• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.501-504
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• 2012

Objective : To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping. Methods : A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant ($30{\times}18mm$ sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow. Conclusion : Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.343-346
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• 2007

Hypoplasia of the internal carotid artery is a rare congenital anomaly. Agenesis, aplasia, and hypoplasia of the internal carotid artery [ICA] are frequently associated with cerebral aneurysms in the circle of Willis. Authors report two cases with congenital hypoplasia of the ICA accompanying with the aneurysms. Transfemoral cerebral angiography [TFCA] in one patient identified nonvisualization of the left ICA. Bilateral anterior cerebral artery [ACA] and middle cerebral artery [MCA] were supplied from the right ICA accompanying with two aneurysms at anterior communicating artery [AcoA] and A1 portion of the left ACA. TFCA in another patient demonstrated hypoplastic left ICA and left ACA filled from the right ICA accompanying with AcoA aneurysm. Left MCA was filled from basilar artery via posterior communicating artery [PcoA]. Skull base computed tomography [CT] in two patients showed hypoplastic carotid canal. Authors performed direct aneurysmal neck clipping. Follow up CT angiography [CTA] at one year after surgery did not show regrowth or new development of the aneurysm. In patients with hypoplastic ICA, neurosurgeons should be aware of the possibility of development of the aneurysms, presumably because of hemodynamic process. Direct aneurysmal neck clipping is a good treatment modality. After operation, regular CTA, magnetic resonance angiography [MRA] or TFCA is needed to find progressive lesion and to prevent cerebrovascular attack [CVA].

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.463-466
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• 2006

A case of parasagittal meningioma en plaque with a peculiar clinical presentation is reported with a review of the literature. A 72-year-old woman presented with dysphasia and right hemiparesis. Computed tomography and magnetic resonance imaging demonstrated focal edema of left frontal lobe and a thick sheet-like parasagittal enhancing lesion with extension along the falx cerebri and adjacent sulcal enhancement. Differential diagnosis included idiopathic hypertrophic pachymeningitis, meningeal neurosarcoidosis, metastasis and meningioma en plaque. Cerebral angiography revealed occlusion of the anterior one-third of the superior sagittal sinus as well as a faint tumor blush supplied from the anterior branch of the middle meningeal artery. At surgery, the tumor invading the dura and skull was removed totally but the tumor invaded into the superior sagittal sinus was removed subtotally. The tumor was confirmed to be a transitional meningioma on pathological examination.

• Journal of Korean Neurosurgical Society
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• 제42권1호
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• pp.49-52
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• 2007

The authors report a unique case of unilateral Moyamoya disease with a rare combination of arteriovenous malformation (AVM) who presented with intracerebral hemorrhage (ICH). A 50-year-old man suffered from sudden onset of mental deterioration and right hemiparesis. Brain computed tomography (CT) showed intracerebral hemorrhage on left thalamus. Brain CT angiography and cerebral digital subtraction angiography (DSA) revealed AVM combined with unilateral moyamoya disease involving left middle cerebral artery (MCA) and choroid plexus in left lateral ventricle. Intraventricular hemorrhage and hydrocephalus were managed conservatively. A rare case of unilateral Moyamoya disease accompanied by a cerebral arteriovenous malformation is described and discussed with review of pertinent literature.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.257-260
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• 2009

Intraventricular hemorrhage long after successful encephaloduroarterio synangiosis (EDAS) is very rare. The effect of revascularization surgery for preventing hemorrhagic event of moyamoya disease remains controversial. We report a 17-year-old female with intracerebral hemorrhage and intraventricular hemorrahge 10 years after successful EDAS. Even though cerebral vessels angiography showed good collateral circulations without specific weak points, a cerebral hemorrhage could occur in patient with ischemic type of moyamoya disease long after successful indirect bypass operations. Good collateralization of cerebral angiography or magnetic resonance perfusion image after indirect bypass surgery would ensure against ischemic symptoms, not a hemorrhage. And, thus a life-time follow-up strategy might be necessary even if a good collateral circulation has been established.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권3호
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• pp.340-346
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• 2023

Bilateral distal anterior cerebral artery (DACA) aneurysms also called "kissing aneurysms" or "mirror aneurysm" are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm's morphology and planning treatment accordingly.

• 대한영상의학회지
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• 제84권6호
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• pp.1361-1366
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• 2023

잔류 원시 후각동맥은 1979년에 처음 보고된 매우 드문 전대뇌동맥의 변이로, 급격하게 꺾이는 머리핀 회전의 구조적 특성에 의하여 혈역학적 스트레스가 유발되고, 이로 인하여 동맥류의 발생과 높은 연관성을 가지는 것으로 보고되고 있다. 우리는 간헐적 두통을 주소로한 46세 여성에서 우연히 발견된 머리핀 회전에서 동맥류를 동반한 제4형 잔류 원시 후각 동맥의 증례에 대하여 보고하고자 한다. 뇌 MRA와 유체속도강조 자기공명혈관조영술(time-offlight MR angiography)에서 왼쪽 전대뇌동맥의 A1 분절에서 시작되어 머리핀 회전을 형성한 후 부 중대뇌동맥으로 이어지는 비정상적인 주행을 보이는 동맥이 확인되었다. 또한 머리핀 회전 분절에서 방추형 동맥류도 확인이 되었다. 이러한 변이들은 극히 드물긴 하지만, 동맥류가 동반될 수 있음을 인지하고 진단하는 것이 중요하다.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제12권2호
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• pp.69-77
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• 2006

Angiography means that a check up to know an abnormal condition in all the blood vessels include from the heart, aortae, cerobrovascular and abdonominal artery to hands and feet. Main examples of this are cerebral angiography, abdominal, liver for urinary anomaly, renovascular angiography, and artery and vein in arms and legs. Angiography uses radial rays or angiography equipment for an image output during interventional procedure and compositive diagnosis. The acts which performed in a projection room have changed drastically. In general, it is performed by using equipment which is attached one or two C-arms and the method of inserting catheter in vein after anesthesia. For this reason, some rooms that consist of angiography room units should be planned not only for expensiveness equipment and facilities also to be germ-free. Nowadays, in the angiography unit case, it is placed independently as the central part of many hospitals. It does not belong to the imaging medical department any more as considering raising filming times and the relation between C.C.U.(coronary care unit) and operation unit. This means the acts performed are diversified and well-organized rooms in support of diagnosis are required. However, it is difficult to plan the angiography room unit due to domestic researches and data on this unit are not enough. Therefore, this study aims at bringing up basic issue for architectural planning of the angiography unit in general hospital.

• 한국방사선학회논문지
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• 제13권7호
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• pp.961-968
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• 2019

본 연구는 CT를 이용한 뇌혈관 추출 검사에서 이중에너지 기법을 활용하여 각 에너지 준위별 뇌혈관 조영술의 유용성을 평가하였다. 방법은 CT 뇌혈관 조영술을 시행한 환자 15명의 DE 영상과 SE 영상을 대상으로 하였다. 영상의 분석은 MCA, 뇌실직 조직, Background에 ROI를 설정하여 평균값, 표준편차 및 SNR, CNR 값을 구하고, SE영상과 비슷하게 구현되는 에너지 영역을 알아보았다. Likert 5점 척도 육안평가를 병행한 결과 DE 40 keV와 SE 120 kVp에서 가장 선명한 MCA 영상을 확인 하였다(p>0.05). SE영상의 SNR 값은 DE영상의 40 keV에너지 준위값과 비슷하게 측정되었고, 40 keV와 50 keV의 저에너지 준위의 영상이 SNR이 높게 측정되어 고에너지 준위의 영상에 비해 대조도가 높아 뇌혈관질환을 유용하게 관찰할 수 있을 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.71-73
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• 2010

A 28-year-old woman was referred to our hospital with a sudden, very severe headache. Brain computed tomographic angiography showed a saccular cerebral aneurysm at the bifurcation of the left middle cerebral artery and infraoptic courses of both anterior cerebral arteries. The anterior cerebral arteries were seen to arise from the ipsilateral internal cerebral arteries at the level of the origin of the ophthalmic artery, passed underneath the ipsilateral optic nerve, and turned upward at ventral portion of the optic chiasm. Infraoptic course of the proximal anterior cerebral artery is an extremely rare anomaly and is often associated with cerebral aneurysms. We report the clinical features, radiological findings, and possible genesis of this anomaly with a literature review.