• Journal of Korean Neurosurgical Society
• /
• 제65권4호
• /
• pp.531-538
• /
• 2022

Objective : Anterior communicating artery (Acom) aneurysm is one of the most common intracranial aneurysms, constituting approximately 30-35% of all aneurysm formation in the brain. Anatomically, the H-complex (the anatomic morphology of both A1 to A2 segments) is thought to affects the nature of the Acom aneurysm due to its close relationship with the hemodynamics of the vessel. Therefore, we investigated the relative risk factors of aneurysmal rupture, especially focusing on H-complex morphology of the Acom. Methods : From January 2016 to December 2020, a total of 209 patients who underwent surgery, including clipping and coiling for Acom aneurysm in our institution were reviewed. There were 102 cases of ruptured aneurysm and 107 cases of unruptured aneurysm. The baseline morphology of aneurysms was investigated and the relationship between the H-complex and the clinical characteristics of patients with Acom aneurysms was assessed. Results : Of the 209 patients, 109 patients (52.1%) had symmetrical A1, 79 patients (37.8%) had unilateral hypoplastic A1, and 21 patients (10.0%) had aplastic A1. The hypoplastic A1 group and the aplastic A1 group were grouped together as unilateral dominancy of A1, and were compared with the symmetrical A1 group. There was no significant difference in demographic characteristics and radiological findings of Acom aneurysms between two groups. However, when dichotomizing the patients into ruptured cases and unruptured cases, unilateral dominance of the A1 segment was associated with aneurysmal rupture with statistical significance (p=0.011). Conclusion : These results suggest that the unilateral dominance of the A1 segment does not have a significant effect on the morphology of Acom aneurysms, but contributes to aneurysmal rupture. Thus, we can better understand the effects of hemodynamics on Acom aneurysm.

• Journal of Korean Neurosurgical Society
• /
• 제49권6호
• /
• pp.329-333
• /
• 2011

Objective : As medical advances have increased life expectancy, it has become imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. We therefore analyzed the clinical characteristics and outcomes of the treatment of unruptured intracranial aneurysms in patients older than 70 years. Methods : We retrospectively reviewed the medical records and results of neuroimaging modalities on 54 aneurysms of 48 consecutive patients with un ruptured intracranial aneurysms. ($mean{\pm}SD$ age, $72.11{\pm}1.96$ years; range, 70-78 years) who underwent surgical clipping over 10 years (May 1999 to June 2010). Results : Of the 54 aneurysms, 22 were located in the internal carotid artery, 19 in the middle cerebral artery, 12 in the anterior cerebral artery, and 1 in the superior cerebellar artery. Six patients had multiple aneurysms. Aneurysm size ranged from 3 mm to 17 mm ($mean{\pm}SD$, $6.82{\pm}3.07$ mm). Fifty of the 54 aneurysms (92.6%) were completely clipped. Three-month outcomes were excellent in 50 (92.6%) aneurysms and good and poor in 2 each (3.7%), with 1 death (2.0%). Procedure-related complications occurred in 7 aneurysms (13.0%), with 2 (3.7%) resulting in permanent neurological deficits, including death. No postoperative subarachnoid hemorrhage occurred during follow-up. The cumulative rates of stroke- or death-free survival at 5 and 10 years were 100% and 78%, respectively. Conclusion : Surgical clipping of unruptured intracranial aneurysms in elderly group could get it as a favorable outcome in well selected cases.

• Journal of Korean Neurosurgical Society
• /
• 제56권4호
• /
• pp.356-360
• /
• 2014

The coexistence of moyamoya disease (MMD) with an arteriovenous malformation (AVM) is exceedingly rare. We report two cases of AVM associated with MMD. The first case was an incidental AVM diagnosed simultaneously with MMD. This AVM was managed expectantly after encephalo-duro-arterio-synangiosis (EDAS) as the main feeders stemmed from the internal carotid artery, which we believed would be obliterated with the progression of MMD. However, the AVM persisted with replacement of the internal carotid artery feeders by new external carotid artery feeders from the EDAS site. The AVM was eventually treated with gamma knife radiosurgery considering an increasing steal effect. The second case was a de novo AVM case. The patient was initially diagnosed with MMD, and acquired an AVM eight years later that was slowly fed by the reconstituted anterior cerebral artery. Because the patient remained asymptomatic, the AVM is currently being closely followed for more than 2 years without further surgical intervention. Possible differences in the pathogenesis and the radiologic presentation of these AVMs are discussed with a literature review. No solid consensus exists on the optimal treatment of MMD-associated AVMs. Gamma knife radiosurgery appears to be an effective treatment option for an incidental AVM. However, a de novo AVM may be managed expectantly considering the possible risks of damaging established collaterals, low flow characteristics, and probably low risks of rupture.

• Journal of Korean Neurosurgical Society
• /
• 제50권3호
• /
• pp.248-251
• /
• 2011

Intracranial pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions consist of one or more arterial connection to a single venous channel without true intervening nidus. A 24-year-old woman visited to our hospital because of headache, vomiting, dizziness and memory disturbance that persisted for three days. She complained several times of drop attack because of sudden weakness on both leg. Cerebral angiograms demonstrated a giant venous aneurysm on right frontal lobe beyond the genu of corpus callosum, multiple varices on both frontal lobes fed by azygos anterior cerebral artery, and markedly dilated draining vein into superior sagittal sinus, suggesting single channel pial AVF with multiple varices. Transarterial coil embolization of giant aneurysm and fistulous portion resulted in complete disappearance of pial AVF without complication.

• Journal of Korean Neurosurgical Society
• /
• 제53권4호
• /
• pp.241-244
• /
• 2013

The authors describe the use of a self-expandable stent in a temporary deployment for treatment of a very wide-neck A1 segment of anterior cerebral artery (ACA) aneurysm following incomplete clipping. A 39-year-old hypertensive man presenting with seizure-like movement underwent computed tomography, which showed acute subarachnoid hemorrhage and an A1 segment of ACA aneurysm with superior and inferior projection. He underwent surgical clipping of the aneurysm, but superior and posterior portion of wide-neck aneurysm remained. We decided to treat the remnant aneurysm using an endovascular modality. After selection of the aneurysm, coil packing was performed assisted by the temporary semi-jailing technique. The Enterprise stent (Cordis Neurovascular, Miami, FL, USA) was deployed and recaptured repeatedly for angiography to ensure safety of the small caliber parent artery. Successful semi-deployment and recapture of the stent allowed subtotal coil occlusion of the aneurysm with good anatomic and clinical results. No complications were encountered. The stent could be recaptured up to the point where the proximal end of the stent marker was aligned with distal marker band of the microcatheter, approximately 70% of the stent length. The temporary semi-jailing technique is feasible for wide-neck aneurysm with small caliber parent artery.

• 대한방사선기술학회지:방사선기술과학
• /
• 제33권3호
• /
• pp.223-230
• /
• 2010

본 연구에서는 MRI와 MRA를 이용하여 우리나라 사람의 뇌혈관 질환 중 뇌혈관의 파열에 의한 뇌혈관 질환을 제외하고 뇌혈관이 좁아지거나 막힌 허혈성 뇌혈관 질환의 분포(호발부위)를 분석하여 임상에서 활용할 수 있도록 하였다. 뇌혈관이 좁아지거나 막힌 허혈성 뇌혈관 질환만의 분포를 분석한 이유는 뇌혈관의 파열에 의한 출혈성 뇌혈관 질환과 뇌경색(brain infarction) 등 허혈성 뇌혈관 질환의 발생학적 기전(mechanism)이 다르기 때문이며 그 결과는 아래와 같다. 1. 연구대상자 총 626명 중 성별로는 남자가 55.0%로 여자 45.0%보다 높은 분포를 보였다. 2. 위치별 허혈성 뇌혈관 질환의 분포에서 우측 뇌혈관이 37.5%로 가장 많았으며, 좌측 뇌혈관 35.1%, 양쪽 뇌혈관 27.3% 순으로 나타났다. 3. 허혈성 뇌혈관 질환의 뇌혈관 별 분포는 ICA가 38.9%로 가장 많았으며, 다음으로 MCA 35.7%, PCA 13.4%, ACA 6.0%, VA 3.3% 순으로 나타났다. 4. A-com에 질환이 있는 경우는 한 명도 없었으며 P-com 에도 남자 1명만이 발생했다. 5. MCA에는 여자가 54.6%로 남자 42.2%보다 많아, 성별에 따라 통계적으로 유의미한 차이를 보였다($x^2$=9.64, p < .01). 6. ICA에서는 남자가 56.4%로 여자 46.8%보다 많아 통계적으로 유의미한 차이를 보였다($x^2$=5.71, p < .05). 7. BA에서도 남자가 2.3%로 여자 0.4%보다 많아 성별에 따라 유의미한 차이를 보였다($x^2$=4.25, p < .05). 8. 연령에 따른 혈관별 질환의 분포에 대한 차이는 없었으며 협착과 폐색의 분포에서는 폐색보다 협착이 많았다.

• Journal of Korean Neurosurgical Society
• /
• 제59권2호
• /
• pp.154-157
• /
• 2016

A continuous electroencephalography (cEEG) can be helpful in detecting vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (SAH). We describe a patient with an aneurysmal SAH whose symptomatic vasospasm was detected promptly by using a real-time cEEG. Patient was immediately treated by intraarterial vasodilator therapy. A 50-year-old woman without any significant medical history presented with a severe bifrontal headache due to acute SAH with a ruptured aneurysm on the anterior communicating artery (Fisher grade 3). On bleed day 6, she developed a sudden onset of global aphasia and left hemiparesis preceded by cEEG changes consistent with vasospasm. A stat chemical dilator therapy was performed and she recovered without significant neurological deficits. A real-time and protocol-based cEEG can be utilized in order to avoid any delay in detection of vasospasm in aneurysmal SAH and thereby improve clinical outcomes.

• Journal of Korean Neurosurgical Society
• /
• 제62권2호
• /
• pp.193-200
• /
• 2019

Objective : Endovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2). Methods : A systematic review was performed for online literature published from January 2004 to December 2016. Primary outcome was successful recanalization rate and symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used if heterogeneity was less than 50%. Results : Eight articles were included. EVT showed successful recanalization rate of 69.1% (95% confidence interval [CI], 54.9-80.4%) and S-ICH rate of 6.1% (95% CI, 4.5-8.3%). The rates of good clinical outcome at 3 months and mortality were 59.4% (95% CI, 49.9-68.2%) and 14.9% (95% CI, 11.4-19.3%), respectively. According to thrombus location (M1 vs. M2), successful recanalization (odds ratio [OR], 1.539; 95% CI, 0.293-8.092; p=0.610) and S-ICH (OR, 1.313; 95% CI, 0.603-2.861; p=0.493) did not differ significantly. Good clinical outcome was more evident in M2 occlusion after EVT than that in M1 occlusion (OR, 1.639; 95% CI, 1.135-2.368; p=0.008). However, mortality did not differ significantly according to thrombus location (OR, 0.788; 95% CI, 0.486-1.276; p=0.332). Conclusion : EVT seems to be technically feasible for acute M2 occlusion. Direct comparative studies between EVT and medical treatment are needed further to find specific beneficiary group after EVT in patient with M2 occlusion.

• 대한한방내과학회지
• /
• 제37권2호
• /
• pp.143-155
• /
• 2016

Objective: This study reports on three cases of cerebellar artery infarction patients treated by traditional Korean medicine.Method: Three patients with cerebellar artery infarction according to cerebellar artery were treated by traditional Korean medicine at the traditional Korean medicine hospital of Daejeon University. The posterior cerebral artery (PCA) infarction patient had ataxia, dysarthria, gait disturbance, and dizziness; the anterior inferior cerebellar artery (AICA) infarction patient had facial palsy, dizziness, and hearing loss; and the posterior inferior cerebellar artery (PICA) infarction patient had gait disturbance and dizziness. Acupuncture, herbal medicine, and pharmacopuncture were used as traditional Korean medicine treatments during hospitalization. We then observed any improvement in the symptoms.Results: The scale for the assessment and rating of ataxia (SARA) score (gait, stance) of the PCA infarction patient was reduced from 8.6 to 2.2, while the dizziness numerical rating scale (NRS) score was reduced from 10 to 2 after treatment. The Yanagihara score of the AICA infarction patient was reduced from 27 to 14, while the dizziness NRS score was reduced from 10 to 2 after treatment. The SARA score (gait, stance) of the PICA infarction patient was reduced from 7.4 to 1.0, and the dizziness NRS score was reduced from 10 to 1 after treatment.Conclusion: Traditional Korean medicine appears to be effective in treating cerebellar infarction symptoms.

• 한방재활의학과학회지
• /
• 제18권1호
• /
• pp.47-63
• /
• 2008

Objectives : Eucommiae cortex is reported that it helps bone and skeletal muscle stronger. In case of bone, many report is presented, but reports related to skeletal muscle are rarely existed. So in order to investigate effects of Eucommiae cortex on the skeletal muscle atrophy following stroke, cerebral infarct was induced by the middle cerebral artery occlusion (MCAO) in the rats. Methods : In order to induce MCAO rats, nylon suture was advanced and then blocked middle cerebral artery(MCA). Water extract of Eucommiae cortex was treated for 15 days, once a day orally, after the MCAO. Effects were evaluated with muscle weights, muscle fiber type composition, cross-sectioned area of muscle fibers in soleus and gastrocnemius of the unaffected and affected hind limbs. And MyoD protein expression in gastrocnemius was demonstrated with immunohistochemistry and western blotting. Results : In the affected hind limb of the MCAO rats, muscle weight loss of gastrocnemius and tibialis anterior muscles were attenuated by Eucommiae cortex treatment. In soleus muscle of the affected hind limb of the MCAO rats, increase of type-I fibers and decrease of type-II fibers were induced by Eucommiae cortex treatment. In soleus muscle of the affected hind limb of the MCAO rats, decrease of cross-sectioned areas of type-I fibers was attenuated by Eucommiae cortex treatment. In gastrocnemius muscle of the affected hind limb of the MCAO rats, increase of type-I fibers and decrease of type-II fibers were induced by Eucommiae cortex treatment. In gastrocnemius muscle of the affected hind limb of the MCAO rats, decreases of cross-sectioned areas of type-I and type-II fibers were attenuated by Eucommiae cortex treatment. In gastrocnemius muscle of the affected and unaffected hind limb of the MCAO rats, MyoD expressions were increased by Eucommiae cortex treatment. Conclusions : These results suggest that Eucommiae cortex has a protective effect against muscle atrophy, through the inhibition of the muscle cell apoptosis, following the central nervous system demage.