• Journal of Korean Neurosurgical Society
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• 제40권5호
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• pp.369-372
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• 2006

The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery[PICA]. The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.399-400
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• 2008

Hemifacial spasm induced by intracranial aneurysm is a rare clinical condition. A 45-year-old male patient presented with a 3-year history of progressive involuntary twitching movement on right face. On radiological study, a dilated vascular lesion compressing the brain stem was found at the junction of vertebral artery and posterior inferior cerebellar artery. On operative field, we found the posterior inferior cerebellar artery and the fusiform aneurysm compressing root exit zone of facial nerve. Microvascular decompression was performed and the facial symptom was relieved without complications.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.175-183
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• 2015

Objective : Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns. Methods : Twenty-three patients with ruptured VADAn received endovascular treatment (EVT) over 7 years. The patient group included 14 women (60.9%) and 9 men (39.1%) between the ages of 39 and 72 years (mean age 54.2 years). Clinical data and radiologic findings were retrospectively analyzed. Results : Four patients had aneurysms on the dominant vertebral artery. Fourteen (61%) aneurysms were located distal to the posterior inferior cerebellar artery (PICA). Six (26%) patients had an extracranial origin of the PICA on the ruptured VA, and 2 patients (9%) had bilateral VADAns. Eighteen patients (78%) were treated with internal coil trapping. Two patients (9%) required an adjunctive bypass procedure. Seven patients (30%) required stent-supported endovascular procedures. Two patients experienced intra-procedural rupture during EVT, one of which was associated with a focal medullary infarction. Two patients (9%) exhibited recanalization of the VADAn during follow-up, which required additional coiling. No recurrent hemorrhage was observed during the follow-up period. Conclusion : EVT of ruptured VADAns based on angioarchitecture is a feasible and effective armamentarium to prevent fatal hemorrhage recurrence with an acceptable low risk of procedural complications. Clinical outcomes depend mainly on the pre-procedural clinical state of the patient. Radiologic follow-up is necessary to prevent hemorrhage recurrence after EVT.

• 대한영상의학회지
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• 제84권5호
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• pp.1152-1157
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• 2023

총경동맥 폐쇄는 비교적 드물고 거의 연구되지 않은 질병이다. 총경동맥 폐쇄는 여러 신경학적 증상을 유발하지만 다양한 문합의 발달 덕분에 때때로 무증상일 수 있다. 저자들은 문합을 통한 혈류로 인한 무증상 총경동맥 폐쇄 환자의 증례를 보고하고자 한다. 환자는 경대퇴동맥 뇌혈관 조영술을 시행하여 총경동맥 폐쇄와 후두 동맥-척추 동맥 연결을 포함한 두 가지 측부 경로가 있는 것으로 확인되었다. 저자들은 총경동맥 폐쇄가 의심되는 경우 경대퇴동맥 뇌혈관 조영술 시행이 중요함을 강조하고, 총경동맥 폐쇄의 유형 및 문합 경로를 문헌고찰하였다.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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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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• 제51권1호
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• pp.59-61
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• 2012

Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.347-349
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• 2013

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.521-524
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• 2016

Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe perior postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.131-135
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• 2008

Objective : Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. Methods : Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004. the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features. the compression patterns of the vessels at the time of surgery and treatment outcomes. Results : There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%). and in 27 cases (34.2 %) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). Conclusion : In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.

• Imaging Science in Dentistry
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• 제51권3호
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• pp.329-332
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• 2021

A markedly enlarged foramen transversarium was discovered incidentally on a cone-beam computed tomography scan of a 72-year-old male patient who was referred for dental implant placement. Further evaluation with magnetic resonance angiography revealed that the foramen enlargement was caused by a tortuosity in the course of the vertebral artery. This case report highlights the importance of recognizing significant incidental findings on diagnostic images and the potential need for additional imaging as part of the complete interpretative process.