• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.437-441
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• 2010

Objective : The precise intra- vs. extradural localization of aneurysms involving the paraclinoid internal carotid artery is critical for the evaluation of patients being considered for aneurysm surgery. The purpose of this study was to investigate the clinical usefulness of T2-weighted threedimensional (3-D) fast spin-echo (FSE) magnetic resonance (MR) imaging in the evaluation of unruptured paraclinoid aneurysms. Methods : Twenty-eight patients with unruptured cerebral aneurysms in their paraclinoid regions were prospectively evaluated using a T2- weighted 3-D FSE MR imaging technique with oblique coronal sections. The MR images were assessed for the location of the cerebral aneurysm in relation to the dural ring and other surrounding anatomic compartments, and were also compared with the surgical or angiographic findings. Results : All 28 aneurysms were identified by T2-weighted 3D FSE MR imaging, which showed the precise anatomic relationships in regards to the subarachnoid space and the surrounding anatomic structures. Consequently, 13 aneurysms were determined to be intradural and the other 15 were deemed extradural as they were confined to the cavernous sinus. Of the 13 aneurysms with intradural locations, three superior hypophyseal artery aneurysms were found to be situated intradurally upon operation. Conclusion : High-resolution T2-weighted 3-D FSE MR imaging is capable of confirming whether a cerebral aneurysm at the paraclinoid region is intradural or extradural, because of the MR imaging's high spatial resolution. The images may help in identifying patients with intradural aneurysms who require treatment, and they also can provide valuable information in the treatment plan for paraclinoid aneurysms.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.75-80
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• 2013

Objective : Aneurysms arising from the proximal segment of the anterior cerebral artery (A1) are rare and challenging to treat. The aim of this study was to report our experience with endovascular treatment of A1 Aneurysms. Methods : From August 2007 through May 2012, eleven A1 aneurysms in eleven patients were treated endovascularly. Six aneurysms were unruptured and 5 were ruptured. One patient with an unruptured A1 aneurysm presented with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm. Procedural data, clinical and angiographic results were reviewed retrospectively. Results : All of the aneurysms were successfully treated with coil embolization. Six were treated with a simple technique while the remaining 5 required adjunctive technique : double catheters (n=2), balloon-assisted (n=2), and stent-assisted (n=1). The immediate angiographic control showed a complete occlusion in all cases. Procedure-related complication occurred in only one patient : parent artery occlusion, which was not clinically significant. All patients had excellent clinical outcomes but one patient was discharged with a slight disability. No neurologic deterioration or bleeding was seen during the follow-up period in this cohort of patients. Follow-up angiography (mean, 20 months) was available in ten patients and revealed stable occlusion in all cases. Conclusion : Endovascular treatment is a feasible and effective therapeutic modality for A1 aneurysms. Tailored microcatheter shaping and/or adjunctive techniques are necessary for successful aneurysm embolization because of the projection and location of A1 aneurysms.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.329-335
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• 2005

Objective: Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH. Methods: We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. Results: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. Conclusion: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.

• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.431-434
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• 2005

Objective : Subarachnoid hemorrhage[SAH] is commonly associated with polyuria [solute diuresis or water diuresis]. The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. Methods : One hundred and forty eight patients with high urine output [>200ml/hr] after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis [diabetes insipidus, DI] was differentiated from solute diuresis by lower urine specific gravity [<1.005] and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. Results : Annual incidence of polyuria decreased markedly since July 2001 : 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in $2.4{\sim}11.1%$. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days [range $1{\sim}27$ days] and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. Conclusion : Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.216-222
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• 2024

Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.

• 한국의학물리학회지:의학물리
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• 제21권3호
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• pp.274-280
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• 2010

선형가속기를 이용하여 single-fraction stereotactic radiosurgery (SRS)를 시행하였던 뇌동맥 기형 치료 환자 25예 중 13예의 임상결과와 혈관조영술 소견에 대해 알아보고자 하였다. 2002년부터 2009년까지 뇌동정맥 기형으로 SRS를 시행하였던 25명 중 추적 혈관조영술이 시행된 기간이 12개월 이상인 환자 15명(남자 6명, 여자 9명)을 대상으로 하였으며 후향적으로 MRI와 혈관조영술에서 동정맥기형 핵의 크기와, 위치, 파열유무, 추적기간 동안의 합병증 유무, 혈관조영술에서의 변화를 분석하였다. 평균 30개월(12~89개월) 동안 추적 혈관조영술이 시행되었던 15명의 환자 (평균나이 33세, 14~56세) 중 모든 환자에서(100%) 동정맥기형이 완전 소실되었고 3명(20%)에서 유출정맥만이 동맥기 촬영에서 확인되었다. 추적기간 중 1명에서 경련이 있었으며 출혈이나 뇌부종에 의한 임상증상이 있었던 환자는 없었다. 동정맥기형 핵의 부피는 평균 4.3 cc (SD 3.7 cc, 범위 0.69~11.7 cc)였으며 방사선 조사 선량은 평균 17 Gy (12~20 Gy)였다. 동정맥기형의 위치는 대엽이 11예, 기저핵이 1예, 뇌교가 1예, 소뇌가 2예였다. 9예는 파열, 나머지 6예는 비 파열 예였다. 선형가속기를 이용한 뇌동정맥기형 방사선 치료의 성적은 추적기간을 4년 이상으로 할 때 높은 완치율을 보이며 동맥기에 유출정맥이 남아 있을 경우 유출정맥이 완전히 소멸될 때까지 추적 관찰이 요구된다.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1030-1036
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• 2000

본 논문에서 뇌동정맥기형에 대해 포톤나이프로 정위적 방사선 수술을 시행한 후 방사선학적으로 10명의 환자중 6례에서 완전 폐색, 4례에서 부분적 폐색을 보였으며, 특히 3cm이하의 작은 뇌동정맥기형 7례중 6례에서 완전 폐색을 보였다(완전 폐색율 : 85.7%). 모든 환자에서 방사선 수술로 인한 방사선학적 합병증의 발병은 없었다. 신경학적으로도 모든 환자에서 방사선 수술 전에 보이던 증상들이 호전을 보였다. 포톤나이프 방사선 수술 시스템은 이미 실험적으로 안정성이 검증된 것으로 이 논문에서 임상적으로 방사선 수술의 안정성 및 정확성을 다시 확인할 수 있었다. 정위적 방사선 수술은 지금까지 치료 불가능했던 부위에 생긴 병소, 수술이나 다른 치료방법으로 완전 제거에 실패한 경우, 노인환자나 다른 내과적 질환으로 수술이 어렵거나 수술적 치료를 거부하는 환자에서도 좋은 치료 방법으로 사용되어지며, 특히 뇌 중요부위나 심부병변에 위치한 경우 또는 최대직경이 3cm 이하의 소 동정맥기형으로 발견 당시 출혈량이 많지 않고 신경학적 결손이 경미한 환자에서 좋은 적응증이 되리라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제66권4호
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• pp.465-475
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• 2023

Objective : Our objective is to analyze the occurrence, clinical course and risk factors for glioma patients with leptomeningeal metastasis (LM) according to different metastasis patterns and clinical variables. Methods : We retrospectively reviewed data from 376 World Health Organization (WHO) grade II-IV adult glioma patients who were treated in the National Cancer Center from 2001 to 2020. Patients who underwent surgery at other institutions, those without initial images or those with pathologically unconfirmed cases were excluded. LM was diagnosed based on magnetic resonance imaging (MRI) findings or cerebrospinal fluid (CSF) cytology. The metastasis pattern was categorized as nodular or linear according to the enhancement pattern. Tumor proximity to the CSF space was classified as involved or separated, whereas location of the tumor was dichotomized as midline, for tumors residing in the thalamus, basal ganglia and brainstem, or lateral, for tumors residing in the cerebral and cerebellar hemispheres. Results : A total of 138 patients were enrolled in the study. A total of 44 patients (38%) were diagnosed with LM during a median follow-up of 9 months (range, 0-60). Among the clinical variables, tumor proximity to CSF space, the location of the tumor and the WHO grade were significant factors for LM development in univariate analysis. In multivariate analysis, the midline location of the tumor and WHO grade IV gliomas were the most significant factor for LM development. The hazard ratio was 2.624 for midline located gliomas (95% confidence interval [CI], 1.384-4.974; p=0.003) and 3.008 for WHO grade IV gliomas (95% CI, 1.379-6.561; p=0.006). Conclusion : Midline location and histological grading are an important factor for LM in glioma patients. The proximity to the CSF circulation pathway is also an important factor for WHO grade IV glioma LM. Patients carrying high risks should be followed up more thoroughly.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.995-1000
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• 2000

Objective : The authors reviewed 280 cases with intracranial arteriovenous malformations(AVMs) to identify risk factors of hemorrhage. Patients and Methods : From 1983 to 1997, a total 280 patients with AVMs were treated. Among them, 64% had a history of hemorrhage. Angiograms were retrospectively analyzed with particular attention to the size of the AVM, venous drainage, the location of the AVM and presence of associated aneurysm or varix. These characteristics were statistically analysed in relation to occurrence of hemorrhage. Results : A single variate analysis demonstrated that small size(p=0.0003), deep venous drainage(p=0.025) and periventricular location(p<0.0001) had a strong positive correlation. Associated aneurysms and varices were not found as hemorrhagic risk factors. A multivariate analysis revealed that the size of the AVM was most significant hemorrhagic factor(p=0.0003) followed by deep venous drainage(p=0.025). AVMs with small size and deep venous drainage bled more frequently regardless of their locations. Conclusion : These data would be useful in identifying patients at higher risk for developing hemorrhage of intracranial AVMs.

• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.287-289
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• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.