OBJECTIVE: Recently the treatment of endovascular coil embolization is gradually increasing compared to the traditional method of microsurgical clipping. However, both methods carry certain risks. The aim of this study was to compare each method's morbidity and complications in patients with ruptured cerebral aneurysms. METHODS: We investigated patients who underwent surgery for subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture between January 2007 to December 2009 in our hospital. Patients' medical records and radiologic images were referenced and initial grade, location and size of aneurysm, treatment method, complications, prognosis, hospital stay and the cost were retrospectively investigated. We divided the patients into two groups according to surgical METHODS: clipping group and coiling group. Treatment results were evaluated using Modified Rankin Scale (MRS). RESULTS: Total 187 aneurysms were treated in 149 patients. Sixty-five and 84 patients were classified as clipping group and coiling group, respectively. The ratio of patients with good outcome in clipping vs. coiling was 83.6% vs. 80.8%. The incidence of vasospasm was significantly lower in the coiling group compared to the clipping group. The length of hospitalization was shorter in the coiling group. The cost and operation time was also less in the coiling group. However, higher numbers of remnant sac and coil compaction were observed in the coiling group. CONCLUSION: Endovascular coil embolization for ruptured cerebral aneurysms had fewer vasospasms and complications. Also, it reduced the hospital stay, operation time, and cost compared with the clipping group. So, in addition to traditional microsurgical neck clipping, we think that endovascular coiling is a good alternative method to treat ruptured aneurysms.
Aneurysm ; Aneurysm, Ruptured ; Hospitalization ; Humans ; Incidence ; Intracranial Aneurysm ; Length of Stay ; Medical Records ; Neck ; Prognosis ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage

OBJECTIVE: This study investigated the proportion of small cerebral aneurysm (<5 mm) to help in the decision making concerning unruptured small aneurysms using the proportion of ruptured small aneurysms as a guide. METHODS: The records of aneurysm patients treated in our hospital from January 2004 to December 2006 were retrospectively reviewed. Patients with ruptured aneurysms were divided into five groups according to their sizes (Group1 defined as tiny :< 3, Group2 defined as very small: 3~5, Group3 defined as small: 5~7, Group4 defined as medium: 7~10 and Group5 defined as large: > 10mm). The clinical and radiological findings of the ruptured aneurysms were also evaluated. RESULTS: The mean age of the 244 enrolled patients was 54.6 years. The mean size of the rupture and the unruptured aneurysms was 6.8 mm. The proportions of aneurysm sizes were 7.8% (<3 mm), 30.7% (3~5 mm), 25.4% (5~7 mm), 19.3% (7~10 mm) and 16.8% (<10 mm). CONCLUSION: The proportion of small ruptured aneurysms (<5 mm) was appreciable; the proportion was not small just to observe. The proportion of very small ruptured aneurysms (3~5 mm) was significant in patients who required surgery or endovascular coiling. Although tiny aneurysms (<3 mm) may have a very low risk of rupture, they should be closely followed-up to preclude such a catastrophe.
Aneurysm ; Aneurysm, Ruptured ; Decision Making ; Humans ; Intracranial Aneurysm ; Retrospective Studies ; Rupture

Although the incidence of intracranial multiple aneurysms are not low, the occurrence of multiple aneurysms more than three developing on the ipsilateral carotid artery is quite rare. We present a patient with five aneurysms on the left internal carotid artery. Four aneurysms arising from the left internal carotid artery underwent microsurgical clipping and wrapping, and remnant superior hypophyseal artery aneurysm was treated by using coil embolization. Incidence and risk factors for management of multiple aneurysms were investigated with the literature review.
Aneurysm ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Risk Factors

Ruptured vertebral artery- dissecting aneurysms (VADAs) must be treated as early as possible due to frequent rebleeding in the early stage. We have reported herein two patients with VADAs who were treated using internal trapping using detachable coils. Both patients were young females in their 40's. They had been admitted to the emergency clinic due to severe headaches and mental deterioration. Brain computed tomography (CT) scans revealed a subarachnoid hemorrhages in the posterior fossa, and transfemoral catheter cerebral angiography revealed dissecting aneurysms at the dominant vertebral arteries. Under general anesthesia, embolization of the parent artery, including the aneurysmal portion, using Guglielmi detachable coils was performed without any procedural complications. Before the induction of general anesthesia, a balloon test occlusion was done on both patients. Both patients improved well after surgery. One patient underwent cerebral angiography at six months after surgery and showed no recurrence of the aneurysm or recanalization of the parent artery. Both patients were free of neurologic findings on follow-up at the 6- and 12- month. Based on these results, patients with ruptured VADAs, located in the dominant vertebral arteries, may be successfully treated with urgent internal trapping using an endovascular technique in selected cases.
Anesthesia, General ; Aneurysm ; Aneurysm, Dissecting ; Arteries ; Balloon Occlusion ; Brain ; Catheters ; Cerebral Angiography ; Embolization, Therapeutic ; Emergencies ; Endovascular Procedures ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parents ; Recurrence ; Subarachnoid Hemorrhage ; Vertebral Artery

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Circle of Willis ; Glycosaminoglycans ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Middle Cerebral Artery ; Ophthalmic Artery ; Optic Nerve ; Subarachnoid Hemorrhage

With the development of devices and techniques, including complex shape coils, balloons, multiple catheter techniques, and intracranial stents, endosaccular treatment of ruptured or unruptured wide-necked cerebral aneurysms has advanced rapidly with respect to indications and outcomes. In contrast to other options, stent-assisted aneurysm embolization has a distinct feature in which the stent is permanently implanted in the cerebral vessels. Therefore, we must consider the short-term effect of stent-assisted aneurysm embolization in the prevention of coil migration and adverse thrombogenicity, but also the permanent mechanical, hemodynamic, and biological influence on the parent vessels and the aneurysm. We have reviewed the current experimental and clinical data on stent-assisted coil embolization of cerebral aneurysms.
Aneurysm ; Catheters ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Parents ; Stents

OBJECTIVE: Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arteriovenous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment. METHODS: Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation, the neurological deficits, the radiographic features and the treatment outcomes. RESULTS: In our series, a total of 25 patients (28 cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by previous treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up. CONCLUSION: Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.
Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cranial Nerve Diseases ; Cranial Nerves ; Endovascular Procedures ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies

OBJECTIVE: This study is aimed to describe our experience with performing hemicraniectomy for treating patients with malignant cerebral infarction. This study also aimed at describing the difference between our experience and that of the published articles. METHODS: Ten patients who had anterior circulation territory cerebral infarction underwent decompressive hemicraniectomy for treating their life threatening brain swelling between August 2004 and October 2007. We retrospectively analyzed the patients' medical records and radiological films and we described the patients' clinical and radiological details. The outcomes were measured according to the case fatality rate at 2 weeks and the modified Rankin scale (mRS) at 9 months. We compared our institution's outcomes with the pooled analysis result of three randomized controlled trials (DESTINY, DECIMAL, HAMLET trial). RESULTS: Nine men and one woman were included in this study. Their mean age was 61.5 +/- 11.9 years, and the mean National Institute of Health Stroke Scale (NIHSS) score on admission was 17.3 +/- 6.0. Five patients died within 2 weeks after operation. Four patients had a mRS of 5 and one had a mRS of 4 at 9 months. Our series included elder patients (mean difference : 9.9~18.3 years) who had a low NIHSS score on admission (mean difference : -4.8~-6.8) as compared to that of the pooled analysis group. Our series revealed a higher proportion of an unfavorable outcome (mRS > or = 4) compared to that of the pooled analysis results (p=0.01). No patient in our series would have been eligible, according to the inclusion criteria, for inclusion in the pooled analysis studies. CONCLUSION: We think that the higher proportion of an unfavorable outcome in our series was a consequence of the elder age of our patients.
Brain Edema ; Cerebral Infarction ; Female ; Humans ; Male ; Medical Records ; Retrospective Studies ; Stroke

OBJECTIVE: The objective of this study was to determine whether postoperative conventional angiography conducted during the early stage after aneurysm clipping is useful in patients with ruptured aneurysm. METHODS: Between May 2008 and November 2009, 57 patients who presented with ruptured cerebral aneurysms were treated with surgical clipping. Among them, a consecutive series of 45 patients who underwent postoperative angiography was analyzed retrospectively. Parameters of the postoperative angiography were categorized as incomplete clippings, vasospasms, vascular compromises, or other aneurysms. RESULTS: The average age of the patients was 49.2 years and ranged from 18 to 72 years. The average timing of the postoperative angiography after the onset of hemorrhage was 11.1 (+/- 5.6) days. Complete aneurysm closure was achieved in 43 (95%) patients. A neck remnant aneurysm was discovered in two patients and a fundus remnant was revealed in one patient. Twelve (27%) patients showed angiographic vasospasms and seven needed angioplasty. Four cases (9%) revealed either parent artery stenosis or branch occlusions, and two of them (4%) were clinically significant. Two cases showed aneurysms at another location, one of which was a ruptured aneurysm. Overall, 21 (47%) patients exhibited significant findings on the postoperative angiography. CONCLUSIONS: Our retrospective analysis revealed that postoperative angiography might be valuable in patients with ruptured aneurysms, especially in the acute stage, in order to determine the presence of vasospasms, incomplete clippings, vascular compromises, or other aneurysms that were missed at the initial cerebral angiography.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Angioplasty ; Arteries ; Cerebral Angiography ; Constriction, Pathologic ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments

OBJECTIVE: Fusiform and dissecting aneurysms cannot be treated with conventional clipping or coiling surgery. Various methods are used for treating these aneurysms, including proximal occlusion of the parent artery or trapping the aneurysms with or without cerebral revascularization. We report here on our experience with treating unclippable and uncoilable aneurysms and we present the clinical and angiographic outcomes. METHODS: Nine patients with unclippable and uncoilable aneurysms were managed during a 5 year period at our institution. We retrospectively reviewed all the patients with aneurysms and who underwent multimodal techniques. The mean age of the 9 patients was 56.5 years. The mean clinical follow-up period was 28.1 months. Six patients presented with subarachnoid hemorrhage and 2 had diplopia. Of these patients, 3 had aneurysms arising from the posterior inferior cerebellar artery (PICA), 2 had vertebral artery (VA) aneurysms, 2 had internal carotid artery aneurysms and 2 had middle cerebral artery aneurysms. Eight aneurysms were fusiform and 1 was a giant saccular aneurysm. RESULTS: The treatment included surgical trapping with bypass in 4 patients, endovascular trapping with bypass in 4 patients and vein graft bypass in 1 patient. Among the bypass surgeries, high-flow bypass was performed for a giant internal cerebral artery (ICA) aneurysm. Trapping of the aneurysms with coil and occipital artery (OA)-PICA bypass were performed for 2 VA aneurysms of the PICA origin. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. CONCLUSION: The cerebral bypass technique is a useful, safe for the treatment of dissecting and otherwise unclippable/uncoilable aneurysms.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Revascularization ; Diplopia ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Parents ; Pica ; Retrospective Studies ; Subarachnoid Hemorrhage ; Transplants ; Veins ; Vertebral Artery