significant factors was not statistically different. The question of whether or not surgery aggravates symptomatic vasospasm is controversial, and symptomatic vasospasm is, in addition, still an ill-defined disease entity. Except for the occurrence of fewer surgical complication and the fact that the incidence of reversible symptomatic vasospasm was less during the second period of treatment, no differences were found in the distribution of factors which significantly influenced symptomatic vasospasm, and this suggests that surgery affects the development of reversible symptomatic vasospasm. On the basis of increased risk of cerebral ischemia associated with surgery in vulnerable ischemic brain resulting from subarachnoid hemorrhage, the use of the term 'delayed ischemic neurologic deficit' after such hemorrhage appears to be more suitable than 'symptomatic vasospasm'.
Aneurysm* ; Brain ; Brain Ischemia ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm ; Mortality ; Neurologic Manifestations* ; Subarachnoid Hemorrhage

A case of isolated dissecting aneurysm of the posterior cerebral artery responsible for ischemic episode and subarachnoid hemorrhage is reported. Angiogram showed a fusiform dilatation of the P1-P2 segment of the right posterior cerebral artery. The dissecting aneurysm was disappeared spontaneously on follow-up angiogram. It is recommended that, in a subset of neurologically stable patient who represents fusiform dilatation angiographically, angiographic monitoring should be undertaken to assess the tendency for spontaneous resolution before planning of surgical intervention.
Aneurysm, Dissecting* ; Dilatation ; Follow-Up Studies ; Humans ; Posterior Cerebral Artery* ; Subarachnoid Hemorrhage

It became possible for a beginner of aneurysm surgery to shorten the stabilization period of surgical technique recently with several advances in the management of subarachnoid hemorrhage, such as early surgery, aggressive critical care, anesthetic technique, calcium channel blockers, and hypervolemia. The present study was conducted to determine whether surgical outcome actually changed over the years and what factors contributed to these changes. 219 good grade(Hunt-Hess grade I to III) patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 190 to 995 were selected to reduce selection bias. All possible clinical and radiological factors for surgical outcome were analyzed to find significant factors, and then distributions of each significant factors were examined between 2 treatment periods(1990 to 1993 vs 1994 to 1995). Surgical outcome began to improve significantly since 1994(1990-93 vs 1994-95, p<0.005):75.0%(12/16) in 1990, 80.8%(21/26) in 1991, 77.4%(24/31) in 1992, 78.4%(40/51) in 1993, 87.8%(36/41) in 1994, 96.3%(52/54) in 1995 experienced good outcome. The decrease of postoperative surgical complications was the only factor influencing an increase of good outcome between 2 treatment periods. The distribution and characteristics of other possible biological significant factors for outcome were not different statistically. Improvement of surgery outcome by a vascular neurosurgeon depends on the number of experienced cases, and case qualities such as distributions of aneurysm size, location, and clinical grade etc. These results suggest that surgical technique importantly affects the change of surgical outcome, and consequently, considering usual level of surgical technique, more careful approach with assistance of an experienced vascular neurosurgeon than surgery by oneself will be necessary for first 4 to 5 years of aneurysm surgery.
Aneurysm* ; Calcium Channel Blockers ; Critical Care ; Humans ; Intracranial Aneurysm ; Postoperative Complications ; Selection Bias ; Subarachnoid Hemorrhage

Seven cases of A2 anomaly including azygous A2 and accessory A2 were observed during aneurysm surgery. We present case histories, angiograms and operative descriptions, and discuss with the clinical significance of the anomaly. The recognition of the anatomic variations prior to clip placement for anterior cerebral artery aneurysm is emphasized.
Aneurysm ; Anterior Cerebral Artery* ; Intracranial Aneurysm*

OBJECTIVE: Although currently only a few middle cerebral artery aneurysms (MCAAs) are inoperable, they still present problems as compared with other aneurysm in the anterior circulaton. MCAAs are less suitable for endovascular surgery, owing to anatomic reasons and frequent association with expanding hematomas, neurosurgeons should focus on the safe treatment of these lesions. Several methods are recently available for the clipping of wide-necked MCAAs. The author emphasizes the techique of multiple clipping in the present study. METHODS: This article contains 5 patients with wide-necked MCAAs who underwent multiple clipping technique with facing and/or tandem fashion, in which the tips of the clip blades are placed in opposite or parallel directions, respectively. RESULTS: Aneurysms were successfully clipped with preservation of the parent vessels. There were four good results and one death directly related to the initial brain injury. CONCLUSION: On the basis of the configurations of domes and their neck, wide-necked MCAAs can be clipped successfully using this multiple clipping technique with facing and tandem fashion.
Aneurysm ; Brain Injuries ; Hematoma ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Neck ; Parents

Options for extracranial-intracranial bypass surgery of anterior circulation include saphenous vein grafts, occipital to middle cerebral artery (MCA) anastomosis, and most commonly superficial temporal artery (STA) to MCA anastomosis. Although less common, posterior circulation revascularization has been successfully peformed. The operative techniques and perioperative management such as anesthetic techniques and electrophysiologic monitoring are reviewed. Finally the author's surgical experiences of STA-MCA anastomosis in 30 patients with symptomatic internal carotid artery or MCA stenoocclusion are reported.
Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Saphenous Vein ; Temporal Arteries ; Transplants

Three dimensional computed tomographic angiography is a rapid and minimally invasive method of detecting intracranial aneurysms, however, there are some limitation to identify the associated cerebrovascular lesions. We report a case of ruptured dorsal wall aneurysm of internal carotid artery in a 50-year-old man who had underlying stenosis of cervical internal carotid artery, which was overlooked due to lesion outside the scan field of view.
Aneurysm ; Angiography* ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Intracranial Aneurysm* ; Middle Aged