• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.173-178
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• 2007

Objective : Hydrocephalus is one of the major complications following spontaneous subarachnoid hemorrhage (SAH). However, the risk factors of the hydrocephalus after SAH are not still well known. This study was focused on verification of the causal relationships between the development of hydrocephalus and SAH. Methods : The patients who developed hydrocephalus after rupture of aneurysms were studied. To obtain prognostic factors regarding to hydrocephalus, several parameters such as age, sex, hypertension, location of aneurysm, existence of intraventricular hemorrhage (IVH) and intracerebral hemorrhage (ICH), Glasgow coma scale (GCS), Hunt-Hess SAH classification & Fisher Grade on admission and the ratio of frontal harn of lateral ventricle diameter to skull inner table diameter at this level (FH/ID) were studied retrospectively. Results : The development of hydrocephalus following SAH is multifactorial. The age, IVH, FH/ID ratio were related to hydrocephalus in analysis. There is a low clinical correlation between sex, hypertension, location of aneurysm, existence of ICH, GCS, Hunt-Hess SAH classification, Fisher Grade on admission and hydrocephalus. Conclusion : Knowledge on risk factors related to the occurrence of hydrocephalus may help guide neurosurgeons in the long-term care of patients who have experienced aneurysmal SAH.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.518-526
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• 2017

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.134-136
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• 2007

A woman who had a spontaneous subarachnoid hemorrhage [SAH] and temporal intracerebral hemorrhge [ICH] without any causative lesions on computed tomography [CT] and digital angiography at the day of the stroke. She was considered to have an angiographically negative SAH and scheduled for a repeated angiography. While she was waiting for the next study, she developed a second hemorrhage. CT angiography showed an aneurysmal shadow in the course of the posterior cerebral artery. After the operation, the aneurysm proved to be a pseudoaneurysm.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.55-59
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• 1999

Vasoconstriction of intracerebral arteries is the leading cause of delayed cerebral infarction and mortality following aneurysmal subarachnoid hemorrhage. Transcranial Doppler studies show and increase in the flow velocities of basal cerebral arteries, which usually start around day 4 following a subarachnoid hemorrhage, and peaking by days 7 to 14. Angiographic studies confirm the presence of at least some degree of MCA vasospasm when the flow velocities are higher than 100 cm/sec. Mean velocities in the 120 to 200 cm/sec range correspond to 25 to 50% luminal narrowing. MCA and ACA vsospasm is detected with around 90% specificity. Sensitivity is 80% and 50% respectively. A 200cm/sec threshold and rapid flow velocity increase exceeding 50 cm/sec on consecutive days, has been associated with subsequent infarction. Transcranial Doppler is also used to monitor the effects of endovascular treatment of vasospasm. Flow velocities decrease following successful angioplasty or papaverine infusion. Overall, transcranial Doppler studies are considered to have acceptable accuracy for the evaluation of vasospasm in aneurysmal subarachnoid hemorrhage, with limitations that have to be taken into consideration in the clinical setting.

• Journal of Korean Neurosurgical Society
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• 제30권6호
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• pp.705-710
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• 2001

목 적 : 파열된 뇌동맥류 수술후 경련발작은 잘 알려진 합병증으로 항경련제 치료가 요구된다. 저자들은 뇌동맥류 파열에 의한 지주막하출혈 환자에서 수술후 경련발작의 위험인자를 조사하여 경련발작 치료에 임상적 의의를 비교 하고자 한다. 방 법 : 1990년부터 1996년까지 파열된 뇌동맥류로 개두술을 시행한 321명의 환자중 1년 이상 추적관찰(1~4.6년)하였던 206명을 대상으로 후향적 방법으로 조사하였다. 모든 환자는 수술후 3~18개월 동안 예방적 항경련제 치료를 받았다. 경련발작에 기여하는 요인으로서 연령, 성별, 내원 당시 신경학적 상태, 수술전후 전산화단층촬영소견, Hunt-Hess grade, Fisher grade, 뇌동맥류의 위치, 고혈압의 기왕력, 수술시기, 그리고 지연성 신경학적 결손 등을 조사하여 비교 분석하였다. 통계적 검증분석 방법으로 chi-square test와 Fisher's exact test를 이용하였다. 결 과 : 평균 추적관찰기간은 1.8년으로 206명중 18명이 경련발작 소견을 보여 8.7%의 발생률을 보였다. 연령에서 나이가 적을수록, 파열된 동맥류의 위치가 중뇌동맥인 경우에서 경련발작이 높게 나타났다. 지연성 신경학적 결손을 보인 42명의 환자에서 8명(19%)이 경련발작이 발생하여 높은 통계학적 유의성을 보였다. 또한 고혈압의 기왕력, 수술후 뇌전산화촬영상 뇌경색등도 이와 관련성이 있었고, 수술전후 뇌내혈종의 소견이 관찰되면 또한 경련발작이 높게 발생되었다. 그러나 Hunt-Hess grade, Fisher grade, Glasgow Outcome Scale, 그리고 출혈후 수술의 시기 등은 경련발작의 발생빈도와는 통계학적 유의성을 보이지 않았다. 결 론 : 뇌동맥류 파열에 의한 수술후 경련발작의 위험인자로 낮은 연령, 중뇌동맥류, 지연성 신경학적 결손, 수술후 뇌전산화촬영상 뇌경색소견, 고혈압, 그리고 수술전후 뇌내혈종의 유무 등이 연관되었고, 이러한 경련발작의 유발인자를 인지함으로서 수술후 경련발작에 대한 예방과 치료에 도움을 줄 수가 있으며 이에 대한 전향적 연구가 요구된다.