Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.
Adhesives ; Aneurysm, False ; Angiography ; Dentistry ; Emergencies ; Enbucrilate ; Facial Nerve ; Female ; Hematoma ; Hemorrhage ; Humans ; Masticatory Muscles ; Maxillary Artery ; Needles ; Parotid Region ; Surgery, Plastic

Posttraumatic high-flow communications between the intracavernous internal carotid artery (ICA) and the cavernous sinus may give rise to two different pathological entities. A connection from the intracavernous ICA system can theoretically connect with two different structures; the vein of the plexus (CCF) or the perivascular bare spaces between the veins (pseudoaneurysm). A CCF and a pseudoaneurysm can be present in the same patient. A 24-year-old man was admitted to our hospital due to sudden mental deterioration. Carotid angiography revealed a CCF, which had occurred after a trauma 5 years earlier, associated with left visual disturbance and skull base fractures. The treatment of choice was permanent coil occlusion of the intracavernous ICA at the level of the lesion. The collateral circulation was evaluated before the endovascular treatment using a balloon test occlusion (BTO). During the BTO, adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. A continuous neurological examination was performed during the procedure. The follow-up angiography showed a persistent aneurysm occlusion. We report our experience of the successful endovascular treatment of combined lesions with a review of the relevant literature.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, Internal ; Cavernous Sinus ; Collateral Circulation ; Fistula* ; Follow-Up Studies ; Humans ; Neurologic Examination ; Skull Base ; Veins ; Young Adult

OBJECTIVES: Shunt-dependent hydrocephalus is the major sequela after subarachnoid hemorrhage (SAH) and this continues to be a major source of morbidity for these patients. The prevalence and risk factors are not clear, despite the significant clinical and basic science research that's been done. We analyze the risk factors of shunt-dependent hydrocephalus such as the clinical and radiological parameters, the treatment modality and the peri-operative preparation. METHODS: We collected data on 475 patients with aneurysmal SAH and who were admitted to our hospital between January 1996 and January 2005. We retrospectively analyzed the age, gender, Hunt-Hess grade, Fisher grade, hypertension, intraventricular hemorrhage (IVH), rebleeding, vasospasm, location of aneurysm, treatment modality, timing of surgery, lumbar drainage, external ventricular drainage (EVD) and the prognosis as risk factors. RESULTS: 22.1% (105/475) of the aneurysmal SAH patients developed shunt-dependent hydrocephalus. Univariate analysis revealed that the patient's age, Hunt Hess grade, IVH, rebleeding, vasospasm, location of aneurysm, timing of operation, lumbar drainage, EVD and the prognosis had statistically significant correlation with the development of shunt-dependent hydrocephalus (p<0.05). Through multivariate regression analysis, the aneurysms located in the posterior circulation, use of lumbar drainage and the cases with acute hydrocephalus showed a high prevalence of shunt-dependent hydrocephalus. CONCLUSION: Among the numerous factors, only lumbar drainage was a partially controllable factor. Further analysis of the clinical factors associated with CSF drainage and re-evaluation of the indications for drainage are needed.
Aneurysm* ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus* ; Hypertension ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage*

OBJECTIVE: The authors investigated the clinical and radiographic characteristics of patients who exhibited contrast extravasation on initial computed tomographic angiography (CTA) and assessed the its association with hematoma expansion. METHODS: Ninety six patients who were diagnosed with intracerebral hemorrhage and who received CTA within 12 hours from initial onset of symptoms and who received a follow up brain CT within 48 hours from the initial CTA between April 2004 and March 2007 were retrospectively assessed. Contrast extravasation was defined as the presence of high-density material within the hematoma. Patients were classified into the extravasation and no extravasation groups. Clinical and radiographic variables were compared between the two groups. RESULTS: Fifteen patients (19%) demonstrated presence of extravasation on initial CTA. A significantly higher rate of hematoma expansion was seen in the extravasation group compared to the non extravasation group (47% vs 17%, p=0.027). Mean time from onset of symptoms to initial CTA was significantly shorter in the extravasation group (3.5+/-1.3 hours vs 7.6+/-2.5 hours, p<0.001). Also, detection of extravasation on CTA significantly correlated with time from symptom onset to intial CTA, especially when it was less than 4 hours (p>0.001). CONCLUSIONS: Earlier detection of extravasation using CTA may help in identifying possibly life threatening complications caused by hematoma expansion. However, a larger prospective cohort is warranted to validate this result.
Angiography* ; Brain ; Cerebral Hemorrhage* ; Cohort Studies ; Follow-Up Studies ; Hematoma ; Humans ; Retrospective Studies

OBJECTIVE: We have investigated the risk factors associated with angiographic recurrence of intracranial aneurysms after endovascular coil embolization in a retrospective manner. METHODS: From January 2000 to June 2005, 128 aneurysms in 114 patients were treated with coil embolization. Among them, 54 aneurysms in 51 patients were followed by repeated intraarterial angiography at 6, 12, 18, and 24 months post-embolization. Recurrence was defined when either coil compaction or aneurysm regrowth was identified on follow-up angiography. Patients were divided into stable and recurred groups according to angiographic recurrence. Clinical parameters, anatomical factors, and the degree of occlusion were retrospectively reviewed. RESULTS: The overall recurrence rate was 29% in our study. The diameter of the largest dimension of the fundus was larger in the recurred group of patients as compared to the stable group of patients (7.33+/-2.26 mm vs. 5.87+/-1.93mm, p = 0.048), and a significant rate of recurrence was seen in fundus size of the same or greater than 10 mm (41.7% vs 14.3%, p = 0.038). The coil packing density was significantly smaller in the recurred group of patients (p = 0.002), with a recurrence rate of 47.0% in cases with a coil packing density below 25% (p = 0.017). CONCLUSIONS: Our study showed that maximum aneurysm fundus size and coil packing density had a close correlation to recurrence. However, a larger number of patients with longer observation times may be needed to define the risk factors affecting angiographic recurrence.
Aneurysm ; Angiography ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Recurrence* ; Retrospective Studies ; Risk Factors

Rosai-Dorfman Disease(RDD) is an idiopathic histiocytic proliferation affecting lymph nodes. Although extranodal involvement has been reported in the skin, orbit, upper respiratory tract, or testes, the isolated intracranial involvement without associated lymphadenopathy is extremely rare. We report our experience with 1 case of an isolated intracranial RDD without associated lymphadenopathy and any other organ involvement. A 61-year-old male presented with an isolated well-circumscribed brain mass in the posterior fossa, preoperatively thought to be a meningioma. But histology and immunohistochemistry confirmed that the lesion was RDD.
Brain ; Histiocytosis, Sinus* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Lymphatic Diseases ; Male ; Meningioma ; Middle Aged ; Orbit ; Respiratory System ; Skin ; Testis

OBJECTIVE: Our goal was to evaluate the usefulness of CT perfusion (CTP) in early detection of the post operative cerebral ischemia, alteration of treatment modality and patient prognosis in cerebral aneurysm patients. METHODS: 24 patients who underwent either surgical operation or endovascular coiling for ruptured aneurysms were selected. All patients undertook an angiogram, conventional CT, and CTP scan immediately following surgical operation or endovascular coiling. All patients performed a CT 2 weeks after treatment to evaluate possible development of a cerebral infarction. Postoperative CT results of patients with abnormal postoperative CTP scan findings were compared, and these results were compared with the CT results and clinical symptoms of patients who developed infarction or not. RESULTS: Of the 24 patients evaluated, 11 patients showed abnormal findings on CTP. 9 patients were diagnosed with cerebral infarction through a CT scan done 2 weeks after treatment; all exhibited abnormal CTP results immediately after treatment. Abnormal CTP findings were divided into two groups; patients with abnormal CBF and MTT maps, but with normal CBV maps, and patients with abnormal CBF, CBV and MTT maps. A correlation was seen between abnormality on CBV maps and cerebral infarction. Patients with abnormal CTP findings also exhibited poorer prognostic value. CONCLUSION: Postoperative CTP in ruptured aneurysm patients is a very useful and objective tool in evaluating abnormal cerebral hemodynamics. The CBV map of CTP is the most precisely predictable value of postoperative patient's status and alteration of treatement modality.
Aneurysm, Ruptured* ; Brain Ischemia ; Cerebral Infarction ; Cytidine Triphosphate ; Hemodynamics ; Humans ; Infarction ; Intracranial Aneurysm ; Perfusion* ; Prognosis ; Tomography, X-Ray Computed

OBJECTIVES: The aim of this study are clinical application of perfusion computed tomography (perfusion CT) in hydrocephalus and comparison its cerebral blood flow parameters with transcranial doppler (TCD) and clinical outcome. METHOD: 25 patients with hydrocephalus took pre- and postoperative perfusion CT and TCD. 15 patients without neurologic deficit were also examined with same protocol as a control. Blood flow parameters of perfusion CT, such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analyzed according to clinical status and postoperative outcome. So did the TCD parameters, mean flow velocity (mFv) and pulsatility index (PI) with regard to clinical outcome. RESULTS: Perfusion CT parameters of the hydrocephalus showed decrease in CBF (gray matter P=0.035, periventricular region P=0.042) and increase in MTT (gray matter P=0.039, periventricular region P=0.045) compared to control. In postoperative improvement group, there noted reversal of perfusion parameters close to those of the control. TCD parameters showed increase in mFv (P=0.047), and decrease in PI (P=0.042) in cases with improvement. CONCLUSION: Perfusion brain CT and TCD can used as clinically useful tools to predict the postoperative outcome on hydrocephalus.
Blood Volume ; Brain ; Humans ; Hydrocephalus* ; Neurologic Manifestations ; Perfusion*

OBJECT: This study is designed to estimate the clinical usefulness of perfusion computed tomography (perfusion CT) as an easily accessible tool to evaluate cerebral blood flow (CBF) in patients with aneurysmal subarachnoid hemorrhage. METHOD: Twenty patients with aneurysmal spontaneous subarachnoid hemorrhage who underwent either aneurysmal neck clipping or interventional coil embolization and who also had taken transcranial doppler study and perfusion CT were included as study group. And as a control group, fifteen patients without neurologic deficit were studied with the same devices. We compared the cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) from obtained perfusion CT with the results of transcranial doppler and clinical course. RESULTS: CBF parameters of perfusion CT in control group showed close accordance with those values of reported xenon CT and positron emission tomography data. In doppler study, the blood flow velocity was higher in cases with vasospasm than without it (p=0.027). There showed significant relationship between vasospasm and perfusion CT parameters, as decrease in CBF (p=0.061) and increase in MTT (p=0.013). Perfusion CT parameters were closely correlated with TCD parameters in clinical vasospasm as reverse correlation in CBF (R2=0.45) and positive in MTT (R2=0.58). CONCLUSION: The cerebral blood flow parameters of Perfusion CT showed reliable and accurate values in control group. The perfusion CT and TCD can be used as easily accessible non-invasive tools to evaluate cerebral blood flow parameters in clinical settings of patients with aneurysmal subarachnoid hemorrhage.
Aneurysm* ; Blood Flow Velocity ; Blood Volume ; Embolization, Therapeutic ; Humans ; Neck ; Neurologic Manifestations ; Perfusion* ; Positron-Emission Tomography ; Subarachnoid Hemorrhage* ; Xenon

No abstract available.
Ependymoma*