• Journal of Korean Neurosurgical Society
• /
• 제57권3호
• /
• pp.167-173
• /
• 2015

Objective : Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods : Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results : Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups. Conclusion : LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.

• Journal of Korean Neurosurgical Society
• /
• 제54권4호
• /
• pp.350-354
• /
• 2013

To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.

• Imaging Science in Dentistry
• /
• 제39권4호
• /
• pp.205-208
• /
• 2009

Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansile lesion of bone. The case of a IS-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracuture which was due to the trauma. Computed tomography (CT) revealed expansile lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

• Tuberculosis and Respiratory Diseases
• /
• 제44권2호
• /
• pp.430-434
• /
• 1997

A 29-year-old male patient was admitted due to subacute onset of right chest pain. He had no history of trauma, chest surgery or other medical disease. Chest roentgenogram showed an expansile, radiolucent lesion on the posterior segment of right seventh rib. Computed tomogram of the chest also showed lytic expansile mass with septation. He took an en-bloc resection of the involved rib. Pathologically there were multiple cystic spaces, filled with blood and collage no fibrous tissue proliferation and locally areas of new bone formation and giant cells of osteoclastic type, which was compatible with aneurysmal bone cyst. We report a case of aneurysmal bone cyst of the rib with a brief review of literature.

• 대한한방내과학회지
• /
• 제42권2호
• /
• pp.197-206
• /
• 2021

Subarachnoid hemorrhage (SAH) is a disease that causes bleeding in the subarachnoid space; 70%-80% of nontraumatic subarachnoid hemorrhages are caused by saccular aneurysms. If the patient has already experienced a ruptured aneurysm that causes subarachnoid bleeding, rebleeding can result in a high mortality rate and serious sequelae. Therefore, if the patient can undergo surgical or interventional treatment, it should always be performed. This patient was diagnosed with acute aneurysmal subarachnoid hemorrhage and hydrocephalus. The patient was hospitalized for uncontrolled headache and vertigo after aneurysm coil embolization and ventriculoperitoneal shunting. The patient was treated with Yangkyuksanwha-tang and acupuncture and was observed with a symptom checklist for 25 days. Headache improved, from a visual analog scale (VAS) score of 7 to 0. Vertigo also improved, from a numeric rating scale (NRS) of 6 to 2, and the vertigo pattern changed from rotational to nonrotational. This case suggests that Korean medicine treatment is helpful in managing subarachnoid hemorrhage sequelae.

• Brain Tumor Research and Treatment
• /
• 제6권2호
• /
• pp.86-91
• /
• 2018

Aneurysmal bone cyst (ABC) is a rare non-neoplastic bone lesion that involves mostly the long bones and vertebrae and may occur very rarely in the craniofacial bones. ABCs may occur as secondary bony pathologies in association with various benign and malignant bone tumors and with fibrous dysplasia (FD). FD is a common non-neoplastic bony pathology mostly affecting craniofacial bones. Secondary ABC occurring in craniofacial FD is extremely rare, with only approximately 20 cases reported in the literature to date. Here, we report on a case of secondary ABC in a 25-year-old woman who has had a craniofacial deformity for over 10 years and who presented to us with a rapidly growing painful pulsatile mass in the right frontal region that began over 2 months prior to admission. On thorough examination of computed tomography and magnetic resonance imaging brain scans taken at two-month interval, an aggressive, rapidly enlarging ABC, arising from the right frontal FD, was diagnosed. The patient underwent preoperative embolization followed by gross total resection of the ABC and cranioplasty. The 6-month follow up showed no recurrence of the ABC, nor was any progression of the FD noticed.

• 대한두개안면성형외과학회지
• /
• 제24권5호
• /
• pp.244-249
• /
• 2023

Fibrous dysplasia (FD) is a rare skeletal disorder characterized by abnormal fibro-osseous connective tissue replacing normal bone. Despite its benign behavior, craniofacial FD can cause morphological disfigurement, headache, and even blindness as a result of the produced mass effect. Surgical resection is recommended when the patient shows apparent clinical symptoms or aggravating facial asymmetry. Postoperative complications have been reported, such as hematoma, surgical site infection, abscess formation, resorption of the bone graft used for reconstruction, and recurrence. An aneurysmal bone cyst (ABC) is a rare benign bony lesion that can occur secondary to preexisting bone tumor. Secondary ABCs in craniofacial FD are extremely rare in the literature, accounting for less than 30, all of which are either case reports or series. We report an extremely rare case of symptomatic secondary ABC arising from craniofacial FD that had been misdiagnosed with abscess formation or recurrence and was surgically removed. Notably, 17 years elapsed between the primary surgery and the complication of secondary ABC. The patient underwent total removal of secondary ABC. After surgery, symptoms were relieved, with no recurrence observed during a 6-month follow-up.

• Journal of Korean Neurosurgical Society
• /
• 제30권6호
• /
• pp.805-812
• /
• 2001

Objectives : The goal of the surgical management of large and giant aneurysm is complete extirpation of the aneurysms with preservation or reconstruction of the parent artery. To improve the surgical management results of those aneurysms in the future, we review our experience and discuss technical maneuvers and strategies used to avoid potential complications of those aneurysm surgery. Material and Methods : During the past 12 years, thirty six cases of large and giant aneurysms(diameter>19mm) were managed by surgery. The clinical characteristics, treatment methods, surgical complications and outcome of those cases were analyzed and, based on the review of the literatures, the preventive methods of surgical complication related to the clipping of those aneurysms were discussed. Results : The locations of those aneurysms were anterior circulation in 34 cases and posterior circulation in 2 cases. The most frequent site of aneurysmal location was a paraclinoidal region of the anterior circulation. The aneurysms were managed surgically by direct clipping of aneurysmal neck in 31 cases, aneurysmal trapping followed by extracranial-intracranial bypass in 2 cases, proximal clipping of parent artery, aneurysmorrhaphy, and excision of aneurysm followed by end to end anastomosis of parent artery in each one case. Surgical complications occurred in 13 cases. A parent vessel occlusion by thrombus formation and parent vessel stenosis after clipping of aneurysm were the main complications. We obtained good outcome in 27, fair 5, poor 1 and dead in 3 case(s). Conclusion : We conclude that selection of suitable management method for each case, high quality of surgical technique and prevention of complication during operation are important key points for the successful treatment of large and giant aneurysm. The heparinization prior to application of temporary clip on parent vessels, aneurysmal decompression during dissection and clipping of aneurysm, complete closing of the aneurysmal neck and avoiding the narrowing of parent vessel after clipping of aneurysm were the main technical maneuvers used to avoid complications of those aneurysm surgery.

• Journal of Korean Neurosurgical Society
• /
• 제30권5호
• /
• pp.592-599
• /
• 2001

Objective : The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. Methods : The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. Results : The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. Conclusion : It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.

• 대한응급의학회지
• /
• 제29권5호
• /
• pp.449-454
• /
• 2018

Objective: The SAFARI score was introduced to assess the risk of convulsive seizure during admission for aneurysmal subarachnoid hemorrhage in 2017. This study was conducted to determine whether the SAFARI score derived from the afore-mentioned study could be applied to patients with aneurysmal subarachnoid hemorrhage in Korea. Methods: We conducted a retrospective study of patients who were diagnosed with aneurysmal subarachnoid hemorrhage from March 2013 to October 2017. Patients' age, sex, blood pressure, pulse rate, body temperature, Glasgow-Coma Scale, Hunt-Hess scale, modified Fisher grade, size of ruptured aneurysm, surgery type, transfusion, and SAFARI score were compared between the seizure and non-seizure groups. The area under the receiver operator characteristic curves was calculated to evaluate the predictive ability for seizure during admission. Logistic regression analysis was used to analyze predictive factors for seizure during admission. Results: A total of 220 patients were included. Ninety-seven (44.1%) were male and 123 (55.9%) were female. The mean age of the patients was 65.8 years old (range, 56-75). The area under the curve of the SAFARI score for predicting seizure was 0.813. The SAFARI score was the only significant predictor of seizure during admission, while other factors were not statistically significant upon logistic regression analysis. Conclusion: The SAFARI score could be used for predicting seizure during admission in patients with aneurysmal subarachnoid hemorrhage.