뇌종양과 동반된 뇌동맥류 3례 : Report of Three Cases

정영선,김민호,한동환,심기범,홍승관 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.11

Thr authors present three cases of intracranial aneurysm associated with brain tumors. Two cases were unruptured intracranial aneurysms(one was located at the origin of anterior choroidal artery of right internal carotid artery and the other at the bifurcation of right middle cerebral artery), which were found incidentally during the transcranial approaches to pituitary adenoma and right frontal glioblastoma multiforme respectively. As preoperative angiography was not performed in those cases, there was some difficulty in clipping the neck of the aneurysms. The third case presented with sudden headache and vomiting, and her brain computed tomography, magnetic resonance imaging and cerebral angiography showed subarachnoid hemorrhage, five anterior and one posterior circulation aneurysms as well as a pituitary adenoma. The patient refused the operation. It is well known that some brain tumors, such as pituitary adenoma, glioma, meningioma, are often associated with intracranial aneurysms. In planning the treatment of those brain tumors, preoperative angiography seems essential to know the status of the vessels adjacent to the tumors and to rule out incidental aneurysms.

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Paiva Aline Lariessy Campos,Aguiar Guilherme Brasileiro de,Flores Juan Antonio Castro,Veiga José Carlos Esteves 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.3

Blood Blister-like aneurysms are intracranial non-saccular aneurysms with higher rupture risk due to its fragile wall. Diagnosis is performed in the acute phase of a subarachnoid hemorrhage. There are several treatment options based on reconstructive or deconstructive techniques. This paper aims to discuss the limitations of microsurgery clipping for a ruptured blister aneurysm. We report on a case of a female patient presented with a Fisher III subarachnoid hemorrhage. Cerebral angiography revealed an internal carotid artery blister aneurysm. Initially microsurgery clipping was successfully performed. However, after a few days the patient presented new subarachnoid hemorrhage. The new cerebral angiography showed growth of the previously clipped aneurysm, with displacement of the clip from the position adjacent to the artery. High-flow bypass was performed obtaining definitive treatment. This is a definitive approach for blister aneurysms. If microsurgery clipping is chosen, a strict follow-up is required due to the dynamic nature of this lesion and the chance of re-bleeding even after successfully clipping.

뇌동맥류의 발견을 위한 얇은 절편의 고속주입 CT 기법의 유용성

김종민 대한영상의학회 1993 대한영상의학회지 Vol.29 No.6

With 2mm-thick CT scanning during the rapid infusion of contrast material (TICT), cerebral aneurysms arising from the circle of Willis and adjacent vessels can be directly visualized. Twenty-five patients who had cerebral aneurysm confirmed by surgery were examined with TICT and digital subtraction angiography. The authors examined TICT prospectively to assess the detection rate of the cerebal aneurysms and to evaluate the clinical usefulness of TICT. The detection rates of aneurysms by TICT and digital subtraction angiography suspected cerebral aneurysm. permitting direct visualization of the aneurysm.

전교통 동맥류의 임상적 분석과 고찰

김형기,안용붕,이상걸,박문선 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

The authors analyzed the radiographs(brain CT and cerebral angiograms) and medical & surgical records of 54 cases of ruptured anterior communicating artery aneurysms resulted in operations at our hospital from January 1991 to December 1995. The results were summarized as follows : 1) The rate of incidence was found to be highest in sixth decade and the ratio of male to female was 1 : 1 2) On the preoperative brain CT, ventricular or cerebral hemorrhage combined cases had high Hunt-Hess and Fisher grades. 3) Of 54 cases, hypertension was observed in 20 cases(37%). Hypertension had no effect on the admission Hunt-Hess and Fisher grades. 4) Classification of the anterior communicating artery aneurysms according to its directions were as follows : anterior direction in 57.4%, superior direction in 18.5%, posterior direction in 13%, inferior direction in 11.1%. 5) The afferent artery of anterior communicating artery aneurysms were as follows ; left A1 in 38 cases(70.4%), right A1 in 12 cases (22.2%), bilateral A1 in 4 cases(7.4%). 6) The ranges of diameters of the aneurysm was as follows ; 6~10mm in 57.4%, below 5mm in 22.2%. 7) The posteriorly directing aneurysms showed less favorable preoperative state, and preoperative hydrocephalus was most common on the posteriorly directing aneurysms. 8) There was no significant relationship between direction of aneurysm and prognosis. However, better Hunt-Hess grades seem to correlate better prognosis. 9) The operation was performed by pterional approach in all cases, the approach side was selected for the presence of dominant feeding artery in 50 cases(92.6%). 10) Overall mortality rats was 14.8%, the patients who died are of the older age group and the cause of death was medical complication in 6 cases.

전교통동맥류 출혈의 방사선학적 소견의 분석

박철완,김광명,정환영,김남규,오석전,이승로 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.6

In anterior communicating artery aneurysm that accounts for about 30% of intracranial aneurysms, it has been pointed out that the hemodynamic factor plays a very important role in all stages such as initiation, growth and rupture of aneurysm. Based upon the relationship between the findings of brain CT and those of cerebral angigram, the authors reviewed 96 cases of ruptured anterior communicating artery aneurysms that were operated on at the Department of Neurosurgery of Hanyang University Hospital from Jan. 1985 to June 1990, to suggest a point referred to which carotid artery should be selected first when direct carotid angiography is inevitable. The results were summarized as followings : 1) Of 96 cases, hemorrhagic evidence was observed in 92 cases(95.8%) and among them, subarachnoid hemorrhage accompanying intracerebral hematoma(37 cases, 38.5%) was the most common type of hemorrhage. 2) Of 96 cases, left A₁ was operated as afferent artery in 61 case(63.5%), right A₁ in 23 cases(24.0%), and both A1, in 12 cases(12.5%). And the direction of aneurysm was to the right in 49 cases(51.0%), to the left in 12 cases(12.5%) and to the midline in 35 cases(36.5%). 3) Of 53 cases which had intracranial hematoma, 28 cases showed unilateral predominance. Among them the predominance of hematoma was opposite to the afferent artery in 82.1%(23/28) and was ipsilateral to the direction of aneurysm in 64.3%(18/28). 4) Of 91 cases which had subarachnoid hemorrhage, 29 cases showed unilateral predominance. Among them the predominance of hemorrhage was opposite to the afferent artery in 72.4%(21/29) and was ipsilateral to the direction of aneurysm in 58.6%(17/29). 5) Above findings suggest that in the cases with suspicious ruptured anterior communicating artery aneurysms on brain CT and direct carotid angiography is inevitable, contralateral carotid angiography should be undertaken at first when intracranial hematoma or subarachnoid hemorrhage shows unilateral predominance on brain CT, and left carotid angiography is preferable than the right one if there is no predominance of intracranial hematoma or subarachnoid hemorrhage on brain CT.

뇌동맥류 환자의 Brain CT Angiography 검사시 Subtraction 기법과 Automatic Bone Remove 기법의 비교를 통한 영상평가와 선량감소 효과에 관한 연구

김현영(Hyun Young Kim),이종민(Jong Min Lee),박관중(Gwan Joong Park),배경덕(Gyung Deok Bae),대창민(Chang Min Dae),민관홍(Gwan Hong Min) 대한CT영상기술학회 2014 대한CT영상기술학회지 Vol.16 No.2

목적 : 뇌동맥류 환자의 Brain CT Angiography 검사 시 Subtraction 기법과 Automatic Bone Remove 기법을 비교하여 영상의 진단적 차이와 선량저감 효과에 대해 알아보고자 하였다. 대상 및 방법 : 2012년 1월부터 2013년 1월까지 본원에서 뇌동맥류를 진단받고 TFCA와 BCTA를 모두 시행한 환자 60명을 대상으로 하였다. 사용한 CT 장비는 64-slice MDCT 3대, 256-slice MDCT 1대이다. 영상평가는 뇌동맥류의 진단, 뇌동맥류의 크기 측정, 뇌동맥류의 형태학적 분류로 평가 하였으며 선량평가는 검사 후 장비에 표시되는 Dose Report를 이용하여 DLP에 ICRP 102에서 권고하는 Conversion Factor 0.0021의 곱으로 얻어진 유효선량을 비교 분석 하였다. 결과 : 영상평가 결과 뇌동맥류의 진단에서는 TFCA 검사의 DSA 영상과 비교하여 Subtraction 기법 의 경우 민감도 97.8% 특이도 100%의 값이 측정 되었으며 Automatic Bone Remove 기법 의 경우 민감도 96.8% 특이도 100%로 높은 발견율의 결과값을 나타내었다. 뇌동맥류의 크기 측정은 Subtraction 기법에서는 Excellent 71.6%, Good 25.0%, Normal 3.4%, Bad 0%의 결과 값을 보였으며 Automatic Bone Remove 기법에서는 Excellent 70.5%, Good 26.7%, Normal 2.8%, Bad 0%를 나타내었다. 뇌동맥류의 형태학적 분류에서는 Subtraction 기법의 경우 Saccular 93.3%, Fusiform 5.0%, Dissecting 1.7%의 결과값을 보였으며 Automatic Bone Remove 기법은 Saccular 90.0%, Fusiform 8.3%, Dissecting 1.7%의 결과 값을 나타내었다. 선량 평가 결과 BCTA 보다 Automatic Bone Remove 기법이 약 50%의 선량저감 효과가 있는 것으로 나타났다. 결론 : 뇌동맥류 환자의 Brain CT Angiography 검사 시 Automatic Bone Remove 기법을 이용하여 3차원 영상을 획득 한다면 영상의 질 저하 없이 선량저감 효과를 얻을 수 있다. Purpose : The study was to compare image quality and dose reduction with Brain CT Angiography subtraction and Automatic Bone Remove techniques in Cerebral aneurysmal patients. Materials and Methods : Cerebral aneurysmal patients 60 people are included who underwent TFCA and Brain CT Angiography since January 1st, 2012 to January 1st, 2013. Three 64-slice MDCT and one 256-slice MDCT are used. Diagnosis of aneurysm, size measurement and aneurysm morphology are evaluated. Dose report and Conversion Factor 0.0021 from ICRP 102 are used for dose evaluation. Results : In Aneurysm diagnosis section, sensitivity 97.8% and specificity 100% were measured by comparing between TFCA and Brain CT Angiography subtraction. Also, Sensitivity 96.8% and specificity 100% was measured with Automatic Bone Remove technique. Brain CT Angiography subtraction’s aneurysm size measurement score was Excellent 71.6%, Good 25.0%, Normal 3.4%, Bad 0%. In Automatic Bone Remove, score was Excellent 70.5%, Good 26.7%, Normal 2.8%, Bad 0%. In Aneurysm morphology section, Subtraction represent Saccular 93.3%, Fusiform 5.0%, Dissecting 1.7% and Automatic Bone Remove represent Saccular 90.0%, Fusiform 8.3%, Dissecting 1.7%. For Automatic Bone Remove, 50% lower dose were used than Brain CT Angiography. Conclusions : For Cerebral aneurysmal Brain CT Angiography, Automatic Bone Remove technique is not only reduce exposure dose but also maintain diagnostic quality of Images.

뇌종양과 동반된 뇌동맥류

윤석환,최병욱,김수천,심재홍 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.5

The reports of the association of cerebral aneurysm and brain tumor are rare. Recently, we experienced five cases of association of cerebral aneurysm and brain tumor and available literature were reviewed. Of five cases of brain tumor, there were two cases of meningioma, two cases of pituitary adenoma and a case of malignant glioma. Vascular clips were used for aneurysm obliteration in three cases, coating was in a case and four cases of them had favorable outcome. The association of cerebral aneurysm and brain tumor had difficult problems in treatment such as brain swelling and hemorrhage from the aneurysm after removal of tumor.

급성 자발성 경막하혈종의 방사선학적 소견

김현정 대한영상의학회 1998 대한영상의학회지 Vol.38 No.3

Purpose : To evaluate the characteristic CT and cerebral angiographic findings in patients with acutespontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome.Materials and Methods : Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presentingduring the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determinethe cause of bleeding, CT and angiographic findings were retrospectively analysed. Clinical history, laboratoryand operative findings, and final clinical outcome were reviewed. Results : The 21 cases of acute spontaneoussubdural hematomas were caused by cerebral vascular abnormalities(n=10), infantile hemorrhagic disease(n=5), orwere of unknown origin(n=6). All ten cases of cerebral vascular abnormality were confirmed angiographically; sixwere aneurysms, three were arteriovenous malformations, and one was moyamoya disease. On CT, subarachnoidhemorrhage was seen to be associated with aneurysms, intracerebral hemorrhage with arteriovenous malformations,and intraventricular hemorrhage with moyamoya disease. All five patients with hemorrhagic disease were infantsaged 1-17 months ; characteristic diffuse distribution of subdural hematoma in both temporoparietal-occipitalregions is typical. The average overall mortality rate was 52.4%(11/21). In patients with cerebral vascularabnormalities, mortality was as low as 20%(2/10), but in hemorrhagic disease was high (60%). In cases of unknownorigin it was 100%. Conclusion : Acute spontaneous subdural hematoma is a rare condition, and the mortality rateis high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid orintracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm andarteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus morkedlyreduce mortality, the causes of bleeding should be prompty determined by means of cerebral angiography.

뇌동맥류 수술시 지속적 국소 뇌혈류 측정

유도성,김달수,허필우,조경석,강중기 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.10

두개내에서 분리된 동맥류 클립의 척추관으로의 이동: 증례 보고

정준용,유원종,임연수,정명희,성미숙,임현욱,윤회수,이해규 대한영상의학회 2004 대한영상의학회지 Vol.51 No.2

매우 드물게 두개강내의 동맥류 결찰에 사용되는 동맥류 클립이 분리되어 뇌척수액을 따라 척추관으로 이동하고 이동된 클립에 의한 신경근의 압박이나 염증에 의해 요통이나 신경근병증등을 일으키기도 한다. 하지만 증상이 없을 경우, 혹은 증상이 있다 하더라도 단순 추간판 탈출로 오인하여 간과하기 쉽다. 최근 분리된 뇌동맥류 클립이 척추관으로 이동한 증례를 경험하여 이를 보고한다. Very rarely, clips used for the ligation of intracranial aneurysms become detached and subsequently migrate into the spinal canal, causing lumbar pain or radiculopathy by compressing nerve roots or inducing inflammatory processes in their newly established location. However, it is easy to overlook the migration of the clip, because there may be either no noticeable symptoms, or a herniated disk may be mistakenly diagnosed as being the source of the present symptoms. Herein, the authors report a case in which an aneurysmal clip migrated into the spinal cord.