Retroperitoneal hematoma after coil embolization of cerebral aneurysm: A case report / 대한마취과학회지

We present the case of a 57-year-old man who developed retroperitoneal hemorrhage due to unintentional arterial puncture during femoral artery cannulation for Guglielmi detachable coil embolization. On emergence from anesthesia, he developed severe hypotension. Computed tomographic angiogram of the abdomen showed retroperitoneal hematomas around the urinary bladder, liver, and spleen. Because femoral artery cannulation is a common procedure for intravascular embolization in neuroradiologic procedures, Clinicians should be aware of the development of severe hematomas as a consequence of femoral artery puncture.

Multi-Modality Treatment for Intracranial Arteriovenous Malformation Associated with Arterial Aneurysm

OBJECTIVE: Intracranial arteriovenous malformation (AVM) associated with aneurysm has been infrequently encountered and the treatment for this malady is challenging. We report here on our clinical experience with AVMs associated with arterial aneurysms that were managed by multimodality treatments, including clipping of the aneurysm, microsurgery, Gamma-knife radiosurgery (GKS) and Guglielmi detachable coil (GDC) embolization. METHODS: We reviewed the treatment plans, radiological findings and clinical courses of 21 patients who were treated with GKS for AVM associated with aneurysm. RESULTS: Twenty-seven aneurysms in 21 patients with AVMs were enrolled in this study. Hemorrhage was the most frequent presenting symptom (17 patients : 80.9%). Bleeding was caused by an AVM nidus in 11 cases, aneurysm rupture in 5 and an undetermined origin in 1. Five patients were treated for associated aneurysm with clipping followed by GKS for the AVM and 11 patients were treated with GDC embolization combined with GKS for an AVM. Although 11 associated aneurysms remained untreated after GKS, none of them ruptured and 4 aneurysms regressed during the follow up period. Two aneurysms increased in size despite the disappearance of the AVM nidus after GKS and then these aneurysms were treated with GDC embolization. CONCLUSION: If combined treatment using microsurgery, GKS and endovascular treatment can be adequately used for these patients, a better prognosis can be obtained. In particular, GKS and GDC embolization are considered to have significant roles to minimize neurologic injury.

Results of Surgical and Endovascular Treatment of Middle Cerebral Artery Bifurcation Aneurysms: Clinical Research / 대한뇌혈관외과학회지

OBJECTIVE: Endovascular treatment as well as surgical treatment has become a treatment method for the management of the intracerebral aneurysms. The authors present the results of surgical and endovascular treatment of middle cerebral artery (MCA) bifurcation aneurysms. METHODS: From 1999 to 2005, 54 MCA bifurcation aneurysms were treated with surgical or endovascular methods at our hospital. Forty two patients had ruptured aneurysms and 12 had unruptured aneurysms. Of 54 aneurysms, 33 were treated with surgical clipping, 20 with Guglielmi detachable coil (GDC) embolization and 1 with cross over treatment. The medical, radiological and operation records were reviewed retrospectively. RESULTS: Of the 54 patients, 37 (68.5%) were female and 17 (31.5%) were male. In the surgically treated group, 22 (66.7%) experienced excellent or good outcomes (GOS 5 or 4), 8 (24.2%) had fair or poor outcomes (GOS 2 to 3), and 3 (9.1%) died (GOS 1). In the endovascularly treated group, 15 (75%) had excellent or good outcomes, 1 (5.0%) had fair outcomes (GOS 3), and 4 (20%) died. Symptomatic vasospasm revealed 9 (25.7%) in the surgically treated group, and 6 (30%) in the endovascularly treated group. Seven (20.5%) complications occurred from the surgical group, 3 (15%) from the endovascular group. On logistic regression analysis, there were no significant differences in GOS and vasospasm between surgically treated group and endovascularly treated group (p=0.788, 0.643, respectively). CONCLUSION: Endovascular treatment of MCA bifurcation aneurysms results in clinical outcome equal to the outcome of surgical treatment of MCA bifurcation aneurysms and it can be a good alternative method for MCA bifurcation aneurysms treatment.

Cerebral Vasospasm after Surgical Clipping Versus GDC Embolization in Ruptured Intracranial Aneurysm

OBJECTIVE: The purpose of this study is to analyze the influence of the treatment modality(surgical cilpping versus GDC embolization) on development of cerebral vasospasm in a non-randomized retrospective analysis of 93 patients of aneurysmal subarachnoid hemorrhage. METHODS: The following parameters were retrospectively reviewed in our institution's data base and analyzed in association with vasospasm-related ischemic infarctions: 1) Hunt and Hess(H&H) grade, 2) Fisher group, 3) location of aneurysm, 4) treatment modality(surgical cilpping versus endovascular treatment). RESULTS: Of the 93 patients, 39 (41.9%) patients suffered delayed ischemic infarctions. The incidence of delayed ischemic infarctions were increased as higher H&H grade and Fisher group but was not related with the location of aneurysms and the treatment modalities. CONCLUSION: Even with vigorous removal of the subarachnoid blood clots in the surgical clipping group, there is no statistical differences in the incidence of cerebral vasospasm between the two treatment modalities.

Experience of Endovascular Treatment of Distal Posterior Cerebral Artery Aneurysms

OBJECTIVE: Distal posterior cerebral artery(PCA) aneurysms requiring the problematic surgical approaches are rarely encountered. With the development of endovascular treatment, distal PCA aneurysms tend to be treated by endovascular method rather than surgery. We report our experience of distal PCA aneurysms, which were managed mainly by endovascular treatment. METHODS: During the last 5 years, there were five patients harboring distal PCA aneurysms(0.7% among a total 656 intracranial aneurysms). Four patients presented with subarachnoid hemorrhage, while one presented with ipsilateral facial hypesthesia. Four of them were treated by endovascular(Guglielmi detachable coil: GDC) embolization and one was treated by surgical clipping after failure of GDC embolization. RESULTS: Complete obliteration with parent artery encroachment was confirmed in 2 cases. There was one occipital lobe infarction and it resulted in the homonymous quadrantanopsia. In the other case, cerebral infarction did not develop. Incomplete coil embolization was inevitably performed to avoid parent artery occlusion in another two cases. CONCLUSION: Even with the obliteration of the parent artery, distal PCA aneurysms could be treated by use of GDC effectively. Adequate collateral supply to the distal arterial territory seems to contribute to it. Further study needs to be performed to verify this hypothesis.

The Quality of Life and Cognitive Deficits According to Treatment Modality of Anterior Communicating Artery Aneurysm: Surgery and GDC Embolization Group

OBJECTIVE: The authors present the difference of cognitive outcome of good recovery patients between direct surgery and Guglioma detachable coil(GDC) embolization group among anterior communicating artery aneurysm patients. METHODS: The clinical records of 21 patients who can be followed up and be answered questionnaires among good recovery patients fter ACoA(anterior communicating artery) aneurysm operation from 1990 to 1999 in our hospital were reviewed as surgery group. On the other hand, 20 good recovery patients after embolization of ACoA aneurysm in the other hospital from 1996 to 1999 are seleted as GDC embolization group. In the surgery group, the degree of brain swelling, the existence of rectus gyrus removal, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are examined. In GDC embolization group, problem during embolization, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are also investigated. After this investigation, patients and their family are questioned with Tidwell's cognitive outcome paper. The total records below 50 were considered as poor outcome. RESULTS: Ages, sex, Hunt and Hess grade, Fisher grade and size of aneurysm in two groups are similar conditions. The more patients get old, the cognitive outcome is worse in both group. In surgery group, those patients who have giant aneurysm, are removed rectus gyrus, are happened immediate post-operative transient neurological deficits and hypodense area in post operative brain CT are poor cognitive outcome. In the embolization group, Fisher grade III and post operative transient neurological deficit are happened, outcome was poor. In comparison with cognitive outcome between surgery and GDC embolization group, the embolization group has generally good result. CONCLUSION: The cognitive outcome is decided by age and the degree of brain injury according to aneurysmal rupture. Direct surgery method can make cognitive outcome poor due to perforator injury, brain retraction injury and removal of rectus gyrus during surgery, in the neuropsychological side and the GDC embolization is the better way than the direct surgery method.

The Quality of Life and Cognitive Deficits According to Treatment Modality of Anterior Communicating Artery Aneurysm: Surgery and GDC Embolization Group

OBJECTIVE: The authors present the difference of cognitive outcome of good recovery patients between direct surgery and Guglioma detachable coil(GDC) embolization group among anterior communicating artery aneurysm patients. METHODS: The clinical records of 21 patients who can be followed up and be answered questionnaires among good recovery patients fter ACoA(anterior communicating artery) aneurysm operation from 1990 to 1999 in our hospital were reviewed as surgery group. On the other hand, 20 good recovery patients after embolization of ACoA aneurysm in the other hospital from 1996 to 1999 are seleted as GDC embolization group. In the surgery group, the degree of brain swelling, the existence of rectus gyrus removal, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are examined. In GDC embolization group, problem during embolization, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are also investigated. After this investigation, patients and their family are questioned with Tidwell's cognitive outcome paper. The total records below 50 were considered as poor outcome. RESULTS: Ages, sex, Hunt and Hess grade, Fisher grade and size of aneurysm in two groups are similar conditions. The more patients get old, the cognitive outcome is worse in both group. In surgery group, those patients who have giant aneurysm, are removed rectus gyrus, are happened immediate post-operative transient neurological deficits and hypodense area in post operative brain CT are poor cognitive outcome. In the embolization group, Fisher grade III and post operative transient neurological deficit are happened, outcome was poor. In comparison with cognitive outcome between surgery and GDC embolization group, the embolization group has generally good result. CONCLUSION: The cognitive outcome is decided by age and the degree of brain injury according to aneurysmal rupture. Direct surgery method can make cognitive outcome poor due to perforator injury, brain retraction injury and removal of rectus gyrus during surgery, in the neuropsychological side and the GDC embolization is the better way than the direct surgery method.

Radiation Dermatitis after GDC Embolization: Case Report

Guglielmi Detachable Coil(GDC) embolization is interventional radiology procedure for the management of aneurysm. The technique is recommended in case of patients' poor general condition, difficult surgical approach, but there is concerning about complications due to radiation exposure. We experienced a patient of radiation-induced dermatitis after GDC embolization. She presented with erythema, pus-like discharge, ulceration on scalp and right preauricular area, which symptoms was improved with medical managements. The authors report the case with pertinent literature review.