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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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Endovascular Treatment of Giant Basilar Trunk Aneurysm: Case Report.

Kyu Sung OH ; Jung Yong AHN

Korean Journal of Cerebrovascular Disease.2001;3(1):83-87.

Treatment of giant aneurysms of the basilar artery remains difficult and controversial. Especially, surgical treatment of the basilar trunk aneurysm have a potential morbidity or mortality due to its anatomical environment and the complicated surgical exposure. A 32-year-old female presented with an unruptured, giant basilar trunk aneurysm manifesting as brainstem compression signs and cranial nerve dysfunction. Cerebral angiography disclosed a giant aneurysm with a wide neck and an intra-aneurysmal thrombus arising from the mid-basilar artery. Aneurysm was embolized with Guglielmi detachable coils; and complete occlusion of the aneurysm was obtained.
Adult ; Aneurysm* ; Arteries ; Basilar Artery ; Brain Stem ; Cerebral Angiography ; Cranial Nerves ; Female ; Humans ; Mortality ; Neck ; Thrombosis

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A Case of Aplastic Anemia Associated with Ticlopidine.

Jee Youn LEE ; Hae Eun SHIN ; Joong Seok KIM ; Kang Soo LEE

Korean Journal of Cerebrovascular Disease.2001;3(1):81-82.

Aplastic anemia is a rare side-effect associated with ticlopidine therapy. We report one case of severe aplastic anemia developed after the use of ticlopidine. A 72-year-old woman took ticlopidine at 500 mg/day to prevent a secondary stroke. Forty days after starting ticlopidine, she developed general weakness and nausea. She showed pancytopenia and was diagnosed as aplastic anemia, confirmed by bone marrow examination. Twelve days after the withdrwal of ticlopidine, the hematologic parameters improved. Physicians are reminded that complete blood cell counts and white blood cell count differentials should be monitored every 2 weeks in ticlopidine users during the first 3 months of treatment.
Aged ; Anemia, Aplastic* ; Blood Cell Count ; Bone Marrow Examination ; Female ; Humans ; Leukocyte Count ; Nausea ; Pancytopenia ; Stroke ; Ticlopidine*

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A Case of Right Middle Cerebral Artery Infarction with Quadriparesis.

Jee Youn LEE ; Si Ryung HAN ; Yeong In KIM

Korean Journal of Cerebrovascular Disease.2001;3(1):78-80.

Diaschisis is classically defined as a sudden inhibition of function, produced by an acute focal disturbance in a remote area which is anatomically connected through fiber tracts. Transhemispheric diaschisis can underlie some diffuse symptoms of acute supratentorial stroke such as agitation, confusion, and coma. We experienced a patient with right middle cerebral artery infarction, presenting a quadriparesis and hypoesthesia at sensory level. This case suggests the diaschisis exacerbate the initial focal deficit such as weakness and sensory loss.
Coma ; Dihydroergotamine ; Humans ; Hypesthesia ; Infarction, Middle Cerebral Artery* ; Quadriplegia* ; Stroke

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Spontaneous Dissecting Aneurysm of the Anterior Cerebral Artery: Report of 2 Cases.

Jae Whan LEE ; Kyu Chang LEE

Korean Journal of Cerebrovascular Disease.2001;3(1):73-77.

The spontaneous dissecting aneurysm of the anterior cerebral artery is very rare and shows difference in nature and clinical presentation. The authors present 2 cases of spontaneous dissecting aneurysms localized to the anterior cerebral artery. Both patients experienced severe headache and ischemic symptoms. The lesions were repaired successfully with wrapping and clipping.
Aneurysm, Dissecting* ; Anterior Cerebral Artery* ; Cerebral Angiography ; Cerebral Infarction ; Headache ; Humans

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Kissing Aneurysms of Distal Anterior Cerebral Arteries: A Case Report.

Seong Jun MOON ; Tae Sun KIM ; Je Hyuk LEE ; In Young KIM ; Jung Kil LEE ; Shin JUNG ; Jae Hyoo KIM ; Soo Han KIM ; Sam Suk KANG

Korean Journal of Cerebrovascular Disease.2001;3(1):70-72.

Kissing aneurysms are very rare with only a few cases having been previously reported in the literature. We report a case of aneurysms arising from bilateral distal anterior cerebral arteries. A 56-year-old man was admitted to our hospital with subarachnoid hemorrhage. CT angiogrms and cerebral angiograms showed mirror image aneurysms touching each other were located at bilateral distal anterior cerebral arteries. During operation we confirmed the aneurysms were in contact.
Aneurysm* ; Anterior Cerebral Artery* ; Humans ; Middle Aged ; Subarachnoid Hemorrhage

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An Analysis of Factors Related to Rebleeding in Patients with Aneurysmal Subarachnoid Hemorrhage.

Chang Young LEE ; Man Bin YIM ; In Yeup SUH ; Ill Man KIM ; Eun Ik SON ; Dong Won KIM

Korean Journal of Cerebrovascular Disease.2001;3(1):63-69.

OBJECTS: To assess risk factors related to the occurrence of rebleeding in patients with aneurysmal subarachnoid hemorrhage (SAH) who had been planned to the early surgery, this study was conducted retrospectively. MATERIAL AND METHODS: During the period from January, 1993 to December, 1995, 258 patients with aneurysmal SAH who admitted within 3 days of their SAH and had been planned to early surgery were selected as study population. Ten variables including age, sex, hypertension history, rebleeding before admission, systolic blood pressure on admission, intracerebral or intraventricular hematoma, clinical grade, computed tomographic (CT) grade, admission time after SAH, hemostatic parameter were analyzed by the univariate and multivariate logistic regression method using the Statistical Analysis System (SAS). RESULTS: Of the 258 patients, 25 (9.69%) patients had rebleeding. Admission within 2 hours after SAH (p=0.001), clinical grade IV-V (p=0.015), rebleeding before admission (p=0.000), and intracerebral or intraventricular hematoma (p=0.04) appeared to be associated with a higher risk of rebleeding on the univariate analysis. Particularly, the patients who admitted to hospital within 2 hours after SAH and who are clinical grade IV or V appeared to be more likely to have early rebleeding. Rebleeding before admission was revealed as a independent factor associated with rebleeding on the multivariate logistic regression analysis. CONCLUSION: The short course use of antifibrinolytics, 3-dimensional CT angiography and endovascular surgery should be considered for the patients with aneurysmal SAH who have rebleeding history before admission, intracerebral or intraventricular hematoma, who admit to hospital within 2 hours after SAH, and who are clinical IV or V to minimize rebleeding in the interval between SAH attack and early surgery.
Aneurysm* ; Angiography ; Antifibrinolytic Agents ; Blood Pressure ; Hematoma ; Humans ; Hypertension ; Intracranial Aneurysm ; Logistic Models ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage*

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Manangement Outcome of 372 Patients with Unruptured Intracranial Aneurysms.

Jae Whan LEE ; Seung Kon HUH ; Dong Ik KIM ; Kyu Chang LEE

Korean Journal of Cerebrovascular Disease.2001;3(1):58-62.

OBJECTIVE: The purpose of this study was to provide management strategy and to improve management outcome of patients with unruptured intracranial aneurysms (UIA). PATIENTS AND METHODS: The authors reviewed the database as sources for identifying and analyzing patients, and analyzed the management outcome of patients with UIA. From June 1979 to June 1999, among total of 1,801 patients treated for intracranial aneurysms, 372 patients with 437 unruptured aneurysms were treated by surgery (335 patients) or neurointervention (37 patients). One hundred and forty - three patients with 158 UIA had no history of SAH from a different aneurysm (group 1), and 229 patients with 279 UIA had a ruptured aneurysm that have been repaired simultaneously or before treatment of UIA (group 2). We reviewed the rate of favorable (good, fair) and unfavorable (poor or dead) outcome one year after the treatment. RESULTS: The rate of favorable and unfavorable outcome in group 1 was 96.5% and 3.5% respectively. In Group 2, the rate was 93.5% and 6.5%. However, the most of the unfavorable outcome in group 2 came from treatment of the ruptured aneurysm, or SAH. The only significant factor contributed to unfavorable outcome in group 1 was size of UIA. Those of group 2 were age, Fisher grade, Hunt - Hess grade, and aneurysm number. Complications attributable to surgical or endovascular treatment of UIA that occurred in 38 of 372 patients (10.2%) were cerebral infarction (17), intracerebral hemorrhage (10), epidural hematoma (4), cranial nerve injury (3), infection (2), venous infarction (1), and subarachnoid hemorrhage (1). CONCLUSION: Rupture of an intracranial aneurysm is a devastating event. The safe size below which rupture is unlikely is unclear. There appears to be increased risk from unruptured aneurysms discovered in SAH patients. All unruptured aneurysms in healthy patients as well as in patients with history of SAH should be repaired.
Aneurysm ; Aneurysm, Ruptured ; Cerebral Hemorrhage ; Cerebral Infarction ; Cranial Nerve Injuries ; Hematoma ; Humans ; Infarction ; Intracranial Aneurysm* ; Rupture ; Subarachnoid Hemorrhage

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Complications after Radiosurgery of the Cerebral Arteriovenous Malformation.

Young II CHUN ; Yang KWON

Korean Journal of Cerebrovascular Disease.2001;3(1):54-57.

Stereotactic radiosurgery is an effective and widely used surgical procedure for the management of cerebral vascular malformations. Long-term analysis of results has led to an evolution in technique and patient selection, a better understanding of the safe and effective dose reponse, and of the risks to surrounding normal tissue. Radiosurgery is a minimally invasive technique but is not risk-free. Successful AVM obliteration depends on proper stereotactic nidus definition and delivery of an adequate radiosurgery dose.
Arteriovenous Malformations ; Intracranial Arteriovenous Malformations* ; Patient Selection ; Radiosurgery* ; Vascular Malformations

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