Endovasular Treatment of Cerebral Aneurysm Remnants after Clipping / 대한뇌혈관외과학회지

The authors report experience using GDC (Guglielmi detachable coil) for the treatment of the cerebral aneurysmal remnant following incomplete surgical clipping. All four patients in whom surgical clipping didn't result in complete obliteration of the aneurysmal sac were anterior circulation aneurysmal remnants. In three patients, aneurysmal remnants were diagnosed by routine follow-up angiography, and one case by recurrent subarachnoid hemorrhage. In all patients, remnants of the aneurysm were completely obliterated by embolization using GDC. There was no neurological morbidity and mortality associated with the treatment. Endovascular treatment of the cerebral aneurysmal remnants may be a effective and safe option for patients in whom surgical clipping does not result in complete obliteration of the aneurysmal sac.

Analysis of Angiographic Findings in Arteriovenous Malformations (AVM) of Brain According to PresentingClinical Manifestations

PURPOSE: To evaluate the different angio-architectures of brain arteriovenour malformatigns (AVMs) accordingto the presence of non-hemorrhagic symptoms or intracerebral (ICH) and/or intraventricular hemorrhage(IVH). MATERIALS AND METHODS: The results of complete cerebral angiography obtained in 215 patients with AVM between1989 and 1994 were retrospectively reviewed. The M:F ratio was 136:78 and their mean age was 29 (ranged 4 - 66)years. On the based of clincal presentation, CT and/or MR images, they were divided into hemorrhagic andnon-hemorrhagic groups. Angiograms were analyzed by two radiologists for the size and location of nidus; thenumber of feeding arteries and the extent of aneurysm, stenosis, dural supply, and angiomatous change; the numberof draining veins and the extent of deep or superficial drainage, stenosis, ectasia, kinking, and stasis. Thestandard chi-square test was used for statistical analysis. RESULTS: Hemorrhage was noted in 140 patients(65%),and no hemorrhage in 75(35%). Hemorrhage was more common in AVM with deep-seated and callosal locations, a nidusof less than 2cm, single feeder and single venous drainage, and deep venous drainage only (p < 0.05 - 0.001).Non-hemorrhagic presentations were more common in AVM with cortical and subcortical location, a nidus of more than5cm, angiomatous change, dural supply, both superficial and deep venous drainage, kinking, and stasis (p <0.05-0.001). CONCLUSION: The angio-architechture of AVM with hemorrhage correlated with clinical symptomaticpresentation. Analysis of the patterns of angioarchitectureis useful for prognosis and in deeiding the direetionof freatment.

Angiographic Analysis of Cerebral Aneurysm

PURPOSE: To analyze the angiographic findings of cerebral aneurysms and to compare them with previousdomestic and foreign reports. MATERIAL AND METHODS: Three hundred and seventeen patients underwent DSA(digitalsubtraction angiography) and the results were retrospectively, reviewed. Among 278 patients, 356 cerebralaneurysms were detected. Patient's age and sex ratio were analysed, as well as the location, size and multiplicityof the aneurysms. RESULT: The most prevalent age group was 40 to 60 years (n=211, 76%), and the male to femaleratio was 1:1.5. Aneurysms were located in the anterior (n=324, 91%) or posterior circulation(n=32, 9%). In theformer, the most common locations were the anterior communicating artery (n=98, 28%), middle cerebral artery (MCA)bifurcation(n=65, 18%) and the posterior communicating artery (n=32, 9%), while in the pasterior circulation, themost common location was the basilar tip(n=11, 3%). One hundred and eighty-eight cerebral aneurysms(53%) were 3-6mm in size, and 75(21%) were 6-10mm. The size of nine aneurysms (3%) was more than 25mm. Multiple aneurysms(n=149)occurred in 65 patients(23%) ; the most common age group was 40 to 60 (74%) and the male to female ratio was 1:4.The most common number of multiple aneurysms were two (77%) and the common locations were the posteriorcommunicating artery (21%), MCA bifurcation (18%) and anterior communicating artery (13%). CONCLUSION: Weanalyzed a large series in a single center and therefore expect that our data will be helpful for the analysis ofaneurysms in the cerebral circulation and for comparison with domestic and foreign studies.

Cranial Chordoma ; Clinical Presentation and Multimodality Treatment

Cranial chordomas are rare and generally slow-growing malignant neoplasms of presumed notochordal origin. They seldom metastasize, but are difficult to manage because of their locally invasive nature and their proximity to critical structures. The clinical presentation and results of operative treatment, radiation therapy, and radiosurgery in a series of 10 patients with cranial chordomas seen at our hospital, between June 1989 and December 1994, are analysed. There were 4 men and 6 women with a mean age of 37.5 years. The most common presenting symptoms were visual loss, motor weakness and diplopia, and the most common presenting sign was visual field defect. The mean interval between symptom onset and initial treatment was 4.8(1-17) months. Three tumors classified as the chondroid type showed better clinical course. Extent of tumor resection included biopsy in 1 patient and subtotal or greater in 9. Four patients received postoperative radiation therapy and 4 patients stereotactic radiosurgery using Leksell gamma unit. Among them 1 patient showed tumor progression after radiation therapy but none after radiosurgery. One patient died due to tumor recurrence and two patients due to therapy but none after radiosurgery. One patient died due to tumor recurrence and two patients due to postoperative complications. At the time of analysis 7 patients were alive. The average length of follow-up for the alive patients was 34 months. The results of this study suggest that multimodality treatment using surgical debulking, radiation therapy and stereotactic radiosurgery is necessary for the optimal management of chordoma.

Effects of 10 % Pentastarch on Hypervolemia and Hemodilution following clipping of cerebral aneurysm / 대한마취과학회지

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is one of the most important causes of cerebral ischemia. Hypervolemic hypertension and hemodilution have been reported to be an effective method for prevention and treatment for cerebral ischemia secondary to cerebral vasospasm.We compared the volume expanding effects between normal saline(20 cases), 10% pentastarch(20 cases) and dextran(20 cases) after clipping of cerebral aneurysm in the patients with subarachnoid hemorrhage and the incidence of vasospasm by transcranial doppler(TCD) postoperatively. The results were as follows ;1) The total amount of infused volume in pentastarch and dextran group were 310+/-46ml, 438 +/-262ml respectively,and were significantly smaller than normal saline group, 1078+/-187ml.(p<0.05) 2) Plasma osmolality was increased by 10 mOsm/kg in pentastarch group, but statistically insignificant. 3) Hematocrit value was decreased significantly in pentastarch and dextran group from 34.9+/-1.03%, 34.8+/-1,4% to 31.6+/-1.38%, 31.9+/-0.9% respectively.(p<0.05) 4) Cases over 80cm/sec by TCD were 3 in normal saline, 2 in pentastarch, and 2 in dextran group. We conclude that 10% pentastareh could be used as an effective blood volume expander after cerebral aneurysm clipping.