• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권1호
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• pp.75-80
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• 2023

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient's disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient's condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.786-793
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• 2000

Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1584-1591
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• 2000

Objective : Until now, it has been little known about the biological mechanisms associated with the genesis, growth, and rupture of intracranial aneurysm. This study was performed to investigate and understand a part of these mechanisms. Materials and Methods : Immunohistochemical stains for angiogenesis growth factors(basic fibroblast growth factor (bFGF) and vascular endothelial growth factor(VEGF)) and selected vascular wall matrix proteins(alpha smooth muscle actin(${\alpha}SMA$) and collagen Type IV) were performed in fixed sections from a normal circle of Willis artery which was taken from the autopsy specimen as a control vessel and 17 aneurysmal wall specimens which was taken during surgical clipping of aneurysms. The staining intensity and distribution of immunoreactivity to angiogenesis growth factors and selected wall matrix proteins in control vessel and aneurysmal wall were examined and compared with each other. The difference of staining intensity according to the size of aneurysm was also investigated. Results : There was no immunoreactivity to bFGF and VEGF in the control vessel. bFGF immunoreactivity was exhibited in 15 of 17 aneurysm specimens around smooth muscle cells within the media of aneurysm. VEGF immunoreactivity was also exhibited in all aneurysm specimens in patches or diffusely affecting all layers of the aneurysmal wall. The degrees of intensity of bFGF and VEGF immunoexpression were proportionate roughly to the size of aneurysm. Strong immunoexpression of both factors were noticed in large aneurysm. A regularly arranged and defined band of immunoreactivity of ${\alpha}SMA$ was noticed in the media of the control vessel, whereas diffuse, faint, irregularly arranged ${\alpha}SMA$ was noticed in the aneurysmal wall. A regularly defined band of collagen Type IV immunoreactivity was also noticed in the subendothelium of the control vessel, whereas diffuse disorganized immunoreactivity of collagen Type IV was noticed in the entire wall of the aneurysm. Conclusion : These results indicate substantial evidences of abnormal expression of angiogenesis factors and changes of selected vascular wall matrix proteins in the wall of intracranial aneurysm. The unbalanced changes of angiogenesis factors and vascular wall matrix proteins in the wall of aneurysm may be one of the biological mechanisms for the growth and rupture of aneurysm.

• Journal of Chest Surgery
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• 제13권3호
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• pp.262-268
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• 1980

Four cases of patients with abdominal aortic aneurysm were experienced in Severance Hospital from July of 1977 to May of 1980. Among them three cases were men who were aged over 60 years. Atherosclerosis was cause of aortic aneurysms. The remained cases were 50 years old woman had inflammatory aneurysm. Excision of the aneurysm and aortoiliac graft was placed successfully. Their postoperative courses were uneventful and they were discharged in good condition.

• Journal of Chest Surgery
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• 제14권1호
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• pp.63-66
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• 1981

True aneurysm of the carotid artery is relatively rare in comparison with the total number of aneurysms of the arterial system. The threat of rupture and embolization from mural thrombi are indications for treatment even though no symptoms may be present. Resection of the aneurysm and restoration of arterial continuity is the treatment of choice. A case of aneurysm of the Lt. common carotid artery of a 21 year-old male patient is presented. The confirmatory diagnosis was made by left carotid angiogram, and the aneurysmectomy & reconstruction with woven dacron vascular prosthesis was done, while cerebral circulation was maintained by internal shunt.

• Journal of Chest Surgery
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• 제27권11호
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• pp.948-952
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• 1994

Superior mesenteric artery aneurysm is the third most common lesion and comprises approximately 5.5 % of all visceral artery aneurysms. The first successful repair was performed by DeBakey and Cooley in 1949. Since then, more than 100 cases have been reported. Fifty to sixty percent of these aneurysms are mycotic in origin. Other less frequent causes include arteriosclerosis, trauma, and medial degeneration. The operations are bypass with autologous tissue or with artificial vascular graft and aneurysmorrhaphy. We have experienced a case of superior mesenteric artery aneurysm which had undergone aneurysmectomy and artificial graft interposition. This is the first domestic case which was successful surgical repaired.

• Journal of Korean Neurosurgical Society
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• 제56권6호
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• pp.492-495
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• 2014

A ruptured distal lenticulostriate artery (LSA) aneurysm is detected occasionally in moyamoya disease (MMD) patients presented with intracerebral hemorrhage. If the aneurysm is detected in hemorrhage site on angiographic evaluation, its obliteration could be considered, because it rebleeds frequently, and is associated with poorer outcome and mortality in MMD related hemorrhage. In this case report, the authors present two MMD cases with ruptured distal LSA aneurysm treated by endovascular embolization.

• Journal of Chest Surgery
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• 제4권2호
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• pp.81-86
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• 1971

Aneurysm of the Aorta is a grave disease mostly producing disabling symptoms and ultimate death by rupture and hemorrhage without surgical intervention. Aneurysm of the thoracic aorta is more common in arteriosclerosis than syphilitic origin,since the incidence of cardiovascular syphilis has been reduced significantly in recent decades and the life span of population has increase. We have experienced a case of luetic aneurysm of aortic arch without pulse in tile left arm which was succesfully treated by surgical intervention.

• Journal of Chest Surgery
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• 제26권7호
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• pp.557-559
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• 1993

We report a case of 62-year-old female who had an aneurysm of the right subclavian artery developed due to atherosclerosis. The preoperative diagnosis was made by chest computed tomography and arteriography. After resection of a 10x10x7cm-diametered and round aneurysm, end to side anastomosis of the right subclavian artery to the right carotid artery was done. She is well for 2 years after surgery.

• Journal of Chest Surgery
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• 제24권4호
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• pp.361-365
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• 1991

We experienced one case of the coronary artery aneurysm. The patient was 67 years old female, who complained of dyspnea on exercise[NYHA functional class III] for two years. Coronary angiogram demonstrated a localized saccular aneurysm on left main coronary artery, just above bifurcation of left anterior descending coronary artery and circumflex artery. On the operative field, the aneurysm was 2cmx2cmx 1.5cm in size with 0.5cm in neck. Resection and aneurysmorrhaphy was done. The patient was recovered and discharged uneventfully. During 8 months follow-up period, she lives in good physical activity and absence of chest pain.