• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.25 no.4
• /
• pp.468-472
• /
• 2023

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.655-662
• /
• 2010

Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

• Journal of Chest Surgery
• /
• v.42 no.3
• /
• pp.331-336
• /
• 2009

Background: Open surgical repair of abdominal aortic aneurysms was initiated by Dubost in 1952. Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized for curative intent. We retrospectively analyzed surgical outcome, complications, and mortality-related factors for patients with abdominal aortic aneurysms over a 6 year period. Material and Method: We analyzed 18 patients who underwent surgery for abdominal aortic aneurysms between March 2002 and March 2008. The indications for surgery were rupture, a maximal aortic diameter >60 mm, medically intractable hypertension, or pain. Result: The mean age was $66.6{\pm}9.3$ years (range, $49\sim81$ years). Twelve patients (66.7%) were males a 6 patients were females. Extension of the aneurysm superior to the renal artery existed in 6 patients (33.3%), and extension to the iliac artery existed in 13 patients (72.2%). Five patients (27.8%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $72.2{\pm}12.9$ mm (range, $58\sim109$ mm). Surgery was performed by a midline laparotomy, and 6 patients underwent emergency surgery. The mean total ischemic time from aorta clamping to revascularization was $82{\pm}42$ minutes (range, $35\sim180$ minutes). The mortality rate was 16.7%; the mortality rate for patients with ruptured aneurysms was 60%, and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included one each of renal failure, femoral artery and vein occlusion, and wound infection. The patients who were discharged had a long-term survival of $34{\pm}26$ months (range, $4\sim90$ months). Rupture and emergency surgery had a statistically significant mortality-related factor (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have a high mortality, but unruptured cases are repaired with relative safety. Successfully operated patients had long-term survival. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, aggressive application should be determined with care. Experience and systemic support of each center is important in the treatment plan.

• Journal of computational fluids engineering
• /
• v.16 no.2
• /
• pp.81-87
• /
• 2011

The importance of shear thinning non-Newtonian blood rheology on the hemodynamic characteristics of idealized cerebral saccular aneurysms were investigated by carrying out CFD simulations assuming two different non-Newtonian rheology models (Carreau and Ballyk models). To explore effects of vessel curvature, a straight and a curved vessel geometry were considered. The wall shear stress(WSS), relative residence time(RRT) and velocity distribution were compared at the different phases of cardiac cycle. As expected, blood entered the aneurysm at the distal neck and created large vortex in both aneurysms, but with higher momentum on the curved vessel. Hemodynamic characteristics such as WSS, and RRT exhibited only minor effects by choice of different rheological models although Ballyk model produced relatively higher effects. We conclude that the assumption of Newtonian fluid is reasonable for studies aimed at quantifying the hemodynamic characteristics, in particular, WSS-based parameters, considering the current accuracy level of medical image of cerebral aneurysm.

• Journal of Chest Surgery
• /
• v.18 no.3
• /
• pp.407-413
• /
• 1985

Ruptured aneurysms of the sinus Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Five patients underwent operative treatment in Catholic Medical Center in recent 2.5 year period. Three patients were male and two patients were female, ages ranged from 20 to 54 years. Bacterial endocarditis was suspected or proved in 3 patients. In 3 patients in our series had a ruptured congenital aneurysms and in 2 patients acquired aneurysms by bacterial endocarditis. Associated cardiac lesions were common; such as aortic insufficiency in 3 patients, atrial septal defect in 2 patients, mitral stenoinsufficiency in 1 patient and tricuspid insufficiency in 1 patient. All aneurysmal ruptures of the sinus Valsalva arose from right coronary sinus and in 4 patients ruptured into right ventricle and in 1 patient into right atrium. Surgical techniques consisted of direct closure 4 in patients and closure with Dacron patch in 1 patient. And we preferred double approach, that is, through both the aorta and the involved cardiac chamber in cases in whom aortic insufficiency was present. So additional aortic valve replacement performed in 2 patients due to severe aortic insufficiency and aortic valvuloplasty performed in 1 patient. One patient who underwent direct closure of ruptured sinus Valsalva and double valve replacement died due to low cardiac output syndrome just after the operation. Operative results were relatively good in remainders.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.111-114
• /
• 2009

Aorto-iliac artery aneurysms are very rare and the natural course of this disease is not well known. However, the risk of rupture is high and the mortality rate after rupture is extremely high. Preserving the pelvic circulation is important for the treatment of aorto-iliac artery aneurysms. We report here on a case of a patient suffering with aorto-iliac artery aneurysms, and these were treated by a hybrid endovascular operation that combined an open bypass of both iliac vessels with endovascular repair.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.1
• /
• pp.49-52
• /
• 2011

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

• Journal of Korean Neurosurgical Society
• /
• v.37 no.6
• /
• pp.399-404
• /
• 2005

Objective: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. Methods: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. Results: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female:male = 8:4). Locations of PICA aneurysms revealed variously(vertebral artery - PICA junction: 8, lateral medullary segment: 2, PICA - anterior inferior cerebellar artery common trunk: 1, telovelomedullary : 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. Conclusion: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.4
• /
• pp.354-356
• /
• 2010

Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of $2{\times}2\;mm$ with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, $9{\times}13\;mm$ sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.27 no.6
• /
• pp.551-555
• /
• 2001

False aneurysms(Pseudoaneurysms) and arteriovenous fistulas have only rarely been reported in the facial region. In this region the false aneurysm arises most frequently in the superficial temporal and facial artery, but other branches of the external carotid are sometimes involved, including the maxillary and lingual artery. False aneurysms can be occurred by blunt trauma that either laceration or rupture the full thickness of the arterial wall. The diagnosis of a false arterial aneurysm can be often made solely on the basis of physical examination. Angiography is helpful for conformation, for delineating the lesion and its vascular supply, and for ruling out the presence of associated vascular lesions such as arteriovenous fistulas. Ultrasonography may also be useful in delineating lesions that are not easily accessible for physical examination. Treatment of false aneurysms is excision, ligation, and arterial embolization. This is a case of false aneurysm of the lingual artery after facial trauma caused by traffic accident. The lesion was successfully treated by embolization and ligation of the lingual and facial branches of the external carotid artery.