• Journal of Korean Neurosurgical Society
• /
• v.62 no.5
• /
• pp.551-560
• /
• 2019

Objective : Intracranial aneurysms are not common in young age patients. We sought to find the characteristics of the intracranial aneurysms in patients under 20 years of age. Methods : We reviewed 23 consecutive patients ${\leq}20$ years of age treated for their intracranial aneurysms during the period from 1995 to 2017. From medical records and imaging studies, we gathered data on age, sex, presentation, associated medical condition, location and characteristics of aneurysms, treatment and clinical outcomes. Results : The patients' ages ranged from 13 months to 20 years (median, 14 years). There were 16 males and seven females (male to female ratio, 2.3 : 1) with 31 aneurysms. Clinical presentations included sudden severe headache in 61%, followed by altered mentality in 17% and seizure in 17%. More than one-fourth patients had specific medical conditions related to the development of the cerebral aneurysms. The majority of aneurysms occurred in the anterior circulation (71%), and were saccular (71%). There were each three patients with false aneurysms (13%) and giant aneurysms (13%), and only one patient with multiple aneurysms (4%). We treated 22 patients : 21 aneurysms with the endovascular methods, three with open surgery, and one with combined treatment. Good functional outcome could be achieved in 86% during the follow-up period. Conclusion : In this series, the young-age patients with intracranial aneurysms were characterized by male predominance, related specific medical conditions, low incidence of multiple aneurysms, high incidence of giant aneurysms and good functional outcome after treatment.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.3
• /
• pp.190-195
• /
• 2005

Objective : This study is performed to evaluate the procedural complications, aneurysm occlusion rate, and mid-term outcome of endovascular treatments in intracranial aneurysms. Methods : We retrospectively investigated 135 patients with 161 cerebral aneurysms who were treated by endovascular means at our institute from March 1999 to December 2004. We statistically analyzed overall outcome, occlusion rate, and occurrence of complications according to the location, size, rupture history, and neck size of aneurysms. Results : Forty-nine patients [36.3%] had experienced acute intracranial or extracranial complications related to the procedure. Among these, there were 13cases of perforation of the aneurysm, 9 of local vasospasm, 8 of thromboembolism, 4 of coil migration, 3 of occlusion of parent vessels due to coil protrusion, and 1 of seizure. Extracranial complications occurred in 14cases including alopecia [9cases], femoral artery thrombosis [2cases], acute renal failure [2cases], and hypovolemic shock [1case]. One hundred twenty-six aneurysms [78.3%] had complete occlusion of the aneurysm and 35 [21.7%] incomplete occlusion at 6months angiographic follow-up. Postembolization clinical follow-up ranged from 1 to 60months [mean, 14.2months]. Seven of the 161 aneurysms underwent additional embolization and 2 incomplete embolized aneurysms required subsequent surgery. Conclusion : The procedural complications and incomplete occlusion rates are substantial. Therefore, endovascular treatment needs close and continued neurosurgical and neuroradiological concerns for the therapy of intracranial aneurysms.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.6
• /
• 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
• /
• v.52 no.3
• /
• pp.187-192
• /
• 2012

Objective : Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling. Methods : From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2. Results : In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits. Conclusion : The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.

• Journal of Korean Neurosurgical Society
• /
• v.43 no.6
• /
• pp.270-274
• /
• 2008

Objective : The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms. Methods : Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed. Results : Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2%; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms, Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months). Conclusion : Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option.

• Journal of Korean Neurosurgical Society
• /
• v.45 no.3
• /
• pp.133-142
• /
• 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
• /
• v.50 no.1
• /
• pp.6-10
• /
• 2011

Objective : Spontaneous acute subdural hematomas (aSDH) secondary to ruptured intracranial aneurysms are rarely reported. This report reviews the clinical features, diagnostic modalities, treatments, and outcomes of this unusual and often fatal condition. Methods : We performed a database search for all cases of intracranial aneurysms treated at our hospital between 2005 and 2010. Patients with ruptured intracranial aneurysms who presented with aSDH on initial computed tomography (CT) were selected for inclusion. The clinical conditions, radiologic findings, treatments, and outcomes were assessed. Results : A total of 551 patients were treated for ruptured intracranial aneurysms during the review period. We selected 23 patients (4.2%) who presented with spontaneous aSDH on initial CT. Ruptured aneurysms were detected on initial 3D-CT angiography in all cases. All ruptured aneurysms were located in the anterior portion of the circle of Willis. The World Federation of Neurosurgical Societies grade on admission was V in 17 cases (73.9%). Immediate decompressive craniotomy was performed 22 cases (95.7%). Obliteration of the ruptured aneurysm was achieved in all cases. The Glasgow outcome scales for the cases were good recovery in 5 cases (21.7%), moderate disability to vegetative in 7 cases (30.4%), and death in 11 cases (47.8%). Conclusion : Spontaneous aSDH caused by a ruptured intracranial aneurysm is rare pattern of aneurysmal subarachnoid hemorrhage. For early detection of aneurysm, 3D-CT angiography is useful. Early decompression with obliteration of the aneurysm is recommended. Outcomes were correlated with the clinical grade and CT findings on admission.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.2
• /
• pp.97-101
• /
• 2011

Objective : It is technically difficult to treat wide-necked intracranial aneurysms by the endovascular method. Various tools and techniques have been introduced to overcome the related technical limitations. The purpose of this study was to evaluate the radiologic and clinical results of widenecked intracranial aneurysm treatment using the endovascular method. Methods : Fifteen aneurysms in 15 patients were treated by the endovascular method from October 2009 to August 2010. Seven patients presented with subarachnoid hemorrhage (SAH), seven patients had unruptured aneurysms, and one patient had an intracerebral hemorrhage and intraventricular hemorrhage due to an incompletely clipped aneurysm. The mean dome-to-neck ratio was 1.1 (range, 0.6-1.7) and the mean height-to-neck ratio was 1.1 (range, 0.6-2.0). We used double microcatheters instead of a stent or a balloon for the first trial. When we failed to make a stable coil frame with two coils, we used a stent-assisted technique. Results : All aneurysms were successfully embolized. Eleven aneurysms (73%) were embolized by the double microcatheter technique without stent insertion, and four aneurysms (27%) were treated by stent-assisted coil embolization. One case had subclinical procedure-related intraoperative hemorrhage. Another case had procedure-related thromboembolism in the left distal anterior cerebral artery. During the follow-up period, one patient (7%) had a recanalized aneurysmal neck 12 months after coil embolization. The recurrent aneurysm was treated by stent-assisted coil embolization. Conclusion : We successfully treated 15 wide-necked intracranial aneurysms by the endovascular method. More clinical data with longer follow-up periods are needed to establish the use of endovascular treatment for wide-necked aneurysm.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.1
• /
• pp.110-113
• /
• 2001

The cerebral arteriovenous malformation(AVM) rarely coexists with primary intracranial tumor. The authors experienced a patient with intracerebral hematoma due to AVM rupture in whom intracranial meningioma and intracranial aneurysms coexisted. The meningioma was located at convexity of right frontal lobe, and arteriovenous malformation at temporo-occipital lobe of same hemisphere with feeding from right middle cerebral artery, and three intracranial aneurysms exist at the cavernous portion of right internal carotid artery, AVM feeding artery, and intranidal of the AVM. The authors report a rare case of coexisted intracranial AVM, meningioma and aneurysms with review of literatures.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.4
• /
• pp.250-257
• /
• 2015

Objective : Endovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization. Methods : Between January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents' medical and radiological records were reviewed retrospectively. Results : Of the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03). Conclusion : The predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.