• Journal of Korean Neurosurgical Society
• /
• v.45 no.1
• /
• pp.11-15
• /
• 2009

Objective : The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. Methods : We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. Results : There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was $5.47{\pm}2.536\;mm$ in anterior cerebral artery (ACA), $6.84{\pm}3.941\;mm$ in ICA, $7.09{\pm}3.652\;mm$ in MCA and $6.21{\pm}3.697\;mm$ in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. Conclusion : Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.25 no.4
• /
• pp.452-461
• /
• 2023

The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) common trunk is a rare variant of cerebral posterior circulation in which a single vessel originating from either the basilar or vertebral arteries supplies both cerebellum and brainstem territories. We present the first case of an unruptured right AICA-PICA aneurysm treated with flow diversion using a Shield-enhanced pipeline endovascular device (PED, VANTAGE Embolization Device with Shield Technology, Medtronic, Canada). We expand on this anatomic variant and review the relevant literature. A 39-year-old man presented to our treatment center with vertigo and right hypoacusis. The initial head CT/CTA was negative, but a 4-month follow-up MRI revealed a 9 mm fusiform dissecting aneurysm of the right AICA. The patient underwent a repeat head CTA and cerebral angiogram, which demonstrated the presence of an aneurysm on the proximal portion of an AICA-PICA anatomical variant. This was treated with an endovascular approach that included flow diversion via a PED equipped with Shield Technology. The patient's post-procedure period was uneventful, and he was discharged home after two days with an intact neurological status. The patient is still asymptomatic after a 7-month follow-up, with MR angiogram evidence of stable aneurysm obliteration and no ischemic lesions. Aneurysms of the AICA-PICA common trunk variants have a high morbidity risk due to the importance and extent of the territory vascularized by a single vessel. Endovascular treatment with flow diversion proved to be both safe and effective in obliterating unruptured cases.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.3
• /
• pp.175-183
• /
• 2015

Objective : Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns. Methods : Twenty-three patients with ruptured VADAn received endovascular treatment (EVT) over 7 years. The patient group included 14 women (60.9%) and 9 men (39.1%) between the ages of 39 and 72 years (mean age 54.2 years). Clinical data and radiologic findings were retrospectively analyzed. Results : Four patients had aneurysms on the dominant vertebral artery. Fourteen (61%) aneurysms were located distal to the posterior inferior cerebellar artery (PICA). Six (26%) patients had an extracranial origin of the PICA on the ruptured VA, and 2 patients (9%) had bilateral VADAns. Eighteen patients (78%) were treated with internal coil trapping. Two patients (9%) required an adjunctive bypass procedure. Seven patients (30%) required stent-supported endovascular procedures. Two patients experienced intra-procedural rupture during EVT, one of which was associated with a focal medullary infarction. Two patients (9%) exhibited recanalization of the VADAn during follow-up, which required additional coiling. No recurrent hemorrhage was observed during the follow-up period. Conclusion : EVT of ruptured VADAns based on angioarchitecture is a feasible and effective armamentarium to prevent fatal hemorrhage recurrence with an acceptable low risk of procedural complications. Clinical outcomes depend mainly on the pre-procedural clinical state of the patient. Radiologic follow-up is necessary to prevent hemorrhage recurrence after EVT.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.1
• /
• pp.66-72
• /
• 2001

Apatient with multiple dissecting aneurysms of a posterior inferior cerebellar artery trunk who presented with SAH is reported. A 58-year-old woman presented with sudden occipital headache, dizziness and vomiting. The intial vertebral angiography revealed a suspicious pearl and string sign at the proximal posterior inferior cerebellar artery(PICA) segment. After 2 weeks, follow up angiography showed a progression of the proximal PICA dissection and newly developed dissecting aneurysm of the distal PICA segment. A far lateral suboccipital transcondylar appoach confirmed two dissecting aneurysms at distant sites of the PICA trunk. The dissection segments were wrapped with muslin wrap, which preserved the flow through the PICA and brain stem perforators. The angiographys at 3 weeks and 6 months after operation revealed serial disappearance of the dissecting aneurysms which is distal to proximal. The diagnosis, course and treatment of the dissecting aneurysms of the PICA are discussed with literature review.

• Korean Journal of Digital Imaging in Medicine
• /
• v.14 no.1
• /
• pp.7-12
• /
• 2012

The purpose of this study was to examine usefulness of 3T equipment-based time-of-flight magnetic resonance angiography (3T-TOF MRA) by comparing standard technique (ST) with high resolution technique (HRT) in evaluation of cerebral blood vessel. The 3T-TOF MRA was performed for 31 patients who were suspected of having cerebrovascular disease from March to July 2010. For evaluation of cerebral blood vessel, classification was conducted randomly: group I that included vertebral artery and basilar artery, group II that ranged from 2.5cm before basin part of common carotid artery to basin part of internal and external carotid arteries and to genu part of internal carotid artery, group III that ranged from vertebral part of internal carotid artery to the first basin art of anterior and middle cerebral through education recognizes the importance of dose reduction and examine if their efforts and further reduce patient dose could achieve optimization of the medical exposure is considered.

• Journal of Korean Neurosurgical Society
• /
• v.64 no.1
• /
• pp.39-50
• /
• 2021

Objective : The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation. Methods : This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018. Results : There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Post-treatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status. Conclusion : Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.

• The Journal of the Korea Contents Association
• /
• v.11 no.3
• /
• pp.302-308
• /
• 2011

The aim of this study is to compare reference levels for radiation dose in angiography and interventional radiology. Proposed reference levels for various procedures and classification of diseases are provided by fluoroscopy time and kerma area product(KAP) rate normalizing the body habitus focusing the cerebrum. Subarachnoid hemorrhage(SAH) represents the highest KAP-rates and aneurysm represents the lowest KAP-rates. According to these types of procedures, internal carotid artery(ICA), common carotid artery(CCA), and vertebral artery(VA) show the highest KAP-rates and guglielmi detachable coil shows the lowest KAP-rates. Therefore, the present study can suggested reference levels for patient radiation dose and is expected to be further useful in the field of radiation dose education and management of angiography and interventional radiology.

• Investigative Magnetic Resonance Imaging
• /
• v.16 no.2
• /
• pp.159-168
• /
• 2012

The proximity of thoracic aortic aneurysm to the left subclavian artery (LSA) has made the coverage of LSA during thoracic endovascular aortic repair (TEVAR) be essential. Despite controversy concerning the safety of LSA coverage and the indications for LSA revascularizations, the cerebral hemodynamic change after LSA coverage has not been demonstrated. We prospectively examined two patients who would undergo TEVAR with LSA coverage by using 2D cine phase contrast MR imaging. After LSA coverage, the left subclavian steal was properly compensated by the increased flow volumes of both carotid arteries and right vertebral artery, which is the major collateral supply. The total brain supply after TEVAR did not lessen, which showed good correlation with uneventful clinical outcome. Therefore, 2D phase contrast MR imaging can be recommended as a useful technique to evaluate the hemodynamic change of the LSA coverage during TEVAR and to triage the candidate for LSA revascularization.

• Journal of the Korean Society of Radiology
• /
• v.82 no.5
• /
• pp.1281-1286
• /
• 2021

Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.5
• /
• pp.355-359
• /
• 2006

Objective : The purpose of our study is to examine the clinical significance of vertebrobasilar artery[VBA] fenestration and duplication. In addition, we review its incidence and pathogenesis. Methods : Cerebral angiography was performed in 803 patients and magnetic resonance angiography[MRA] in 880; the patients had or were suspected to have cerebrovascular disease. We retrospectively reviewed angiography and MRA. Results : Fifteen patients [eight men, seven women, 3 to 77 years of age, median age = 58 years] had a VBA fenestration and duplication. Seven [7/803 = 0.87%] of the patients undergoing cerebral angiography revealed fenestrations and one duplication of VBA. Ten patients [10/880 = 114%] among 880 patients that underwent MRA demonstrated fenestration of basilar artery[BA]. Two of 66 patients that underwent both conventional cerebral angiography and cranial MRA showed a fenestration of BA. Twelve fenestrations were located in the proximal portion of the BA and one was in the mid portion of the BA. One vertebral artery[VA] fenestration was located in the intracranial portion of the right VA, and one VA duplication was at the level of $C_{1-2}$ in the left VA. Conclusion : In addition to medial defects, flow phenomena at the proximal end of fenestrations, where hemodynamic stress and increased turbulence are present, may contribute to aneurysm formation. And arterial fenestration is a predisposing factor in vascular injury and cerebral ischemia.