• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.258-264
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• 2007

Objective : The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. Methods : From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: $54.8{\pm}13.1$ years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. Results : In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: $54.9{\pm}13.2$ years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was $7.8{\pm}1.7$, $10.5{\pm}2.7$, and $9.1{\pm}2.1$ per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was $8.8{\pm}1.4$, $11.2{\pm}1.3$ and $10.0{\pm}1.0$, respectively in the coastal regions of Youngdong district from 1999 to 2006. Conclusion : In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.187-189
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• 2013

We report an unusual case of cerebral aneurysmal subarachnoid hemorrage (SAH) with Fabry's disease. A 42-year-old woman presented with aneurysmal SAH originated from a saccular aneurysm of the right posterior communicating artery. The patient was treated by an endovascular coil embolization of aneurysm. Postoperatively the patient recovered favorably without any neurological deficit. During her admission, the patient had a sign of proteinuria in urine analysis. The pathologic findings of kidney needle biopsy implied nephrosialidosis (mucolipidosis of lysosomal stroage disease), which is consistent with a Fabry's disease. It is uncommon that Fabry's disease is presented with aneurysmal SAH, especially in middle-aged patients, but could be a clinical concern. Further investigations are needed to reveal risk factors, vascular anatomy, and causative mechanisms of Fabry's disease with aneurysmal SAH.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.100-104
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• 2007

Objective : Despite the widespread use of preoperative ventriculostomy in aneurysmal subarachnoid hemorrhage [SAH], there is no general consensus regarding the risk of bleeding associated with its use before aneurysm repair. This study was conducted to define the efficacy and rebleeding risk of ventriculostomy in aneurysmal SAH. Methods : The authors reviewed 339 consecutive patients with aneurysmal SAH who were treated at our hospital between January 1998 and December 2004. Results : Preoperative ventriculostomy was performed on 73 patients for acute hydrocephalus after aneurysmal SAH. The Hunt-Hess[H-H] grades of patients who underwent ventriculostomy were higher. Out of the 73 patients who underwent preoperative ventriculostomy, 58 [79%] demonstrated immediate clinical improvement after ventriculostomy. Of those same 73 patients 22 [30%] suffered aneurysmal rebleeding, whereas only 11 [4%] of the 266 patients who did not undergo ventriculostomy showed preoperative aneurysm rebleeding. The causes of rebleeding in the 22 patients who underwent ventriculostomy before surgery were related to the ventriculostomy procedure itself, subsequent cerebrospinal fluid [CSF] drainage, angiography and patient care procedures, such as endotracheal suction and nursing care. The mean time interval between SAH and surgery in the patients who underwent ventriculostomy was not statistically different from those who did not receive preoperative ventriculostomies [44.66 compared with 42.13 hours; p=0.73]. Conclusion : The preoperative ventriculostomy improved patients' clinical condition but increased the risk of rebleeding after aneurysmal SAH. When necessary, however, rapid change in transmural pressure during ventriculostomy must be avoided, careful management during ventricular drainage is needed, and surgery should be performed as soon as possible to prevent or reduce the incidence of rebleeding.

• Journal of Korean Neurosurgical Society
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• 제41권3호
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• pp.153-156
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• 2007

Objective : Cerebral vasospasm is a devastating medical complication of aneurysmal subarachnoid hemorrhage [SAH]. Therefore, prompt detection of vasospasms in aneurysmal SAH is important to the clinical outcome of the patient. For better prediction and effective management of vasospasms, identifying risk factors is essential. This study is aimed at evaluating the relationship between clinical hematologic values, especially white blood cell count, and cerebral vasospasms. Methods : A retrospective review was conducted on 249 patients with aneurysmal SAH who underwent surgical clipping [230 cases] or endovascular intervention [19 cases] between 2003 and 2005. The underlying clinical conditions assessed were leukocytosis, fever, hypertension, diabetes, smoking, Hunt and Hess grade, Fisher grade, aneurysm location, and direct clipping versus endovascular intervention. Results : Two hundred forty-nine patients were treated for aneurysmal SAH during this period. We selected 158 patients in Hunt and Hess grade I - III. Cases of infectious conditions, rebleeding and other surgical/clinical complications were excluded. Vasospasms occurred $7.0{\pm}3.1$ days after the onset of SAH. There were several independent predictors of vasospasm : Fisher grade III [p=0.002], fever within two weeks on admission [p<0.001], and a serum leukocyte count >$10.8{\times}10^3/mm^3$ on admission [p=0.018]. Conclusion : This study results indicate that leukocytosis and fever increase the risk of vasospasms. However, other known risk factors, such as hypertension and smoking, were not correlated with respect to predicting of cerebral vasospasm. Monitoring the serum leukocyte count may be a helpful and useful marker of vasospasms after aneurysmal SAH.

• Journal of Korean Neurosurgical Society
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• 제38권1호
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• pp.1-11
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• 2005

Objective : The purpose of this study is to evaluate the correlation of the ICAM-l levels in serum and CSF with cerebral vasospasm in early aneurysmal subarachnoid hemorrhage [SAH] patients. Methods : A prospective analysis was performed in thirty consecutive patients who underwent early surgery for intracranial aneurysmal SAH. The serum and CSF were obtained daily through the indwelling arterial lines and intraoperative ventriculostomy, or cisternal drain for 4 consecutive days after surgery. The ICAM-1 levels in serum and CSF samples were measured via quantitative enzyme-linked immunosorbent assay. Results : The mean concentration of serum in aneurysmal SAH patients was 207.89ng/ml compared with 132.25ng/ml in controls. The mean concentration of CSF in aneurysmal SAH patients was 76.39ng/ml compared with 3.96ng/ml in controls. There were no significant differences between serum and CSF ICAM-1 level with regards to clinical characteristics in patients with aneurysmal SAH [P>0.05]. However, CSF ICAM-1 levels increased significantly in patients with vasospasm compared with those without vasospasm [P<0.05]. Conclusion : The major result of this study shows that ICAM-1 is increased in CSF after early aneurysmal SAH and that this increase in ICAM-1 has correlation with cerebral vasospasm. Further study is needed to determine whether ICAM-1 levels may be indicator in the pathogenesis of important events leading to cerebral vasospasm.

• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.125-129
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• 2006

Objective : The purpose of this study is to identify any differential point in computerized tomographic[CT] findings between aneurysmal subarachnoid hemorrhage[ASAH] and traumatic subarachnoid hemorrhage[TSAH], which sometimes make us not confident in differentiation. Methods : CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. Results : Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. Conclusion : As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH > 1mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.

• Journal of Korean Neurosurgical Society
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• 제43권4호
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• pp.177-181
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• 2008

Objective : Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. Methods : Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (${\geqq}14$ days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. Results : Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not show significant correlation of development of shunt-dependent chronic hydrocephalus. Conclusion : Hydrocephalus after aneurysmal subarachnoid hemorrhage seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.526-535
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• 2019

Objective : While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. Methods : Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. Results : In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p=0.032). Cerebral angiography after SAH was performed on 88 patients ${\leq}3$ hours, 74 patients between 3-6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ${\leq}3$ hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. Conclusion : Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.124-127
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• 2010

Objective : The incidence of subarachnoid hemorrhage (SAH) worldwide varies considerably. In spite of many reports about the incidence of SAH, there has been no report about the incidence of SAH on the basis of the Korean population. The purpose of this hospital-based study was to assess the actual incidence rates of aneurysmal SAH in Gwangju city and Jeollanamdo province. Methods : All cases of SAH confirmed by computerized tomography (CT) between January 2007 and December 2007 were selected for analysis. For the data collection, three major training hospital and ten general hospitals working the CT in Gwangju city and four major general hospitals in Jeollanamdo province participate in this study. Results : According to the official census of Korea, the population was 1,413,444 in Gwangju city and 1.929,836 in Jeollanamdo province in 2007. There were 163 patients in Gwangju city and 266 patients in Jeollanamdo province confirmed SAH by CT in 2007. The crude and the age- and sex-adjusted annual incidence rates per 100,000 population for all ages in Gwangju city were 11.5 and 12.4 for aneurysmal SAH and in Jeollanamdo province were 13.8 and 10.8. The incidence was higher in women and increased with age. The gender distribution varied with age. At young ages. the incidence was higher in men while after the age of 40 years, the incidence was higher in women. Conclusion : In the present study, the age- and sex-adjusted annual incidence rates is 11.8 in Gwangju city and Jeollanamdo province. The incidence was higher in women and increased with age.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1476-1483
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• 2000

Objectives : The incidence of acute hydrocephalus(AHC) after aneurysmal subarachnoid hemorrhage reported as 13-31%. The AHC resolves spontaneously in some cases(simple AHC), but about 30% of the AHC progresses to shunt-dependent hydrocephalus(SDHC). The aim of this study was to understand clinical predisposing factors causing SDHC with performing differential clinical analyses between 2 subgroups, the simple AHC and the progresed SDHC. Methods : The 250 surgically treated patients with aneurysmal SAH over last two years were evaluated. Forty four patients(17.6%) of them showed the AHC. Of theses 37 cases were retrospectively analyzed, excluding 7 patients who died within 2 weeks after hemorrhage attack. Of the 37 AHC cases, 21 patient(56.8%) were complicated with the simple AHC, and 16 cases(43.2%) were progressed SDHC. Results : The older age(p<0.05), poor clinical grade(p＝0.03), larger amount of SAH in perimesencephalic cistern on CT scan(p＝0.005) were significantly related to the SDHC. No significant difference was noted in aneurysm location, multiplicity, rebleeding, hypertension and Fisher grade between 2 subgroups. Conclusion : Of the total 37 AHC, the simple AHC was 56.8% and the progressed SDHC 43.2%. The older age, poor clinical grade, large amount of SAH in perimesencephalic cistern were significant predisposing factors causing the SDHC. The large amount of SAH in perimesencephalic cistern is the single most important predisposing factor developing the progressed SDHC.