• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.330-335
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• 2000

Objective : The purpose of this report is to assess the morbidity and mortality associated with clipping of intracranial unruptured aneurysms. Methods : At the authors' institution between May 1989 and December 1998, a total of 128 unruptured aneurysms in 110 patients were treated with surgical clippings. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : The main locations of the aneurysms were : middle cerebral artery 31%, internal carotid-posterior communicating artery 28%, anterior communicating artery 16%, paraclinoid 6.5%, internal carotid-anterior choroidal artery 7%, posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was : Glasgow outcome scale(GOS) I 86%, GOS II 6%, GOS III 4.3%, GOS IV 0% and GOS V(death) 3.5%. The operative risk is higher for large to giant aneurysms, and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality, but morbidity of 8.2%, and in posterior circulation : 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm, mortality and morbidity were 25% and 25%, respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%). The postoperative morbidity was related to occlusion of artery(9/13), intraoperative rupture(3/13), and cranial nerve injury(1/13). Conclusion : This report documents 3.5% mortality and 13% of morbidity in the clipping surgery for unruptured intracranial aneurysms, and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still controversial. However, with respect to surgical results, unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.11-15
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• 2009

Objective : The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. Methods : We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. Results : There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was $5.47{\pm}2.536\;mm$ in anterior cerebral artery (ACA), $6.84{\pm}3.941\;mm$ in ICA, $7.09{\pm}3.652\;mm$ in MCA and $6.21{\pm}3.697\;mm$ in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. Conclusion : Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.227-233
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• 2006

Objective : To determine the rationale for treating pure unruptured intracranial aneurysms[UIAs]. it is mandatory to know the risk of each treatment modality. The purpose of this study is to evaluate the surgical risk for treating UIAs. Methods : Between December 1994 and May 2005, 147 unruptured aneurysms in 135 patients were treated. The majority of these cases [94.6%] were treated with aneurysmal neck clipping. The remainder received aneurysmal wrapping [2.7%], trapping with bypass [20%], or proximal occlusion [0.7%]. The clinical outcomes were evaluated in each patient by the Glasgow Outcome Scale at one month post-surgery. Results : The patient pool consisted of 41 males and 94 females. The mean age was 55.9 years [range : $16{\sim}82$]. The aneurysms were located at middle cerebral artery in 63 [42.9%]. anterior communicating artery 30 [20.4%], posterior communicating artery in 26 [177%]. internal carotid artery[ICA] in 14 [95%], anterior choroidal artery in 4 [2.7%] and others in 10[6.9%]. One hundred fifteen [78.2%] of aneurysms were small [<10mm]. Others were large [10 to 25mm] and giant [>25mm]; 29 [19.7%] and 3 [21%] respectively. More than ninety percent [91.1%] of all patients recovered well. Mild to severe disability was seen in 8.7% of the patients. One patient succumbed to complications following injury to the ICA. Conclusion : The mortality and morbidity associated with UIA surgery at our hospital compared very favorably to the previous reported literature and with the previously established natural history of this disease.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.272-274
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• 2007

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.102-106
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• 2011

Objective : Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. Methods : A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. Results : Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. Conclusion : The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.

• Journal of Korean Neurosurgical Society
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• 제45권2호
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• pp.99-102
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• 2009

Inflammatory pseudotumor is an uncommon lesion with unknown etiology characterized by sclerosing inflammation which clinically and radiographically mimics a neoplastic lesion. A 47-year-old man presented with sudden headache and dysarthria. Brain CT scan revealed a $2.6{\times}2.2\;cm$ sized, round, and hyperdense mass in the anterolateral wall of the left lateral ventricular trigone. On MR imaging studies, the mass showed low signal intensity in the wall of the trigone on T2-weighted image, central mixed (iso- and high-) signal intensity with peripheral low-signal intensity on T1-weighted image. Subtle staining of left choroid plexus with irregular shaped distal branch of anterior choroidal artery was found on the cerebral angiography. These findings suggested a small tumorous lesion originated from the left choroid plexus. During the hospital days, the mass manifested as repeated hemorrhages. The mass was successfully removed via left occipital transcortical approach. The histopathological report of the specimen was hemorrhage and fibrosis, with dense lymphoplasma cell infiltration, suggestive of an inflammatory pseudotumor.