Superficial Temporal Artery-Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion by Subacute In-Stent Thrombosis after Carotid Artery Stenting

Alternative to carotid endarterectomy, carotid artery stenting (CAS) can be performed for symptomatic severe stenosis of internal carotid artery, especially for high-risk patients. Among several complications after CAS, subacute in-stent thrombosis is rare but important, because patient's condition can deteriorate rapidly. Subacute in-stent thrombosis with carotid artery occlusion can be managed by superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. We report two cases of STA-MCA anastomosis for internal carotid artery occlusion by subacute in-stent thrombosis after CAS.

Clinical Aspect of Spontaneous Pontine Hemorrhage / 대한뇌혈관외과학회지

OBJECT: Spontaneous pontine hemorrhage can be diagnosed by CT or MRI, but the clinical course is variable according to the location of the hemorrhage. MATERIALS AND METHODS: Author attempted to analyse 39 cases of spontaneous pontine hemorrhage, considering factors to influence their prognosis, admitted in Inje University Busan Paik Hospital from 1998 to 2002. RESULT: Pontine hemorrhage was classified according to the finding of CT scan;4 cases of Type I (hematoma, localized in the tegmentum), 18 cases of Type II (those in the tegmentolaterally), 16 in Type III (those in the basis pontis mainly with tegmentum and midbrain). Male to female ratio was 31:8, mean age was 48.2 years (9-76 years). Initial Glascow Coma scale was 7.6 (3-14), and mean follow-up period was 5.1 months (0.1-52 months). Associated diseases were as follows;hypertension;20, pulmonary tuberculosis;2, hypertension with D.M;1. Treatment modality was consisted of 36 conservative treatment, 1 stereotactic hematoma aspiration, 2 Gamma-Knife radiosurgery for associated cavernous malformations. Prognosis was good at following order of the tegmentotectal, tegmentolateral type. CONCLUSION: The prognosis of tegmentotectal, tegmentolateral type hemorrhage was better than basis pontis. The little volume of the hematoma, the better prognosis.

Gamma-Knife Radiosurgery for Vestibular Schwannoma

OBJECT: The goals of radiosurgery include preservation of neurological function and prevention of tumor growth. We document the results of gamma-knife radio-surgery for vestibular schwannoma. METHOD AND OBJECT: Eighty-two patients underwent stereotactic radiosurgery for an vestibular schwannoma from October, 1994 to December, 2000. Sixty-five of these patients were followed up for radiological and clinical evaluation. As pregamma-knife modality, surgical resection were done in 23 patients,and V-P shunt in 2 patients. Initial symptoms were headache(n=45), dizziness(n=16), tinnitus(n=17). While normal facial function(House-Brackmann grade 1) was present in 48 patients(73.8%), other patients showed grade 2 function in 8, grade 3 function in 7,and grade 4 function in 2. The Gardner/Robertson scale was used to code hearing function. Male to female ratio was 1:3. Mean tumor volume was 7.98cm3. Mean dose delivered to the tumor margin was 14.2Gy,and mean maximal dose was 28.3Gy. RESULTS: Mean follow-up duration of 19.9 months. Thirty-five showed decrease(53.8%) in size, 19 patients(29.2%) stationary, 3(4.6%) initial decrease follow up increase, 5(7.6%) initial increase follow up decrease,and 59 patients (90.8%) were well controlled. Two patients experienced transient facial neuropathy, one transient trigeminal neuropathy, and one transient hearing deterioration. After gamma-knife radiosurgery, ventriculoperitoneal shunt was done in 4 patients. CONCLUSIONS: Gamma-knife radiosurgery can be used to treat postoperative residual tumors as well as in patients with concomitant medical problems in patients with preserved hearing function. Gamma-knife radiosurgery is safe and effective method to treat small, medium sized(less than 3cm in extracanalicular diameter), intracanalicular vestibular schwannoma, associated with low rate of cranial neuropathy.

Gamma Knife Radiosurgery on Uveal Melanoma

Uveal melanoma is uncommon but life-threatening intraocular malignancy and has been treated by irradiation, local excision and enucleation. Gamma-Knife radiosurgery allows a high dose of radiation to be delivered to an intracranial target with a very high spatial accuracy and has been used for the treatment of ocular melanomas. We have treated two cases of uveal melanoma between October 1994 and December 1999. They include one man and one woman(34, 62 years, respectively). They were followed up for 12 momths. Mean maximal dose was 65Gy. In one case, the tumor disappeared 7 months after gamma-knife radiosurgery. In another case, multiple tumors (uveal, suprasellar and cerebellar tumor) had decreased in size. These results show that single and high dose gamma-knife radiosurgery is may be an option in the local control of uveal melanoma which can spare the eyeball and vision.