• Journal of Korean Neurosurgical Society
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• 제37권3호
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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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• 제30권12호
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• pp.1361-1368
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• 2001

Objective : "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. Methods : Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. Results : Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were : Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. Conclusion : The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.240-247
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• 2017

자기공명혈관영상(magnetic resonance angiography: MRA)을 이용한 뇌혈관검사가 증가하면서 비파열 동맥류의 발견이 많아졌다. 비파열 동맥류(unruptured intracranial aneurysm: UIA)의 병태생리 이해를 위해 비파열 동맥류의 분포와 관련요인을 아는 것이 도움이 될 것으로 생각한다. 환자군은 건강검진 시 MRA를 시행받은 사람을 대상으로 하였다. 비파열 동맥류의 발생과 위험요인(나이, 성별, 고혈압, 당뇨, 흡연, 음주력, 관상동맥질환)을 크기(3 mm이상 대 3 mm미만)와 다발성 동맥류(단일 대 다발성 동맥류)에 따라 비교하였다. 그리고 위치에 따른 비파열 동맥류 발생 빈도를 비교하였다. 2007년 1월부터 2016년 12월까지 건강검진 센터를 방문하여 건강검진을 받은 사람을 대상으로 하였다. 건강검진을 받은 187166명의 사람 중 18954명이 MRA를 찍었으며, 이 중 367명(1.93%)이 비파열 동맥류를 보였다. 3 mm이상과 3 mm미만의 동맥류를 비교하였을 때 3 mm이상의 동맥류 환자군에서 평균 나이가 유의하게 높았다(3 mm이상 $57.16{\pm}8.47$ 대 3 mm미만 $55.12{\pm}8.19$; p=0.07). 고밀도 지질단백질(high-density lipoprotein)은 3 mm이상의 동맥류 환자군에서 유의하게 높았다(3 mm 이상 $55.95{\pm}16.03$ 대 3 mm미만 $50.85{\pm}13.65$; p=0.007). 고혈압은 다발성 동맥류 환자군에서 의미있게 높은 경향을 보였다(단일 동맥류 399명 중 153명(38.3%) 대 다발성 동맥류 35명 중 19명 (54.3%); p=0.065). 3mm미만의 동맥류는 내경동맥 말단부(34.3%)와 중대뇌동맥 분기부(16.4%)에서 호발하였다(p=0.003). 3 mm이상의 동맥류는 내경동맥 말단부(43.3%)와 중대뇌동맥 분기부(13.4%) 및 앞교통동맥(13.4%)에서 호발하였다(p=0.003). 동맥류는 크기 차이와 단일 혹은 다발성에 따라 서로 다른 위험요인과의 상관성을 보였으나, 두가지 위험요인 모두 혈관의 퇴행성 변화와 혈류역학적 장애가 동맥류 발생의 원인이 될 수 있다는 것을 보여준다.