• Journal of Chest Surgery
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• v.33 no.8
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• pp.676-680
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• 2000

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.815-821
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• 2000

Parasplenial arteriovenous malformations(AVMs) are rare vascular malformations which have distinct clinical and anatomical features. They are situated at the confluence of the hippocampus, isthmus of the cingulate gyrus and the gyrus occipitotemporalis medialis. These lesions are anterior to the calcarine sulcus and their apex extends towards the medial surface of the trigonum. Posterolaterally, these lesions are in close proximity to the visual cortex and optic radiation. The objectives in the surgery of parasplenial AVMs are complete resection of the lesions and preservation of vision. These objectives must be achieved with comprehensive understanding of the following anatomical features :1) the deep central location of the lesions within eloquent brain tissue ; 2) the lack of cortical representation of the AVMs that requires retraction of visual cortex ; 3) deep arterial supply ; 4) deep venous drainage ; 5) juxtaposition to the choroid plexus with which arterial supply and venous drainage are shared. A 16-year-old female student presented with intraventricular hemorrhage from a right parasplenial-subtrigonal AVM. The lesion, fed by posterior cerebral artery and drained into the vein of Galen, was successfully treated by the inter-hemispheric parietooccipital approach. To avoid visual field defect a small incision was made on precuneus anterior to the calcarine sulcus. In this report, the authors describe a surgical approach with special consideration on preservation of visual field.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.711-716
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• 2001

Objectives : Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography( CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). Methods : We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. Results : Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.

• Journal of Korean Neurosurgical Society
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• v.53 no.4
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• pp.235-240
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• 2013

Fusiform aneurysms on the basilar artery (BA) trunk are rare. The microsurgical management of these aneurysms is difficult because of their deep location, dense collection of vital cranial nerves, and perforating arteries to the brain stem. Endovascular treatment is relatively easier and safer compared with microsurgical treatment. Selective occlusion of the aneurysmal sac with preservation of the parent artery is the endovascular treatment of choice. But, some cases, particularly giant or fusiform aneurysms, are unsuitable for selective sac occlusion. Therefore, endovascular coiling of the aneurysm with parent vessel occlusion is an alternative treatment option. In this situation, it is important to determine whether a patient can tolerate parent vessel occlusion without developing neurological deficits. We report a rare case of fusiform aneurysms in the BA trunk. An 18-year-old female suffered a headache for 2 weeks. Computed tomography and magnetic resonance image revealed a fusiform aneurysm of the lower basilar artery trunk. Digital subtraction angiography revealed a $7.1{\times}11.0$ mm-sized fusiform aneurysm located between vertebrovasilar junction and the anterior inferior cerebellar arteries. We had good clinical result using endovascular coiling of unruptured fusiform aneurysm on the lower BA trunk with parent vessel occlusion after confirming the tolerance of the patient by balloon test occlusion with induced hypotension and accompanied by neurophysiologic monitoring, transcranial Doppler and single photon emission computed tomography. In this study, we discuss the importance of preoperative meticulous studies for avoidance of delayed neurological deficit in the patient with fusiform aneurysm on lower basilar trunk.

• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.41-44
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• 2008

Even though intracerebral hematoma (ICH) due to ruptured cerebral aneurysm has been treated by aneurysm clipping at the same time of removal of ICH through craniotomy, such management strategy is controversial in an aged patients with poor clinical grade. In this regards, stereotactic aspiration of hematoma following coil embolization can be an alternative treatment modality. Thus, the authors report a case of an aged patient who underwent stereotactic aspiration of ICH following coil embolization for the ruptured aneurysm with a brief review of literature.

• Annals of Clinical Neurophysiology
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• v.15 no.2
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• pp.59-62
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• 2013

Man-in-the-barrel syndrome (MIBS) is a clinical syndrome of bilateral upper limb weakness with normal lower extremity function. It can be caused by various neurological conditions such as bilateral cerebral hypoperfusion, syringomyelia, motor neuron disease, or cervical myelopathies. We report a patient with MIBS after cervical spinal cord ischemia. It is postulated to be caused by ischemic insults of anterior spinal artery from repeated and prolonged neck extension.

• Annals of Clinical Neurophysiology
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• v.18 no.1
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• pp.1-6
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• 2016

Background: Moyamoya disease is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal diameter might be different, but reflects the size of internal carotid artery passing through the bony carotid canal. In this study, we aimed to identify the relationship between bony carotid canal diameter and clinical manifestation. Methods: 146 consecutive patients diagnosed with moyamoya disease by brain imaging studies were included. We measured the diameter of a transverse portion of bony carotid canal on bone window of a brain computed tomography(CT) image. Patients were divided into two groups, ischemic or hemorrhagic stroke according to clinical manifestation. As a result, 115 patients were included. The Suzuki stage was used as criteria for disease progression. Results: Bony carotid canal diameter was $3.6{\pm}0.5$ (right) and $3.6{\pm}0.4$ (left) in the hemorrhagic stroke group, and $3.7{\pm}0.4$ (right) and $3.6{\pm}0.4$ (left) in the ischemic stroke group. The bony carotid canal diameter of the moyamoya vessels (3.6 mm) was smaller than the diameter of non-moyamoya vessels (3.8 mm), significantly (p = 0.042). However, there was no difference in the collateral patterns and clinical manifestation in a comparison of both groups. Conclusions: In our study, there was no significant difference of clinical manifestations and collateral patterns depend on the bony carotid canal diameter in patients with moyamoya disease. These findings suggest that the clinical presentations of moyamoya disease are not related to the onset time of the disease.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.246-255
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• 2022

Objective: To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. Materials and Methods: Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. Results: The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). Conclusion: Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.270-274
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• 2008

Objective : The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms. Methods : Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed. Results : Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2%; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms, Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months). Conclusion : Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.347-354
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• 2006

Objective : We evaluate the role of multislice computerized tomographic angiography[MCTA] in the diagnosis of intracranial vasospasm following subarachnoid hemorrhage[SAH] in patients suspected of having vasospasm on clinical ground. Methods : Between October 2003 and June 2005, patients with ruptured cerebral aneurysms of the anterior circulation clipped within 3 days of the onset were included. We performed follow-up MCTAs in patients who were suspected to have vasospasm on transcranial doppler sonography[TCD] findings and clinical grounds. Based on the clinical presentation of symptomatic vasospasm, we investigated the correlation between clinical, TCD, and MCTA signs of vasospasm and evaluated the role of MCTA in vasospasm. Results : One hundred one patients met the inclusion criteria and symptomatic vasospasm developed in 25 patients [24.8%]. We performed follow-up MCTAs in 28 patients. MCTA revealed spasm in the vessels of 26 patients. The sensitivity of MCTA was 100%. Among the 26 patients with MCTA evidence of vasospasm, 3 patients had TCD signs of vasospasm after symptomatic vasospasm presentation. Another 3 patients with symptomatic vasospasm had no TCD signs of vasospasm in daily serial recordings. Six other patients without symptomatic vasospasm showed MCTA evidence of vasospasm [false positive result] but these patients had also positive TCD signs of vasospasm. Volume rendering[VR] images tended to show significantly more exaggerated vasospasm than maximum intensity projection[MIP] images. The mean cerebral blood flow velocity of both proximal segment of the middle cerebral artery [M1] was significantly correlated with each reduced M1 diameter on MCTA [P<005]. Conclusion : MCTA could be a useful tool for evaluation and planning management of critically ill patients suspected of having vasospasm; however, more randomized controlled trials are necessary to assess these points definitively.