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Journal of Cerebrovascular and Endovascular Neurosurgery

Yoon Ha Hwang, Young Sub Kwon, Yun Ho Lee
Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Hah Yong Mun, Taek Kyun Nam, Hyun Ho Choi, Yong Sook Park
We report a rare case of a patient with Moyamoya syndrome who presented with intracerebral hemorrhage resulting from rupture of a middle meningeal artery pseudoaneurysm. This 38-year-old woman was unconscious and hemiplegic when she was admitted to our hospital. The patient had mental retardation as a result of tuberculous meningitis infection at the age of one year. On radiologic examination, she had intracerebral hemorrhage in the right temporo-parietal lobe and an aneurysm in the middle meningeal artery with right internal carotid artery occlusion...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Hyun-Jae Jeon, Jong-Hwa Park, Jong-Young Lee, Hong-Jun Jeon, Seoung-Woo Park, Byung-Moon Cho
Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Hye Seon Kim, Ji Hoon Phi, Jeong Eun Kim, Ji Yeoun Lee, Seung-Ki Kim, Kyu-Chang Wang, Won-Sang Cho
Cavernous malformations (CMs) are angiographically occult vascular lesions, and their clinical presentations vary widely according to location of the lesion. Here, we reviewed three cases of CM located at the optic apparatus. All three patients experienced visual deterioration and underwent surgical resection. One achieved complete resection of the CM, whereas the others achieved subtotal resection. Visual symptoms of the two patients who achieved subtotal resection improved, but the visual symptom of the patient who achieved complete resection remained unchanged...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Hyun-Nyung Lee, Bum-Tea Kim, Soo-Bin Im, Sun-Chul Hwang, Je-Hoon Jeong, Moon-Young Chung, Jong-Hyun Park, Dong-Seong Shin
Objective: Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET. Materials and Methods: We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Joo-Seok Lee, Dong-Jun Song, Jong-Hwan Hong, Tae-Sun Kim, Sung-Pil Joo
Objective: Ischemic postconditioning (IPostC), consisted of transient brain ischemia/reperfusion cycles, is considered to have neuroprotective effect. However, there is no best single protocol of IPostC, because varied factors like species tested and characteristics of the tissue may affect the efficacy of IPostC. Thus, we investgated whether different protocols of IPostC affect neuroprotective effects in experimental animal models. Materials and Methods: Through occlusion of middle cerebral artery (MCA) with intraluminal suture, stroke was induced in a transient focal ischemia model in mice...
September 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Yun-Hee Choi, Hyun-Seok Park, Myong-Jin Kang, Jae-Kwan Cha
Intravenous thrombolysis (IVT) and endovascular treatment (EVT) are currently the main treatments for reperfusion in acute ischemic stroke. Although the EVT recanalization rate has increased, unsuccessful recanalization is still observed in 10-30% cases. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is considered a rescue therapy in such cases, but in most centers it is not usually performed for acute ischemic stroke. Graft occlusion is rare following STA-MCA bypass, but it might lead to recurrent ischemic stroke...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Hyunjun Kim, Yoon-Soo Lee, Ho-Jun Kang, Min-Seok Lee, Sang-Jun Suh, Jeong-Ho Lee, Dong-Gee Kang
Dural arteriovenous fistula (D-AVF) at the foramen magnum is an extremely rare disease entity. It produces venous hypertension, and can lead to progressive cervical myelopathy thereafter. On the other hand, the venous hypertension may lead to formation of a venous varix, and it can rarely result in an abrupt onset of subarachnoid hemorrhage (SAH) when the venous varix is ruptured. The diagnosis of D-AVF at the foramen magnum as a cause of SAH may be difficult due to its low incidence. Furthermore, when the D-AVF is fed solely by the ascending pharyngeal artery (APA), it may be missed if the external carotid angiography is not performed...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Young-Min Lee, Hae-Won Koo, Hyung Koo Kang, Jin Woo Kim, Seong Rok Han, Sang Won Yoon, Chan Young Choi, Moon-Jun Sohn, Chae Heuck Lee
Objective: Cerebral microbleeds (CMBs) are known as the neuroimaging markers of risk in stroke and dementia. Many studies on CMBs in elderly patients with hemorrhagic or ischemic stroke have been reported; however, reports on CMBs in young populations with intracerebral hemorrhage (ICH) are lacking. Materials and Methods: A total of 272 patients aged 18-54 years presented to our hospital with ICH between December 2009 and August 2017. Among these, CMB presence, count, and topography with respect to ICH were evaluated on magnetic resonance imaging (MRI) gradient echo images (GREs)...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Sung Min Kim, Hyun Gon Lee, Byung Sam Choi, Jung Soo Kim, Sung Joon Lee, Hae Yu Kim, Sung Tae Kim, Young Gyun Jeong, Jin Wook Baek, Hae Woong Jeong, Sung-Chul Jin
Objective: In our series, endovascular coiling with Target® Nano™ coils (Stryker Neurovascular, Fremont, CA, USA) with diameters of 1 or 1.5 mm exhibited favorable technical feasibility in the treatment of small cerebral aneurysms (< 4 mm). However, little is known about the recurrence of small cerebral aneurysms treated using Target® Nano™ coils. We investigated recurrence following the treatment of small cerebral aneurysms using Target® Nano™ coils. Materials and Methods: Between January 2012 and November 2013, 143 patients with 148 small cerebral aneurysms (< 4 mm) were included our study...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Sooji Sirh, Hye Ran Park
Objective: Minimally invasive techniques such as stereotactic aspiration have been regarded as promising alternative methods to replace craniotomy in the treatment of intracerebral hemorrhage (ICH). The aim of this study was to identify the optimal timing of stereotactic aspiration and analyze the factors affecting the clinical outcome. Materials and Methods: This retrospective study included 81 patients who underwent stereotactic aspiration for spontaneous supratentorial ICH at single institution...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Tae Oong Eom, Eun Suk Park, Jun Bum Park, Soon Chan Kwon, Hong Bo Sim, In Uk Lyo, Min Soo Kim
Objective: We investigated whether clipping or endovascular treatment (EVT) can reduce the incidence of delayed hydrocephalus. We also investigated whether additional procedures, namely lumbar drainage and extra-ventricular drainage (EVD), decrease the incidence of delayed hydrocephalus in patients with subarachnoid hemorrhage (SAH). Materials and Methods: One-hundred and fifty-two patients who had undergone an operation for SAH were enrolled in this study. Clinical data, radiological data, and procedural data were investigated...
June 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Joseph Withrow, Nathan Todnem, Scott Rahimi
The neurosurgical approach to the management of ischemic stroke has evolved dramatically over the past century with the bulk of these changes occurring over the past 25 years. With recent advances in technology and continued refinements in neurosurgical techniques there has been significant improvement to the safety and efficacy of our treatment options. The focus of this article will be to review the historical and recent reports in the literature related to revascularization techniques.
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Michael George Zaki Ghali, Visish M Srinivasan, Kathryn M Wagner, Sandi Lam, Jeremiah N Johnson, Peter Kan
Several anatomical variables critically influence therapeutic strategizing for anterior choroidal artery (AChA) aneurysms, and specifically, the safety of flow diversion for these lesions. We review the microsurgical anatomy of the AChA, discussing and detailing these considerations in the treatment of AChA aneurysms, theoretically and in the light of our recent findings.
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Sooji Sirh, Hye Ran Park, Sukh Que Park
Spontaneous chronic subdural hematoma (SDH) is a rare condition that could develop in association with hematologic disease. A 66-year-old male developed a chronic SDH as an initial manifestation of chronic myelomonocytic leukemia (CMML). He experienced recurrent chronic subdural hemorrhage and newly developed intracerebral hemorrhage. Considering the scheduled long-term chemotherapy, bilateral middle meningeal artery (MMA) embolization was performed to prevent recurrence of subdural hemorrhage. Although pancytopenia occurred during the 7 months' follow-up period, residual chronic subdural hemorrhage was absorbed without recurrence...
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Seong-Mook Kim, Chang-Hyun Kim, Chang-Young Lee
We present the case of a patient who developed pulsatile tinnitus that was found to be associated with a petrous carotid aneurysm. The aneurysm was successfully obliterated using stent-assisted coiling, after which the patient was symptom-free. Although aneurysms arising from the petrous segment of the internal carotid artery are rare, this pathology must be considered as a causative factor in patients with pulsatile tinnitus. Endovascular treatment appears to have been successful in resolving the symptoms associated with this pathology...
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Sang Hyub Lee, Chul Hee Lee, In Sung Park, Jong Woo Han
A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left...
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Jong-Hoon Kim, Chul-Hoon Chang, Young-Jin Jung
An intracranial pseudoaneurysm (PA) is a very rare disease and is known to occur in less than 1% of intracranial aneurysms. The pathophysiology and the modality of the proper treatment of PA have not yet been clearly established. We report a case of PA associated with ruptured cerebral aneurysms which was successfully treated by coil embolization, and also discuss the possible hypothesis on the formation of the PA and feasibility of endovascular treatments.
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Sang Hyub Lee, In Sung Park, Ja Myoung Lee, Kwangho Lee, Hyun Park, Chul Hee Lee
Objective: The aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban). Materials and Methods: We retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment...
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
Jong-Hoon Kim, Ji-Hyun Yi, Chul-Hoon Chang, Young-Jin Jung
Objective: The purpose of this retrospective study is to determine the accuracy of maximum intensity projection (MIP) images of computed tomographic angiography (CTA) for diagnosis of cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) compared with that of digital subtraction angiography (DSA). Materials and Methods: For patients admitted to our hospital for SAH, MIP images of CTA and DSA were checked at admission, and images were taken again 1 week later...
March 2018: Journal of Cerebrovascular and Endovascular Neurosurgery
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