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True Posterior Communicating Artery Aneurysm.

Seong Min CHO ; Sung Min CHO ; Yong Jun CHO ; Seung Koan HONG

Korean Journal of Cerebrovascular Surgery.2003;5(1):71-73.

A case with a true posterior communicating artery aneurysm is reported, who had been managed by early surgical neck clipping and post-operative intensive cares for numerous complications. The small saccular aneurysm was located at the proximal posterior communicating artery and directed superiorly. A lacunar infarct developed at right anterior thalamus post-operatively, which had resulted probably from the occlusion of a fine posterior communicating arterial perforator. Aneurysms of the posterior communicating artery itself are saccular or fusiform. Great cares should be taken in surgical aneurysmal neck clipping to avoid any injury of the perforators and the oculomotor nerve;trapping of the posterior communicating artery to treat fusiform or wide-necked aneurysms will result in unpredictable outcomes.
Aneurysm ; Arteries ; Intracranial Aneurysm* ; Neck ; Stroke, Lacunar ; Thalamus

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Spontaneous Resolution of Dissecting Aneurysm of the Vertebral Artery.

Suk Hyung KANG ; Jong Sik SUK ; Byung Kook MIN ; Jeong Taik KWON ; Sang Jun YEO

Korean Journal of Cerebrovascular Surgery.2003;5(1):67-70.

Although dissecting aneurysm of vertebral artery were once thought to be extremely rare, they are now recognized with increasing frequency by dint of aggressive work-up using sophisticated imaging techniques. Vertebral dissection most commonly result from cervical hyperextension and lateral cervical rotation. Our two cases followed suit respectively and presented with ischemic symptoms. The vertebral angiogram demonstrated a pseudoaneurysm at the site of dissection in both cases. Presence or absence of SAH, size of dissection and incorporation of the PICA into dissection greatly have influence upon the outcome after treatment. The authors report two cases of dissecting aneurysm of vertebral artery, in which complete resolution of the pseudoaneurysm was spontaneously achieved following conservative management.
Aneurysm, Dissecting* ; Aneurysm, False ; Pica ; Vertebral Artery*

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Clinical Characteristics and Surgical Treatment of Patients with Distal Middle Cerebral Artery Aneurysms.

Seong Jun LEE ; Yoo Shik SHIM ; Keun Young PARK ; Chang Ki HONG ; Jae Whan LEE ; Jung Yong AHN

Korean Journal of Cerebrovascular Surgery.2008;10(3):508-512.

OBJECTIVE: Middle cerebral artery (MCA) aneurysm is a common source of aneurysmal subarachnoid hemorrhage, but distal MCA aneurysms are rare. This present study was conducted to evaluate the clinical characteristics of the distal MCA aneurysms and the optimal treatment for a good outcome. METHODS: Among 3323 patients underwent aneurysmal surgery from 1975 to 2007, 21 patients with distal MCA aneurysm was identified. The clinical, radiological and operative records of 21 patients with distal MCA aneurysms who underwent surgical management were reviewed retrospectively. The clinical outcomes were evaluated according to the Glasgow Outcome Scale. RESULTS: The clinical analyses of 21 patients with distal MCA aneurysms has following characteristics. (1) Mean aneurysm size of 5.3mm (range 2~8mm). (2) All lesions were considered to be saccular except one case. (3) The location being M2 in one patient, M2-3 junction in 12, M3 in 3, and M4 in 5 patients. (4) In 7 of 21 patients, initial CT scan revealed intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). (5) All patients underwent surgical treatment for aneurysm; the procedures were clipping in 17 patients, trapping in 2 patients, trapping and end-to-end anastomosis in 1 patient, and direct vessel suture in 1 patient. (6) All patients without ICH had a good recovery. However, the patient with ICH had a different prognosis. Of the 7 patients with ICH, 4 patients had a good recovery and 2 patients had a moderate disability. 1 patient died due to severe brain swelling. CONCLUSION: The patients with distal MCA aneurysm were relatively young, and there was no female predominance. The aneurysms have high rates of cardiac problems such as infective endocarditis or mitral valve prolapse, attributing to be developed infectious aneurysm. Ruptured distal MCA aneurysms are rare and can cause life-threatening ICH with SAH. However, the appropriate surgical treatments can obtain a favorable outcome.
Aneurysm ; Brain Edema ; Cerebral Hemorrhage ; Endocarditis ; Female ; Glycosaminoglycans ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mitral Valve Prolapse ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage ; Sutures

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Clinical Comparison between Simple Craniectomy and Lesionectomy in the Patients with Acute Cerebral Infarction.

Sung Hoon PARK ; Joon Soo KIM ; Jae Il LEE ; Young Zoon KIM ; Yong Woon CHO ; Kyu Hong KIM

Korean Journal of Cerebrovascular Surgery.2008;10(3):502-507.

OBJECTIVE: Life-threatening middle cerebral artery infarction may be accompanied by severe post-ischemic brain swelling due to cytotoxic vasogenic edema. The resultant progressive mass effect may prove fatal, owing to increased intracranial pressure and herniation. Recent studies have shown that early decompressive craniectomy decreases mortality, but no comparison has been performed between the outcomes achieved with simple craniectomy and those achieved with craniectomy combined with lesionectomy. This study was performed to compare the outcomes achieved after simple craniectomy and after craniectomy combined with lesionectomy. MATERIALS AND METHODS: We prospectively reviewed the records of 59 patients who presented with acute middle cerebral infarction between January 2001 and October 2007. Thirty-one patients (Group A) underwent simple decompressive craniectomy, and 28 patients (Group B) underwent lesionectomy with craniectomy. In all patients, lesion volume and mid-line shift were measured radiologically. Outcomes were quantified using the Glasgow Outcome Scale. RESULT: Patient factors (age, sex), Glasgow Coma Scale, radiologic findings, and lobe involvement were the same for the two groups. However, the outcomes for the two groups were different. At 6 months after surgery, the mean Glasgow Outcome Scale for Group A was 2.71 and that for Group B was 3.39 (p<0.05). CONCLUSION: Surgical treatment, especially decompressive craniectomy combined with lesionectomy, was beneficial in the setting of malignant cerebral infarction.
Brain Edema ; Cerebral Infarction ; Decompressive Craniectomy ; Edema ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction, Middle Cerebral Artery ; Intracranial Pressure ; Prospective Studies

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Therapeutic results of intracrainal dural arteriovenous fistula.

Yong Sik BAE ; Keun Young PARK ; Jae Whan LEE ; Dong Jun KIM ; Dong Ik KIM ; Seung Kon HUH

Korean Journal of Cerebrovascular Surgery.2008;10(3):496-501.

OBJECTIVES: This report was designed to study the prognostic factors that affect the therapeutic results of dural arteriovenous fistula (DAVF). METHODS: We retrospectively reviewed 97 patients who were treated for DAVF at our institute from January, 2000 to August, 2008. The DAVFs were usually located in four sites (cavernous sinus, transverse-sigmoid sinus, superior sagittal sinus and others). The diagnosis and the results of treatment were obtained by performing cerebral angiography. RESULTS: The most common location of DAVF was the cavernous sinus (59.4%) and the next most common location was the transverse-sigmoid sinus (30.2%). Borden classification type II (72.2%) was most common and the next most common was type I (18.6%). Cortical venous reflux was abundant in the transverse-sigmoid sinus DAVFs and superior sagittal sinus DAVFs. Complete obliteration was achieved in 52 cases (55.3%) of all the 94 treated cases and incomplete obliteration was achieved in 42 cases (44.7%). Complete obliteration of the DAVF was achieved for 66.7% of the cavernous sinus lesions and in 41.4% of the transverse-sigmoid sinus lesions. Repeated treatments due to partial obliteration or recanalization were done in 18 cases. CONCLUSION: Transverse-sigmoid sinus lesion and cortical venous reflux in a DAVF are closely related to the aggressive clinical features. Active treatment should be considered to treat these lesions. (ED note: some of this abstract was not clear and you need to check the revised abstract.)
Cavernous Sinus ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Humans ; Retrospective Studies ; Superior Sagittal Sinus

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Useful parameters utilizing perfusion CT study to evaluate the hemodynamic status in chronic ischemic stroke patients.

Byung Suck BAIK ; Kwang Wook JO ; Hoon KIM ; Young Woo KIM ; Ik Seong PARK ; Min Woo BAIK

Korean Journal of Cerebrovascular Surgery.2008;10(3):490-495.

OBJECTIVE: Perfusion-computed tomography (CT) is useful and quick diagnostic tool for evaluating ischemic stroke patients. We evaluated three measurement maps, cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) for their usefulness in deciding on revascularization surgery using CT parameters after single photon emission computed tomography (SPECT) findings in chronic steno-occlusive disease patients. METHODS: We retrospectively investigated 47 patients with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) steno-occlusive disease . All patients underwent digital subtraction angiography (DSA) as well as an acetazolamide challenge with SPECT and perfusion CT. Patients who showed decreased reserve capacity with a Diamox challenge were classified in the positive group, whereas patients who had no difference in reserve capacity were placed in the negative group. RESULTS: Thirty-one patients were positive and the remaining 16 were negative. Differences in rCBV and rCBF parameters between normal cerebral hemispheres and cerebral hemispheres with steno-occlusive disease did not correlate with SPECT results, but TTP values did. SPECT results seemed relevant when TTP differences between hemispheres with normal and steno-occlusive disease were more than 1.55 times. CONCLUSION: Perfusion CT is a useful tool for the rapid, adequate diagnosis of large territorial infarcts, and the TTP map of perfusion CT is a sensitive and reliable parameter to show the status of collateral circulation in chronic cerebrovascular ischemic disease.
Acetazolamide ; Angiography, Digital Subtraction ; Blood Volume ; Carotid Artery, Internal ; Cerebrum ; Collateral Circulation ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Perfusion ; Retrospective Studies ; Stroke ; Thymine Nucleotides ; Tomography, Emission-Computed, Single-Photon

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Successful Endovascular Treatment of Ruptured Superior Cerebellar Artery Aneurysm Associated with Moyamoya Disease : A Case Report and Review of the Literature.

Hyun Woong PARK ; Sung Pil JOO ; Tae Sun KIM ; Bo Ra SEO

Korean Journal of Cerebrovascular Surgery.2008;10(3):485-489.

We present a patient with moyamoya disease and a ruptured superior cerebellar artery aneurysm that was managed by endovascular embolization. A 53-year-old man with sudden onset severe headache and altered mental status was referred to our hospital. Computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography showed evidence of moyamoya disease and a 7 mm saccular aneurysm at the origin of the right superior cerebellar artery. Endovascular coil embolization was performed successfully without posterior cerebral artery and superior cerebellar artery obliteration. Endovascular treatment with microcoils appear particularly safe for moyamoya patients with cerebral saccular aneurysms.
Aneurysm ; Arteries ; Cerebral Angiography ; Headache ; Humans ; Middle Aged ; Moyamoya Disease ; Polyenes ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

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Practical role of TCD and 3D-CTA in planning the angioplasty for the treatment of DIND after aneurismal subarachnoid hemorrhage.

Hong Jun JEON ; Byung Moon CHO ; Jeong Han KANG ; Moon Kyu KIM ; Dae Young YOON ; Se Hyuck PARK ; Sae Moon OH

Korean Journal of Cerebrovascular Surgery.2008;10(3):477-484.

OBJECTIVE: We evaluated the relationship between transcranial Doppler sonography (TCD) and three-dimensional computerized tomography angiography (3D-CTA) under delayed ischemic neurologic deficit (DIND) with angioplasty following vasospasm. MATERIALS & METHODS: Twenty consecutive patients with DIND following vasospasm who received sequential TCD and CTA were analyzed. On TCD, vasospasm was defined as anterior circulation peak mean velocity>120 cm/s, daily increases of 50cm/s, and a Lindegaard ratio (LR)degrees root 3. On 3D-CTA data were subdivided into local and combined types according to the position where vasospasm occurred, and into mild, moderate, and severe by the blood vessel diameter. RESULTS: Among the 20 consecutive patients with DIND, 13 of them received angioplasty. On TCD, the angioplasty group had more frequent vasospasm and tended to have an LR higher than 3. The mean blood flow velocity of MCA in the angioplasty group was 40 cm/sec higher than the group without angioplasty. On CTA, the angioplasty group showed combined, moderate types more frequently. After 3D-CTA evaluation, TCD sensitivity, specificity, positive predictive value and negative predictive value, analyzed with the index of diminished vessel diameter that was more than moderate, were 92.6%, 83.3%, 72.2% and 50.0%, respectively. CONCLUSION: TCD and 3D-CTA could be useful tools for evaluation and management planning of critical patients suspected of having DIND by vasospasm.
Angiography ; Angioplasty ; Blood Flow Velocity ; Blood Vessels ; Glycosaminoglycans ; Humans ; Neurologic Manifestations ; Sensitivity and Specificity ; Subarachnoid Hemorrhage ; Ultrasonography, Doppler, Transcranial

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Thromboembolism: Another substantial cause of delayed ischemic neurologic deficits after aneurysmal subarachnoid hemorrhage.

Dong Charn CHO ; Jae Min KIM ; Hyun Jong HONG ; Jin Hwan CHEONG ; Koang Hum BAK ; Choong Hyun KIM

Korean Journal of Cerebrovascular Surgery.2008;10(3):473-476.

Vasospasm has been known as one of the most potent causes of delayed ischemic neurologic deficits (DINDs) after aneurysmal subarachnoid hemorrhage (SAH). An established effective therapy for vasospasm has been used in preventing cerebral ischemia. Nevertheless, several reports suggested the possibility that there may be other causes of DINDs from the cases which couldn't be explained by hemodynamic vasospasm. Authors experienced two cases of thromboembolic infarction as a cause of DINDs after aneurysmal SAH. We propose that thromboembolism can be a considerable cause of DINDs independent of hemodynamic vasospasm.
Aneurysm ; Brain Ischemia ; Hemodynamics ; Infarction ; Neurologic Manifestations ; Subarachnoid Hemorrhage ; Thromboembolism

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Clinical Analysis of Distal Posterior Inferior Cerebellar Artery Aneurysm.

In Hyun BAEK ; Keun Young PARK ; Jae Whan LEE ; Seung Kon HUH ; Dong Joon KIM ; Dong Ik KIM ; Kyu Chang LEE

Korean Journal of Cerebrovascular Surgery.2008;10(3):465-472.

OBJECTIVE: This study was designed to determine the clinical characteristics of patients with aneurysms that are located at the distal posterior inferior cerebellar artery (dPICA). PATIENTS & METHODS: From September 1976 to June 2007, 54 consecutive patients with PICA aneurysms were treated at our institute. Among them, 19 patients had PICA aneurysms distal to the junction of the vertebral artery-PICA. We retrospectively reviewed the database and imaging studies as sources of information for analysis. RESULTS: Five patients were male and 14 patients were female. The mean age was 44.6 years old (range: 23-70). Sixteen patients had ruptured lesions: 1 patient was Hunt and Hess Grade I, 4 were Grade II, 5 were Grade III, 4 were Grade IV and 2 were Grade V. Intraventricular hemorrhage or intracerebral hemorrhage was identified in 5 patients on the initial computed tomography (CT). Three patients had unruptured lesions. The locations of aneurysm were the lateral medullary segment in 10 patients, the tonsillomedullary segment in 1 patient, the telovelotonsillar segment in 5 patients and the cortical segment in 3 patients. Most aneurysms (17) were the saccular shape. Seventeen aneurysms were small and 2 were large or giant. The mean diameter of aneurysm was 6.5 mm (range: 2.0-28.0) and the mean diameter of the ruptured aneurysm was 4.8 mm (range: 2.0-12.0). Two patients had mirror aneurysms. Post-hemorrhagic hydrocephalus was identified in 10 patients on the initial CT and shunt surgery was performed on 3 patients. The obliteration methods of the aneurysms were microsurgery in 15 patients (midline suboccipital approach: 9, lateral suboccipital approach: 6) and endovascular surgery in 4 patients (therapeutic distal PICA occlusion: 3, intra-aneurysmal coiling: 1). Early surgery was performed on 2 patients, intermediate surgery (days between rupture: 4-10) was performed on 4 patients and delayed surgery was performed on 10 patients. The mean post-treatment follow up period was 49.5 months (range: 7-156). The clinical outcome was assessed using the modified Glasgow Outcome Scale. All the patients showed favorable outcomes. Five patients suffered from treatmentrelated complications (a CSF collection requiring wound revision for dura repair: 2, shunt surgery: 1 and transient hemiparesis due to impairment of the blood flow distal to the aneurysm: 2). CONCLUSIONS: In our series, distal PICA aneurysms had the characteristics of a female predominance, they more often presented with intraventricular hemorrhage and the rupture was of a relatively small size. Both microsurgery and endovascular surgery can be troublesome due to the small size, wide neck and tortuosity of the proximal parent artery and the location of aneurysms at a branching site. The surgeons should be careful for preserving vessel patency and insuring watertight dura repair.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Cerebral Hemorrhage ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Glycosaminoglycans ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Male ; Microsurgery ; Neck ; Parents ; Paresis ; Pica ; Retrospective Studies ; Rupture

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