• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.231-239
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• 2000

Objectives : A postoperative hydrocephalus is compromises the clinical outcome of patients with aneurysmal clippings as one of the major complications of SAH. Subdural hygroma is often complicated after aneurysmal clippings, which subsides spontaneously as simple hygroma, or progresses to shunt-dependent hydrocephalus (SDHC). To predict development of SDHC from the hygroma, and to improve clinical outcome of patients with aneurysmal clippings, we analyzed clinical predisposing factors between 2 subgroups, simple hygroma and SDHC. Patients and Methods : A retrospective study of 232 consecutive cases of clipped aneurysmal patient was undertaken in our hospital for last two years. The 46 patients(19.8%) developed hygromas after aneurysmal clippings. There were 22 cases with simple hygroma(9.5%), and 24 patients with SDHC(10.3%). Comparison of 2 subgroups was made for various clinical and radiological factors. Results : Older age(p＝0.03), poor preoperative clinical grade(p＝0.01), high Fisher grade(p＝0.005), large amount of hygroma(p＝0.014) and increased size of lateral ventricle ipsilateral to hygroma(p＝0.001) were correlated significantly with SDHC. There was no statistical significance in sex, aneurysmal location and presence of acute preoperative ventricular dilatation between 2 subgroups. Conclusion : The clinical factors, such as older age, poor preoperative clinical grade, high Fisher grade, large amount of hygroma and increased size of lateral ventricle ipsilateral to hygroma showed statistical sinificance for differentiating SDHC from simple hygroma.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.99-107
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• 2001

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.134-136
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• 2007

A woman who had a spontaneous subarachnoid hemorrhage [SAH] and temporal intracerebral hemorrhge [ICH] without any causative lesions on computed tomography [CT] and digital angiography at the day of the stroke. She was considered to have an angiographically negative SAH and scheduled for a repeated angiography. While she was waiting for the next study, she developed a second hemorrhage. CT angiography showed an aneurysmal shadow in the course of the posterior cerebral artery. After the operation, the aneurysm proved to be a pseudoaneurysm.

• The Journal of Internal Korean Medicine
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• v.42 no.2
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• pp.197-206
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• 2021

Subarachnoid hemorrhage (SAH) is a disease that causes bleeding in the subarachnoid space; 70%-80% of nontraumatic subarachnoid hemorrhages are caused by saccular aneurysms. If the patient has already experienced a ruptured aneurysm that causes subarachnoid bleeding, rebleeding can result in a high mortality rate and serious sequelae. Therefore, if the patient can undergo surgical or interventional treatment, it should always be performed. This patient was diagnosed with acute aneurysmal subarachnoid hemorrhage and hydrocephalus. The patient was hospitalized for uncontrolled headache and vertigo after aneurysm coil embolization and ventriculoperitoneal shunting. The patient was treated with Yangkyuksanwha-tang and acupuncture and was observed with a symptom checklist for 25 days. Headache improved, from a visual analog scale (VAS) score of 7 to 0. Vertigo also improved, from a numeric rating scale (NRS) of 6 to 2, and the vertigo pattern changed from rotational to nonrotational. This case suggests that Korean medicine treatment is helpful in managing subarachnoid hemorrhage sequelae.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.717-723
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• 2001

Objective : Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. Materials and Methods : From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups ; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. Results : Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p>0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. Conclusion : According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.167-171
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• 2012

Objective : The aim of this study was to compare clinical characteristics of ruptured aneurysms in young adults, of the third and fourth decades of life, and to compare several clinical characteristics affecting the outcome of patients. Methods : We retrospectively investigated 1459 patients who underwent surgery and endovascular treatment for ruptured cerebral aneurysms from June 1992 to December 2010 and compared clinical characteristics. We also reviewed pre-existing medical conditions and perioperative complications. Results : Among 1459 patients, there were 21 patients (1.44%) in the third decade and 104 patients (7.13%) in the fourth decade of life. Within two age groups, 88 (70.4%) were male and 37 (29.6%) were female, a ratio of 2.37 : 1. In both groups, we observed the anterior cerebral artery (ACA) aneurysm with the most frequency (p=0.028). In general, favorable outcome was achieved in both age groups (90.5% and 81.7%, respectively). An initial univariate analysis showed Hunt-Hess grade, Fisher grade, location of aneurysm, and rebleeding significantly associated with outcome after aneurysm rupture. Further, multivariate analysis demonstrated that only Hunt-Hess grade (grade 4-5) was a risk factor for the outcome (odds ratio=9.730, 95% confidence interval 2.069-45.756, p=0.004). Conclusion : The incidence of subarachnoid hemorrhage (SAH) was higher in the male population of the third and fourth decades of life. Aneurysms on the ACA were most frequently occurred in both age groups and the outcome of aneurysmal SAH among the third and fourth decades was favorable. Multivariate analysis revealed that high Hunt-Hess grade was a risk factor for patient's outcome.

• Journal of Korean Neurosurgical Society
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• v.39 no.2
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• pp.120-124
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• 2006

Objective : This study is aimed to assess the clinical outcome in early and minimally invasive surgery using incision for the patients with poor grade aneurysm. Methods : The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess[H-H] grade IV and V who suffered aneurysmal subarachnoid hemorrhage[SAH] between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale[GOS] and compared with that of conventional pterional approach. Results : Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms, Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group[ESG] were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group[PAG]. 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. Conclusion : It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.157-162
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• 2011

Objective : Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. Methods : Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. Results : TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. Conclusion : This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1563-1569
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• 2000

Objective : Delayed ischemic neurologic deficit(DIND) is one of the major complications following aneurysmal subarachnoid hemorrhage(SAH). However, the correlation between angiographic vasospasm(AV) and DIND after SAH is not precisely known. The authors investigated the timing, incidence, characteristics of DIND, and analyzed correlation between AV and DIND. Patients and Methods : A series of 126 patients with SAH and performed cerebral angiography which, confirmed anterior circulation aneurysm, admitted to between January 1996 to December 1998, were studied retrospectively. A comparative analysis between group 1(G1) in which AV patients presented with DIND, and group 2(G2) patients did not DIND, were done. AV was graded according to location, distribution and degree. Location of vasospasm was classified as basal type(BT), distal type(DT). BT was involved horizontally and include the bilateral carotid systems, proximal middle cerebral artery(MCA) and proximal anterior cerebral artery(ACA). DT was involved vertically and include the MCA branches as they become vertically or posteriorly oriented and the ACA distal to the anterior communicating artery. BT and DT all defined ether as localized type(LT) or combined type(CT). Distribution of vasospasm was classified as type I, type II and type III. Type I represents the involvement of bilateral carotid systems and bilateral anterior cerebral artery, type II was designed as one carotid system without involving anterior cerebral artery, and type III when only some portions of the anterior cerebral artery were involved, bilaterally. Degree of vasospasm was classified as mild(less than 25%), moderate(between 25-50%), severe(greater than 50%), and those were determined by comparing the caliber of the artery in vasospasm to that of the nearest area of apparently normal vessel. Results : The incidence of AV & DIND was 57/126(45.2%), 29/126(23.0%), and timing of DIND was 9 days(${\pm}4.1$) after initial hemorrhage. As for the location, BT was seen in 12 cases(40.0%), DT 11 cases(36.7%) and CT 7 cases (23.3%), respectively. Where as G1, BT was seen 5 cases(18.5%), DT 5 cases(18.5%) and CT 17 cases(63.0%), respectively in G2. CT AV was more correlated with DIND than LT AV(p<0.05). For distribution, type I was seen in 16 cases(59.2%), type II 4 cases(14.8%), type III 7 cases(25.9%) in G1 where as type I was seen in 7 cases(23.3%), type II 10 cases(33.3%), type III 13(43.3%) in G2. Type I AV was well correlated with DIND unlike to type II or type III(p<0.05). As for the degree, mild was seen in 4 cases(14.8%), moderate 14 cases(51.9%), severe 9 cases (33.3%) in G1, and mild 16 cases(18.5%), moderate 11 cases(36.7%) and severe 3 cases(10.0%) in G2. Moderate to severe type AV was well correlated with DIND(p<0.05). Conclusion : These results indicate that it may be possible to predict DIND according to careful analysis of location, distribution, degree of AV in patients with aneurysmal SAH.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.699-704
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• 2001

Objectives : The rupture of middle cerebral artery(MCA) aneurysm usually cause or is associated with higher incidence of intracerebral hemorrhages(ICH) than any other aneurysmal ruptures. Also, the outcome of patients who had ICH is known to be worse than patients who had subarachnoid hemorrhage(SAH) only. The authors report the bleeding pattern and outcome of ruptured MCA aneurysm patients. Patients and Methods : A total 106 ruptured MCA aneurysm patients who were surgically treated were included and they were divided into 2 groups by the initial brain CT findings according to the presence or absence of ICH over 10cc in amount. The clinical data were analysed retrospectively. Results : The overall mortality was 18.9%. Among 81 patients(76.4%) who had subarachnoid hemorrhage(SAH) only, 68 patients(84%) showed favorable outcome. Twenty five patients(23.6%) had ICH over 10cc in amount with or without SAH, and among them, 11 patients(44%) showed favorable outcome. The ICH was located in temporal lobe(15 patients, 60%), frontal lobe(3, 12%), sylvian fissure(6, 24%) and frontal-temporal lobe(1, 4%). Among 15 patients who had ICH in temporal lobe, only 4 patients(26.6%) showed favorable outcome and all 3 patients who had ICH in frontal lobe showed favorable outcome. Conclusion : ICH was presented in 23.6% of ruptured MCA aneurysm patients and the prognosis of patients with ICH was worse than patients with SAH only. The ICH was located mainly in the temporal lobe and sylvian fissure.