Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제13권3호
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  • Pages.160-169
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  • 2011
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  • 2234-8565(pISSN)
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  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
권호 표지

Endovascular or Microsurgical Treatment of Ruptured Distal Anterior Cerebral Artery Aneurysms : Clinical Outcomes and Technical Considerations

  • Koh, Hack Cheol (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong) ;
  • Koh, Jun Seok (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong) ;
  • Lee, Seung Hwan (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong) ;
  • Lee, Sun Joo (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong) ;
  • Kim, Gook Ki (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong) ;
  • Lim, Young Jin (Department of Neurosurgery, Kyung Hee University Medical Center Seoul)
  • 발행 : 2011.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : To analyze the clinical characteristics and outcomes of ruptured distal anterior cerebral artery (DACA) aneurysms and to discuss optimal treatment strategy. Methods : Out of 488 patients with ruptured intracranial aneurysms, 24 were treated for DACA aneurysms between February 2001 and January 2009. The medical records, radiological data and outpatient clinic charts of these patients were retrospectively reviewed. Results : The 24 patients (6 men, 18 women) had a mean age of 52 years (range, 30-70). Among the 24 patients, 6 underwent coiling and 17 underwent clipping. Fifteen patients had a Hunt-Hess grade of II, 5 with III 3 with IV and 1 had a grade of V. Nine patients had a Fisher grade of II, 1 with III and 14 had a grade of IV. Twenty-one (88%) patients had a good clinical course after treatment with endovascular (5 of 6 patients, 83%) or surgical (16 of 18 patients, 89%) treatments. Nineteen of 20 patients (95%) with good preoperative states (Hunt-Hess grade I-III) and 2 of the 4 patients (50%) with poor preoperative states (Hunt-Hess grade IV and V) demonstrated good clinical outcomes with Glasgow Outcome Scale (GOS) scores of 4-5. Two patients (8%) died due to pneumonia or preoperative severe brain damage. Conclusions : Acceptable and favorable outcomes were achieved in patients with good preoperative states who were treated with either clipping or coiling of ruptured DACA aneurysms. Immediate and active treatment should be mandatory for favorable outcomes.

키워드

참고문헌

  1. de Sousa AA, Dantas FL, de Cardoso GT, Costa BS. Distal anterior cerebral artery aneurysms. Surg Neurol 52:128-36, 1999 https://doi.org/10.1016/S0090-3019(99)00066-X
  2. Dinc C, Iplikcioglu AC, Bikmaz K. Distal anterior cerebral artery aneurysms: report of 26 cases. Neurol Med Chir (Tokyo) 46:575-80, 2006 https://doi.org/10.2176/nmc.46.575
  3. Hernesniemi J, Tapaninaho A, Vapalahti M, Niskanen M, Kari A, Luukkonen M. Saccular aneurysms of the distal anterior cerebral artery and its branches. Neurosurgery 31:994-8, 1992 https://doi.org/10.1227/00006123-199212000-00002
  4. Huang Q, Shen J, Xu Y, Liu J. Endovascular treatment of ruptured distal anterior cerebral artery aneurysm. Neurol India 58:259-63, 2010 https://doi.org/10.4103/0028-3886.63809
  5. Inci S, Erbengi A, Ozgen T. Aneurysms of the distal anterior cerebral artery: report of 14 cases and a review of the literature. Surg Neurol 50:130-9, 1998 https://doi.org/10.1016/S0090-3019(97)00344-3
  6. Kawashima M, Matsushima T, Sasaki T. Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy. J Neurosurg 99:517-25, 2003 https://doi.org/10.3171/jns.2003.99.3.0517
  7. Keston P, White PM, Horribine L, Sellar R. The endovascular management of pericallosal artery aneurysms. J Neuroradiol 31:384-90, 2004 https://doi.org/10.1016/S0150-9861(04)97021-6
  8. Kuwabara S, Ishikawa S, Andoh S, Matsumoto S, Sekimoto H, Uemura Y et al. Aneurysms of the distal anterior cerebral artery. Report of 18 cases and review of 191 reported cases. Neurol Med Chir (Tokyo) 24:580-90, 1984 https://doi.org/10.2176/nmc.24.580
  9. Laitinen L, Snellman A. Aneurysms of the pericallosal artery: A study of 14 cases verified angiographically and treated mainly by direct surgical attack. J Neurosurg 17:447-58, 1960 https://doi.org/10.3171/jns.1960.17.3.0447
  10. Lehecka M, Porras M, Dashti R, Niemela M, Hernesniemi JA. Anatomic features of distal anterior cerebral artery aneurysms: a detailed angiographic analysis of 101 patients. Neurosurgery 63:219-28, 2008 https://doi.org/10.1227/01.NEU.0000310695.44670.32
  11. Mann KS, Yue CP, Wong G. Aneurysms of the pericallosal-callosomarginal junction. Surg Neurol 21:261-6, 1984 https://doi.org/10.1016/0090-3019(84)90199-X
  12. Menovsky T, van Rooij WJ, Sluzewski M, Wijnalda D. Coiling of ruptured pericallosal artery aneurysms. Neurosurgery 50:11-4, 2002
  13. Miyazawa N, Nukui H, Yagi S, Yamagata Z, Horikoshi T, Yagishita T et al. Statistical analysis of factors affecting the out-come of patients with ruptured distal anterior cerebral artery aneurysms. Acta Neurochir (Wien) 142:1241-6, 2000 https://doi.org/10.1007/s007010070020
  14. Oshiro S, Tsugu H, Sakamoto S, Nonaka M, Iwaasa M, Hayashi S et al. Ruptured aneurysm of the distal anterior cerebral artery: clinical features and surgical strategies. Neurol Med Chir (Tokyo) 47:159-63, 2007 https://doi.org/10.2176/nmc.47.159
  15. Proust F, Toussaint P, Hannequin D, Rabenenoina C, Le Gars D, Freger P. Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke 28:2405-9, 1997 https://doi.org/10.1161/01.STR.28.12.2405
  16. Snyckers FD, Drake CG. Aneurysms of the distal anterior cerebral artery: A report on 24 verified cases. S Afr Med J 47:1787-91, 1973
  17. Steven DA, Lownie SP, Ferguson GG. Aneurysms of the distal anterior cerebral artery: results in 59 consecutively managed patients. Neurosurgery 60:227-33, 2007 https://doi.org/10.1227/01.NEU.0000249267.33945.E7
  18. Traynelis VC, Dunker RO. Interhemispheric approach with callosal resection for distal anterior cerebral artery aneurysms. Technical note. J Neurosurg 77:481-3, 1992 https://doi.org/10.3171/jns.1992.77.3.0481
  19. Vora N, Thomas AJ, Gupta R, Gologorsky Y, Panapitiya N, Jovin T et al. Endovascular treatment of distal anterior cerebral artery aneurysms: technical results and review of the literature. J Neuroimaging 20:70-3, 2010 https://doi.org/10.1111/j.1552-6569.2008.00324.x
  20. Yasargil MG, Carter LP. Saccular aneurysms of the distal anterior cerebral artery. J Neurosurg 40:218-23, 1974 https://doi.org/10.3171/jns.1974.40.2.0218