Clinical Characteristics of Pediatric Cerebral Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: The aim of this study was to define the clinical characteristics of pediatric cerebral aneurysms. METHODS: During the past 30 years, among a total of 3,330 patients treated for cerebral aneurysms, 12 patients were under the age of 18. The authors reviewed the database and imaging studies as sources for identification and analysis. RESULTS: Seven patients were male and 5 were female. The mean age was 12.9 years old (range: 3~18). Nine patients had ruptured lesions and the remaining 3 had unruptured lesions. Four patients presented with a subarachnoid hemorrhage, and the other 5 patients presented with an intracerebral hemorrhage (ICH). Five aneurysms were located at the posterior cerebral artery or vertebrobasilar artery, 4 at the middle cerebral artery, and 3 at the internal carotid artery, respectively. The giant aneurysm was observed in 2 (18%) patients. Eleven aneurysms were saccular, and 1 was serpentine in shape. No patient had multiple aneurysms. Rebleeding was observed in 3 cases (33%). No child suffered from clinical vasospasm. All but one patient showed a favorable outcome (good: 11, dead: 1). CONCLUSIONS: Pediatric cerebral aneurysms in this study showed a male predominance, a high incidence of presentation with ICH, a location on the distal circulation of the major arteries or on the posterior circulation, and a large or giant aneurysm, high rebleeding rate and a low incidence of vasospasm. The overall clinical outcome was excellent in 91.7% in this study. With the knowledge of these features, aneurysmal obliteration and active brain resuscitation can improve the clinical outcome and prognosis.

Stent-Assisted Recanalization for Acute Ischemic Stroke / 대한뇌혈관외과학회지

OBJECTIVE: Acute ischemic stroke attributable to major cerebral arteries occlusion is frequently associated with severe disability or death. Pharmacological or mechanical thrombolysis may achieve better results if the treatment can be performed within 3 hours of stroke onset. If failed thrombolysis, stent-assisted recanalization may improve recanalization rates. METHODS: We reviewed retrospectively 9 patients with acute ischemic stroke resistant to standard thromolytic therapy, who received stent-assisted recanalization from January 2002 to December 2005. Dermographics, clinical, and radiographic presentation and outcomes were studied. RESULTS: Five men and four women with a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 15 (range, 12-20) were included. Five lesions were located in the extracranial internal carotid artery, two in the middle cerebral artery, one in the common carotid artery, and one in the mid-basilar artery. Mean time to treatment was 9.8+/-14.6 hours from symptom onset. All occlusions were successfully recanalized with thrombolysis and stent placement, and the stenotic ratio was reduced from 91% (pre-stenting) to 5% (post-stenting) on average. Procedure-related complications occurred in two patients (22%): distal embolism in one and subacute thrombotic occlusion in the other. NIHSS score at discharge showed significant improvement (P<0.05, Wilcoxon rank sum test). CONCLUSION: Emergency stent angioplasty for acute ischemic stroke with failed thrombolysis appears to have a high recanalization rate and to improve outcome in our retrospective study. This study reveals that emergency stent angioplasty could be considered as an optimal treatment for recalcitrant arterial occlusions.

Dissecting Aneurysm of the Posterior Cerebral Artery Masquerading as Saccular Giant Aneurysm / 대한뇌혈관외과학회지

The aneurysm nature and configuration in a giant aneurysm of the PCA is important and careful angiographic examination is needed. We present a case of dissecting aneurysm of the posterior cerebral artery masquerading as saccular giant aneurysm. A 17-year-old man presented with subarachnoid haemorrhage. Cerebral angiograms on admission showed a giant saccular aneurysm with wide neck at P1-P2 junction. The patient underwent endovascular coils embolization and extraventricular drainage of cerebrospinal fluid successfully. However, the patient was aggravated neurologically and got the rebleeding on postembolization 8 days. Repeat cerebral angiograms revealed dilated P1 segment with aneurysmal change of P2 segment. We report the angiographic feature and unusual clinical course and discuss the endovascular treatment of dissecting aneurysms.