• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.434-437
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• 2010

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

• Proceedings of the Zoological Society Korea Conference
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• 1994.10a
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• pp.161.1-161
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• 1994

No Abstract, See Full Text

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.130-132
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• 2024

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.269-275
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• 2016

Objective : Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. Methods : Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. Results : Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. Conclusion : Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.

• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.6-10
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• 2016

Objective : The objectives of this study was to determine the incidence and outcomes of procedural rupture (PR) during coil embolization of unruptured intracranial aneurysm (UIA) and to explore potential risk factors. Methods : This retrospective study evaluated 1038 patients treated with coil embolization between January 2001 and May 2013 in a single tertiary medical institute. PR was defined as evidence of rupture during coil embolization or post procedural imaging. The patient's medical records were reviewed including procedure description, image findings and clinical outcomes. Results : Twelve of 1038 (1.1%) patients showed PR. Points and time of rupture were parent artery rupture during stent delivery (n=2), aneurysm rupture during filling stage (n=9) and unknown (n=1). Two parent artery rupture and one aneurysm neck rupture showed poor clinical outcomes [modified Rankin Scale (mRs) >2] Nine aneurysm dome rupture cases showed favorable outcomes ($mRS{\leq}2$). Location (anterior cerebral artery) of aneurysm was associated with high procedural rupture rate (p<0.05). Conclusion : The clinical course of a patientwith procedural aneurysm rupture during filling stage seemed benign. Parent artery and aneurysm neck rupture seemed relatively urgent, serious and life threatening. Although the permanent morbidity rate was low, clinicians should pay attention to prevent PR, especially when confronting the anterior cerebral artery aneurysm.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.518-526
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• 2017

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.42-49
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• 2024

Objective : There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. Methods : This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. Results : In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. Conclusion : SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.

• Journal of Korean Neurosurgical Society
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• v.51 no.3
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• pp.155-159
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• 2012

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.426-429
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• 2000

Arare case of bilateral abducens nerve paralyses after rupture of a left posterior communicating artery(PcomA) aneurysm with multiple unruptured aneurysms in a 46-year-old female is presented. Sudden left abducens nerve paralysis followed by progressive right abducens nerve paralysis were present without additional neuroophthalmological signs. Postoperatively, bilateral abducens nerve paralyses gradually recovered and disappeared in 2 weeks. The authors reviewed and discussed the possible mechanisms involved in this uncommon neuro-ophthalmological manifestation.

• 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.