, Sung Hak Kim Improvements in microsurgical and neuroanesthesiological have resulted in an increasing number of operation for aneurysm clipping in elderly patients. It is the purpose of this article to evaluate surgical outcome of elderly patients(stand point of three groups), considering neurologic grade on admission, amount of subarachnoid hemorrhage(SAH) on computerized tomography(CT) findings and timing of surgery.
The subjects of the present study are 34 patients who were admitted to department of neurosurgery and treated surgically between 1991 and 1997 in Mok-Dong and Tongdaemun hospital. All the patients in this study were verified as having aneurysmal SAH on CT scanning followed b cerebral argiography. The patients were classified by age into three groups : 65 to 70 years(24 cases), 76 years(7 cases) and 76 years or older(3 cases). On admission, the clinical condition of patients was graded according to the scals of Hunt and Hess and the amounts of SAH was graded according to grading system of Fisher. The day 7 SAH was defined as Day O. the timing of operation was divided into three. 1-3 days ; 3-7 days; 8-days.
The surgical mortality according to the different age groups, Hunt-hess grade, grading system of Fisher and timing of operation was analised.
Overall, 11 of the 34 patients died, for a mortality rate 32%. The mortality rate by age groups was 21% for 65 to 70 years, 57% for 71 to 75 years and 20% for 76 years of older. The mortality rate by Hunt-Hess grade was 35%, in I-II, 33% in III and 20% in IV-V, and the mortality rate as related to grading system of Fisher was 0% in 1, 36% in 2, 36% in 3 and 25% in IV. The mortality rate according to timing of operation was 31% in 1-3 days, 25% in 3-7 days and 25% in over days.
In recent years, with improvement in surgical technique and neuroanesthesia, the number of operation for ruptured aneurysm have increased in elderly patient. A more aggressive treatment in elderly patients is justified.
, Si-Hoon Park, Gil Ja Shin, Woo Hyung Lee Aortic dissection is caused by a circumferential or transverse tear of the intima by a discrepancy between the strength of the aortic wall and the intraluminal pressure.
Arterial hypertension seems clearly to be a factor in the genesis of aortic dissection.
An elevated blood pressure or evidence of its existence can be found in 70-80 percent of patients. Other factors predisposing to aortic dissection are congenital disorder of connective tissue, vasculitis, etc. But trauma or physical strain is unusual cause of classic dissection.
Diagnosis is confirmed by computed tomography, aortography or echocardiography.
A 62-year-old man without a history of hypertension, emphysema or congestive heart failure visited our hospital because of hoarseness which developed suddenly during the physical strain. A contrast material-enhanced computed tomographic (CT) scan was performed at an other hospital due to hoarseness, mild fever and general weakness. Then he visited to our ENT department and performed laryngeal CT due to hoarseness. The CT shows somewhat mass-like soft tissue, so he was transferred to our internal medical department.
The chest CT scan and simple chest PA was done and we found a dissecting aneurysm.
This case developed by Physical strain and diagnosed by hoarseness is unusual and rare.
The clinical value of three-dimensional time-of-flight magnetic resonance angiography(MRA)was retrospectively evaluated in 23 patients with arteriovenous malformations(AVM) in 8 and aneurysms in 15 cases. MR angiogram were compared with conventional angiogram(CA) in all cases. The topography of the AVM nidus and feeding artery were equally well appreciated on the MRA as on the conventional angiogram except one of nidus that was obscured by methemoglobin stated hematoma. Howevere, in four of 8 AVM, the draining veins were incompletely shown on MRA because of slow flow effect or out of field of view. In cases of aneuryms, all were equally depicted on MRA as on the conventional angiogram. But, the neck of aneurysm was more better shown on MRA than CA. MR angiography reliably depict intracranial vascular lesions, especially aneurysm and arteriovenous malformation.
, Si-Hoon Park, Gil Ja Shin, Woo Hyung Lee Femoral pseudoaneurysm is important complication after diagnostic femoral catheterizationor more complex procedure.
With the increasing use of larger-size percutaneous instruments and periprocedual anticoagulant or antiplatelet agent the incidence of postcatheterization femorl artery injuries ncluding pseudoaneuiysm has increased in the past few years.
Duplex ultrasonography and addition of color- flow Doppler provides an accurate, noninvasive. risk-free diagnosis and faster detection of intraaneurysrnal blood flow and the track betweenthe injured artery and the pseudoaneurysm.
Though early surgical repair of the arterial defect is usually recommended because of severeand life-threatening complication such as rupture, fhrornboembolism, compression neuropathyetc, Ultrasono-Guided Compression Repair(UGCR) is to be first-line treatment for its advantagesuch as high success rate, low morbidity and cost-effectiveness.
The authors report 2 cases of femoral psoudoaneurysrns treated using UGCR with nlanualcompression with C-clamp at the same time as a nonsurgical treatment.
, Sung-Hak Kim In treatment for intracranial aneurysms by coil embolization, recanalization remains the major limitation of coiling, particularly wide-necked or larger aneurysms. The aim of this study was to evaluate technical results and clinical outcome in a single center of consecutive patients with intracranial aneurysms treated with endovascular embolization using polyglycolic-lactic acid (PGLA) coated coils.
Between January 2005 and December 2010, 33 patients (male, 8 patients; female, 25 patients; mean age, 57 years) with saccular intracranial aneurysms were treated by means of an endovascular approach using PGLA coated coils. The endovascular procedures and technical outcomes were evaluated. The mean follow-up duration was 15.9 months (range, 6 to 72 months).
Successful embolizations with satisfactory results were achieved in 91%. The degree of occlusion of the treated aneurysm was complete in 23 (69.6%), small neck remnant in 7 (21.2%), and residual filling in 3 (9%). Thirty patients (90.9%) showed no interval change of the residual neck. Three patients (9.1%) demonstrated the recanalization, and 2 of them were successfully recoiled.
This preliminary study showed that PGLA coated coils may be safe option and preventable for recanalization in patients with intracranial aneurysms. Further study with more cases, longer follow-up data and well controlled design are required to confirm our results.
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