Embolization through the Ophthalmic Artery with Onyx in Bilateral Ethmoidal Dural Arteriovenous Fistula: A Case Report / 대한뇌혈관외과학회지

Endovascular treatment of ethmoidal dural arteriovenous fistula (DAVF) has not been widely performed because of the technical difficulty of the procedure and the potential risk of central retinal artery occlusion. We report the case of a patient who underwent Onyx embolization through the ophthalmic artery in bilateral ethmoidal DAVF; to our best knowledge this is the first report.

Is Extravasation of Radiographic Contrast a Predictor of Hematoma Enlargement in Spontaneous Supratentorial Intracerebral Hemorrhage? / 대한뇌혈관외과학회지

BACKGROUND AND PURPOSE: The enlargement of a hematoma occurs commonly in patients with spontaneous intracerebral hemorrhage (ICH) after hospitalization and can worsen the clinical outcome. We conducted this study to determine whether extravasation of a radiographic contrast agent is a predictor of hematoma enlargement occurring after admission in patients with spontaneous ICH. METHODS: We reviewed the clinical records and computerized tomography (CT) scan findings of 384 patients with spontaneous ICH admitted within 24 hours of ictus from 2002 to 2005. Only 71 patients with primary ICH in the basal ganglia or thalamus were included in the study. The first CT scan was preformed within 24 hours of onset and the second CT scan was preformed within 72 hours of onset. We compared patients with and without hematoma enlargement according to the radiological findings, clinical characteristics and laboratory data. RESULTS: Seventeen patients (23.9%) showed hematoma enlargement after admission. Extravasation of the radiographic contrast agent on a CT scan was seen in 23 patients (32.4%). The presence of contrast extravasation on a CT scan closely correlated with evidence of hematoma enlargement, as seen on a follow-up CT scan (p = 0.000). Other variables did not reach statistical significance for the independent association with hematoma enlargement. CONCLUSIONS: Due to a high risk for hematoma enlargement, patients with spontaneous ICH in the basal ganglia and thalamus, especially those with evidence of contrast extravasation on a CT scan, should be closely observed. Short term followup radiological studies are needed for the verification of hematoma enlargement.

Dissecting Aneurysm at the A1 Segment of the Anterior Cerebral Artery Manifesting as Subarachnoid Hemorrhage: Two Case Reports / 대한뇌혈관외과학회지

Two cases of intracranial dissecting aneurysms of the A1 segment of the anterior cerebral artery(ACA) associated with subarachnoid hemorrhage(SAH) are described. Two patients presented with a ruptured dissecting aneurysm manifesting as sudden bursting headache. Computerized tomography(CT) revealed subarachnoid hemorrhage. In the first case, cerebral angiography revealed a diffuse dilatation of left A1 segment with pooling of contrast medium and poor collateral flow through the anterior communicating artery(AcomA). The dissecting aneurysm was wrapped with a trousers shaped artificial dura, fixed with an aneurysmal clip and coated with fibrin glue. He was discharged without neurological deficit. In the second case, 3 dimensional computerized tomography(3D CT) was checked because the diagnostic angiography was not available due to poor patient's condition. 3D CT showed fusiform dilatation of right A1 segment, focal severe stenosis of proximal A1 segment of ACA, AcomA within normal shape and no laterality of A1 dominance. Trapping surgery was done successfully and she had no neurological deficit at discharge. In the case of SAH of unknown origin, dissecting aneurysm should be kept in mind and surgical treatment might be beneficial.