Endovascular treatment of ruptured tiny aneurysms

OBJECTIVE: Endovascular coiling of ruptured tiny aneurysms (RTAs) in the brain has been known to be technically challenging owing to the higher rate of adverse events, such as thromboembolism and intraoperative rupture. The aim of this study was to report our ex-periences of endovascular treatment of RTAs (size, ≤3 mm).METHODS: From January 2006 to December 2017, 35 RTAs in 35 patients were treated at our institution with an endosaccular coiling. Procedural data and clinical and angiographic results were retrospectively reviewed.RESULTS: The mean size of the RTAs was 2.53 mm (SD: 0.38). The neck remodeling technique was applied to 14 aneurysms, including stent-assisted coiling (n=7) and balloon-assisted coiling (n=7). Procedure-related complications included intraprocedural rupture (n=2), thromboembolic event (n=1), and early rebleeding (n=2), which needed recoiling. Regarding immediate angiographic control, complete occlusion was achieved in 25 aneurysms (71.4%), small neck remnant in 5 (14.3%), and definite remnant in 5 (14.3%). At the end of follow-up, 31 of the 35 patients (88.6%) were able to function independently. Twenty-two of the 35 patients underwent follow-up conventional angiography (mean, 468 days). Stable occlusion was achieved in 20 of the 22 patients (90.9%), minor recanalization in 1 (4.5%), and major recanalization, which required recoiling, in 1 (4.5%).CONCLUSION: Our experiences demonstrate that endovascular treatment for RTAs is both feasible and effective. However, periprocedural rebleedings were found to occur more often (11.4%) than what is generally suspected.

Endovascular Treatment Following Gauze Packing for the Control of Massive Bleeding from Traumatic Transverse Sinus Lesion / 대한신경손상학회지

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.

A Clinical Study of the Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal cancer is the most common malignancy in head and neck region. The aim of this study was to evaluate the clinical features and treatment outcomes of laryngeal cancer. MATERIALS AND METHODS: We reviewed medical records of 169 patients from 1984 to 1997 retrospectively. We investigated age, sex distribution, TNM staging in 169 patients and treatment modalities, survival rate in 141 patients who were treated. RESULTS: In all patients, there were 64 glottic, 57 supraglottic, 46 transglottic and 2 subglottic cancers. Among 141 patients, we performed 92 surgical procedures and 49 radiotherapies. Total and near total laryngectomy were performed in 45 cases and conservation laryngectomy in 47 cases. Five year survival rate (YSR) was 88.4% totally. In early cancer cases, 5 YSR was excellent in both surgery and radiotherapy group. Glottic and supraglottic cancer showed much better prognosis than transglottic cancer. There was no statistical differences in the view of 5 YSR between surgery and radiotherapy group. Treatment failures were mainly found at primary sites. Functional preservation of larynx was successful in 79 cases after 3 year-follow up. CONCLUSIONS: Compared with previous studies, our study presented higher proportion of conservation laryngectomy and functional preservation procedues. Early diagnosis and treatment are important and required to improve patient's outcome.