• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.73-78
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• 2001

Objective : Intraoperative rupture of an intracranial aneurysm can interrupt a microsurgical procedure and jeopardize the patient's chance to favorable outcome. The purpose of this study was to analyse and evaluate intraoperative aneurysmal rupture and render ideal prevention and management to intraoperative rupture. Patients and Methods : The authors retrospectively analysed the results of 609 patients who underwent cerebral aneurysm surgery from January 1991 to December 2000. Results : 1) Intraoperative aneurysmal rupture occurred in 73 of 609 consecutive aneurysm surgery, so the incidence was about 12.0% and it was relatively lower than other reports. 2) Aneurysms arising from anterior communicating artery appeared more prone to intraoperative rupture. 3) The size of aneurysm and timing of operation didn't influence intraoperative aneurysmal rupture and temporary clipping didn't reduce the incidence of intraoperative aneurysmal rupture. 4) Intraoperative aneurysmal rupture occured during three specific periods : (1) dissection stage in 61%, (2) clip application stage in 29 %, (3) predissection stage in 10%. 5) In the patients with intraoperative aneurysmal rupture, surgical outcome was relatively good and there was no significant difference in outcome compared with unruptured group. Conclusion : Our suggestion for prevention methods of intraoperative aneurysmal rupture are as follows : 1) minimal brain retraction, 2) sharp and careful aneurysmal neck dissection, 3) gentle clipping with proper clip selection etc. Management methods after intraoperative aneurysmal rupture are as follows : 1) strong aspiration of bleeding point, 2) rapid application of temporary and/or tentative clip, 3) following rapid dissection of neck and proper clip application, 4) use of encircling clip etc.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.68-72
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• 2001

Objective : The goal of this study was to document the influence of the treatment modality(surgery versus endovascular treatment) on the development of chronic shunt-dependent hydrocephalus in a series of 296 patients treated after aneurysmal subarachnoid hemorrhage(SAH). Methods : The following parameters were retrospectively analyzed for association with chronic shunt-dependent hydrocephalus : 1) Age and Sex, 2) Hunt and Hess grade, 3) Fisher computed tomographic grade, 4) aneurysm location, and 5) treatment modality(surgery versus endovascular treatment). Results : Thirty-six of 251 patients(14.3%) who survived the SAH and its neurological and/or medical sequelae underwent definitive shunting for treatment of chronic hydrocephalus. The rate of shunt dependency was positively correlated with a higher age, a higher Hunt and Hess grade, a higher Fisher computed tomographic grade, and aneurysms arising at the anterior communicating artery(p<0.05). Conclusion : The results of the present study indicate that the treatment modality used does not affect the risk of the later development of chronic shunt-dependent hydrocephalus(surgery, 16.2% [25 of 154] ; endovascular treatment, 11.3% [11 of 97] ; p=0.45).

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.431-434
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• 2005

Objective : Subarachnoid hemorrhage[SAH] is commonly associated with polyuria [solute diuresis or water diuresis]. The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. Methods : One hundred and forty eight patients with high urine output [>200ml/hr] after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis [diabetes insipidus, DI] was differentiated from solute diuresis by lower urine specific gravity [<1.005] and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. Results : Annual incidence of polyuria decreased markedly since July 2001 : 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in $2.4{\sim}11.1%$. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days [range $1{\sim}27$ days] and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. Conclusion : Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.240-247
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• 2017

The increased investigation of the cerebral arteries with magnetic resonance angiography has resulted in an increase in the identification of unruptured intracranial aneurysms (UIAs). Knowledge of the distribution and factors associated with UIAs might be helpful for understanding the pathological mechanism of unruptured aneurysms. This study examined patients who visited a health care center and had a health examination from January 2007 to December 2016. Subjects who underwent magnetic resonance angiography with a health examination at the Health Screening were enrolled in this study. The incidence and risk factors of UIAs (age, sex, hypertension, diabetes mellitus, smoking, alcohol, and coronary artery disease) were investigated by comparing the size (more than 3 mm vs. less than 3 mm) and multiple aneurysm (single vs. multiple aneurysms). The frequency of aneurysm according to the site was also analyzed. Among the 187166 subjects, who received a health examination, 18954 underwent magnetic resonance angiography. Of them, 367 (1.93%) had UIAs. A comparison of the size of more than 3 mm and less than 3 mm showed that the mean age of the more than 3 mm group of patients was significantly higher than the other size groups (more than 3 mm $57.16{\pm}8.47$ vs. less than 3 mm $55.12{\pm}8.19$; p=0.07). High-density lipoprotein was significantly higher in the more than 3 mm group than in the less than 3 mm($55.95{\pm}16.03$ vs. less than 3 mm $50.85{\pm}13.65$; p=0.007). Hypertension was significantly higher in the multiple aneurysm group (single 153 in 399 (38.3%) VS multiple 19 in 35 (54.3%); p=0.065). An aneurysm of less than 3 mm in size was frequent in the distal internal carotid artery (34.3%) and MCA-bifurcation (16.4%) (p=0.003). Aneurysms of more than 3 mm were frequent in the distal internal carotid artery (43.4%) and MCA-bifurcation (13.4%), and anterior communicating artery (13.4%) (p=0.003). The difference in size and single or multiple aneurysm revealed other risk factors. These risk factors suggest that degenerative and hemodynamic disorders may lead to the presence of aneurysms.

• 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.45 no.2
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• pp.85-89
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• 2009

Objective : The International Study of Unruptured Intracranial Aneurysms (ISUIA) reported that the 5-year cumulative rupture rate of small unruptured aneurysms less than 7 mm in diameter is very low depending on the aneurysm's location. However, we have seen a large number of ruptured aneurysms less than 7 mm in clinical practice. The purpose of this study was to review our experience and to measure the size and location at which aneurysms ruptured in our patient population. Methods : We reviewed the characteristics of aneurysms, such as size and location, from the original angiograms of patients who were admitted to our hospital between January 2004 and December 2007. All aneurysms were treated surgically or through endovascular procedures. Results : Interventional or surgical treatment was given to a total of 889 patients, including 568 females and 321 males. At the time of our study, 627 cases were ruptured aneurysms and 262 cases were unruptured aneurysms. Of the ruptured cases, the mean diameter of the aneurysm was 6.28 mm. We found that 71.8% of ruptured aneurysms were smaller than 7 mm in diameter, and 87.9%, were smaller than 10 mm. Based on location, the data show that anterior communicating artery aneurysms most often presented with rupture sizes less than 7 mm (76.8%) and 10 mm (92.1%) in diameter. Most ruptured aneurysms were less than 7 mm in size, although recent studies have noted that small aneurysms are less likely to rupture. Conclusion : Although the natural history of unruptured intracranial aneurysms remains controversial, the aneurysm size and location play a signigicant role in determining the risk of rupture. Larger sample sizes and a long term study are needed to reveal the natural history and the rupture risk of unruptured intracranial aneurysms because the size of most ruptured aneurysms was less than 7 mm in diameter in our series.

• Journal of Korean Neurosurgical Society
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• v.30 no.7
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• pp.891-895
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• 2001

Objective : Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. Method : Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. Result : Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. Conclusion : It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.