• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.42-49
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• 2024

Objective : There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. Methods : This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. Results : In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. Conclusion : SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.49-52
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• 2011

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.336-339
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• 2007

Traumatic intracranial aneurysm rarely occurs after a head injury. The authors report a case of a 51-year-old man in whom subarachnoid hemorrhage was developed as a result of delayed traumatic aneurysmal rupture of the distal portion of the middle cerebral artery following a minor, closed-head injury. The unruptured aneurysm had been evident on the magnetic resonance image taken two days prior to onset of the subarachnoid hemorrhage. The clinical presentation and possible underlying mechanism are discussed with a review of pertinent literature.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.133-142
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• 2009

The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that field have supplanted microsurgical treatment for many intracranial aneurysms. Applying current outcome data and other parameters, nuances of selecting the modality of treatment for intracranial aneurysms are reviewed. Patient factors, such a age, co-morbidities, vasospasm and other medical conditions, are addressed. A custom-tailored multimodality treatment paradigm for the management of ruptured and unruptured aneurysms will maximize the favorable results seen in this difficult patient population.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.457-459
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• 2011

A rare case of spontaneous subarachnoid hemorrhage from newly developed cerebral aneurysm in glioblastoma patient is presented. A 57-year-old man was presented with headache and memory impairment. On the magnetic resonance image and the magnetic resonance angiography, a large enhancing mass was found at right frontal subcortex and intracranial aneurysm was not found. The mass was removed subtotally and revealed as glioblastoma. He took concurrent PCV chemotherapy and radiation therapy, but the mass recurred one month later after radiotherapy. He was then treated with temozolomide for 7 cycles. Three months after the completion of temozolomide therapy, he suffered from a subarachnoid hemorrhage due to a rupture of a small de novo aneurysm at distal anterior cerebral artery. He underwent an aneurysm clipping and discharged without neurologic complication.

• 한국가시화정보학회지
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• 제20권2호
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• pp.45-54
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• 2022

We analyzed the low wall-shear stress area in the intracranial aneurysm that occurred at an anterior communicating artery with a special emphasis on vortical structures close to the wall. We reconstructed the aneurysm model from patient CTA data. We assumed blood as an incompressible Newtonian fluid and treated the blood vessel as a solid wall. The pulsatile boundary condition was applied at the inlet of the anterior cerebral artery. From the instantaneous flow field, we computed the histogram of the wall-shear stress over the aneurysm wall and found the low wall-shear stress event (< 0.4 Pa). This extreme event was due to the low wall-shear stress area that occurred at the daughter sac. We found that the merging of two vortices induced the low wall-shear stress area; one arises from the morphological characteristics of the daughter sac, and the other is formed by a jet flow into the aneurysm sac. The latter approaches the daughter sac, which ultimately leads to the strong ejection event near the daughter sac.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.73-77
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• 2001

Object : To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. Method : Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. Result : Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. Conclusion : Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.891-895
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• 2001

Objective : Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. Method : Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. Result : Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. Conclusion : It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1584-1591
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• 2000

Objective : Until now, it has been little known about the biological mechanisms associated with the genesis, growth, and rupture of intracranial aneurysm. This study was performed to investigate and understand a part of these mechanisms. Materials and Methods : Immunohistochemical stains for angiogenesis growth factors(basic fibroblast growth factor (bFGF) and vascular endothelial growth factor(VEGF)) and selected vascular wall matrix proteins(alpha smooth muscle actin(${\alpha}SMA$) and collagen Type IV) were performed in fixed sections from a normal circle of Willis artery which was taken from the autopsy specimen as a control vessel and 17 aneurysmal wall specimens which was taken during surgical clipping of aneurysms. The staining intensity and distribution of immunoreactivity to angiogenesis growth factors and selected wall matrix proteins in control vessel and aneurysmal wall were examined and compared with each other. The difference of staining intensity according to the size of aneurysm was also investigated. Results : There was no immunoreactivity to bFGF and VEGF in the control vessel. bFGF immunoreactivity was exhibited in 15 of 17 aneurysm specimens around smooth muscle cells within the media of aneurysm. VEGF immunoreactivity was also exhibited in all aneurysm specimens in patches or diffusely affecting all layers of the aneurysmal wall. The degrees of intensity of bFGF and VEGF immunoexpression were proportionate roughly to the size of aneurysm. Strong immunoexpression of both factors were noticed in large aneurysm. A regularly arranged and defined band of immunoreactivity of ${\alpha}SMA$ was noticed in the media of the control vessel, whereas diffuse, faint, irregularly arranged ${\alpha}SMA$ was noticed in the aneurysmal wall. A regularly defined band of collagen Type IV immunoreactivity was also noticed in the subendothelium of the control vessel, whereas diffuse disorganized immunoreactivity of collagen Type IV was noticed in the entire wall of the aneurysm. Conclusion : These results indicate substantial evidences of abnormal expression of angiogenesis factors and changes of selected vascular wall matrix proteins in the wall of intracranial aneurysm. The unbalanced changes of angiogenesis factors and vascular wall matrix proteins in the wall of aneurysm may be one of the biological mechanisms for the growth and rupture of aneurysm.

• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.94-102
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• 1997

목적: 자기공명혈관조영술(magnetic resonance angiography: MRA)을 이용하여 뇌동맥류를 비침습적 방법으로 진단하고자 하는 시도가 있었지만 크기가 3mm 이하인 경우 진단에 애로가 많았다. 뇌동맥류의 진단에 있어 최근 개발된 고해상도, 고속의 slice interpolation 자기 공명혈관조영술과 디지탈 감산 혈관조영술(digital subtraction angiography: DSA)의 결과를 전향적으로 비교하여 보편적인 선별 검사법으로 가능성을 확인하고자 하였다. 대상 및 방법: 총 19명의 환자에서 26개의 뇌동맥류를 대상으로 하였다. 모두 자기공명혈관조영술을 먼저 촬영하여 기원혈관, 동맥류경부의 확인, 인근 작은 혈관과의 연관관계등을 확인한 후 디지탈 감산 혈관조영술을 시행하여 비교하였다. 영상은 1.5T 초전도형기계(Vision, Siemens, erlangen, Germany)를 이용하여 slice interpolation 을 이용한 자기공명혈관조영술로 촬영하였다. 촬영은 TR / TE / FA = 30 / 6.4 / 25, matrix $512{\times}160$, 관찰면 $200{\times}150$, 촬영시간 7분 42초, 유효 두께 0.7mm, 총 두께가 102.2mm로 하여 대공(foramen magnum)에서 전뇌동맥(anterior cerebral artery)의 A3 부위까지 충분히 포함되도록 하였다. 영상분석은 최대강도투사(maximum intensity projection: MIP)를 사용하였으며 두개강내 동맥류가 있는 경우 다면재구성(multiplanar reconstruction: MPR) 기법을 사용하였다. 결과: 19명의 환자중 2명이 3개, 3명이 2개, 나머지 14명이 각각 1개씩의 두개강내 동맥류를 가져 모두 26개 였으며 파열된 동맥류가 14개였고 파열되지 않은 동맥류가 12 개이었다. 크기가 2mm 이하가 8개, 3-5mm가 9개, 6-9mm가 7개이며 10mm이상이 2개가 있었다. 처음 검사에서 자기공명혈관조영술과 디지탈 감산 혈관조영술에서 23개의 동맥류중 내경동맥에 1mm 크기의 동맥류 1개를 제외한 25개를 각각 발견할 수 있어 96%의 예민도를 보였으나 진음성과 위음성은 없어 특이도를 측정할 수 없었다. 크기와 모양을 확인하는데 자기공명혈과조영술과 다면재구성을 동시에 사용한 경우 디지탈 감산 혈관조영술과 같은 성적을 보인 반면 동맥류 경부와 기원혈관을 확인하는데도 자기공명혈관조영술의 다면재구성을 동시에 사용한 경우가 자기공명혈관조영술 또는 디지탈 감산 혈관조영술만 사용한 경우 보다 월등히 좋았다. 결론: Slice interpolation 기법을 이용한 고해상 자기공명혈관조영술은 두개강내 동맥류를 검사하는데 디지탈 감산 혈관조영술과 동일한 성적을 보여 앞으로 비침습적 일차 선별 검사법으로 가능할 것으로 생각된다.