• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권1호
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• pp.19-27
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• 2023

Objective: The purpose of this study was to determine the efficacy of a 3D-printed aneurysm simulation model (3DPM) in educating patients and improving physicians' comprehension and performance. Methods: This prospective study involved 40 patients who were diagnosed with unruptured intracranial aneurysms (UIAs) and scheduled for surgical clipping or endovascular coiling and randomly divided into two groups (the 3DPM group and the non-3DPM group). The 3DPM was used in preoperative consultation with patients and intraoperatively referenced by surgeons. The patients, 7 neurosurgical residents, and 10 surgeons completed questionnaires (5-point Likert scale) to determine the usefulness of the 3DPM. Results: Patients in the 3DPM group had significantly higher scores in terms of their understanding of the disease (mean 4.85 vs. 3.95, p<0.001) and the treatment plan (mean 4.85 vs. 4.20, p=0.005) and reported higher satisfaction during consultation (5.0 vs. 4.60, p=0.036) than patients in the non-3DPM group. During patient consultation, 3DPMs were most useful in improving doctor-patient communication (mean 4.57, range 4-5). During clipping surgery, the models were most useful in assessing adjacent arteries (mean 4.9, range 4-5); during endovascular coiling, they were especially helpful in microcatheter shaping (mean 4.7, range 4-5). Conclusions: In general, 3DPMs are beneficial in educating patients and improving the physician's performance in terms of surgical clipping and endovascular coiling of UIAs.

• Journal of Korean Neurosurgical Society
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• 제67권5호
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• pp.541-549
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• 2024

Objective : Advancements in AVM surgical techniques for cerebral arteriovenous malformation (AVM) underscore its efficacy. Our research aims to showcase the positive outcomes of treating low-grade AVMs surgically, focusing on safety and effectiveness. Methods : We retrospectively reviewed 55 patients (36 males and 19 females; average age 37.4 years) with Spetzler-Martin (S-M) grade 1 and 2 AVMs who underwent surgical resection between January 2009 and December 2022. Results : In our study, 55 patients with S-M grade 1 and 2 AVMs underwent surgical resection, evenly divided between grades 1 (50.9%) and 2 (49.1%). Intracranial hemorrhage was the primary symptom in 74.5% of cases. Pre-operative Glasgow coma scale (GCS) scores revealed 69.1% of patients scored above 13, with 18% below 8. Successful resection was achieved in 87.3%. Postoperatively, 95.5% of ruptured and 90.9% of unruptured AVM patients showed lower or same modified Rankin scale scores. Poorer outcomes were significantly linked to lower GCS scores and intranidal/flow-related aneurysms through multivariate logistic regression. Postoperative seizures noted in nine patients, were exclusive to the ruptured AVM group. Conclusion : Our findings indicate surgical resection as a beneficial treatment for low-grade AVMs, yielding high cure rates and positive functional outcomes in both ruptured and unruptured cases. Preoperative GCS scores and the presence of associated aneurysms are predictive of postoperative functional status. Additionally, managing postoperative seizures effectively is key to enhancing prognosis.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.452-461
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• 2023

The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) common trunk is a rare variant of cerebral posterior circulation in which a single vessel originating from either the basilar or vertebral arteries supplies both cerebellum and brainstem territories. We present the first case of an unruptured right AICA-PICA aneurysm treated with flow diversion using a Shield-enhanced pipeline endovascular device (PED, VANTAGE Embolization Device with Shield Technology, Medtronic, Canada). We expand on this anatomic variant and review the relevant literature. A 39-year-old man presented to our treatment center with vertigo and right hypoacusis. The initial head CT/CTA was negative, but a 4-month follow-up MRI revealed a 9 mm fusiform dissecting aneurysm of the right AICA. The patient underwent a repeat head CTA and cerebral angiogram, which demonstrated the presence of an aneurysm on the proximal portion of an AICA-PICA anatomical variant. This was treated with an endovascular approach that included flow diversion via a PED equipped with Shield Technology. The patient's post-procedure period was uneventful, and he was discharged home after two days with an intact neurological status. The patient is still asymptomatic after a 7-month follow-up, with MR angiogram evidence of stable aneurysm obliteration and no ischemic lesions. Aneurysms of the AICA-PICA common trunk variants have a high morbidity risk due to the importance and extent of the territory vascularized by a single vessel. Endovascular treatment with flow diversion proved to be both safe and effective in obliterating unruptured cases.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.475-484
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• 2023

Objective: This study aimed to develop microsurgical strategies based on the anatomical relationship between dorsal internal carotid artery (ICA) aneurysms, the falciform ligament (FL), and the anterior clinoid process (ACP). Methods: Between 2017 and 2022, 25 patients with unruptured dorsal ICA aneurysms (less than 4 mm in diameter) underwent microsurgical direct clipping. These cases involved the left ICA (n=17) and the right ICA (n=8), with a mean aneurysm size of 3.3 mm (range, 2.5 to 4 mm). We used computed tomography angiography (CTA) and digital subtraction angiography to elucidate the anatomical relationship between dorsal ICA aneurysms and other structures. All procedures involved an ipsilateral pterional approach with securement of the ipsilateral cervical ICA for proximal control. Results: Among the 25 dorsal ICA aneurysms, 8 (32%) were clipped without the FL being incised. Another 5 (20%) were clipped solely after the FL was cut. For the remaining 12 cases, the aneurysms were successfully clipped following FL incision and partial ACP removal. Patients exhibited favorable postoperative recoveries with good outcomes, and postoperative CTA revealed complete aneurysm clipping without any residual remnants. Conclusions: We were able to perform clipping without removing the ACP in 13 patients (52%), and in 8 of these (32%), the clipping was carried out directly without cutting the FL. Microsurgery, coupled with proximal control of the cervical ICA, can serve as a viable alternative for patients with small dorsal ICA aneurysms, especially when endovascular treatment options are limited, and 3D CTA confirms a clear anatomical relationship with the ACP.

• Journal of Korean Neurosurgical Society
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• 제63권1호
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• pp.4-13
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• 2020

For surgical minimalism to reduce iatrogenic traumatization, a supraorbital keyhole approach has already been successfully applied to treat many unruptured anterior circulation aneurysms. However, using this minimal approach also raises several technical concerns due to the small cranial opening and cosmetic impact of a facial incision. Yet, such technical limitations can be overcome by using favorable surgical indications, slender surgical instruments, and optimized surgical techniques, while excellent cosmetic outcomes can be achieved using a short skin incision located <1 cm from the supraorbital margin, reconstruction of any bone defects around the bone flap, and meticulous wound closure. Thus, given such reassuring surgical results, in terms of the clipping status, neurological effects, and cosmetic outcomes, any concerns can be transitioned into confidence.

• Journal of Korean Neurosurgical Society
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• 제51권6호
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• pp.370-373
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• 2012

The intracranial stent functions primarily to prevent protrusion of coils into the parent vessel during the embolization of wide-necked cerebral aneurysms and might also reduce aneurysm recanalization rate. In spite of these advantages, little is known about the long-term interaction of the stent with the parent vessel wall. We present a rare case of severe in-stent stenosis occurring as a delayed complication of Neuroform stent-assisted coil embolization of an unruptured intracranial aneurysm.

• Journal of Korean Neurosurgical Society
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• 제42권6호
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• pp.478-480
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• 2007

Unruptured non-traumatic dissecting aneurysm in the M4 segment of the middle cerebral artery (MCA) accompanied by complete occlusion of the ipsilateral internal cerebral artery (ICA) has never been reported. A 41-year-old man presented with an infarction manifesting as left-sided weakness and dysarthria. Magnetic resonance angiography revealed a subacute stage infarction in the right MCA territory and complete occlusion of the right ICA. Angiography demonstrated aneurysmal dilatation of the M4 segment of the right MCA. Surgery was performed to prevent hemorrhage from the aneurysm. The aneurysm was proximally clipped guided by Navigation-CT angiography and flow to the distal MCA was restored by superficial temporal artery-middle cerebral artery (STA-MCA) anastornosis. We report this rare case with literature review.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.832-835
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• 2000

A case of unruptured cerebral aneurysm at the junction of accessory middle cerebral artery and the distal portion of the $A_1$ segment of the anterior cerebral artery is reported. To the authors' knowledge, this is the first reported case of cerebral aneurysm developed at the junction of accessory middle cerebral artery, demonstrated on magnetic resonance angiography(MRA). The accessory middle cerebral artery is a rare vascular variant of middle cerebral artery. Furthermore, it is extremely rare for an aneurysm to be developed at the origin of the accessory middle cerebral artery. The development of the accessory middle cerebral artery is very important in surgery of cerebral aneurysm and collateral circulation of cerebral infarction. Review of the literature regarding the genesis and anatomical variation of the accessory middle cerebral artery is also presented.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.336-339
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• 2007

Traumatic intracranial aneurysm rarely occurs after a head injury. The authors report a case of a 51-year-old man in whom subarachnoid hemorrhage was developed as a result of delayed traumatic aneurysmal rupture of the distal portion of the middle cerebral artery following a minor, closed-head injury. The unruptured aneurysm had been evident on the magnetic resonance image taken two days prior to onset of the subarachnoid hemorrhage. The clinical presentation and possible underlying mechanism are discussed with a review of pertinent literature.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.259-262
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• 2010

Large to giant middle cerebral artery aneurysm is a challenging disease, especially when incorporating important perforating arteries. Surgical risk increases by perforator infarction and anatomical complexity. In this clinical setting, extensive consideration of surgical options is needed. The two cases described here were unruptured and had rather stable wall. Because of their large and giant size, hardness and incorporated arteries, it was not affordable to isolate them by means of clipping or trapping. The procedure as the alternative to conventional treatment modalities, extracranial-intracranial bypass followed by clipping of only the efferent artery successfully treated the aneurysms.