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Surgical Management of Multiple Aneurysms Including Distal Anterior Cerebral Artery Aneurysms.

Jong Moo LEE ; Jae Sung AHN ; Young Il CHUN ; Yang KWON ; Byung Duk KWUN

Korean Journal of Cerebrovascular Disease.2001;3(2):191-195.

OBJECTIVE: The goal of this study is to evaluate the surgical outcome of multiple aneurysms including distal anterior cerebral artery (DACA) aneurysms. MATERIAL AND METHOD: From May 1989 to March 2000, 12 patients with multiple aneurysms including DACA aneurysms, presented with subarachnoid hemorrhage, had been surgically treated. Their medial record and radiological studies were studied retrospectively. Of 12 patients, in 5 patients, all of the aneurysms were clipped through a single craniotomy extended from midline to pterion in one stage, in 5 patients, multiple aneurysms were treated through separate craniotomies in one stage and 2 patients were treated in staged operation. RESULTS: Two patients showed Glasgow Outcome Scale (GOS) 5-4, 2 patients showed GOS 3-2 and 1 patient showed GOS 1 in 5 patients treated through a single craniotomy in one stage, 2 patients showed GOS 5-4 and 3 patients showed GOS 3-2. All patients treated in staged operation showed favorable outcome. CONCLUSION: In surgical management of multiple aneurysms including DACA aneurysms surgery through separate bony windows in two stages seemed to show more favorable outcome.
Aneurysm* ; Anterior Cerebral Artery* ; Craniotomy ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage

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The Operative Treatment of Distal Middle Cerebral Artery Aneurysm Using Viewing Wand Navigator190.

Yun Sok KIM ; Jae Sung AHN ; Sang Ryong JEON ; Jeong Hoon KIM ; Young Shin RA ; Yang KWON ; Byung Duk KWUN

Korean Journal of Cerebrovascular Disease.2001;3(2):188-190.

The authors present use of Viewing wand navigator for localization and clipping of an aneurysm of distal middle cerebral artery. This method significantly decreased the operative time and minimized unnecessary dissection for localization of distally located aneurysms in selected cases.
Aneurysm ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Operative Time

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Takayasus Arteritis with Pregnancy Induced Eclampsia.

Kook Jin AHN ; Seong Tai HAHN ; Dong Won YANG ; Sang Hoon LEE ; Beum Saeng KIM ; Kyu Ho CHOI

Korean Journal of Cerebrovascular Disease.2001;3(2):184-187.

We experienced a case of Takayasus arteritis with eclampsia in a 43-year-old woman. The patient had angiographically definite Takayasus arteritis with the involvement of right common and internal carotid arteries. On MR images performed at clinical manifestations of eclampsia, unilateral involvement of T2 high signal intensities were demonstrated in right cerebral hemisphere. We report this case with a literature review.
Adult ; Carotid Artery, Internal ; Cerebrum ; Eclampsia* ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy* ; Takayasu Arteritis*

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Mirror-Image Intracerebral Hemorrhage in Basal Ganglia: Case Report.

Nok Young LEE ; Jae Min KIM ; Koang Hum BAK ; Choong Hyun KIM ; Suck Jun OH

Korean Journal of Cerebrovascular Disease.2001;3(2):178-183.

Intracerebral hemorrhage in the brain is the most common complication of hypertension, aneurysmal rupture, or vascular malformation. The occurrence of symmetrically bilateral intracerebral hemorrhage is an unusual clinical event that develops in only a small percentage of all patients who have intracerebral hemorrhage. Even though, the size of contralateral hemorrhage is not too large, majority of patients with bilateral intracerebral hemorrhage in basal ganglia or thalamus have generally a poor outcome. In all cases of this report, the contralateral intracerebral hemorrhage was resulted from an inadequate control of hypertension. Therefore, optimal control of blood pressure must be considered as the most important treatment option to prevent recurrence. Authors report the characteristic clinical and radiologic features of four cases in which mirror-image bilateral intracerebral hemorrhage occurred.
Aneurysm ; Basal Ganglia* ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Hemorrhage ; Humans ; Hypertension ; Recurrence ; Rupture ; Thalamus ; Vascular Malformations

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Thrombosed Cerebral Arteriovenous Malformation (AVM): Operative Case Report.

Yu Sik CHAE ; Hyeong Joong YI ; Kwang Myung KIM ; Young Soo KIM ; Yong KO ; Suck Jun OH

Korean Journal of Cerebrovascular Disease.2001;3(2):173-177.

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.
Adult ; Epilepsy ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Male ; Seizures

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Completely Thrombosed Contralateral Internal Carotid Artery Aneurysm Combined with Ruptured Anterior Communicating Artery Aneurysm: Case Report.

Chang Hee KIM ; Jae Min KIM ; Jin Hwan CHEONG ; Koang Hum BAK ; Choong Hyun KIM ; Suck Jun OH

Korean Journal of Cerebrovascular Disease.2001;3(2):169-172.

Giant intracranial aneurysm, approximately 5-7% of all intracranial aneurysm, is defined as aneurysm with a maximal sac diameter reaching or exceeding 25 mm. Its high incidence of thrombus formation causes difficulty in diagnosis through imaging studies. Recently, we have experienced a giant contralateral internal carotid artery aneurysm that was completely thrombosed and negative in imaging studies. It was only verified during surgery for clipping of an anterior communicating artery aneurysm. On initial cerebral angiography, authors had not found any other aneurysm except a small-sized anterior communicating artery aneurysm. There was no evidence of aneurysm or mass on right internal carotid artery even though in postoperative computed tomographic angiography (CTA). We emphasize the fact that another completely thrombosed aneurysm may be present as a hidden lesion during initially planned aneurysmal surgery.
Aneurysm* ; Angiography ; Carotid Artery, Internal* ; Cerebral Angiography ; Diagnosis ; Incidence ; Intracranial Aneurysm* ; Thrombosis

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Acute Expansion of Hematoma in Hypertensive Intracerebral Hemorrhage.

Chang Taek MOON ; Sung Joon LIM ; Seung Hwan YOON ; Joon CHO ; Sang Keun CHANG

Korean Journal of Cerebrovascular Disease.2001;3(2):163-168.

Hypertensive intracerebral hemorrhage is one of the most common cause of death in Korea and usually considered as a monophasic event. But recently acute expansion of the hematoma within an hour to a day, has been reported as a cause of severe neurological deterioration and death. To know the incidence and risk factors of acute expansion of the hematoma in hypertensive intracerebral hemorrhage, the authors retrospectively analysed 96 hypertensive intracerebral hemorrhage patients who were admitted to Minjoong hospital from January 1997 to December 1998. Neurological examination with Glasgow Coma Scale and first computed tomography (CT) scan were performed as soon as possible after arrival. Then second CT scan was performed within an hour to a day before the operation. Blood sample was taken within an hour for routine laboratory examination including liver function and coagulation test. The amount and shape of hematoma on CT scans were carefully measured to know whether acute expansion was occurred or not. The patients who have acute expansion of the hematoma were 15 patients (15.6%). Expansion of the hematoma was not correlated with sex, age, site, shape, or amount of hematoma statistically. But thalamic hematoma in location, irregular shape of hematoma, or large amount of hematoma has a tendency of acute expansion. The time of onset to arrival, initial systolic pressure, liver dysfunction and history of heavy alcohol drinking were correlated with acute expansion statistically (p<0.05). The shorter the time of onset to arrival and the higher initial systolic pressure, the more the incidence of acute expansion of the hematoma significantly. Acute expansion of the hematoma was significantly increased with the severity of liver dysfunction and history of heavy alcohol drinking. The levels of glutamic oxaloacetic transaminase (GOT), alkaline phosphatase, gamma-glutamyl transpeptidase (gamma-GTP) and platelet (PLT) count were meaningful indices of hematoma expansion.
Alcohol Drinking ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Blood Platelets ; Blood Pressure ; Cause of Death ; Cerebral Hemorrhage ; gamma-Glutamyltransferase ; Glasgow Coma Scale ; Hematoma* ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Liver ; Liver Diseases ; Neurologic Examination ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

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A2 Anomaly Associated with Anterior Cerebral Artery Aneurysm.

Ki Seong EOM ; Sung Don KANG

Korean Journal of Cerebrovascular Disease.2001;3(2):159-162.

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*

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Multiple Clipping Technique of Wide-Necked Middle Cerebral Artery Aneurysms.

Moon Young LEE ; Sung Don KANG

Korean Journal of Cerebrovascular Disease.2001;3(2):154-158.

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

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Radiosurgery for Cavernous Malformations.

Young Jin LIM

Korean Journal of Cerebrovascular Disease.2001;3(2):147-153.

Cavernous malformations (CM) are vascular lesions that comprise the majority of vascular malformations with arteriovenous malformations (AVM). Microsurgical resection of CMs is the preferred management for patients with symptomatic lesion. But in group of patients with hemorrhagic cavernous malformations located in critical brain regions that were thought to pose an excessive risk for microsurgical resection. GKRS has been used as an alternative management approach for this lesions since first application by Karolinska institute in 1985. The favorable results of Gamma Knife radiosurgery (GKRS) for AVMs prompted pilot series in which GKRS was used to treat cavernous malformations. Some authors had suggested that GKRS could reduce the annual rate of hemorrhage, especially after 2-4 years latency interval. The problem with evaluating treatment results in cases of CMs is that, unlike in AVMs, that no imaging modality accurately identifies obliteration of the CM after radiosurgery. To evaluate the potential protection against hemorrhage, the incidence of posttreatment hemorrhage must be compared with the natural course of the disease. Another problem associated with radiosurgical treatment of CMs is that the radiation-induced complication rate appears to be greater than expected compared with that associated with radiosurgery of AVMs. So, radiosurgery for cavernous malformations remains controversial until present time. The clinical application of radiosurgery in CMs needs further investigation, in particular, issues of patient selection, methods of follow-up, long-term risks, and safe dose levels must be addressed.
Arteriovenous Malformations ; Brain ; Hemorrhage ; Humans ; Incidence ; Patient Selection ; Radiosurgery* ; Vascular Malformations

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