• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.141-143
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• 2005

We report a case of pseudoaneurysm formation after aneurysmal clipping. An aneurysm, which was located on the beginning of orbitofrontal artery, was clipped and wrapped with $Surgicel^{(R)}$ and fibrin glue. Four weeks later, an enlarged aneurysm was detected at the same site on postoperative angiography. We could not find a new aneurysm in the second operation except inflated wrapping region. And clip had been slipped from the original aneurysmal neck. So we concluded that a new aneurysm was a pseudoaneurysm made with surgicel and fibrin glue. And it had been formed from continuous minor leakage caused by slipped clip.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.287-289
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• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.281-288
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• 2001

Objectives : The purpose of this study is to evaluate the usefulness of SSEP monitoring during intracranial aneurysm surgery and compare the characteristics of wave change in relation to neurologic changes between ACA aneurysms and MCA aneurysms. Methods : During recent three years(between January 1997 and November 1999), intraoperative SSEP monitoring had been done in 63 operations for intracranial aneurysms. We had monitored the median nerve SSEP during surgery for aneurysms of MCA and the posterior tibial nerve SSEP for aneurysms of ACoA or ACA. A more than 50% reduction of any cortical SEP response was considered to be a significant SEP change, compared to its baseline value before the start of surgery. Changes in the SEPs were categorized as follows : Type IA, no significant amplitude changes without temporary clipping ; Type IB, no significant amplitude changes with temporary clipping ; Type II, significant changes with temporary clipping and complete return to control amplitude ; Type III, significant changes with temporary clipping and incomplete return to control amplitude ; Type IV, significant changes with temporary clipping and more decreased amplitude changes. Results : Among the 63 intraoperative monitoring, there were 37 cases of ACA aneurysms(An), and 26 of MCA An. The temporary proximal arterial occlusion during surgery were performed in 31(83.8%)cases of ACA An, 22(84.6%) of MCA An. Seven of the 31 ACA An(22.6%) and ten of the 22 MCA An(45.5%) had significant changes. The type were as follows : 4 patients with type II and 3 with type III in the ACA An ; 3 patients with type II and 3 with type III and 4 with type IV in the MCA An. In both group type II changes had no new postoperative neurological deficit. All 6 patients with type III had new neurological deficits ; However, One case in the ACA An and two cases in the MCA An. had transient neurologic deficit and improved markedly over the next two months. All 4 type IV changes in the MCA An. had permanant neurologic deficits. Two out of 30 cases(6.7%) in the ACA An. and one out of 16 cases(6.3%) in the MCA An. without significant amplitude change had new neurologic deficit postoperatively. Conclusion : Based on this study, Intraoperative SSEP monitoring during aneurysm surgery would provide useful information for detecting cerebral ischemia. SSEP response during surgery for MCA An. is more sensitive than ACA An. Otherwise, there were no meaningful difference in rate of false negativity.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.269-275
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• 2016

Objective : Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. Methods : Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. Results : Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. Conclusion : Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.

• Journal of Korean Neurosurgical Society
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• v.49 no.1
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• pp.49-52
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• 2011

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.293-296
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• 2013

The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.501-504
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• 2012

Objective : To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping. Methods : A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant ($30{\times}18mm$ sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow. Conclusion : Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.337-339
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• 2001

The development of completely new intracranial aneurysms after previous successfully treated aneurysm is uncommon. A 50-year-old female presented with a case of multiple de novo aneurysm which were an aneurysm of right ophthalmic segment of internal carotid artery and an aneurysm of right A1 artery, 6 years after the clipping of an aneurysm of right posterior communicating artery. She had no history of hypertension, cigarette smoking and use of oral contraceptives, and had no evidence of genetic disorder. The laboratory findings were normal. All de novo aneurysms were clipped by basal anterior interhemispheric approach in one stage due to the direction of the aneurysm of the ophthalmic segment of the internal carotid artery.

• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.112-118
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• 2010

Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.411-417
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• 2024

Objective : To confirm the usefulness of the extradural anterior clinoidectomy during the clipping of a low riding posterior communicating artery (PCoA) aneurysm through cadaver dissection. Methods : Anatomic measurements of 12 adult cadaveric heads (24 sides total) were performed to compare the microsurgical exposure of the PCoA and internal carotid artery (ICA) before and after clinoidectomy. A standard pterional craniotomy and transsylvian approach were performed in all cadavers. The distance from the ICA bifurcation to the origin of PCoA (D1), pre-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D2), post-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D3), pre-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D4) and post-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D5) and the distance of the ICA obtained after anterior clinoidectomy (D6) were measured. We measured the precise thickness of the blade for the Yasargil clip with a digital precision ruler to confirm the usefulness of the extradural anterior clinoidectomy. Results : Twenty-four sites were dissected from 12 cadavers. The age of the cadavers was 79.83±6.25 years. The number of males was the same as the females. The space from the proximal origin of the PCoA to the preclinoid-tentorium (D4) was 1.45±1.08 mm (max, 4.01; min, 0.56). After the clinoidectomy, the space from the proximal origin of the PCoA to the postclinoid-tentorium (D5) was 3.612±1.15 mm (max, 6.14; min, 1.83). The length (D6) of the exposed proximal ICA after the extradural clinoididectomy was 2.17±1.04 mm on the lateral side and 2.16±0.89 mm on the medial side. The thickness of the Yasargil clip blade used during the clipping surgery was 1.35 mm measured with a digital precision ruler. Conclusion : The proximal length obtained by performing an external anterior clinoidectomy is about 2 mm, sufficient for proximal control during PCoA aneurysm surgery, considering the thickness of the aneurysm clips. In a subarachnoid hemorrhage, performing an extradural anterior clinoidectomy could prevent a devastating situation during PCoA aneurysm clipping.