• Journal of Korean Neurosurgical Society
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• v.44 no.1
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• pp.43-46
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• 2008

A 35-year-old man's vision had progressively deteriorated over a 3-month period. His left visual acuity was 5/20. Enhanced orbital computed tomographic (CT) scans revealed a fusiform dilatation of the ophthalmic artery in the left optic canal. Cerebral Angiography revealed a fusiform aneurysm on the left ophthalmic artery in the optic canal, measuring $6.2{\times}4.6\;mm$ in size. Four days after admission, visual acuity dropped to hand-motion. Endovascular treatment was chosen and a microcatheter was guided into the proximal segment of the ophthalmic artery. Using 4 detachable coils, parent artery occlusion was done. Three months after the intervention, the visual acuity in his left eye improved to 20/20. Dramatic recovery of visual acuity is exceptional with an ophthalmic artery trunk aneurysm. When an occlusion of the proximal ophthalmic artery is the only treatment option in such a situation, the endovascular occlusion of the proximal ophthalmic artery is quite feasible in the sense that it does not require any optic nerve manipulation.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.128-130
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• 2006

Aneurysms arising from the ophthalmic artery itself are very rare compared with aneurysms originating from the bifurcation of the ophthalmic artery and carotid artery. There was only one reported case of a ruptured aneurysm of the ophthalmic artery itself. We discuss clinical significance of an aneurysm at this site, as well as the role of three dimentional image of multislice computed tomography angiogram[3D-image of MCTA] in determining the cause of subarachnoid hemorrhage[SAH].

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.203-210
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• 2001

Objective : Paraclinoidal aneurysms termed that aneurysms arising from proximal internal carotid artery(ICA) between the site of emergence of the carotid artery from roof of the cavernous sinus and origin of the posterior communicating artery(PCoA). These aneurysms pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. The efficiency of surgical technique according to the location of paraclinoidal aneurysm was studied for minimal exposure. Materials and Methods : Over the past four years, the authors treated surgically 171 cases of cerebral aneurysm, among them ten patients were paraclinoidal aneurysms with two patients unruptured aneurysms. Mean age was 47 years old, and all patients were female. Three patients were proximal posterior carotid artery wall aneurysms(one large, one giant), four patients carotid-ophthalmic artery aneurysms and three patients superior hypophyseal artery aneurysms. Results : There could be done clip in all cases, there were no deaths and no complication. And no patient developed sustained neurological deficits including visual function except hydrocephalus in one case. Four patients complained of visual disturbance but two patients had recovery after postoperation and two patient were not longer to bad. Conclusion : Our recent experience suggests that preoperative scrutiny of diagnostic angiography allows classification of all paraclinoidal aneurysms regardless of size and surgical technique which this classification has focused on operative approaches unique to each aneurysm projection was helpful to improve the operative outcome with good visual function and to shorten the operative time.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.337-339
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• 2001

The development of completely new intracranial aneurysms after previous successfully treated aneurysm is uncommon. A 50-year-old female presented with a case of multiple de novo aneurysm which were an aneurysm of right ophthalmic segment of internal carotid artery and an aneurysm of right A1 artery, 6 years after the clipping of an aneurysm of right posterior communicating artery. She had no history of hypertension, cigarette smoking and use of oral contraceptives, and had no evidence of genetic disorder. The laboratory findings were normal. All de novo aneurysms were clipped by basal anterior interhemispheric approach in one stage due to the direction of the aneurysm of the ophthalmic segment of the internal carotid artery.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.22-30
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• 2024

Objective : This study aimed to determine the frequency of paraclinoid aneurysms among ruptured cerebral aneurysms and compare paraclinoid aneurysms with other aneurysms to clarify the characteristics of ruptured paraclinoid aneurysms. Methods : This study included 970 ruptured cerebral aneurysms treated at our hospital between 2003 and 2020. Results : There were 15 cases (1.3%) of paraclinoid aneurysms with maximum diameters of 5-22 mm (mean±standard deviation [SD], 11.6±5.4 mm). Treatment consisted of clipping in four patients and endovascular treatment in 11. Factors significantly different in multivariate analysis for paraclinoid aneurysms compared with those for other aneurysms were a history of hypertension (odds ratio [OR], 1.2-9.8; p=0.021) and aneurysm ≥10 mm (OR, 7.5-390.3; p<0.001). The sites of paraclinoid aneurysm were ophthalmic artery type in nine patients, anterior wall type in five, medial wall type in one, and ventral wall type in zero. The medial wall type (22 mm) was significantly larger than the ophthalmic artery type (mean±SD, 7.2±2.0 mm) (p=0.003), and the anterior wall type (mean±SD, 12.2±4.8 mm) was significantly larger than the ophthalmic artery type (p=0.024). Conclusion : This study showed a low frequency of paraclinoid aneurysms among ruptured cerebral aneurysms. Most were upward-facing with relatively large aneurysms, and no aneurysms were smaller than 5 mm. With recent advances in endovascular treatment devices, paraclinoid aneurysms are easily treatable. However, the treatment indication of each paraclinoid aneurysm should be carefully considered.

• Journal of Korean Neurosurgical Society
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• v.45 no.4
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• pp.236-239
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• 2009

Carotid occlusion is an inevitable therapeutic modality for the treatment of complex aneurysms such as giant, traumatic, and intracavernous aneurysms. Late complications of carotid occlusion include 'de novo' aneurysm formation at a distant site because of hemodynamic changes in the circle of Willis. We report a case of de novo aneurysm in a vessel that appeared to be normal on initial angiography. The patient developed an anterior communicating artery aneurysm and marked growth of a basilar bifurcation aneurysm 9 years after trapping of the left internal carotid artery for the treatment of a ruptured large saccular aneurysm involving ophthalmic and cavernous segments. We propose that patients who undergo therapeutic carotid occlusion should be periodically followed by magnetic resonance angiography or computed tomographic angiography to evaluate the possibility of de novo aneurysm formation; this advice is in line with previous reports.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.71-73
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• 2010

A 28-year-old woman was referred to our hospital with a sudden, very severe headache. Brain computed tomographic angiography showed a saccular cerebral aneurysm at the bifurcation of the left middle cerebral artery and infraoptic courses of both anterior cerebral arteries. The anterior cerebral arteries were seen to arise from the ipsilateral internal cerebral arteries at the level of the origin of the ophthalmic artery, passed underneath the ipsilateral optic nerve, and turned upward at ventral portion of the optic chiasm. Infraoptic course of the proximal anterior cerebral artery is an extremely rare anomaly and is often associated with cerebral aneurysms. We report the clinical features, radiological findings, and possible genesis of this anomaly with a literature review.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.137-152
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• 2020

In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.