• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.179-186
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• 2005

Objective: The purpose of this paper is to report our experiences in managing seventeen cases of residual intracranial aneurysms following surgical or endovascular treatment and discuss the incidence of residual aneurysms, the indications and technique of retreatment of residual aneurysms. Methods: During a period of 42 months, we treated 391 aneurysms in 339 patients with microsurgical clipping or GDC embolization as a primary treatment. In 39 of them, follow-up angiography revealed residual aneurysms and seventeen of whom were retreated. There were eleven cases in ACoA, three cases in distal ICA, one, in each of MCA, ACA and basilar artery. We reviewed retrospectively the clinical notes, operation records and cerebral angiograms of seventeen patients who had been treated for residual aneurysms. Results: Complementary treatment was performed in 8 cases by means of surgery and in 9 cases by means of GDC embolization. There were eleven females and six males with an age variation between 29 and 78 years. The mean duration of angiographic follow-up was 17.3 months. Of the seventeen cases that were treated for residual aneurysms, fourteen achieved complete occlusion. Of 17 retreated patients, fifteen patients had good recovery according to the Glasgow Outcome Scale. Conclusion: When occlusion after endovascular or surgical treatment is incomplete, a new multidisciplinary approach should be carried out. Given our experiences, we recommend coil embolization of the choice in cases that the residual aneurysmal neck had been narrowed by previous clipping. On the other hand, if the residual aneurysm has enough space to clip but not enough to coil, we recommend the microsurgical clipping.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.268-271
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• 2012

Objective : To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately. Methods : From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm. Results : According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome. Conclusion : The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.

• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1322-1327
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• 2000

Objectives : To assess the surgical results for patients with multiple intracranial aneurysms and factors related to prognosis of patients. Materials and Methods : We retrospectively analyzed the clinical characteristics of 47 patients with multiple intracranial aneurysms and assessed the types of surgical treatment and prognosis of 44 patients who received surgical treatment from January 1986 to March 1999. Results : The 47 patients presented altogether 108 aneurysms with male to female ratio of 1 : 3.7, and average age 54.9 years(range 33-81 years). Common locations for multiple aneurysms were P-com(31%), MCA(30%) and Acom( 15%). The postoperative good and poor outcomes were 30 cases(68%) and 11 cases(25%), respectively and there were 3 deaths(7%). The analyzed results for 44 surgically treated patients were as follows ; 1) The size of aneurysm was relevant to frequency of rupture ; the lowest for lesions less than 1cm(21%), rising to 85% for lesions greater than 3cm(p<0.05). 2) The surgical outcome was significantly correlated with preoperative clinical status of the patients(p<0.05). 3) The good outcome was associated with surgery within 7 days(especially 24 hours) after clinical onset of symptoms but not with type of operation and laterality of aneurysms. Conclusion : With regard to the surgical treatment for multiple aneurysm cases, surgeons should consider the salient factors in a good prognosis such as patient's preoperative status, size of aneurysm, timing of surgery, and type of operation.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.228-233
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• 2008

Objective : The standard treatment strategy of intracranial aneurysms includes either endovascular coiling or microsurgical clipping. In certain situations such as in giant or dissecting aneurysms, bypass surgery followed by proximal occlusion or trapping of parent artery is required. Methods : The authors assessed the result of extracranial-intracranial (EC-IC) bypass surgery in the treatment of complex intracranial aneurysms in one institute between 2003 and 2007 retrospectively to propose its role as treatment modality. The outcomes of 15 patients with complex aneurysms treated during the last 5 years were reviewed. Six male and 9 female patients, aged 14 to 76 years, presented with symptoms related to hemorrhage in 6 cases, transient ischemic attack (TIA) in 2 un ruptured cases, and permanent infarction in one, and compressive symptoms in 3 cases. Aneurysms were mainly in the internal carotid artery (ICA) in 11 cases, middle cerebral artery (MCA) in 2, posterior cerebral artery (PCA) in one and posterior inferior cerebellar artery (PICA) in one case. Results : The types of aneurysms were 8 cases of large to giant size aneurysms, 5 cases of ICA blood blister-like aneurysms, one dissecting aneurysm, and one pseudoaneurysm related to trauma. High-flow bypass surgery was done in 6 cases with radial artery graft (RAG) in five and saphenous vein graft (SVG) in one. Low-flow bypass was done in nine cases using superficial temporal artery (STA) in eight and occipital artery (OA) in one case. Parent artery occlusion was performed with clipping in 9 patients, with coiling in 4, and with balloon plus coil in 1. Direct aneurysm clip was done in one case. The follow up period ranged from 2 to 48 months (mean 15.0 months). There was no mortality case. The long-term clinical outcome measured by Glasgow outcome scale (GOS) showed good or excellent outcome in 13/15. The overall surgery related morbidity was 20% (3/15) including 2 emergency bypass surgeries due to unexpected parent artery occlusion during direct clipping procedure. The short-term postoperative bypass graft patency rates were 100% but the long-term bypass patency rates were 86.7% (13/15). Nonetheless, there was no bypass surgery related morbidity due to occlusion of the graft. Conclusion : Revascularization technique is a pivotal armament in managing complex aneurysms and scrupulous prior planning is essential to successful outcomes.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.303-305
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• 2005

The incidence of intracranial aneurysms in childhood is rare, especially in infancy. We report a case of a 45-day-old girl who presented with seizure due to a ruptured large saccular aneurysm of the middle cerebral artery[MCA] with subsequent subarachnoid, intracerebral and intraventricular hemorrhage. The baby has enjoyed an excellent clinical outcome after surgical management. The clinical features of the case and review of the literature are presented.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.455-458
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• 2006

The incidence of blindness after aneurysm surgery is very rare. We experienced a case of unilateral blindness after internal carotid artery[ICA] aneurysm wrapping. A 43-year-old male immediately developed ipsilateral ocular pain and visual loss in his left eye after the treatment of a lateral ICA aneurysm by wrapping with muscle pieces. He had also multiple aneurysms, which were multilobulated anterior communicating artery [A-com], middle cerebral artery[MCA] and posterior communicating artery [P-com] aneurysms. Coilings were done for a part of A-com artery aneurysm and P-com artery aneurysm on admission. The remaining A-com artery aneurysm was clipped and ICA aneurysm was wrapped with temporal muscle piece. A retrobulbar optic neuropathy might have resulted from either direct injury or damage to small dural vessels of the posterior optic nerve. Actually, the optico-carotid space was tight and the optic nerve was compressed by swollen muscle piece. Despite releasing of compression of the optic nerve on second day, his visual loss was irreversible.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.471-474
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• 2005

Pure sylvian fissure arteriovenous malformations[AVMs] are vascular malformations confined to the sylvian fissure without parenchymal involvement. Surgical removal is regarded as difficult because the nidus is located just lateral to important structures such as the basal ganglia and the internal capsule. Because most feeding arteries to the nidus are branches of the middle cerebral artery[MCA], differentiation between these feeders from en passant and normal vessels is of great importance in order to reduce morbidity and mortality from surgical intervention. We report a case of pure sylvian fissure AVM who presented with an intra-temporal lobe hematoma that was located around venous aneurysms distant from the nidus. The clinical characteristics of this AVM and the surgical methods employed to avoid complications are discussed.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.240-247
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• 2017

The increased investigation of the cerebral arteries with magnetic resonance angiography has resulted in an increase in the identification of unruptured intracranial aneurysms (UIAs). Knowledge of the distribution and factors associated with UIAs might be helpful for understanding the pathological mechanism of unruptured aneurysms. This study examined patients who visited a health care center and had a health examination from January 2007 to December 2016. Subjects who underwent magnetic resonance angiography with a health examination at the Health Screening were enrolled in this study. The incidence and risk factors of UIAs (age, sex, hypertension, diabetes mellitus, smoking, alcohol, and coronary artery disease) were investigated by comparing the size (more than 3 mm vs. less than 3 mm) and multiple aneurysm (single vs. multiple aneurysms). The frequency of aneurysm according to the site was also analyzed. Among the 187166 subjects, who received a health examination, 18954 underwent magnetic resonance angiography. Of them, 367 (1.93%) had UIAs. A comparison of the size of more than 3 mm and less than 3 mm showed that the mean age of the more than 3 mm group of patients was significantly higher than the other size groups (more than 3 mm $57.16{\pm}8.47$ vs. less than 3 mm $55.12{\pm}8.19$; p=0.07). High-density lipoprotein was significantly higher in the more than 3 mm group than in the less than 3 mm($55.95{\pm}16.03$ vs. less than 3 mm $50.85{\pm}13.65$; p=0.007). Hypertension was significantly higher in the multiple aneurysm group (single 153 in 399 (38.3%) VS multiple 19 in 35 (54.3%); p=0.065). An aneurysm of less than 3 mm in size was frequent in the distal internal carotid artery (34.3%) and MCA-bifurcation (16.4%) (p=0.003). Aneurysms of more than 3 mm were frequent in the distal internal carotid artery (43.4%) and MCA-bifurcation (13.4%), and anterior communicating artery (13.4%) (p=0.003). The difference in size and single or multiple aneurysm revealed other risk factors. These risk factors suggest that degenerative and hemodynamic disorders may lead to the presence of aneurysms.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.705-710
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• 2001

Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p = 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p <0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.