• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.22-30
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• 1995

To predict preoperatively the safety of permanent occlusion of an internal carotid artery with $^{99m}Tc$-HMPAO brain single photon emission computed tomography(SPECT) from an objective point of view, Twenty-four patients underwent balloon test occlusion (BTO) of the internal carotid arteries because of neck and skull base tumors. The authors assessed the uptake of both middle cerebral artery territories before and during BTO with $^{99m}Tc$-HMPAO brain SPECT using semiquantitative analysis method and compared the results with other factors(neurologic examination, arterial stump pressure and electroenceph-alogram). Nineteen patients had not experienced neurological deteriorating or any problem during BTO. Their comparative uptakes of the middle cerebral artery territories were 95 to 101% of the pre-BTO state. The remaining five patients showed severe neurologic symptoms such as transient hemiplegia and unconsciousness. Their comparative uptake of the middle cerebral artery territories were 77 to 85% of the pre-BTO state, and were well matched with other factors. $^{99m}Tc$-HMPAO brain SPECT before and during BTO seems to be a simple and objective method for prediction of permanent neurologic deficits when the comparative uptake of middle cerebral artery territories during BTO is lower than 85% of that before BTO.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.536-544
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• 2019

Objective : The objective of this study was to evaluatelong-term radiologic prognosis and characteristics of in-stent stenosis (ISS) after stent assisted coiling (SAC) for cerebral aneurysm and analyze its risk factors. Methods : Radiological records of 362 cases of SAC during 10 years were retrospectively reviewed. Patients were included in this study if they had follow-up angiogram using catheter selected angiography at least twice. All subjected were followed up from 12 months to over 30 months. Of 120 patients, 123 aneurysms were enrolled. Patient data including age, sex, aneurysm size, neck size, procedural complication, kinds of stent, ISS associated symptom, ruptured state, location of ISS, degree of ISS, radiologic prognosis of ISS, follow-up period of time, and medical comorbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were collected.Statistical comparisons of group clinical characteristics were conducted for the total population. Results : Among 123 casesof aneurysm, 22 cases (17.9%) of ISS were revealed on follow-up angiography. Multiple stenting was performed in three cases and intra-procedural rupture occurred in two cases. Most cases were asymptomatic and symptomatic stenosis was identified in only one case. Sixteen cases were ruptured aneurysm. Mild stenosis was observed in 11 cases. Moderate stenosis was found in eight cases and severe stenosis was identified in three cases. Mean timing of identification of ISS was 8.90 months. The most common type was proximal type. Most cases were improved or not changed on follow-up angiography. Only one case was aggravated from mild stenosis to occlusion of parent artery. Mean follow-up period was 44.3 months. We compared risk factors and characteristic between ISS group and non-ISS group using univariate analysis. Multiple stenting was performed for three cases (13.6%) of the ISS group and four cases (4.0%) of the non-ISS group, showing no statistical difference between the two groups (p=0.108). Additionally, the proportion of patients who had more than two risk factors among four medical risk factors (hypertension, DM, dyslipidemia, and smoking) was higher in the ISS group than that in the non-ISS group, the difference between the two was not statistically significant either (31.8% vs. 12.9%, p=0.05). Conclusion : Clinical course and long-term prognosis of ISS might be benign. Most cases of ISS could be improved or not aggravated. Control of medical co-morbidity might be important. To the best of our knowledge, our study had more cases with longer follow-up period of time than other reports.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.250-257
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• 2015

Objective : Endovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization. Methods : Between January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents' medical and radiological records were reviewed retrospectively. Results : Of the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03). Conclusion : The predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.105-108
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• 2015

Background: The most definitive diagnosis of neck pain caused by facet joints can be obtained through cervical medial branch blocks (CMBBs). However, intravascular injections need to be carefully monitored, as they can increase the risk of false-negative blocks when diagnosing cervical facet joint syndrome. In addition, intravascular injections can cause neurologic deficits such as spinal infarction or cerebral infarction. Digital subtraction angiography (DSA) is a radiological technique that can be used to clearly visualize the blood vessels from surrounding bones or dense soft tissues. The purpose of this study was to compare the rate of detection of intravascular injections during CMBBs using DSA and static images obtained through conventional fluoroscopy. Methods: Seventy-two patients were included, and a total of 178 CMBBs were performed. The respective incidences of intravascular injections during CMBBs using DSA and static images from conventional fluoroscopy were measured. Results: A total of 178 CMBBs were performed on 72 patients. All cases of intravascular injections evidenced by the static images were detected by the DSAs. The detection rate of intravascular injections was higher from DSA images than from static images (10.7% vs. 1.7%, P < 0.001). Conclusions: According to these findings, the use of DSA can improve the detection rate of intravascular injections during CMBBs. The use of DSA may therefore lead to an increase in the diagnostic and therapeutic value of CMBBs. In addition, it can decrease the incidence of potential side effects during CMBBs.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.194-196
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• 2013

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.

• Journal of radiological science and technology
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• v.46 no.1
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• pp.9-14
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• 2023

When measuring cerebrovascular with 3D rotational angiography, the accuracy was verified by comparing the actual size and measurement size, respectively. It is intended to help select therapeutic materials and instruments during cerebrovascular intervention by comparing the average error rates for measured values in the 3DRA and CTA methods by examining with protocols such as brain CTA, which are always performed in emergency situations. The mean error rate between the groups of measurers was ±3.655% for radiation technologist and ±3.331% for university students, and the mean error rate of the student group was within tolerance (±10%), and the independent sample T-test result t =0.879, p=0.394 (p>0.05) showed no statistically difference between the two. In addition, the average error rate measured by both groups by 3DRA was measured below ±5% within the tolerance error rate (±10%), and most of CTA was measured within the tolerance range (±10%), but showed an average error rate of up to 5.65%, and the independent sample T-test result was statistically more accurate than 3DRA. Both the 3DRA method and the brain CTA method for measuring cerebrovascular size could be accurately measured within tolerance, but it would be better to measure cerebrovascular blood vessels using a more accurate 3DRA method during cerebrovascular intervention.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.398-404
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• 2019

Objective : Recently, three-dimensional (3D) printed models of the intracranial vascular have served as useful tools in simulation and training for cerebral aneurysm clipping surgery. Precise and realistic 3D printed aneurysm models may improve patients' understanding of the 3D cerebral aneurysm structure. Therefore, we created patient-specific 3D printed aneurysm models as an educational and clinical tool for patients undergoing aneurysm clipping surgery. Herein, we describe how these 3D models can be created and the effects of applying them for patient education purpose. Methods : Twenty patients with unruptured intracranial aneurysm were randomly divided into two groups. We explained and received informed consent from patients in whom 3D printed models-(group I) or computed tomography angiography-(group II) was used to explain aneurysm clipping surgery. The 3D printed intracranial aneurysm models were created based on time-of-flight magnetic resonance angiography using a 3D printer with acrylonitrile-butadiene-styrene resin as the model material. After describing the model to the patients, they completed a questionnaire about their understanding and satisfaction with aneurysm clipping surgery. Results : The 3D printed models were successfully made, and they precisely replicated the actual intracranial aneurysm structure of the corresponding patients. The use of the 3D model was associated with a higher understanding and satisfaction of preoperative patient education and consultation. On a 5-point Likert scale, the average level of understanding was scored as 4.7 (range, 3.0-5.0) in group I. In group II, the average response was 2.5 (range, 2.0-3.0). Conclusion : The 3D printed models were accurate and useful for understanding the intracranial aneurysm structure. In this study, 3D printed intracranial aneurysm models were proven to be helpful in preoperative patient consultation.

• Journal of Digital Contents Society
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• v.12 no.3
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• pp.271-277
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• 2011

This research studied 249 patients who has an aneurysm and went through computerized CT angiography at S University Hospital in Northern Kyung-sang area from October 1st 2008 to September 30th 2010, and the results are the following. Among total 249 of research objects, 159 women (63.9%) showed higher distribution than 90 men (36.1%) The order of the distribution of aneurysm classified by blood vessel is the following. Posterior communicating artery 34.9% as the highest, internal carotid artery 21.7%, middle cerebral artery of 15.7%, anterior communicating artery 14.5%, posterior cerebral artery and posterior cerebral artery channel 3.6% each, anterior cerebral artery and vertebral artery 2.4% each, and posterior inferior cerebellar artery 1.2%. As a result of analysis of distribution of aneurysm classified by gender, there was no case of posterior cerebral artery and posterior cerebral artery channel among men, and there was no case of posterior inferior cerebellar artery among women. Distribution of aneurysm classified by vessel according to gender showed no statistic significance. (p<0.05). And distribution of aneurysm classified by vessel according to the age, showed no statistic significance. (p>0.05), After applying post analysis to understand the group with age difference, the significance was the highest among the group of 61-70, (4.21), and the group of the age under 30 was the lowest. (2.0) There was statistic significance on the distribution of aneurysm classified by vessel according to the season. (p<0.05). After applying post-analysis in order to understand the groups with difference between seasons, it was found that fall was the highest (4.55) and spring was the lowest. (2.50)

• Clinical and Experimental Pediatrics
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• v.56 no.12
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• pp.545-549
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• 2013

We report the case of a 17-year-old Korean girl with systemic lupus erythematosus (SLE) who presented with sudden weakness of the right-sided extremities and dysarthria. Oral prednisolone was being taken to control SLE. Results of clinical and laboratory examinations did not show any evidence of antiphospholipid syndrome or thromboembolic disease nor SLE activity. Cerebral angiography showed stenosis of the left internal carotid artery and right anterior cerebral artery with accompanying collateral circulation (moyamoya vessels). After the patient underwent bypass surgery on the left side, she recovered from the neurological problems and did not experience any additional ischemic attack during the 14-month follow-up period. This case represents an unusual association between moyamoya syndrome and inactive SLE (inactive for a relatively long interval of 2 years) in a young girl.

• Journal of Korean Neurosurgical Society
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• v.45 no.1
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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.