• Journal of Korean Neurosurgical Society
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• 제54권1호
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• pp.50-53
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• 2013

Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.

• Journal of Chest Surgery
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• 제19권3호
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• pp.500-505
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• 1986

Eight patients received operation for ascending aortic aneurysm and aortic regurgitation associated with Marfan`s syndrome from January 1984 to July 1986 at Seoul National University Hospital. The patients` age ranged from 29 to 51 years [mean 37.3 years]. Five patients were male and three were female. All of them showed some stigmata of skeletal system in Marfan`s syndrome. Three patients had dissecting aneurysm and five patients had fusiform aneurysm of ascending aorta. Two patients had concomitant fusiform aneurysm of abdominal aorta. All patients showed aortic regurgitation of grade III to IV. One patient received insertion of intraluminal ringed graft and resuspension of aortic valve, and seven patients received modified Bentall operation [Carol`s method]. There was no hospital death and all showed functional improvement in the 7.4 patient-years follow-up period.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권2호
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• pp.208-213
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• 2023

Flow-diverting stents (FDSs) have proven advantageous for the treatment of large, fusiform, and dissecting aneurysms that are otherwise difficult to treat. Retreatment strategies for recurrent large or giant aneurysms after FDSs are limited to overlapping implantation of an additional FDS or definitive occlusion of the parent vessel. We report a recurrent giant aneurysm that was initially treated with an FDS with coils and was successfully treated with an additional FDS. Visual symptoms due to the mass effect of the recurrent aneurysm were completely resolved, and follow-up digital subtraction angiography revealed complete obliteration of the aneurysm. Additional FDS implantation for the retreatment of incompletely occluded aneurysms after the initial FDS treatment may be feasible and safe. Further studies are required to validate these results.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.891-900
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• 2021

Objective : Vertebral artery dissecting aneurysm (VADA) is a very rare subtype of intracranial aneurysms; when ruptured, it is associated with significantly high rates of morbidity and mortality. Despite several discussions and debates, the optimal treatment for VADA has not yet been established. In the last 10 years, flow diverter devices (FDD) have emerged as a challenging and new treatment method, and various clinical and radiological results have been reported about their safety and effectiveness. The aim of our study was to evaluate the clinical and radiological results with the use of FDD in the treatment of unruptured VADA. Methods : We retrospectively evaluated the data of all patients with unruptured VADA treated with FDD between January 2018 and February 2021 at our hybrid operating room. Nine patients with unruptured VADA, deemed hemodynamically unstable, were treated with FDD. Among other parameters, the technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcomes were evaluated. Results : Successful FDD deployment was achieved in all cases, and the immediate follow-up angiography showed intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of facial numbness and palsy was noted in one patient; however, the symptoms had completely disappeared when followed up at the outpatient clinic 2 weeks after the procedure. The 3-6 months follow-up angiography (n=9) demonstrated complete/near-complete obliteration of the aneurysm in seven patients, and partial obliteration and segmental occlusion in one patient each. In the patient who achieved only partial obliteration, there was a sac 13 mm in size, and there was no change in the 1-year follow-up angiography. In the patient with segmental occlusion, the cause could not be determined. The clinical outcome was modified Rankin Scale 0 in all patients. Conclusion : Our preliminary study using FDD to treat hemodynamically unstable unruptured VADA showed that FDD is safe and effective. Our study has limitations in that the number of cases is small, and it is not a prospective study. However, we believe that the study contributes to evidence regarding the safety and effectiveness of FDD in the treatment of unruptured VADA.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권1호
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• pp.75-80
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• 2023

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient's disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient's condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture.

• Journal of Chest Surgery
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• 제29권4호
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• pp.449-453
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• 1996

20개월 전에 신장이식을 시행한 환자에 있어서 해리성 흥복부 대동맥류를 성공적으로 절제하였다. 이 식된 신장은 정상 신장에 비하여 허혈에 보다 민감하므로 동맥혈 차단후 이식된 신장의 관류를 위하 여 대퇴 동-정맥으로 심페기를 연결하였다. 138분간의 대동맥 교차 차단중에 신장으로의 관류는 관류압이 (19-)1) 27 minHg이고 관류량은 0.53에서 0.83 Limin 였고, 32mm 크기의 헤마쉴드(길이 22cm)가 동맥류 부위 에 대용되 었다. 수술후 특별한 합병증은 없었으며 심폐기를 이용한 대퇴동-정맥 우회술은 이와같은 수술시 척수와 신 장을 보호하는 간단하고 효율적 인 방법으로 사료된다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.251-264
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• 1976

Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

• Journal of Korean Neurosurgical Society
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• 제67권5호
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• pp.531-540
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• 2024

Objective : The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs. Methods : From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed. Results : All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients. Conclusion : A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.

• Journal of Chest Surgery
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• 제35권9호
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• pp.675-679
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• 2002

대동맥 궁 후방 또는 근위부 하행 흉부 대동맥에 병변이 있는 경우 일반적인 정중 흉골 절개술을 통한 접근 방법은 폐 질환으로 인한 유착이 심한 환자에 있어서 제한점이 있다. 본원에서는 객혈을 주소로 내원 한 근위부 하행 흉부 대동맥류 질환을 가진 66세 남자환자에서 정중 흉골 절제술을 통해 대동맥-폐간 유착 박리 등 폐조작을 가하지 않고 성공적으로 상행, 궁부, 하행 대동맥을 치환함으로써 이에 증례 보고하는 바이다.

• Journal of Chest Surgery
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• 제30권7호
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• pp.686-692
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• 1997

저자들은 1994년 2월부터 1995년 8월사이에 본 교실에서 흉부대동맥류로 외과적 치료를 받았던 15 례의 임상성적을 분석하여 수술수기 및 수술결과를 향상시키는 계기로 삼고저 한다. 남자가 9례, 여자 가 6례였으며 평균연령은 55.07$\pm$11.76세였다. 원인질환은 대동맥박리증이 9례, 죽상경화증이 4례, 외 상이 2례이었다. 9례에서 상행 대동맥 및 대동맥궁의 부분 및 완전 치환술을 시행하였으며 3례에서 하행 대동맥 및 흉복부 대동맥치 환술을 시행하였고, 1례에서는 전체 대동백치환술을 시행하였으며, 외 상성 대동맥류 2례에서는 단단문합하였는데 대동맥 박리증 환자에서는 Wheat씨 방법으로 봉합부위를 보강한 후 치환하였다. 9례에서는 정중흉골절개술을, 4례에서는 후외측 흉벽절개술을, 2례에서는 후외 측 흉부절개후 흉복부절개술을 시행하였다. 상행 대동맥 및 대동맥궁을 치환하였던 9례에서는 상대정맥을 통한 역행성 뇌관류를 평균 56.67$\pm$29.25분 동안 시행하였고 하행 대동맥 및 흉복부 대동맥을 치환하였던 3례에서도 고도의 저체온화를 시행하였는데 술후 항구적인 뇌나 척추 신경장애가 발생한 례는 없었다. 술후 외상성 복담즙에 의한 복막염, 다장기 기능부전, 악성고혈압에 의한 잔여 박리성 동 맥류파열로 3례(20%, 3/15)가 사망하였다. 술후 합병증으로는 출혈에 의한 재수술이 4례, 일시적인 의식장애 3례, 늑막삼출 등의 폐 합병증이 3례, 심낭압진 1례 있었다. 타의료기관에서 관찰중인 1례를 제외한 11례를 추적관찰중인데 사망하거나 만기 합병증을 보인 례는 없었다.