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Cerebral Aneursyms Associated with the Behcet's Disease.

Tae Yup KIM ; Jae Whan LEE ; Seung Kon HUH ; Kyu Chang LEE

Korean Journal of Cerebrovascular Surgery.2006;8(2):135-137.

We report two cases of ruptured cerebral aneurysms associated with Behcet's disease. One was from right superior cerebellar artery and treated by intra-aneurysmal coil embolization. The other was from the bifurcation of right middle cerebral artery and treated by clipping. Both patients showed good result.
Arteries ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery

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Persistent Primitive Hypoglossal Artery Associated with Cerebral Aneurysm.

Chang Ki HONG ; Sang Hyun SUH ; Jung Yong AHN ; Jin Yang JOO

Korean Journal of Cerebrovascular Surgery.2006;8(2):132-134.

A persistent primitive hypoglossal artery (PPHA) is a rare vascular anomaly, which belongs to the group of carotid-basilar anastomosis that may occur in adults. The association of PPHA with cerebral aneurysms has also rarely reported. A review of the published cases of PPHA with cerebral aneurysms is made including the author's own case of 66 years-old woman with the left internal carotid artery aneurysm, which treated with surgical clipping. Key points concerning the definition, imaging, and clinical series data available for PPHA with cerebral aneurysm are highlighted.
Adult ; Aged ; Aneurysm ; Arteries* ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm* ; Surgical Instruments

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Ruptured Distal Lenticulostriate Artery Aneurysm Associated with Ipsilateral Middle Cerebral Artery Occlusion : Case Report.

In Bo HAN ; Jung Yong AHN ; Young Sun CHUNG

Korean Journal of Cerebrovascular Surgery.2006;8(2):128-131.

A 49-year-old man presented with right basal ganglia hemorrhage due to a ruptured distal lenticulostriate artery aneurysm associated with ipsilateral occlusion of M1 segment of middle cerebral artery with moyamoya-type vessels. Conservative treatment was initially selected. However, the patient suddenly became drowsy with left hemiparesis due to recurrent bleeding 14 days after admission, and excision of the aneurysm was urgently performed via right frontotemporal craniotomy. The follow-up angiography showed successful resolution of the aneurysm. This report describes a rare case of a distal lenticulostriate artery aneurysm associated with ipsilateral middle cerebral artery occlusion with moyamoya-type vessels, which resulted in intracerebral hemorrhage on the right basal ganglia and intraventricular hemorrhage.
Aneurysm* ; Angiography ; Arteries* ; Basal Ganglia ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Craniotomy ; Follow-Up Studies ; Hemorrhage ; Humans ; Infarction, Middle Cerebral Artery* ; Intracranial Aneurysm ; Middle Aged ; Middle Cerebral Artery* ; Paresis

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Transarterial Embolization of Congenital Dural Arteriovenous Shunt at the Torcular Herophili.

Mi Jung LEE ; Jinna KIM ; Sang Hyun SUH ; Young Jun LEE ; Dong Joon KIM ; Dong Ik KIM ; Dae Chul SUH

Korean Journal of Cerebrovascular Surgery.2006;8(2):124-127.

Congenital dural arteriovenous shunt (DAVS) is a rare disease entity. A neonate diagnosed to have cystic mass in posterior fossa during prenatal sonography presented with heart failure and hydrocephalus. Cerebral angiography revealed a DAVS at the torcular herophili. Successful occlusion of feeders was achieved by staged transarterial embolizations, with subsequent improvement of heart failure. Transarterial embolization could be a successful treatment method in pediatric patients with congenital DAVS, in case of limited numbered feeders.
Cerebral Angiography ; Embolization, Therapeutic ; Heart Failure ; Humans ; Hydrocephalus ; Infant, Newborn ; Intracranial Arteriovenous Malformations ; Rare Diseases

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Endovascular Stent Treatment for Traumatic Common Carotid Artery Dissection with Cerebral Infarction : Case Report and Literature Review.

Soon Don PARK ; Yu Sam WON ; Chun Sik CHOI ; Eun Chul CHUNG

Korean Journal of Cerebrovascular Surgery.2006;8(2):119-123.

Accurate determination of the true incidence of blunt carotid artery injury is difficult because the patient may be asymptomatic or the condition may be masked by concomitant injuries. We present a case of blunt injury to the right common carotid artery and dissection with acute infarction on right fronto-temporo-parietal area and treated with carotid stent. We review the blunt carotid artery injury rate of occurrence, mechanism, presentation, screening, radiologic diagnosis, management and outcome.
Carotid Artery Injuries ; Carotid Artery, Common* ; Cerebral Infarction* ; Diagnosis ; Humans ; Incidence ; Infarction ; Masks ; Mass Screening ; Stents* ; Wounds, Nonpenetrating

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Direction of Middle Cerebral Artery Bifurcation Aneurysms and Surgical Approach.

Chang Ki HONG ; Jung Yong AHN ; Jin Yang JOO

Korean Journal of Cerebrovascular Surgery.2006;8(2):114-118.

OBJECTIVE: This study will discuss both analysis and surgical approach for the management of middle cerebral artery bifurcation aneurysms on the basis of the author's experience. METHODS: We reviewed 105 middle cerebral artery bifurcation aneurysms in 94 patients operated from May 1997 to May 2004. The clinical presentations, neurological findings, CT findings, operative approaches and outcome were analyzed. The standard pterional approach was used. The sylvian fissure can be opened in one of three ways; the medial sylvian fissure approach, distal sylvian fissure approach, transcortical approach. We favor a lateral to medial sylvian approach for most aneurysms, because it provides excellent exposure of the aneurysm and minimizes manipulation of the brain and vascular structures. RESULTS: The mean age was 55 years. 72 patients (76.6%) had subarachnoid hemorrhage (SAH), 22 patients (23.4%) had both SAH and intracranial hemorrhage (ICH). Of the 94 patients, 68 patients had single aneurysm and 26 patients had multiple aneurysm. Distal sylvian fissure approach was used in 69 operations and proximal sylvian fissure approach was used in 29 operations. The transcortical approach was used in 9 operations. 85 patients among 94 patients had good outcome after surgery. 2 patients remained disabled, and 4 patients died. CONCLUSION: We suggest that distal sylvian fissure approach can be used as routine method of operation for the management of middle cerebral artery aneurysms unless patients have either multiple aneurysms or ICH.
Aneurysm* ; Brain ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Middle Cerebral Artery* ; Subarachnoid Hemorrhage

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The Management and Characteristics of Posterior Cerebral Artery Aneurysms.

Dong Wan KANG ; Byung Kwan CHOI ; Chang Hwa CHOI

Korean Journal of Cerebrovascular Surgery.2006;8(2):107-113.

Posterior cerebral artery (PCA) aneurysm is a rare disease, and has some distinctive features compared with aneurysms located elsewhere. This study is to investigate results of the management and characteristics of posterior cerebral artery aneurysm. Between 1996 and 2005, we treated 8 patients (4 male, 4 female) via endovascular or surgical approach. Six patients underwent endovascular treatment and two were treated with open surgery. The Glasgow Outcome Scale (GOS) was used for estimating the results. Five patients had ruptured PCA aneurysms and three had unruptured aneurysms. The locations were one case of P1 branch, two cases of P1-P2 junction, four cases of P2-P3 junction and one case of distal P4 branch. Among 8 patients, five had good recovery, two had a moderate disability and another one was expired due to rebleeding. Optimal treatment of PCA aneurysms is able to perform via surgical or endovascular approach. Endovascular treatment is effective and an alternative method for PCA aneurysm because of the difficulty and several complications of surgical approach.
Aneurysm ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Male ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Rare Diseases

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Difference in Induction Rate of Experimental Cerebral Aneurysm According to High Salt, High Lipid and Normal Diet.

Hwan Young CHOI ; Jin Seok YI ; Hyung Jin LEE ; Ji Ho YANG ; Il Woo LEE

Korean Journal of Cerebrovascular Surgery.2006;8(2):102-106.

OBJECTIVE: An intracranial aneurysm is an important acquired cerebrovascular disease that can cause a catastrophic subarachnoid hemorrhage. Atherosclerosis is one of possible mechanism, but its contribution to aneurysm formation is unclear. Experimentally induced cerebral aneurysm rate by high lipid diet was evaluated and compared with high salt and normal diet to elucidate the role of lipid metabolism in the process of cerebral aneurysm formation. METHODS: Thirty-seven 7-week-old male Sprague-Dawley (SD) rats received a cerebral aneurysm induction procedure. The control animals (n=11) were fed a normal diet, and the experimental animals were fed a diet containing 8% salt (n=15) and high lipid (n=11) for three months. Three months after the operation, the rats were killed, their cerebral arteries were dissected, and the regions of the bifurcation of the right anterior cerebral artery-olfactory artery (ACA-OA) bifurcations were examined histologically and aneurysm induction rates among three groups were analysed. RESULTS: Average systolic blood pressures after 3 months feeding in three groups (high salt diet group, high lipid diet group and normal diet group) were 175.9+/-3.4 mmHg, 133.7+/-5.1 mmHg and 128+/-2.9 mmHg, respectively. The difference between high lipid group and normal diet group was not significant (P=0.215). The aneurysm induction rate in three group were 87%, 63% and 36%. The difference between high lipid diet group and normal diet group was significant (Pearson k2, P=0.029). CONCLUSIONS: High lipid diet significantly increase the cerebral aneurysm induction rate in experimentally induced cerebral aneurysm model of rats. That suggests a possible adverse role for hyperlipidemia leading to aneurysm formation. Further studies are necessary to elucidate the exact role of hyperlipidemia in the pathophysiology of cerebral aneurysm.
Aneurysm ; Animals ; Arteries ; Atherosclerosis ; Cerebral Arteries ; Diet* ; Humans ; Hyperlipidemias ; Intracranial Aneurysm* ; Lipid Metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Subarachnoid Hemorrhage

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Dissecting Aneurysms on Vertebral Artery and its Branches.

Eui Kyo SEO ; Pyung JUN ; Yong Jae CHO ; Sang Jin KIM

Korean Journal of Cerebrovascular Surgery.2006;8(2):96-101.

BACKGROUND: Dissecting aneurysms of the vertebral artery are rare. Diagnosis and treatment of such condition aneurysm has a potentially higher degree of technical difficulty. The authors analyzed the clinical features and treatment modality for dissecting aneurysms arising from vertebral artery and its branches. METHODS: At the authors'institution between April. 2001 and Sep. 2004, 18 patients were diagnosed and treated for dissecting aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: 18 patients were comprised of 8 female and 10 male patients aged from 24~69 year old (mean: 44.2). Of the 18 patients, 8 patients (44.4%) had subarachnoid hemorrhage. 6 patients with subarachnoid hemorrahge were in good neurological status before treatment. Four patients were treated with transcranial surgery and 7 patients with endovascular treatment. the other 7 patient were merely treated with conservative care. All patients were diagnosed with digital subtraction angiography (DSA), but Magnetic resonance angiography (MRA) showed 12 dissecting aneurysms, 2 suspicious cases and 3 normal finding. In the case of anterior inferior cerebellar artery (AICA) dissecting aneurysm, MR angiography showed no visible AICA. Posterior inferior cerebellar artery (PICA) was occluded in postoperative DSA after wrapping of PICA for dissecting aneurysm of proximal protion of AICA. But the patient show no neurologic deficit. One patient developed bilateral vertebral artery dissecting aneurysms. One patient treated only conservative care revealed normal DSA finding on follow-up study. CONCLUSION: DSA is the only accurate diagnostic tool for vertebral dissecting aneurysm. Proximal GDC occlusion of vertebral artery may be a safe and effective therapy for patients with vertebral artery dissecting aneurysm. For proper decision of safe treatment modality, one should consider vertebral artery dominancy, collateral circulation, PICA invasion.
Aneurysm ; Aneurysm, Dissecting* ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Collateral Circulation ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Male ; Medical Records ; Neuroimaging ; Neurologic Manifestations ; Pica ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vertebral Artery*

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Internal Carotid Artery Trunk Aneurysms - Management and Outcome.

Chang Ki HONG ; Jung Yong AHN ; Jin Yang JOO

Korean Journal of Cerebrovascular Surgery.2006;8(2):91-95.

OBJECTIVE: Internal carotid artery (ICA) trunk aneurysms are rare constituting about 0.9 to 6.5% of all ICA aneurysms. They may arise from medial, lateral, ventral (posterior) or dorsal (anterior) walls of ICA. The most frequent site of origin is dorsomedial, followed by dorsal, dorsolateral and ventromedial wall. ICA dorsal wall aneurysms can be divided into the saccular type and blister type, which have different shapes, wall histological features and surgical tactics. The authors report an analysis of 27 cases of ICA trunk aneurysms treated with surgical clipping or GDC embolization. METHODS: Of 145 cases of ICA aneurysms from May 1998 to December 2005, we found 27 cases (17.5%) of such unusual aneurysms located at nonbranching sites of the intradural ICA. Features of neuroimagings and medical records were analyzed. RESULTS: Out of 27 aneurysms, 10 were located at ICA dorsal wall, 8 aneurysms were developed at ICA medialwall. Seven aneurysms originated from ICA ventral wall. Seven cases presented with subarachnoid hemorrhage and 20 cases were found unruptured. Two patients had blister-like aneurysm, and the others had saccular aneurysms. All patients were treated successfully with microsurgical clippings or GDC embolization. Microsurgical clipping were performed in 14 cases and among them, removal of anterior clinoid process was done in 12 cases. Eleven aneurysms were occluded with detachabel coil. Two patients underwent balloon occlusion of ICA. Blister aneurysm was clipped including a portion of the normal ICA wall. Good outcomes were obtained in 25 patients, and two patients were dead. CONCLUSION: ICA trunk aneurysms are developed at any site of ICA circumference. Therefore we consider a variety of treatment strategies. On clipping of aneurysms at proximal ICA trunk, removal of anterior clinoid process is important. Endovascular treatment may be good an alternative. However, surgical treatment is essential for blister like aneurysms.
Aneurysm* ; Balloon Occlusion ; Blister ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Medical Records ; Subarachnoid Hemorrhage ; Surgical Instruments

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