Therapeutic Results of Dissecting Aneurysms of Vertebral Artery

OBJECTIVE: We present a retrospective analysis of clinical characteristics of vertebral artery dissecting aneurysms and efficacy of treatment outcome according to the various treatment modalities. METHODS: From March 2001 to February 2002, seven patients with dissecting aneurysm of vertebral artery were diagnosed by cerebral angiography. Five patients presented with subarchnoid hemorrhage and two patients with mass effect. Five patients were treated endovascularly using Guglielmi detachable coils and a patient with severe brainstem compression underwent direct surgery. Another patient rebled before treatment and subsequently died. RESULTS: We had no endovascular procedure-related complications. Four patients with subarachnoid hemorrhage who underwent endovascular treatment survived with good recovery. One of them rebled after initial treatment and was treated by additional endovascular procedure. Among patients with mass effect, one patient was treated with proximal occlusion of vertebral artery and another underwent complete excision of aneurysm, with anastomosis of the PICA into the dissecting aneurysm proximal portion. We obtained a good treatment results with improvement of myelopathy in both patients, however, the patients who had underwent bypass surgery suffered from transient lower cranial nerve palsy. CONCLUSION: The endovascular treatment for vertebral artery dissecting aneurysm could be the treatment of choice for these lesions to prevent early rebleeding and obtain optimal results. However, the choice for the treatment modality in such lesions should be determined according to the individual lesions considering the status of patients, clinical characteristics, and relation with posterior inferior cerebellar artery.

Clinical Characteristics of Aneurysm Rupture with the Focus of Hypertension and Smoking as Predisposing Factors

OBJECTIVE: The purpose of this study is to identify risk factors for subarachnoid hemorrhage(SAH) in Korea. METHODS: The clinical record and environmental data of 250 patients who had admitted our hospital between September 2001 and May 2003 were reviewed retrospectively by the neurosurgical nursing practitioners. RESULTS: In this study, the peak age for presentation with ruptured intracranial aneurysm was around 5th decade which is most active period of his or her life. The peak time of aneurysm rupture was from 6 to 12 A.M.(34.8%) and the onset of SAH occurred the most frequently at work(30.4%). The prevalence of hypertension in SAH patients was 42.8%, That of cigarette smoking in men and in women were 81.7% and 15.8% respectively. Hypertension was significantly corrected with the amount of hemorrhage based on Fisher Grading system(P<0.05). The consumption of smoking and the amount of hemorrhage was closely correlated also(P<0.05). CONCLUSION: Hypertension and cigarette smoking may be closely related to aneurysmal SAH. Undoubtedly, they are significantly related to massive, fatal SAH with poor neurologic condition. To prevent reduce aneurysmal SAH, cessation of smoking, anti-hypertensive medication and stress control are most important basic step in promotion of public health.

Syringomyelia as a Sequelae of the 4th Ventricular Dilatation from Traumatic Hydrocephalus and Cerebellar Atrophy

A 32-year-old man with stuporous mental state was transferred to our hospital emergency room after a car accident. The brain computed tomography(CT) showed 4th ventricular hemorrhage. He woke up 2 weeks after admission and then discharged. However, he returned to the hospital 10 months after discharge because of both shoulder pain and weakness of both arms. His brain CT showed marked dilatation of the 4th ventricle. His MRI showed whole spinal syringomyelia without Chiari malformation. The patient then underwent ventriculo-peritoneal shunt. His symptoms dramatically improved on the immediate postoperative day, and the syringomyelia also disappeared after operation. The authors report a very rare case of syringomyelia that was developed as a sequelae, especially of the 4th ventricular dilatation without intracranial pressure elevation after traumatic hydrocephalus and cerebellar atrophy, favoring Gardner's hypothesis.