• Clinical and Experimental Pediatrics
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• 제49권3호
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• pp.287-291
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• 2006

목 적 : 발살바동 동맥류는 선천성으로 발생하며 비교적 드문 질환이나 파열시 급성 심부전으로 진행되어 사망할 수 있으므로 수술만이 유일한 치료방법이다. 이에 저자는 지난 14년간 발살 바동 동맥류 파열로 수술을 받은 환자들을 대상으로 임상적 특징 및 수술 결과에 대하여 알아보고자 하였다. 방 법 : 이번 연구는 1990년 1월부터 2004년 2월까지 경북대학교병원에서 발살바동 동맥류 파열로 진단 받은 17명의 환자를 대상으로 임상증상, 이학적 소견, 과거병력, 동반 심질환 유무, 수술소견 및 장기적인 예후에 대하여 조사하였다. 결 과 : 남자가 13례, 여자가 4례 였으며, 평균연령은 $30{\pm}12.5$세(10-59세)였다. 술전 시행한 초음파 검사상 동반된 심질환으로는 심실 중격 결손이 8례(모두 이중연관 동맥하 결손), 대동맥 폐쇄부전이 11례에서 관찰되었다. 수술 소견상 누공의 위치는 우관상 동맥동-우심실 13례, 우관상 동맥동-우심방 1례, 비관상동맥동-우심실 2례 그리고 비관상 동맥동-우심방이 1례였으며, 심실 중격 결손이 14례에서 관찰되었으며, 모두 이중연관 동맥하결손이었다. 수술방법은 13례에서 첩포봉합, 4례에서 단순봉합을 실시하였으며, 대동맥판막 치환술은 4례, 대동맥판막 성형술은 2례에서 시행되었다. 수술로 인한 사망은 한 례도 없었으며, 추적 관찰기간($40{\pm}49$개월) 중 심질환으로 사망한 례도 없었다. 결 론 : 발살바동 동맥류는 많은 환자에서 심실 중격 결손, 특히 이중연관 동맥하 결손을 동반하므로, 심초음파 검사를 시행할 때 이 결손을 찾기 위해 세밀한 주의가 필요하다. 나아가서 크기가 작은 이중연관 동맥하 심실 중격 결손의 치료 방침도 재조명할 필요가 있을 것이다.

• 대한영상의학회지
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• 제83권4호
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• pp.887-897
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• 2022

목적 심각한 증상이 없는 파열된 급성뇌동맥류에서 스텐트를 이용한 코일 색전술 기법의 안전성과 유효성을 평가하고, 지주막하출혈 환자에서 스텐트 자체의 유용성을 평가해 보고자 한다. 대상과 방법 2017년 1월부터 2019년 6월까지 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류에 대해 코일 색전술로 치료받은 118명의 환자를 대상으로 하였다. 스텐트를 사용한 56명과 스텐트를 사용하지 않은 62명에 대해 시술 이후 합병증, 6개월 수정 랜킨척도, 6개월 영상의학적 결과에 대해 비교하였다. 결과 스텐트를 사용한 군과 스텐트 사용하지 않은 군에서 좋은 임상 결과의 비율(수정 랜킨척도 2 이하)과 출혈성 및 허혈성 합병증의 비율은 유의한 차이를 보이지 않았다. 그러나 스텐트를 사용한 군은 6개월 추적 뇌혈관조영술에서 재개통률이 낮았다(20.0% 대 39.3%, p = 0.001). 결론 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류의 코일 색전술에서 스텐트의 사용은 임상 결과와 유의한 관련성이 없었다. 스텐트를 사용함으로써 추적 뇌혈관조영술에서 재개통률이 감소하였다.

• Journal of Korean Neurosurgical Society
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• 제48권2호
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• pp.115-118
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• 2010

Objective : Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice versa during endosaccular embolization for recovering from CN III palsy, because it may give a greater chance for the daughter sac to shrink by itself later. We reviewed the initial results of our experiences of such cases. Methods : Among 9 aneurysms accompanied by CN III palsy, 7 (6 unruptured, 1 ruptured) showed a daughter sac. We tried to fill the main dome completely and spare the daughter sac from coil filling to increase the possibility of decompression. We evaluated the short-term effectiveness of this concept using medical records and angiograms. Results : After initial embolization, all of CN III palsy caused by unruptured aneurysms (6/6) resolved completely after various periods (3-90 days) of time. No adverse effects were noted during and after the procedures except for one case of harmless coil stretching during coil filling using double microcatheter. Conclusion : During the coil embolization of the cerebral aneurysm causing CN III palsy, sparing the daughter sac from coil packing while tightly packing the main dome, can be helpful in increasing the effectiveness of decompression. However, a long-term follow-up will be required.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.73-77
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• 2001

Object : To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. Method : Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. Result : Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. Conclusion : Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.918-922
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• 2000

Objective : The authors analyzed the results of management outcomes for basilar bifurcation aneurysms treated with transcranial surgery and endovascular surgery. Methods : At the authors' institution between May 1989 and December 1998, 47 aneurysms with 45 patients were treated with transcranial surgery including surgical clipping/wrapping and endovascular surgery for basilar bifurcation aneurysms. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Of the 45 patients, 87 percent of the aneurysms were ruptured and 13% unruptured. Forty six percent of the patients had multiple aneurysms including basilar bifurcation aneurysm. Of the 39 patients with subarachnoid hemorrahge, 77% were in good neurological status(Hunt Hess grade I-III), 23% were in poor grade(H-H grade IV-V). Thirty two patients were treated with transcranial surgery and 15 patients were treated with endovascular surgery. Two patients who had treated with wrapping surgery later bled during follow-up period and treated with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I 66%, GOS II 12.5%, GOS III 6.3%, GOS IV 6.3% and GOS V(death) 9.4%. The major causes of morbidity related to transcranial surgery were perforator occlusion, vasospasm and retraction injury. The management outcome of the endovascular surgery was : GOS I 66.7%, GOS II 6.7%, and GOS V 26.7%. The major causes of mortality related to endovascular surgery were related to intraoperative aneurysmal bleeding. Conclusion : This report documents that more than 75% of patients undergoing treatment either transcranial or endovascular surgery can expect good clinical outcomes. Treatment modality in management of basilar bifurcation aneurysm must be carefully selected based on various considering factors.

• Clinical and Experimental Pediatrics
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• 제48권6호
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• pp.655-659
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• 2005

저자들은 발열과 끙끙거림을 주소로 내원한 2개월 된 소아에서 빈도가 드문 선천성 식도 중복의 감염, 파열로 인하여 농흉, 유미흉과 종격동염을 초래하고 이로 인하여 대동맥류를 초래한 1례를 경험하였기에 보고하고자 한다. 본 증례의 희귀함과 종격동염, 농흉, 대동맥류와 같은 다양한 합병증의 발생은 식도 중복을 진단하는데 있어서 어려운 점이었다.

• Journal of Korean Neurosurgical Society
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• 제44권5호
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• pp.314-319
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• 2008

Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.159-166
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• 2015

Objective : We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. Methods : A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). Results : Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. Conclusion : Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.136-140
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• 2008

Objective : Numerous studies have compared the characteristics of familial intracranial aneurysms with those of non-familial aneurysms. To better understand familial subarachnoid hemorrhage (SAH), we studied a series of patients with SAH who had at least one first-degree relative with SAH, and compared our results with those of previous studies. Methods : We identified patients treated for SAH at our hospital between January 1993 and October 2006 and analyzed those patients with one or more first-degree relatives with SAH. We retrospectively collected data from patients with a family history and searched for patients who had relatives with aneurysms or who had been treated at other hospitals for SAH. Results : We identified 12 patients from six families with at least two first-degree relatives with SAH. All patients had affected first-degree relatives; in five families, they were siblings. The mean age at the time of rupture was 49.75 years; in four families, the age difference was within 5 years. In five patients (42%), the aneurysm was located in the middle cerebral artery. Only one patient had an aneurysm in the anterior communicating artery. Conclusion : In agreement with previous studies, our results showed that familial aneurysms, in comparison with non-familiar aneurysms, ruptured at a younger age and smaller size, had a high incidence in the middle cerebral artery, and were underrepresented in the anterior communicating artery. Interestingly, the age at the time of rupture was similar between relatives. Screening should be considered in the fifth or sixth decade for those who have a sibling with SAH.

• Journal of Korean Neurosurgical Society
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• 제39권4호
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• pp.286-291
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• 2006

Objective : We evaluate the effect of the copolymer-coated coils on immediate occlusion of the aneurysm, preventing rupture, and decreasing compaction or re-growth. Methods : Thirty-five aneurysms treated between September 2003 and December 2004 using Matrix detachable coil were reviewed. Study population consisted of 12 men and 23 women ranging in age from 34 to 75 years[mean, 55.1 years]. Twenty-two aneurysms were ruptured and 23 aneurysms were located in the anterior circulation. Follow-up angiography was obtained in 16 patients after 6 months from the procedure. Results : Initial complete occlusion was achieved in 17 aneurysms[48.6%], and the others remained as a residual neck in 8 aneurysms[22.8%] and residual sac in 10 aneurysms[28.6%]. Among these incompletely occluded aneurysms, 7 aneurysms were performed follow-up angiography. And 6 of them converted into complete occlusion. In the other hands, among 17 aneurysms achieved complete occlusion initially, 9 aneurysms were performed follow-up angiography. Recurrence due to coil compaction occurred in one aneurysm and the others maintained complete occlusion. There was one mortality case due to thromboembolic complication. Conclusion : In spite of difficulty in achieving complete occlusion with Matrix coil system, there is no rupture or re-rupture during follow-up period. Follow-up angiography shows many conversions of residual sac into complete occlusion. Embolization using Matrix coil system is safe and effective, but the effects of PGLA copolymer need further investigation.