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Objective@#: Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs. @*Methods@#: This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications. @*Results@#: We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed. @*Conclusion@#: GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi.
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Objective@#: Delayed cerebral ischemia (DCI) is a major cause of disability in patients who survive aneurysmal subarachnoid hemorrhage (aSAH). Systemic inflammatory markers, such as peripheral leukocyte count and systemic immune-inflammatory index (SII) score, have been considered predictors of DCI in previous studies. This study aims to investigate which systemic biomarkers are significant predictors of DCI. @*Methods@#: We conducted a retrospective, observational, single-center study of 170 patients with SAH admitted between May 2018 and March 2022. We analyzed the patients’ clinical and laboratory parameters within 1 hour and 3–4 and 5–7 days after admission. The DCI and non-DCI groups were compared. Variables showing statistical significance in the univariate logistic analysis (p<0.05) were entered into a multivariate regression model. @*Results@#: Hunt-Hess grade “4–5” at admission, modified Fisher scale grade “3–4” at admission, hydrocephalus, intraventricular hemorrhage, and infection showed statistical significance (p<0.05) on a univariate logistic regression. Lymphocyte and monocyte count at admission, SII scores and C-reactive protein levels on days 3–4, and leukocyte and neutrophil counts on days 5–7 exhibited statistical significance on the univariate logistic regression. Multivariate logistic regression analysis revealed that monocyte count at admission (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.04–2.65; p=0.036) and SII score at days 3–4 (OR, 1.55; 95% CI, 1.02–2.47; p=0.049) were independent predictors of DCI. @*Conclusion@#: Monocyte count at admission and SII score 3–4 days after rupture are independent predictors of clinical deterioration caused by DCI after aSAH. Peripheral monocytosis may be the primer for the innate immune reaction, and the SII score at days 3–4 can promptly represent the propagated systemic immune reaction toward DCI.
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Objective@#To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. @*Materials and Methods@#Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. @*Results@#The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). @*Conclusion@#Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.
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Pediatric abusive head trauma (AHT) is a serious, repeated child abuse that causes grave brain damage. In Korea, AHT cases have been reported rarely, especially infants. We present 4 cases of AHT in infants diagnosed in our institution during last 2 years. We collected the demographic data, ophthalmologic examination, imaging study, and outcomes. The mean age was 7.2 months, and 2 infants were girls and the others were boys. All four were admitted with no history of head trauma, and among them 2 patients presented with an episode of seizure and respiratory arrest with no history of head trauma. The initial mental status was semi-coma in 3 cases, and stupor in 1 case. There were multiple retinal hemorrhages in both eyes in 2 cases; one had multiple old fractures on the extremities and another child showed multiple skull fractures. All patients underwent emergent surgery for acute bilateral subdural hemorrhages; 3 had craniotomy and another had burr-hole drainage. Two children expired and the other 2 are in vegetative status. The AHT has recently become more frequent in Korea so that neurosurgeons must alert AHT even in infants with head trauma.
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Objective@#Intracranial aneurysm most frequently occurs in old aged patients; however, aneurysmal subarachnoid hemorrhage (SAH) has been occasionally reported in young adults. This study aimed to compare patients with intracranial aneurysms younger than 40 years with those ≥40 years and investigates the characteristics of their ruptured aneurysm. @*Methods@#We retrospectively collected the data of 389 patients (103 patients aged 20 to 39 years; 286 patients aged above 40 years) who were treated for ruptured cerebral aneurysms between January 2008 and December 2018 at our institution. @*Results@#The young adult patients were more often men and were smokers as compared to controls (63.1% vs. 39.2%, 40.5% vs. 36.0%, respectively). The young adult patients showed a tendency for lower Hunt and Hess grade, modified Fisher grade, less postoperative morbidity, and better clinical outcome. Aneurysm ruptures occurred most frequently in the anterior cerebral artery in both groups, but aneurysms ruptures in the internal carotid artery and posterior circulation was infrequent among young adult patients. The aneurysms in young adult patients were more often elongated or irregularly shaped (82.5% vs. 64.0%, respectively) and were significantly smaller (5.9 mm) than that in controls (6.8 mm). @*Conclusions@#Ruptured aneurysms of young adult patients have unique characteristics with regard to its preponderance in male smoker, elongated or irregular shape and relatively smaller size.
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PURPOSE: The purpose of this study was to report the authors’ experience with external ventricular drainage (EVD) before endovascular treatment (EVT) in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its relation to hemorrhagic complications. MATERIALS AND METHODS: Between March 2010 and December 2017, a total of 122 patients were recruited who had an aSAH, underwent EVT to secure the ruptured aneurysm, and had EVD performed within 72 hours of rupture. The pre-embo EVD group (n=67) comprised patients who underwent EVD before EVT, and the post-embo EVD group (n=55) comprised those who underwent EVD after EVT. RESULTS: Overall, EVD-related hemorrhage occurred in 18 patients (14.8%): six (8.9%) in the pre-embo EVD group and 12 (21.8%) in the post-embo EVD group (P=0.065). No rebleeding occurred between EVD and EVT in the pre-embo EVD group. Clinical outcomes at discharge did not differ significantly between groups (P=0.384). At discharge, the final modified Rankin Scale score in patients who experienced pre-embo rebleeding was better in the pre-embo EVD group than in the post-embo EVD group (P=0.041). Current use of an antiplatelet agent or anticoagulant on admission (odds ratio [OR], 2.928; 95% confidence interval [CI], 1.234–7.439; P=0.042) and stent use (OR, 2.430; 95% CI, 1.524–7.613; P=0.047) remained independent risk factors for EVD-related hemorrhagic complications. CONCLUSION: EVD before EVT in patients with aSAH in acute period did not increase the rate of rebleeding as well as EVD-related hemorrhagic complications. Thus, performing EVD before EVT may be beneficial by normalizing increased intracranial pressure. Especially in patients with rebleeding before the ruptured aneurysm is secured, pre-embo EVD may improve clinical outcomes at discharge.
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Humanos , Aneurisma , Aneurisma Roto , Drenaje , Hemorragia , Hidrocefalia , Aneurisma Intracraneal , Presión Intracraneal , Factores de Riesgo , Rotura , Stents , Hemorragia SubaracnoideaRESUMEN
OBJECTIVE: The objective of this study was to reinterpret the neurodevelopmental prognostic factors that are associated with birth head injury by performing a long-term follow-up. METHODS: Seventy-three neonates with head injuries were retrospectively analyzed after a duration of 10.0±7.3 years to determine the correlations between perinatal factors, including gender, head circumference, gestational age, body weight, and mode of delivery, and head injury factors from radiologic imaging with social, fine motor, language, and motor developmental quotients. RESULTS: There was a statistically significant difference between perinatal factors and head injury factors with respect to head circumference, body weight, gestational age, mode of delivery, Apgar scores at 1 min, cephalohematoma, subdural hemorrhage, subarachnoid hemorrhage, and hypoxic injury, but no direct correlation by regression analysis was observed between perinatal factors and developmental quotients. Of the head injury factors, falx hemorrhage showed a significant indirect relationship with the language and motor developmental quotients. Mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, epidural hemorrhage (EDH), tentorial hemorrhage, brain swelling, and hypoxic injury showed an indirect relationship with social development. CONCLUSION: In terms of perinatal factors and head injury factors, mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, EDH, tentorial hemorrhage, falx hemorrhage, brain swelling, and hypoxic injury displayed an indirect relationship with long-term development, and therefore these factors require particular attention for perinatal care.
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Humanos , Recién Nacido , Traumatismos del Nacimiento , Peso Corporal , Traumatismos Craneocerebrales , Estudios de Seguimiento , Edad Gestacional , Cabeza , Hematoma , Hematoma Subdural , Hemorragia , Hemorragias Intracraneales , Parto , Atención Perinatal , Estudios Retrospectivos , Fracturas Craneales , Cambio Social , Hemorragia SubaracnoideaRESUMEN
BACKGROUND: Glanzmann thrombasthenia (GT) is a rare disease with severe insufficiency of platelet function. There are no reports of GT associated with a cerebral hemorrhage. CASE REPORT: A 45-year-old woman had a stuporous mentality. Her computed tomographic (CT) angiography revealed a rupture of the posterior cerebral artery aneurysm. Hunt-Hess grade was 4 points and Fisher grade was 3 points. A clipping of the aneurysm was performed and proceeded to external ventricular drainage for hydrocephalus after 6 days. But, a new hemorrhage was detected several times via a follow-up brain CT. Various blood tests were conducted to evaluate the bleeding tendency, and the GT was diagnosed with PFA-200. The ventriculoperitoneal shunt was performed after the platelets transfusion, and she was discharged without other complications. CONCLUSION: With nonspecific and recurrent intracranial hemorrhage, a GT should be included in the differential diagnosis, which is important in controlling bleeding during the surgery.
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Femenino , Humanos , Persona de Mediana Edad , Aneurisma , Aneurisma Roto , Angiografía , Plaquetas , Encéfalo , Hemorragia Cerebral , Diagnóstico Diferencial , Drenaje , Estudios de Seguimiento , Pruebas Hematológicas , Hemorragia , Hidrocefalia , Aneurisma Intracraneal , Hemorragias Intracraneales , Hemorragia Posoperatoria , Enfermedades Raras , Rotura , Estupor , Trombastenia , Derivación VentriculoperitonealRESUMEN
BACKGROUND: The purpose of this study was to survey the anatomical angiographic finding of the aneurysm and identify parameters associated with visual recovery of the patients with Terson syndrome (TS). METHODS: This retrospective study was conducted on 494 patients with aneurysmal subarachnoid hemorrhage (SAH) from 2008 to 2015. Radiologists independently reviewed findings on computed tomography scans and cerebral digital subtraction angiography. Ophthalmologists conducted ophthalmological examinations for patients who had no communication problem. The degree of visual acuity recovery (DVAR) was measured based on the visual acuity difference between the initial and sixth-month follow-up. Favorable visual recovery was defined as DVAR >0.4. RESULTS: A total of 494 patients diagnosed with aneurysmal SAH were given admission to a single institute, of whom 171 received ophthalmological examinations. Of the total, 40 patients were diagnosed with TS and 54 eyeballs were affected by vitreous or retinal hemorrhage. In the multivariable analysis, male sex (odds ratio [OR] 9.530; 95% confidence interval [CI] 1.824–49.801), favorable Glasgow coma scale (GCS) (≥13 points) (OR 8.073; 95% CI 1.226–53.148), and anterior orientation of aneurysm (OR 5.006; 95% CI 1.842–29.751) were identified as independent factors predicting favorable visual recovery after adjusting covariables. CONCLUSION: TS was identified in 23.4% of patients with aneurysmal SAH. Male sex, favorable GCS at admission, and anterior orientation of the aneurysm were identified as prognostic factors for favorable visual recovery. It is proposed that positive ophthalmologic consultation and treatment can be helpful in improving vision and quality of life of TS patients.
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Humanos , Masculino , Aneurisma , Angiografía de Substracción Digital , Estudios de Seguimiento , Escala de Coma de Glasgow , Pronóstico , Calidad de Vida , Hemorragia Retiniana , Estudios Retrospectivos , Hemorragia Subaracnoidea , Agudeza VisualRESUMEN
PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aneurisma Roto , Angiografía de Substracción Digital/métodos , Angiografía Cerebral/métodos , Imagenología Tridimensional/métodos , Incidencia , Aneurisma Intracraneal/epidemiología , Hemorragias Intracraneales/epidemiología , Recurrencia , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aneurisma Roto , Angiografía de Substracción Digital/métodos , Angiografía Cerebral/métodos , Imagenología Tridimensional/métodos , Incidencia , Aneurisma Intracraneal/epidemiología , Hemorragias Intracraneales/epidemiología , Recurrencia , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI. METHODS: Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score. RESULTS: The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up. CONCLUSION: Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.
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Humanos , Lesiones Encefálicas , Encéfalo , Clasificación , Descompresión , Craniectomía Descompresiva , Estudios de Seguimiento , Escala de Coma de Glasgow , Hipertensión Intracraneal , Presión Intracraneal , Mortalidad , Estado Vegetativo Persistente , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management. MATERIALS AND METHODS: We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes. RESULTS: A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome. CONCLUSION: SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.
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Anciano , Humanos , Aneurisma , Hematoma , Aneurisma Intracraneal , Registros Médicos , Mortalidad , Estudios Retrospectivos , Factores de Riesgo , Hemorragia SubaracnoideaRESUMEN
OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.
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Humanos , Aneurisma , Angiografía , Arterias , Aneurisma Intracraneal , Arteria Cerebral Media , CuelloRESUMEN
OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.
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Humanos , Aneurisma , Angiografía , Arterias , Aneurisma Intracraneal , Arteria Cerebral Media , CuelloRESUMEN
OBJECTIVE: The purpose of this study was to retrospectively evaluate and compare the incidence of diffusion-weighted image (DWI) lesions between the Guglielmi detachable coil (GDC) and the Target coil for treating unruptured intracranial aneurysm. METHODS: From 2010 to 2011, consecutive 222 patients with an intracranial aneurysm underwent coil embolization. Inclusion criterias were : 1) unruptured intracranial aneurysm, 2) one or more GDC or Target coils used with or without other coils, 3) DWI examination within 24 hours after coiling, and 4) coiling performed without a balloon or stent. RESULTS: Ninety patients (92 cases) met the inclusion criteria. DWI lesions were detected in 55 (61.1%) of 90 patients. In the GDC group (n=44), DWI lesions were detected in 31 (70.5%). The average number of DWI lesions was 5.0+/-8.7 (mean+/-SD; range, 1-40) in aneurysm-related territory. In the Target coil group (n=48), DWI lesions were detected in 24 (50.0%). The number of DWI lesion was 2.1+/-5.4 (range, 1-32) in aneurysm-related territory. There was no significant correlation between a number of coils and DWI lesions. No significant differences were also observed in the number of DWI lesions in each group. CONCLUSION: The GDC and Target coils, which have an electrolytic detachable system, showed no differences in the incidence of DWI lesion.
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Humanos , Incidencia , Aneurisma Intracraneal , Imagen por Resonancia Magnética , Estudios Retrospectivos , TromboemboliaRESUMEN
OBJECTIVE: The objective of this study is to evaluate the clinical presentation and outcomes of patients with an intracerebral hematoma (ICH) associated with a ruptured middle cerebral artery (MCA) aneurysm, and the correlation factors associated with the aneurysm and characteristics of the hematoma. METHODS: A retrospective evaluation of clinical and radiologic characteristics and outcomes was conducted for 24 patients (11 men and 13 women; mean age, 53 years) with ruptured MCA aneurysms associated with ICH between September 2008 and December 2011. RESULTS: Thirteen (54%) of the 24 patients had a favorable outcome, four (17%) suffered from severe disability, and seven (29%) died. Based on Hunt and Hess grade, one patient was classified as Grade II, three as Grade III, 12 as Grade IV, and eight as Grade V. Patients with an unfavorable outcome had significantly larger aneurysms (p = 0.047) and ICH volumes (p = 0.002), compared with patients in the group with a favorable outcome. The most frequent rupture point of aneurysms was the lateral aspect of the aneurysm (54.2%). When the rupture point is toward the lateral direction, the distribution of ICH tended to be located at the temporal lobe and intrasylvian. CONCLUSION: Results of the present study suggest an association of the initial clinical state, the size of the aneurysm, and ICH volume with outcome. Although no difference was observed between the location of the rupture point and patient outcomes, an accurate assessment of ICH patterns and the rupture point in angiography may help to ensure surgical exposure and a safe aneurysm clipping.
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Humanos , Masculino , Aneurisma , Angiografía , Sacarosa en la Dieta , Hematoma , Aneurisma Intracraneal , Arteria Cerebral Media , Estudios Retrospectivos , Rotura , Lóbulo TemporalRESUMEN
Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity. The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS.
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Humanos , Asma , Sistema Nervioso Central , Hemorragia Cerebral , Síndrome de Churg-Strauss , Eosinofilia , Granuloma Eosinófilo , Tracto Gastrointestinal , Corazón , Hemorragias Intracraneales , Pulmón , Nervios Periféricos , Piel , Hemorragia Subaracnoidea , VasculitisRESUMEN
OBJECTIVE: Intracranial pressure (ICP) is one of the critical parameter for the patients of severe traumatic brain injury (TBI) to determine the treatment modalities and predict clinical outcomes. Hence, the ICP monitoring with accuracy and safety is essential for the TBI patients. The purpose of this study is to compare its safety and clinical usefulness of intraventricular ICP monitoring method to the parenchymal type. METHODS: We retrospectively reviewed the medical records and imaging data of 18 severe TBI patients. We used intraventricular ICP monitoring in 10 patients and parenchymal 8 patients. We compared the clinical findings of the two type ICP monitoring methods including procedure time, neurological status, outcome, complications and mortality. RESULTS: The initial Glasgow Coma Scale of intraventricular ICP monitoring and parenchymal ICP monitoring patients were 5.8 (range: 4-7) and 6.5 (range: 3-7) respectively. The Glasgow Outcome Scale after 6 months was a little higher in intraventricular monitoring patients than parenchymal monitoring patients (2.8 vs. 2.0, p=0.25). We could not find any intraventricular catheter related complication in intraventricular ICP monitoring patients. There was no difference in mortality in both groups (p=0.56). CONCLUSION: Our results suggest that intraventricular catheter insertion for ICP monitoring is relatively a safe procedure in the severe TBI patients. We could not demonstrate the significant benefit of intraventricular type ICP monitoring compared with parenchymal type ICP monitoring. Considering intraventricular type ICP monitoring have advantages of the accuracy and extraventricular drainage, intraventricular type ICP monitoring could be considered for severe TBI patients, regardless of hydrocephalus.
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Humanos , Lesiones Encefálicas , Catéteres , Drenaje , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Hidrocefalia , Presión Intracraneal , Registros Médicos , Estudios RetrospectivosRESUMEN
Intracranial mycotic aneurysms due to Aspergillus species are extremely uncommon but fatal. A medium-sized ruptured intracranial aneurysm at the middle cerebral artery bifurcation was identified in a 50-year-old female patient. Proper microsurgical clipping was not feasible due to the aneurysm's friable nature. Microsuture and wrapping were done instead. Histological findings confirmed a mycotic aneurysm caused by Aspergillus. Herein, we report on the clinical course and histopathological findings with a relevant literature review.