• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.657-661
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• 2001

Intracranial giant aneurysms have been known to cause clinical signs and symptoms, either by rupture, compression of surrounding structures, repeated minor leakage, or cerebral ischemia due to thromboembolism. A giant aneurysm which manifests only a seizure disorder comprises relatively few contributions. The authors present a case of a giant, unruptured aneurysm solely presenting with generalized tonic-clonic type seizure in a 43-year-old man. Brain computed tomogram(CT) and 3-D CT angiogram demonstrated a huge calcified aneurysm at the bifurcation of right middle cerebral artery. Complete neck clipping and aneurysmectomy followed by uneventful neurologic recovery.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.568-571
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• 2009

Accessory middle cerebral artery (MCA) is an infrequent vascular anomaly of the brain. Cerebral aneurysms associated with this anomalous artery are also very rare. To our knowledge, there have only been ten previous reports of an aneurysm associated with accessory MCA. The authors present two patients with accessory MCA-related aneurysms. A 38-year-old male and a 59-year-old female both presented with sudden-onset severe headache. In both patients, computed tomography (CT) scan revealed subarachnoid hemorrhage. A subsequent angiogram demonstrated an accessory MCA arising from the anterior cerebral artery (ACA) and a saccular aneurysm at the anterior communicating artery (ACoA) complex associated with an accessory MCA. Surgical clipping allowed for complete exclusion of the aneurysm from the arterial circulation. Based on our review of the ten cases of aneurysms associated with accessory MCA documented in the literature, we suggest that accessory MCA-related aneurysms can be classified according to whether the accessory MCA originates from the proximal A1 segment or from the ACoA complex. We also emphasize the importance of precise interpretation of preoperative angiograms and intraoperative precaution in determining the presence of this anomalous artery prior to temporary clip placement.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.112-114
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• 2013

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.

• 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.57 no.4
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• pp.271-275
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• 2015

Objective : Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms. Methods : This retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH. Results : Sixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study. Conclusion : The incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.

• Journal of Korean Neurosurgical Society
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• v.61 no.6
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• pp.761-766
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• 2018

Objective : Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane. Methods : This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index. Results : Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616-45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007-0.683). Conclusion : This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.517-520
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• 2021

Innominate artery aneurysms are challenging for surgeons to treat because of the requirement for brain protection during surgery. In innominate artery aneurysms, the endovascular approach does not require cardiopulmonary bypass, but patients who can be treated using this approach are limited in number, and the long-term results of endovascular treatment are unclear. Here, we report our experience of successfully treating a patient with an innominate artery aneurysm using near-infrared spectroscopy without cardiopulmonary bypass support or hypothermic circulatory arrest.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.413-415
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• 2007

A 26-year-old man was admitted to our department due to intermittent left hemiparesis for 3 months. Magnetic resonance Image showed subacute infarction in the right precentral gyrus. Digital subtraction angiography and magnetic resonance angiography revealed an aneurysmal protrusion at the right middle cerebral artery (MCA) bifurcation. It was difficult to differentiate the aneurysm from the occlusion of the middle trunk of the MCA trifurcation. Brain single photon emission computerized tomography showed a decrease in perfusion in the right posterior frontal lobe without vascular reserve. Therefore, we planned a superficial temporal artery MCA anastomosis with an exploration of the right MCA bifurcation. Intraoperatively, the aneurysmal opacification on preoperative angiography proved to be the proximal stump of the occluded middle trunk of the MCA trifurcation. An aneurysmal protrusion at the MCA bifurcation does not always indicate an aneurysm. In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered according to their angioanatomical appearance and the history of the patient.

• 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.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.