• Journal of Korean Neurosurgical Society
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• v.59 no.5
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• pp.449-457
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• 2016

Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.330-335
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• 2000

Objective : The purpose of this report is to assess the morbidity and mortality associated with clipping of intracranial unruptured aneurysms. Methods : At the authors' institution between May 1989 and December 1998, a total of 128 unruptured aneurysms in 110 patients were treated with surgical clippings. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : The main locations of the aneurysms were : middle cerebral artery 31%, internal carotid-posterior communicating artery 28%, anterior communicating artery 16%, paraclinoid 6.5%, internal carotid-anterior choroidal artery 7%, posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was : Glasgow outcome scale(GOS) I 86%, GOS II 6%, GOS III 4.3%, GOS IV 0% and GOS V(death) 3.5%. The operative risk is higher for large to giant aneurysms, and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality, but morbidity of 8.2%, and in posterior circulation : 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm, mortality and morbidity were 25% and 25%, respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%). The postoperative morbidity was related to occlusion of artery(9/13), intraoperative rupture(3/13), and cranial nerve injury(1/13). Conclusion : This report documents 3.5% mortality and 13% of morbidity in the clipping surgery for unruptured intracranial aneurysms, and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still controversial. However, with respect to surgical results, unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.

• Journal of Medicine and Life Science
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• v.21 no.1
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• pp.15-19
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• 2024

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic necrotizing vasculitis that predominantly affects small vessels of the body. The two most common ANCAs are myeloperoxidase ANCA and proteinase 3 ANCA. Neurological manifestations are frequent in patients with AAV, including peripheral neuropathy, meningitis, and stroke. AAV-associated ischemic stroke usually affects small vessels supplying the white matter or brainstem. This case report details the presentation and treatment course of a 70-year-old man with rapidly progressive multiple intracranial large artery involvement attributed to myeloperoxidase ANCA-associated vasculitis. Despite treatment with high-dose steroids and a rituximab infusion, the patient developed new speech difficulties and respiratory distress, and brain imaging confirmed new stroke lesions with progressive multiple intracranial large cerebral artery involvement. The patient died from SARS-CoV-2 infection 4 months after the diagnosis. This case emphasized the rare presentation of rapidly progressive large vessel involvement in a patient with myeloperoxidase ANCA-associated vasculitis despite active immunotherapy.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.313-320
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• 2014

Objective : The purpose of this study is to demonstrate the technical feasibility and clinical efficacy of emergent carotid angioplasty and stenting (CAS) for acute stroke due to athero-thrombotic occlusion of the cervical internal carotid artery (ICA). Methods : Review of medical records identified 17 patients who underwent emergent CAS for treatment of athero-thrombotic occlusion of the cervical ICA with acute stroke between 2009 and 2013. Eleven patients (64.7%) presented with concomitant intracranial artery occlusion, which was treated primarily by mechanical thrombectomy after CAS. Results : Successful revascularization of the cervical ICA with emergent CAS was achieved in all patients. After CAS, intracranial recanalization with Thrombolysis in Cerebral Infarction ${\geq}2b$ flow was achieved in four of the 11 patients (36.4%). The overall recanalization rate (cervical ICA and intracranial artery) was 10 of 17 patients (58.8%). Symptomatic intracranial hemorrhage occurred in two patients (11.8%), resulting in death. Ten patients (58.8%) showed improvement (decrease in NIHSS score of ${\geq}4$ points) at seven days after recanalization. Nine patients (52.9%) showed a favorable outcome ($mRS{\leq}2$) at the last follow-up. A favorable outcome ($mRS{\leq}2$) was obtained in four of the six patients with isolated cervical ICA occlusion (4/6, 66.7%) and five of 11 patients with intracranial tandem occlusion (5/11, 45.5%). Conclusion : Emergent CAS for acute stroke due to athero-thrombotic occusion of the cervical ICA showed a good technical feasibility and favorable clinical outcome.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.223-227
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• 2005

Systemic multiple aneurysms are rare, and an association between intracranial and visceral arterial or abdominal aortic aneurysm in the same patient is a very rare occurrence. We report herein three such cases. In one case, aneurysms of the right internal carotid artery(ICA) and the right middle cerebral arterial bifurcation(MCAB) coexisted with the inferior pancreaticoduodenal arterial pseudoaneurysm and two ileal arterial aneurysms. In another case, the patient had the A-com arterial aneurysm and the right renal arterial aneurysm. And in the other patient, he had the right vertebral artery dissecting aneurysm with the abdominal aortic aneurym. Initially, all patients were referred to our hospital with subarachnoid hemorrhage(SAH), and thereafter first two patients developed visceral arterial aneurysm rupture in the course of hospital stay and in the last patient, the abdominal aortic aneurysm was detected incidentally during carotid angiogram for Guglielmi detachable coil(GDC) embolization of vertebral dissecting aneurym. After thorough review of our cases together with pertinent literatures, we emphasize the possibility of underlying extracranial aneurysms in ruptured intracranial arterial aneurysm patient and it's uncommon but fatal complication.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.186-189
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• 2011

In recent years the immunocompromised population has increased rapidly to include people with acquired immune deficiency syndrome (AIDS), drug abusers, and transplant patients. Accordingly, the incidence of intracranial fungal infection has increased. Our institution experienced 2 cases of internal carotid artery (ICA) occlusion due to invasion of the cavernous sinus by an intracranial fungal infection. The first case was a 60-year-old man who presented with headache, eye pain, conjunctival injection, right-sided diplopia, and blurred vision. Infected tissues within the frontal and ethmoid sinuses were removed via bifrontal craniotomy and endoscopic sinus surgery through the Caldwell Luc approach. The second case was a 63-year-old woman who developed right-sided facial pain after a tooth extraction. The infection was not controlled despite continuous use of antifungal agents, resulting in death from sepsis. We believe that when intracranial fungal infection is suspected in a patient with orbital symptoms and a focal neurologic deficit, immediate angiographic investigation of possible ICA occlusion is warranted. Aggressive treatment with antifungal agents is the only way to improve prognosis.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.187-192
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• 2012

Objective : Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling. Methods : From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2. Results : In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits. Conclusion : The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.265-269
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• 2000

Traumatic aneurysm is a rare complication of head trauma. Unfortunately, it is rarely recognized until their presence is heralded by delayed deterioration or intracranial hematoma, etc,. Early diagnosis and surgical treatment are most important for good outcome. We recently encountered a patient who developed a pericallosal aneurysm after major trauma. With a high index of suspicion about traumatic aneurysm, brain MRI and MRA were performed. Definitive diagnosis was made by transfemoral carotid angiography, revealing a aneurysm of the right proximal pericallosal artery. The aneurysm was explored through right interhemispheric approch. A $15{\times}15mm$ sized traumatic aneurysmal sac, located in proximal portion of right pericallosal artery was noted. It was dissected from the falx of cerebri and its neck was clipped. The postoperative course was uneventful. Traumatic intracranial aneurysm should be suspected in any patient who deteriorates after the trauma. Early recognition and prompt treatment are warranted in this setting. Definitive surgical treatment of all traumatic intracranial aneurysm is recommended.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.185-190
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• 2011

Objective : To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods : The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results : Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion : EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.262-268
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• 2017

Objective : Stents are widely used in coil embolization of intracranial aneurysms, but on occasion, a microcatheter must traverse a stented segment of artery (so-called trans-cell technique) to select an aneurysm, or double stenting may necessary. In such situations, microguidewire passage and microcatheter delivery through a tortuous stented parent artery may pose a technical challenge. Described herein is a microguidewire looping technique to facilitate endovascular navigation in these circumstances. Methods : To apply this technique, the microguidewire tip is looped before entering the stented parent artery and then advanced distally past the stented segment, with the loop intact. Rounding of the tip prevents interference from stent struts during passage. A microcatheter is subsequently passed into the stented artery for positioning near the neck of aneurysm, with microguidewire assistance. The aneurysm is then selected, steering the microcatheter tip (via inner microguidewire) into the dome. Results : This technique proved successful during coil embolization of nine saccular intracranial aneurysms (internal carotid artery [ICA], 6; middle cerebral artery, 2; basilar tip, 1), performing eight trans-cell deliveries and one additional stenting. Selective endovascular embolization was enabled in all patients, resulting in excellent clinical and radiologic outcomes, with no morbidity or mortality directly attributable to microguidewire looping. Conclusion : Microguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites.