• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.204-207
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• 2015

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.54-57
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• 2015

A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.518-520
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• 2016

Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device ($4{\times}20mm$) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR ($6{\times}20mm$). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.

• 대한방사선기술학회지:방사선기술과학
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• 제46권5호
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• pp.427-433
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• 2023

This study aimed to quantitatively compare the diameters measured directly from the coronal plane or sagittal plane of 2D digital subtraction angiography (DSA) and the cross-sectional area-converted diameters calculated from contrast-enhanced MR (CE-MR) imaging. A retrospective analysis was conducted on 20 patients who underwent both 2D DSA and CE-MR imaging. Firstly, the venous diameters of the superior sagittal sinus (SSS) and transverse sinus (TS) were directly measured from 2D DSA. Subsequently, the axial planes for SSS diameter and the sagittal plane for TS in CE-MR imaging were utilized to calculate cross-sectional area-based converted diameters. The numerical values obtained from 2D DSA and CE-MR imaging were compared pairwise at each location. For SSS, the diameter measured by 2D DSA was 27% larger than the conversion-based diameter from CE-MR imaging (9.8±1.4 mm vs. 7.1±1.3 mm, P<0.05). Similarly, for the right TS, the difference was 16% (8.8±3.2 mm vs. 7.4±2.0 mm, P<0.05), and for the left TS, the difference was 22% (8.4±2.8 mm vs. 6.6±1.3 mm, P<0.05). In conclusion, the diameter measured directly in conventional 2D DSA may be larger than the diameter converted based on the cross-sectional area. Therefore, when selecting the size of the stent, it is crucial to make precise determinations while keeping this fact in mind.

• Journal of Trauma and Injury
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• 제30권3호
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• pp.98-102
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• 2017

Vertex epidural hematoma (VEH) is an uncommon presentation of all epidural hematomas and presents with a wide range of symptom and signs. Diagnosis as well as treatment of VEH is also difficult because of its location adjacent to superior sagittal sinus (SSS). A 43-year-old male visited our hospital after fall down and was diagnosed with VEH. While evaluating its location and patency of SSS, he was deteriorated and urgently underwent evacuation of VEH. Bilateral craniotomies on each side, leaving a central bony island to avoid bleeding of midline structure and provide an anchor for dural tack-ups. After the operation, VEH was totally removed and the patient has restored.

• Korean Journal of Radiology
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• 제24권5호
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• pp.444-453
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• 2023

Objective: Meningeal lymphatic vessels are predominantly located in the parasagittal dural space (PSD); these vessels drain interstitial fluids out of the brain and contribute to the glymphatic system. We aimed to investigate the ability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing the dynamic changes in the meningeal lymphatic vessels in PSD. Materials and Methods: Eighteen participants (26-71 years; male:female, 10:8), without neurological or psychiatric diseases, were prospectively enrolled and underwent DCE-MRI. Three regions of interests (ROIs) were placed on the PSD, superior sagittal sinus (SSS), and cortical vein. Early and delayed enhancement patterns and six kinetic curve-derived parameters were obtained and compared between the three ROIs. Moreover, the participants were grouped into the young (< 65 years; n = 9) or older (≥ 65 years; n = 9) groups. Enhancement patterns and kinetic curve-derived parameters in the PSD were compared between the two groups. Results: The PSD showed different enhancement patterns than the SSS and cortical veins (P < 0.001 and P < 0.001, respectively) in the early and delayed phases. The PSD showed slow early enhancement and a delayed wash-out pattern. The six kinetic curve-derived parameters of PSD was significantly different than that of the SSS and cortical vein. The PSD washout rate of older participants was significantly lower (median, 0.09; interquartile range [IQR], 0.01-0.15) than that of younger participants (median, 0.32; IQR, 0.07-0.45) (P = 0.040). Conclusion: This study shows that the dynamic changes of meningeal lymphatic vessels in PSD can be assessed with DCE-MRI, and the results are different from those of the venous structures. Our finding that delayed wash-out was more pronounced in the PSD of older participants suggests that aging may disturb the meningeal lymphatic drainage.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1555-1562
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• 2000

목 적 : 원위부 전대뇌 동맥에 발생하는 동맥류는 모동맥의 확보가 힘들고 재출혈 및 수술중 조기출혈의 빈도가 높으며, 익숙치 않은 수술적 접근법이 필요하다든지 하는 몇 가지 독특한 문제점이 있다. 따라서 전대뇌 반구간열 주변의 해부학적 구조물과 박리 시작점에 대한 수술전 지식을 요한다. 저자들은 박리 시작점에 대한 일관된 외부표식자를 이용하여 전두 기저부 대뇌반구간열 접근법 수술을 시행하였고 이를 심부 구조물들에 대한 접근 지표로 삼고자 하였다. 대상 및 방법 : 1995년 11월부터 1999년 6월까지 동맥류경을 결찰한 총 131명의 뇌동맥류파열 환자 중에서 원위부 전대뇌 동맥류 9명에 대하여 혈관조영술, 의무기록지, 수술소견을 통해 임상적, 수술소견을 조사하였다. 결 과 : 원위부 전대뇌동맥류의 빈도는 6.3%였고, 6례에서 뇌량 연변 동맥이 기시하는 뇌량 주위 동맥에서 발생하였고, 3례에서는 전두극동맥이 기시하는 뇌량 주위 동맥에서 발생하였다. 동반된 다른 혈관기형 및 다른 동맥류는 각각 3예에서 발견되었다. 술전 환자 상태는 일반적으로 불량했다. 조기수술은 7예에서 실시되었으며, 전두 기저부 대뇌반구간열 접근법으로 동맥류 결찰을 시행한 경우도 7예였다. 술후 심한 혈관연축과 흡인성 폐렴으로 인한 사망이 각각 1례씩이었으며 그 이외에는 신경학적 소견은 정상이었다. 결 론 : 원위부 전대뇌 동맥류의 조기수술시에 전두 기저부 대뇌반구간열 접근법이 유용하였다. 이 방법으로 뇌견인을 최소화할 수 있었으며 동맥류의 조기파열을 방지할 수 있었다. 저자들은 대뇌반구 간열의 박리 시작점으로 첫번째 교정맥(전두극 정맥)이 상시상 정맥동으로 유출되는 지점을 기준으로 하여 뇌량 및 뇌량 주변부 원위부 전대뇌동맥류에 접근할 수 있었다.

• 대한의용생체공학회:의공학회지
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• 제33권2호
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• pp.72-77
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• 2012

Phase Contrast MR Angiography(PC MRA) is excellent MRA technique for measuring the velocity of vessels in the human body. PC MRA need to at least four images for angiogram reconstruction and it caused longer scan time. Therefore, we used keyhole imaging combined PC MRA to reduce the scan time. However, keyhole imaging can lead the erroneous effects as loss of phase information or frequency discontinuous. In this study, we applied the keyhole imaging combined 2D PC MRA for improving the temporal resolution and also measured the velocity to evaluate the accuracy of phase information. We used 0.32T MRI scanner(Magfinder II, Scimedix, Korea). Using the 2D PC MRA pulse sequence, the vascular images for a human brain targeted on the Superior Sagittal Sinus(SSS) were obtained. We applied tukey window function for keyhole images to minimize the ringing artifact and erroneous factors that are induced frequency discontinuous and phase information loss. We also applied zero-padded algorithm to peripheral missing k-space lines to compare keyhole imaging results and the artifact power(AP) value was measured on the complex difference images to validate the image quality. Consider as based on our results, heavy image distortions and artifacts were shown until using at least 50% keyhole factor. Using above the 50% keyhole factors are shown well reconstructed and matched for magnitude images and velocity information measurements. In conclusion, we confirmed the image quality and velocity information of keyhole technique combined 2D PC MRA. Especially, measured velocity information through the keyhole imaging combination was similar to the velocity information of full sampled k-space image despite of frequency discontinuous and phase information loss in the keyhole imaging reconstruction process. Consequently, the keyhole imaging combined 2D PC MRA will give some clinical usefulness and advantages as improving the temporal resolution and measuring the velocity information via selecting the appropriate keyhole factor at low tesla MRI system.