Predictive Risk Factors for Refracture after Percutaneous Vertebroplasty

OBJECTIVE: To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty. METHOD: A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney U-tests. RESULTS: Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant. CONCLUSION: Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.

Strategy for the Patient with Tuberculum Sellae Meningioma Combining Bilateral Internal Artery Aneurysm

A 43-year-old woman was admitted with the chief complaint of progressive visual disturbance and her brain radiological studies disclosed well demarcated tumor at tuberculum sellae area and bilateral mirror image paraclinoid internal carotid artery saccular aneurysms. A larger left side aneurysm was pointing medialy and almost encased by the tumor. Although a brain tumor and intracranial aneurysm can be simultaneously treated by surgery, the high risk of intra-operative aneurysm rupture should be considered. Therefore, the author secondly performed tumor resection after the endovascular embolization of the aneurysm which was embedding the tumor using a Guglielmi detachable coil. After successful treatment of the patient with tuberculum sellae meningioma associated with bilateral mirror image paraclinoid aneurysms using endovascular and surgical techniques, the authors present the case with a review of the related literatures.

Cost-Effectiveness of Microsurgical Clipping versus Endovascular Coiling in Cerebral Aneurysmal Patient in Korea / 대한뇌혈관외과학회지

OBJECTIVE: The purpose of this study is to compare the cost-effectiveness of coiling as opposed to clipping in patients with cerebral aneurysm. METHODS: In this retrospective study, 6032 cases with cerebral aneurysms where were gathered from the Korea Health Insurance Review Agency were treated between January 2001 and September 2002. The cases were divided into two groups according to the treatment protocol : clipping and coiling, and then we did a comparative study of cost-effectiveness between the two groups. RESULTS: 5420 cases and 612 cases underwent clipping and coiling procedures, respectively. The average length of hospitalization day was longer in the clipping group (39.05+/-21.56 days compared with 34.69+/-21.70 days in the coiling group ; p<0.05). The average clinical cost per case was cheaper in the clipping group (9,196,159+/-4,811,659 Won compared with 10,752,703+/-5,856,210 Won in the coiling group ; p<0.05). The average material cost was more expensive in the coiling group (3,548,914+/-2,170,584 Won compared with 235,390+/-131,553 Won in the clipping group ; p<0.05). CONCLUSION: The results showed that although endovascular coiling of aneurysmal management allows a shorter hospital stay and is less invasive than surgical clipping, it has a higher clinical cost per patient under the present our national insurance. We think that further costs of long term follow-up care, such as periodic diagnostic procedures and re-operation, would be needed.

Clinical Value of Computed Tomographic Angiography: Our Prospective Clinical Trial / 대한뇌혈관외과학회지

OBJECTIVES: Computed tomographic angiography (CTA) to diagnose intracranial aneurysms in patients with spontaneous subarachnoid hemorrhage (SAH) has been well documented and widely accepted. In this study, it was assessed whether aneurysm surgery can be performed in aneurysm patients by using CTA regardless of their status. METHODS: To assess the clinical value of CTA, we treated patients with SAH using it as the primary means of diagnosis. During the period between August 2001 and May 2003, a consecutive series of 82 cases of ruptured cerebral aneurysms were evaluated via both CTA and postoperative transfemoral cerebral angiography(TFCA), and we investigated the detectability of cerebral aneurysms. In cases of vague CTA findings, we performed TFCA preoperatively. We correlated the CTA results with operative findings and preoperative TFCA, when performed. RESULTS: In 82 patients, 100 aneurysms (96 aneurysms via CTA, 1 aneurysm via TFCA, 3 aneurysms via operation) were disclosed. The size of aneurysms detected by CTA ranged from 1.95 mm to 19.4 mm. Aneurysms that were not found via TFCA were detected by CTA in two patients. Three additional small multiple aneurysms that could not be confirmed via CTA were found through operation. No previously undiscovered aneurysms were found via postoperative TFCA. Corresponding to the operative findings, the sensitivity of CTA was 96%. CONCLUSION: According to our results, we hold that CTA is the first choice among diagnostic methods for the treatment of SAH.