• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.243-245
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• 2012

It is well known that spontaneous thrombosis in giant cerebral aneurysm is common. However, spontaneous obliteration of a non-giant and unruptured cerebral aneurysm has been reported to be rare and its pathogenic mechanism is not clear. We describe a case with rare vascular phenomenon and review the relevant literatures.

• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.354-356
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• 2010

Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of $2{\times}2\;mm$ with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, $9{\times}13\;mm$ sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.

• 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 Chest Surgery
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• 제27권10호
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• pp.854-857
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• 1994

Hypothermia and circulatory arrest is efficatious adjunct in the surgical treatment of conventionally difficult or otherwise inoperable lesion. This technique was utilized in 5 patients, 3 with membraneous obstruction of inferior vena cava[MOVC] and 1 with giant middle cerebral artery aneurysm and 1 with renal cell carcinoma invading inferior vena cava. All membraneous obstruction of inferior vena cava patients had excellent results but the others died of operative complications. The rationale for the use of complete cardiac arrest with hypothermia is reviewed and the use of these technique in selected patients is warrented.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.137-152
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• 2020

In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.

• 대한의용생체공학회:의공학회지
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• 제25권4호
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• pp.295-300
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• 2004

코일을 동맥류에 삽입하여 동맥류 내부 유동 정체를 유발하므로 동맥류를 치료 방법이 최근 많이 사용되고있다. 동맥류의 내부를 코일로 완전히 채우지 못하고 부분 폐색할 경우가 발생하며, 동맥류의 부분 폐색 위치에 따라 혈류 유동이 변하므로 이는 동맥류 내부의 혈전 형성에 영향을 미필 수 있다. 또한 동맥류가 발생한 모혈관의 형상에 따라 동맥류로 유입되는 유동 특성이 변하므로, 모혈관의 형상에 따라 효율적인 동맥류 폐색을 위한 코일의 위치가 변할 수 있다. 효율적인 동맥류 폐색을 위한 코일 위치를 제시하기 위하여 내경 동맥에서 발생한 측방 동맥류의 부분 폐색위치와 내경 동맥의 형상에 따른 동맥류 내부 유동장을 수치해석을 이용하여 해석하였다. 3차원 맥동 유동장은 혈액의 비뉴톤성 점성 특성을 고려하여 계산되었다. 또한 동맥류 폐색에 영향을 미치는 유체역학적 인자인 동맥류 유입 유량 및 벽전단응력을 계산하였다. 코일은 동맥류 목에 삽입하였을 경우에는 천정부에 삽입한 경우에 비해 동맥류 내부로 혈류의 유입을 감소되었다. 임계 벽전단응력 이하의 저 전단응력지역은 곡선형 모혈관에 비해 직선형 모혈관에서 컸으며, 원위부 목 폐색 모델에서 가장 크게 나타났다. 따라서 동맥류 원위부 목은 동맥류 내부로의 혈류 유입이 감소하고, 저 전단응력 지역을 크게하는 코일 위치이므로, 이 위치는 동맥류 색전술시 혈전의 형성으로 인한 동맥류 폐색에 적합한 위치로 예상된다.