• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.159-163
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• 2006

Objective : Unique Internal carotid artery angiographic findings have been found especially in very poor grade aneurysmal subarachnoid hemorrhage[SAH] patients before and during the endovascular coiling. The author investigates their patterns and classifies them into lour subtypes. Methods : Among Hunt&Hess grade IV, V SAH patients, the author could gather eight patients who showed abnormal intracranial circulation in cerebral catheter-based angiography. Results : The author introduces new term 'misery collaterals' first and has classified them into four types with the case illustrations. Type 1 is the worst condition defined as almost no intracranial circulation. Type 2 is the condition of little intracranial circulation with contrast filling just only at vessels of brain base, type 3 is of no or little cortical circulation with contrast filling at bilateral large vessels of brain base through circle of Willis channel and type 4 is of visible bilateral cortical circulation but delayed intracranial circulation time. The prognosis of these eight patients showed misery collaterals were disappointed. Conclusion : These finding can be used as the supportive information in deciding a management plan in poor grade SAH patients.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.290-291
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• 2011

Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.471-474
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• 2005

Pure sylvian fissure arteriovenous malformations[AVMs] are vascular malformations confined to the sylvian fissure without parenchymal involvement. Surgical removal is regarded as difficult because the nidus is located just lateral to important structures such as the basal ganglia and the internal capsule. Because most feeding arteries to the nidus are branches of the middle cerebral artery[MCA], differentiation between these feeders from en passant and normal vessels is of great importance in order to reduce morbidity and mortality from surgical intervention. We report a case of pure sylvian fissure AVM who presented with an intra-temporal lobe hematoma that was located around venous aneurysms distant from the nidus. The clinical characteristics of this AVM and the surgical methods employed to avoid complications are discussed.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.69-78
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• 2008

Recently, due to the evolution of technology, the field of neurosurgery is receiving spotlight. In particular endovascular neurosurgery has gained a great interest along with the advancement of the modern neurosurgery. The most remarkable advances were made in embolization of the cerebral aneurysms, arteriovenous malformations and intracranial stenosis during the past 10 years. These advances will further change the role of neurosurgeons in treating cerebrovascular disease. Because interventional neuroradiologists have performed most of procedures in the past, neurosurgeons have been deprived of chances to learn endovascular procedure. This article discusses the development of technological aspect of endovascular neurosurgery in chronological order. By understanding the history and current status of the endovascular surgery, the future of neurosurgery will be promising.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.681-689
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• 2023

Objective : Subarachnoid hemorrhage (SAH) is a condition characterized by bleeding in the subarachnoid space, often resulting from the rupture of a cerebral aneurysm. Delayed cerebral ischemia caused by vasospasm is a significant cause of mortality and morbidity in SAH patients, and inflammatory markers such as systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) have shown potential in predicting clinical vasospasm and outcomes in SAH patients. This article aims to investigate the relationship between inflammatory markers and cerebral vasospasm after aneurysmatic SAH (aSAH) and evaluate the predictive value of various indices, including SIRI, SII, NLR, and dNLR, in predicting clinical vasospasm. Methods : A retrospective analysis was performed on a cohort of 96 patients who met the inclusion criteria out of a total of 139 patients admitted Trakya University Hospital with a confirmed diagnosis of aSAH between January 2013 and December 2021. Diagnostic procedures, neurological examinations, and laboratory tests were performed to assess the patients' condition. The Student's t-test compared age variables, while the chi-square test compared categorical variables between the non-vasospasm (NVS) and vasospasm (VS) groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of laboratory parameters, calculating the area under the ROC curve, cut-off values, sensitivity, and specificity. A significance level of p<0.05 was considered statistically significant. Results : The study included 96 patients divided into two groups : NVS and VS. Various laboratory parameters, such as NLR, SII, and dNLR, were measured daily for 15 days, and statistically significant differences were found in NLR on 7 days, with specific cut-off values identified for each day. SII showed a significant difference on day 9, while dNLR had significant differences on days 2, 4, and 9. Graphs depicting the values of these markers for each day are provided. Conclusion : Neuroinflammatory biomarkers, when used alongside radiology and scoring scales, can aid in predicting prognosis, determining severity and treatment decisions for aSAH, and further studies with larger patient groups are needed to gain more insights.

• Journal of the Korean Society of Radiology
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• v.83 no.4
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• pp.887-897
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• 2022

Purpose To evaluate the safety and efficacy of stent-assisted coil embolization (SAC) in acutely ruptured cerebral aneurysms without severe symptoms, and thus, the usefulness of the stent itself in patients with subarachnoid hemorrhages. Materials and Methods From January 2017 to June 2019, 118 patients were treated with coil embolization for acutely ruptured cerebral aneurysms without severe symptoms (Hunt & Hess grade ≤ 3). The periprocedural complications, six-month modified Rankin scores (mRS), and six-month radiologic outcomes were compared between 56 patients with SAC and 62 patients without SAC (non-SAC). Results The rate of good clinical outcomes (mRS ≤ 2), as well as the rate of hemorrhagic and ischemic complications, showed no significant difference between the SAC and non-SAC groups. Moreover, compared to the non-SAC group, the SAC group showed a lower recanalization rate on the six-month follow-up angiogram (20% vs. 39.3%, p = 0.001). Conclusion Although stent use was not significantly associated with clinical outcomes in coil embolization of ruptured cerebral aneurysms with non-severe symptoms (Hunt & Hess grade ≤ 3), it significantly decreased the rate of recanalization on follow-up cerebral angiograms.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.495-502
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• 2019

A typical cerebrovascular disease among cerebrovascular diseases is vascular diseases such as cerebral infarction, cerebral hemorrhage, cerebral aneurysm, cerebrovascular stenosis. If the disease occurs and causes cerebral damage, it may be difficult to recover completely. So that, Must continue to perform health care through examination early. In particular, Because most cerebrovascular disease examining use radiation equipment and Thus this study was to find out how to select about the optimal examining method and X-ray dose decrease method among different examining method though comparison and analysis for the entrance surface dose (ESD) on cerebrovascular examining with Trance Femoral Cerebral angiography (TFCA) and Cerebral Computed Tomographic Angiography (CCTA). Also, want to find out how to select about the optimal examining method for worried patient that contrast medium side effect though measuring and evaluating for contrast usage. Data were collected from 70 patients (43 males and 27 females) who underwent CCTA at Yeosoo region hospital from June 2018 to December 2018 and 61 patients (34 males and 27 females) who underwent TFCA at Pyeongtaek region hospital from June 2018 to November 2018. ESD analysis method collected retrospective data though M-view and PACS PLUS program, Used contrast usage measuring method did reality measuring method. In the analysis using SPSS, the ESD of TFCA was $245.74{\pm}71.91$, which was $32.05{\pm}7.74$ lower than the dose of $277.79{\pm}79.65$ of CCTA ESD, and statistically significant at t = 3.249, p = 0.017 (p<0.05). As a result of the comparison of the total amount of contrast agent, the mean contrast agent used in TFCA was $55.05{\pm}17.68ml$, which was about 14.95 smaller than the amount of contrast agent used in CCTA, and statistically significant t = -4.548, p<0.001. In conclusion, the ESD of TFCA was statistically significantly lower than that of CCTA, and also the used contrast usage was significantly tiny than that of CCTA. Therefore, Select the method to increase the utilization of TFCA for cerebral disease examining, we can consider X-ray dose decrease method at the same time as to decrease side effect of contrast medium.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.251-264
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• 1976

Forty three patients with disease of the aorta were admitted in this department during the period from beginning of 1956 to the end of 1976. They consisted of eighteen cases of aortic aneurysms, eight cases of Takayasu's arteritis, eight Leriche syndromes, six dissecting aneurysms, two aortic coarctations and one case of vascular ring. Of eighteen aortic aneurysms, twelve were operated resulting in eight survivors. Three of four mortalities were in shock preoperatively because of aneurysmal rupture. Among six dissecting aortic aneurysms, four were type III and two were type I according to DeBakey's classification. For the purpose of relief of acute arterial insufficiency in the lower extremities, a re-entry operation grafting a Y-shaped dacron vessel between abdominal aorta and common iliac arteries was performed. The patient regained consciousness soon after the operation and was well until postoperative second day, when severe convulsion developed abruptly and died. And in a chronic case of type III dissecting aneurysm, a dacron graft bypass shunt between ascending aorta and lower descending thoracic aorta with resection of the aneurysm was performed, but acute severe aortic insufficiency developed soon after the operation and fell into intractable heart failure resulting in death. The cause of the aortic insufficiency seems to be retrograde dissection from the proximal anastomosis site in the ascending aorta. Three cases were treated medically with Wheat's regimen. Two of them survived with relief of symptoms. Eight patients of Takayasu's arteritis were all females and aged between twenty and forty-four averaging twenty nine. Bypass graft operation between aortic arch and carotid arteries using Y-shaped nylon prostheses were performed in three patients resulting in death in two cases postoperatively due to severe cerebral arterial insufficiency during the procedure. All the patients with Leriche syndrome were males and over forty. In two cases, bypass graft with Y-shaped dacron vessel between terminal aorta and common iliac or femoral arteries were performed with good result. Thromboembolectomy or thromboendarterectomy was employed in three patients, of whom one was aggravated in sexual problem postoperatively. One out of two aortic coarctations and a vascular ring were treated surgically with excellent results.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.179-186
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• 2005

Objective: The purpose of this paper is to report our experiences in managing seventeen cases of residual intracranial aneurysms following surgical or endovascular treatment and discuss the incidence of residual aneurysms, the indications and technique of retreatment of residual aneurysms. Methods: During a period of 42 months, we treated 391 aneurysms in 339 patients with microsurgical clipping or GDC embolization as a primary treatment. In 39 of them, follow-up angiography revealed residual aneurysms and seventeen of whom were retreated. There were eleven cases in ACoA, three cases in distal ICA, one, in each of MCA, ACA and basilar artery. We reviewed retrospectively the clinical notes, operation records and cerebral angiograms of seventeen patients who had been treated for residual aneurysms. Results: Complementary treatment was performed in 8 cases by means of surgery and in 9 cases by means of GDC embolization. There were eleven females and six males with an age variation between 29 and 78 years. The mean duration of angiographic follow-up was 17.3 months. Of the seventeen cases that were treated for residual aneurysms, fourteen achieved complete occlusion. Of 17 retreated patients, fifteen patients had good recovery according to the Glasgow Outcome Scale. Conclusion: When occlusion after endovascular or surgical treatment is incomplete, a new multidisciplinary approach should be carried out. Given our experiences, we recommend coil embolization of the choice in cases that the residual aneurysmal neck had been narrowed by previous clipping. On the other hand, if the residual aneurysm has enough space to clip but not enough to coil, we recommend the microsurgical clipping.

• Journal of Korean Neurosurgical Society
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• v.49 no.1
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• pp.20-25
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• 2011

Objective: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. Methods: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients: age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups: Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). Results: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for Clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. Conclusion: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients, In the treatment of patients more than 65 years old, age is not the limiting factor.