Journal of Korean Neurosurgical Society

  • 제55권5호
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  • Pages.273-276
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  • 2014
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy

  • Kim, Ki Dae (Department of Neurosurgery, Yeungnam University Medical Center and Medical School) ;
  • Chang, Chul Hoon (Department of Neurosurgery, Yeungnam University Medical Center and Medical School) ;
  • Choi, Byung Yon (Department of Neurosurgery, Yeungnam University Medical Center and Medical School) ;
  • Jung, Young Jin (Department of Neurosurgery, Yeungnam University Medical Center and Medical School)
  • 투고 : 2013.06.25
  • 심사 : 2014.01.10
  • 발행 : 2014.05.28
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초록

Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We performed endovascular coil embolization attempting to minimize radiation exposure. She was discharged with no neurologic deficit and delivered a healthy baby by cesarean section at the 38th week of gestation. This case study reported the shortest gestational period and this is the first report on an aneurysmal rupture arising from PICA which was treated using an endovascular method. Using an appropriate technique for reduced radiation exposure to the fetus and limited alterations in maternal-fetal physiology, endovascular coil embolization could guarantee good results in treatment of aneurysmal SAH in pregnant women.

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참고문헌

  1. Botterell EH, Cannell DE : Subarachnoid hemorrhage and pregnancy. Am J Obstet Gynecol 72 : 844-855, 1956 https://doi.org/10.1016/0002-9378(56)90176-4
  2. Daane TA, Tandy RW : Rupture of congenital intracranial aneurysm in pregnancy. Obstet Gynecol 15 : 305-314, 1960
  3. Dias MS, Sekhar LN : Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery 27 : 855-865; discussion 865-866, 1990 https://doi.org/10.1227/00006123-199012000-00001
  4. Giannotta SL, Daniels J, Golde SH, Zelman V, Bayat A : Ruptured intracranial aneurysms during pregnancy. A report of four cases. J Reprod Med 31 : 139-147, 1986
  5. International Commission on Radiological Protection : Pregnancy and medical radiation. Ann ICRP 30 : iii-viii, 1-43, 2000 https://doi.org/10.1016/S0146-6453(00)00037-3
  6. Kizilkilic O, Albayram S, Adaletli I, Kantarci F, Uzma O, Islak C, et al. : Endovascular treatment of ruptured intracranial aneurysms during pregnancy : report of three cases. Arch Gynecol Obstet 268 : 325-328, 2003 https://doi.org/10.1007/s00404-002-0384-6
  7. Kuon E, Schmitt M, Dahm JB : Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding. Am J Cardiol 89 : 44-49, 2002 https://doi.org/10.1016/S0002-9149(01)02161-0
  8. Mas JL, Lamy C : Stroke in pregnancy and the puerperium. J Neurol 245 : 305-313, 1998 https://doi.org/10.1007/s004150050224
  9. Meyers PM, Halbach VV, Malek AM, Phatouros CC, Dowd CF, Lawton MT, et al. : Endovascular treatment of cerebral artery aneurysms during pregnancy : report of three cases. AJNR Am J Neuroradiol 21 : 1306-1311, 2000
  10. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005 https://doi.org/10.1016/S0140-6736(05)67214-5
  11. Mosiewicz A, Jakiel G, Janusz W, Markiewicz P : [Treatment of intracranial aneurysms during pregnancy]. Ginekol Pol 72 : 86-92, 2001
  12. Muir S, McLeod R, Dove R : Light-weight lead aprons--light on weight, protection or labelling accuracy? Australas Phys Eng Sci Med 28 : 128-130, 2005 https://doi.org/10.1007/BF03178704
  13. Ogilvy CS, Quinones-Hinojosa A : Surgical treatment of vertebral and posterior inferior cerebellar artery aneurysms. Neurosurg Clin N Am 9 : 851-860, 1998
  14. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB : Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 29 : 86-90, 2008 https://doi.org/10.3174/ajnr.A0758
  15. Piotin M, de Souza Filho CB, Kothimbakam R, Moret J : Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy. Am J Obstet Gynecol 185 : 1261-1262, 2001 https://doi.org/10.1067/mob.2001.115861
  16. Pool JL : Treatment of intracranial aneurysms during pregnancy. JAMA 192 : 209-214, 1965 https://doi.org/10.1001/jama.1965.03080160029007
  17. Pumar JM, Pardo MI, Carreira JM, Castillo J, Blanco M, Garcia-Allut A : Endovascular treatment of an acutely ruptured intracranial aneurysm in pregnancy : report of eight cases. Emerg Radiol 17 : 205-207, 2010 https://doi.org/10.1007/s10140-009-0848-0
  18. Riviello C, Ammannati F, Bordi L, Lamassa M, Mennonna P, Parretti E, et al. : Pregnancy and subarachnoid hemorrhage: a case report. J Matern Fetal Neonatal Med 16 : 245-246, 2004 https://doi.org/10.1080/jmf.16.4.245.246
  19. Schwartz J : Pregnancy complicated by subarachnoid hemorrhage. Am J Obstet Gynecol 62 : 539-547, 1951 https://doi.org/10.1016/0002-9378(51)91152-0
  20. Stoodley MA, Macdonald RL, Weir BK : Pregnancy and intracranial aneurysms. Neurosurg Clin N Am 9 : 549-556, 1998
  21. Tarnaris A, Haliasos N, Watkins LD : Endovascular treatment of ruptured intracranial aneurysms during pregnancy: is this the best way forward? Case report and review of the literature. Clin Neurol Neurosurg 114 : 703-706, 2012 https://doi.org/10.1016/j.clineuro.2011.11.025
  22. Youmans JR, Winn HR : Youmans Neurological Surgery, ed 6. Philadelphia : Saunders/Elsevier, 2011

피인용 문헌

  1. Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature vol.21, pp.6, 2014, https://doi.org/10.1177/1591019915609134
  2. Management of intracranial pathology during pregnancy: Case example and review of management strategies vol.6, pp.None, 2015, https://doi.org/10.4103/2152-7806.153845
  3. Endovascular treatment of a ruptured internal carotid artery aneurysm in early pregnancy: a case report vol.38, pp.4, 2014, https://doi.org/10.3995/jstroke.10356