Difference in Induction Rate of Experimental Cerebral Aneurysm According to High Salt, High Lipid and Normal Diet / 대한뇌혈관외과학회지

OBJECTIVE: An intracranial aneurysm is an important acquired cerebrovascular disease that can cause a catastrophic subarachnoid hemorrhage. Atherosclerosis is one of possible mechanism, but its contribution to aneurysm formation is unclear. Experimentally induced cerebral aneurysm rate by high lipid diet was evaluated and compared with high salt and normal diet to elucidate the role of lipid metabolism in the process of cerebral aneurysm formation. METHODS: Thirty-seven 7-week-old male Sprague-Dawley (SD) rats received a cerebral aneurysm induction procedure. The control animals (n=11) were fed a normal diet, and the experimental animals were fed a diet containing 8% salt (n=15) and high lipid (n=11) for three months. Three months after the operation, the rats were killed, their cerebral arteries were dissected, and the regions of the bifurcation of the right anterior cerebral artery-olfactory artery (ACA-OA) bifurcations were examined histologically and aneurysm induction rates among three groups were analysed. RESULTS: Average systolic blood pressures after 3 months feeding in three groups (high salt diet group, high lipid diet group and normal diet group) were 175.9+/-3.4 mmHg, 133.7+/-5.1 mmHg and 128+/-2.9 mmHg, respectively. The difference between high lipid group and normal diet group was not significant (P=0.215). The aneurysm induction rate in three group were 87%, 63% and 36%. The difference between high lipid diet group and normal diet group was significant (Pearson k2, P=0.029). CONCLUSIONS: High lipid diet significantly increase the cerebral aneurysm induction rate in experimentally induced cerebral aneurysm model of rats. That suggests a possible adverse role for hyperlipidemia leading to aneurysm formation. Further studies are necessary to elucidate the exact role of hyperlipidemia in the pathophysiology of cerebral aneurysm.

Frontal Sinus Mucocele with Massive Skull Destruction

A 63-year-old female complained of left frontal headache and swelling for several months. Physical examination revealed a left supraorbital soft, nontender, nonpulsatile mass without bruit. The left eye was displaced downward with respect to the normal right globe. Based on the clinical and radiological findings, the patient was diagnosed as a mucocele arising from the left frontal sinus. The patient underwent a transcranial approach through coronal incision. In this patient, large portions of the anterior and posterior frontal sinus walls were destroyed in association with epidural spread, so we performed cranialization of the frontal sinus and removed the mucosal wall with the aid of a microscope. With a brief review we present a patient with mucocele of the frontal sinus extending into the intracranial and intraorbital region, which was successfully treated by a transcranial approach.

Transient Myocardial Ischemia during General Anesthesia with Isoflurane: Case report / 대한마취과학회지

Myocardial ischemia occurs when myocardial oxygen availability is inadequate to meet metabolic requirements. The common cause of myocardial ischemia is atherosclerotic epicardial coronary arteries. Isoflurane is a potent small vessel-type coronary vasodilator and has the potential for causing regional myocardial ischemia in patients with coronary disease, but it's still controversial. We experienced a case of transient myocardial ischemia during general anesthesia with isoflurane. The patient was a 51 year- old male who underwent a direct clipping of an anterior communicating artery aneurysm. There was no specific abnormality on preoperative laboratory tests except for mild mitral valve regurgitation on the cardiac echocardiogram. He had once experienced several minutes of sudden severe chest tightness just 3 months before admission, but it had subsided without any specific treatment. One hour after beginning of operation, abnormal EKG changes such as ST-T elevation, QRS widening, VPC, ventricular tachytcardia and ST-T depression appeared and then normalized within 2 minutes with stopping isoflurane and using isosorbide dinitrate. He discharged 12 days later without complications. After discharge, Tread-mill test, SPECT and 2D echocardiogram were performed but there was no any evidence of coronary artery disease.