• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.504-510
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• 2017

Objective : To investigate the morphological and hemodynamic parameters associated with middle cerebral artery (MCA) bifurcation aneurysm rupture. Methods : A retrospective study of 67 consecutive patients was carried out based on 3D digital subtraction angiography data. Morphological and hemodynamic parameters including aneurysm size parameters (dome width, height, and perpendicular height), longest dimension from the aneurysm neck to the dome tip, neck width, aneurysm area, aspect ratio, Longest dimension from the aneurysm neck to the dome tip (Dmax) to dome width, and height-width, Bottleneck factor, as well as wall shear stress (WSS), low WSS area (LSA), percentage of LSA (LSA%) and energy loss (EL) were estimated. Parameters between ruptured and un-ruptured groups were analyzed. Receiver operating characteristics were generated to check prediction performance of all significant variables. Results : Sixty-seven patients with MCA bifurcation aneurysm were included (31 unruptured, 36 ruptured). Dmax (p=0.008) was greater in ruptured group than that in un-ruptured group. D/W (p<0.001) and the percentage of the low WSS area ($0.09{\pm}0.13$ vs. $0.01{\pm}0.03$, p<0.001) were also greater in the ruptured group. Moreover, the EL in ruptured group was higher than that in unruptured group ($6.39{\pm}5.04$ vs. $1.53{\pm}0.86$, p<0.001). Multivariate regression analysis suggested D/W and EL were significant predictors of rupture of MCA bifurcation aneurysms. Correlation analyses revealed the D/W value was positively associated with the EL (R=0.442, p<0.01). Conclusion : D/W and EL might be the most two favorable factors to predict rupture risk of MCA bifurcation aneurysms.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.187-189
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• 2013

We report an unusual case of cerebral aneurysmal subarachnoid hemorrage (SAH) with Fabry's disease. A 42-year-old woman presented with aneurysmal SAH originated from a saccular aneurysm of the right posterior communicating artery. The patient was treated by an endovascular coil embolization of aneurysm. Postoperatively the patient recovered favorably without any neurological deficit. During her admission, the patient had a sign of proteinuria in urine analysis. The pathologic findings of kidney needle biopsy implied nephrosialidosis (mucolipidosis of lysosomal stroage disease), which is consistent with a Fabry's disease. It is uncommon that Fabry's disease is presented with aneurysmal SAH, especially in middle-aged patients, but could be a clinical concern. Further investigations are needed to reveal risk factors, vascular anatomy, and causative mechanisms of Fabry's disease with aneurysmal SAH.

• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.743-747
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• 2023

Ruptured intracranial aneurysms in infants are rare and infantile fusiform anterior cerebral artery (ACA) aneurysms are much rarer. In this report, we described the case of a 7-month-old infant with a ruptured fusiform ACA aneurysm who presented with seizure and underwent endovascular treatment. The patient was initially in a coma and the neurologic condition did not improve after treatment. The clinical characteristics of the case and literature review were discussed.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.49-52
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• 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
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• 제42권1호
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• pp.59-63
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• 2007

Operative clipping after previous endovascular coiling in an aneurysm is a different problem from primary clipping procedure for neurosurgeons. With the increasing use of coil embolization, neurosurgeons will more and more face the similar situation. We report surgical clipping cases of intracranial aneurysm regrown after endovascular coiling. Three patients with a history of subarachnoid hemorrhage due to ruptured aneurysm underwent endovascular treatment (EVT) with detachable coils. The aneurysms were in the posterior communicating artery, the middle cerebral artery and distal anterior cerebral artery (DACA). Two near-total occlusions and one partial occlusion were achieved by EVT. After several months, angiographic follow-up revealed regrowth of the aneurysm requiring surgical clipping. Here, we report three cases in which surgical clipping was more difficult than a usual clipping procedure performed several months after EVT, because of adhesion and coil bulging into the aneurysmal neck. The difficulty of the treatment of the residual aneurysm after coiling is discussed, as are the surgical complications and limitations of clipping.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.43-45
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• 2009

A 75-year-old female presented with subarachnoid hemorrhage. Angiography revealed a partial duplication (fenestration) in the proximal $A_1$ segment and a ruptured aneurysm at the distal end of $A_1$ fenestration. This congenital anomaly accompanying an aneurysm was associated with duplicated ipsilateral middle cerebral artery (MCA). Congenital defect of the arterial wall and hemodynamic factors at the fenestrated $A_1$ are considered to play a significant role in the development of this aneurysm. The present case is peculiar because not only the ruptured $A_1$ aneurysm was related with the anterior and middle cerebral artery duplication but also the location of $A_1$ fenestration and the origin of $A_1$ aneurysm in a fenestration are quite unusual.

• 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 Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.462-467
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• 2023

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a well-formed clot was visualized through the aneurysm's wall obstructing the left DACA flow. We proceeded to open the aneurysm's dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA. Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient's postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2003년도 춘계학술대회
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• pp.1930-1935
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• 2003

The aim of this study is to apply engineering modeling tools to examine hemodynamics such as blood flow patterns or shear stress distributions, in order to determine the link between hemodynamics and cerebral aneurysms. Image-Based Simulation is used to analyze the realistic middle cerebral artery constructed from computed tomography raw data. As a result of simulation, high wall shear stress is appeared at the bifurcated region. And existence of the recirculation flow at the inlet of bifurcation($D_2$) is predict to affect at the development of the cerebral aneurysm.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.281-285
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• 2007

Objective : Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of DACA aneurysms, we reviewed our surgical strategy and its results postoperatively. Methods : A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January 1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe. Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation. Results : Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate disability, while 2 patients died. Conclusion : With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm.