• Journal of Korean Neurosurgical Society
• /
• 제40권2호
• /
• pp.131-134
• /
• 2006

The cerebral vasospasm after clipping surgery of unruptured aneurysm is uncommon. A 44-year-old man with unruptured left middle cerebral artery[MCA] aneurysm had clipping surgery. From the third postoperative day, he presented with drowsy mentality, dysphasia and right hemiparesis. Computed tomographic scans showed low density area in frontotemporal lobe and midline shift. Transfemoral cerebral angiography revealed severe vasospasm in supraclinoid internal carotid artery, anterior cerebral artery, and MCA on the operative side. We performed left frontotemporoparietal craniectomy and hypertensive-hypervolemic therapy. He recovered without neurological deficits but for dysphasia. Neurosurgeon should be alert to the possibility of vasospasm after clipping surgery even in case of unruptured cerebral aneurysm.

• Journal of Korean Neurosurgical Society
• /
• 제64권4호
• /
• pp.665-670
• /
• 2021

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

• Journal of Korean Neurosurgical Society
• /
• 제52권3호
• /
• pp.243-245
• /
• 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
• /
• 제48권5호
• /
• pp.434-437
• /
• 2010

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

• Journal of Korean Neurosurgical Society
• /
• 제30권5호
• /
• pp.657-661
• /
• 2001

Intracranial giant aneurysms have been known to cause clinical signs and symptoms, either by rupture, compression of surrounding structures, repeated minor leakage, or cerebral ischemia due to thromboembolism. A giant aneurysm which manifests only a seizure disorder comprises relatively few contributions. The authors present a case of a giant, unruptured aneurysm solely presenting with generalized tonic-clonic type seizure in a 43-year-old man. Brain computed tomogram(CT) and 3-D CT angiogram demonstrated a huge calcified aneurysm at the bifurcation of right middle cerebral artery. Complete neck clipping and aneurysmectomy followed by uneventful neurologic recovery.

• Journal of Korean Neurosurgical Society
• /
• 제42권3호
• /
• pp.235-237
• /
• 2007

We describe a case of an unruptured basilar top aneurysm that was associated with early rupture after incomplete coiling. A 62-year-old woman with a history of several small infarctions has undergone coiling of unruptured basilar top aneurysm. Two weeks after initial coiling the patient presented with Hunt and Hess grade IV subarachnoid hemorrhage consistent with a ruptured basilar top aneurysm. Repeat angiography revealed a rupture of recanalized basilar top aneurysm. Second embolization with additional coils resulted in complete occlusion. However, her neurological status was not improved afterward and she was transferred to department of rehabilitation one month after hemorrhage with comatous state. To our knowledge, this is the first case of fatal early rupture after coiling of unruptured aneurysm. It has been speculated that coiling could cause injury to aneurysmal wall and facilitate rupture.

• Journal of Korean Neurosurgical Society
• /
• 제29권6호
• /
• pp.832-835
• /
• 2000

A case of unruptured cerebral aneurysm at the junction of accessory middle cerebral artery and the distal portion of the $A_1$ segment of the anterior cerebral artery is reported. To the authors' knowledge, this is the first reported case of cerebral aneurysm developed at the junction of accessory middle cerebral artery, demonstrated on magnetic resonance angiography(MRA). The accessory middle cerebral artery is a rare vascular variant of middle cerebral artery. Furthermore, it is extremely rare for an aneurysm to be developed at the origin of the accessory middle cerebral artery. The development of the accessory middle cerebral artery is very important in surgery of cerebral aneurysm and collateral circulation of cerebral infarction. Review of the literature regarding the genesis and anatomical variation of the accessory middle cerebral artery is also presented.

• Journal of Korean Neurosurgical Society
• /
• 제59권6호
• /
• pp.564-569
• /
• 2016

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

• Journal of Korean Neurosurgical Society
• /
• 제42권6호
• /
• pp.478-480
• /
• 2007

Unruptured non-traumatic dissecting aneurysm in the M4 segment of the middle cerebral artery (MCA) accompanied by complete occlusion of the ipsilateral internal cerebral artery (ICA) has never been reported. A 41-year-old man presented with an infarction manifesting as left-sided weakness and dysarthria. Magnetic resonance angiography revealed a subacute stage infarction in the right MCA territory and complete occlusion of the right ICA. Angiography demonstrated aneurysmal dilatation of the M4 segment of the right MCA. Surgery was performed to prevent hemorrhage from the aneurysm. The aneurysm was proximally clipped guided by Navigation-CT angiography and flow to the distal MCA was restored by superficial temporal artery-middle cerebral artery (STA-MCA) anastornosis. We report this rare case with literature review.

• Journal of Korean Neurosurgical Society
• /
• 제60권5호
• /
• pp.518-526
• /
• 2017

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.