Maeng Ki Cho

The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. METHODS Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. RESULTS The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1% compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. CONCLUSION Lumbar CSF drainage remains to play a prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.

Intraventricular Glioblastoma Multiforme with Previous History of Intracerebral Hemorrhage : A Case Report

GBM is the most common primary brain tumor, but intraventricular GBM is rare and only few cases have been reported in the literature. The authors report a case of 64-year-old man who had a remote history of previous periventricular intracerebral hemorrhage. Brain computed tomography (CT) and magnetic resonance (MR) imaging showed an intraventricular lesion with inhomogeneous enhancement, infiltrative borders and necrotic cyst, and obstructive hydrocephalus. The patient underwent surgical removal through transcortical route via the bottom of previous hemorrhage site and the final pathologic diagnosis was GBM. We present a rare case of an intraventricular GBM with detailed clinical course, radiological findings, and pathological findings, and the possible origin of this lesion is discussed.

Experience of Y-Configured Stents for Small Basilar Tip Aneurysms

Among posterior circulation aneurysms, basilar tip aneurysm is the most difficult to treat. Because of their deep location in front of the brainstem and their intimate relationship to perforating vessels, morbidity and mortality rates associated with direct exposure used to be daunting. Complex intracranial aneurysms are not uncommonly encountered in cerebrovascular practice. Often their complexity can render standard treatment either impossible or exceedingly hazardous. Although endovascular therapy is an available alternative to surgical clipping, it is not without risks. The Neuroform stent represents a significant advance in the endovascular treatment of intracranial aneurysms. The Y-configured reconstruction method of the Neuroform stent may represent a variable therapeutic option especially in the case of terminal type including bifurcation aneurysms. We report the results of our experience in two small basilar tip aneurysms using stent-assisted coiling.

Neuroform Stent Applications in Ruptured Intracranial Aneurysms with Small Parent Vessels

The Neuroform stent is a device specifically designed for use in cerebral vessels and is increasingly being used in the embolization of broad-necked aneurysms, but long-term results are unsatisfactory. Reconstructive treatments using stents improve the occlusion rate and protect parent vessels. Stent-assisted coiling of broad-necked cerebral aneurysms is a technique that has rendered most aneurysms amenable to coiling. Recently, the use of stent-assisted coiling with preservation of the parent vessel lumen has been described in some series. Several studies have shown that with the advances in device technology intracranial stenting is feasible even in the distal part of the ICA. But, endovascular treatment of these aneurysms (small parent vessel less than 2.0 mm) in Neuroform stent-assisted coiling has no clinical applications. These lesions have seemed more difficult to treat than other aneurysms because of subsequent thrombus formation and vessel trauma after stent deployment and navigation. The purpose of this study was to review the safety and durability of our aneurysms treated with stent-assisted coiling of ruptured aneurysms with small parent vessesl.

Temporary Hidden Aneurysms During Pregnancy: A Case Report

There are a number of reports on cerebral aneurysmal ruptures during pregnancy. Although the cerebral aneurysmal rupture is quite rare during pregnancy, it leads to a high maternal mortality; which gives rise to a clinical significance. We have encountered a number of multiple cerebral aneurysms during pregnancy, and the ruptured cases were successfully treated with the coiling procedures. The coiling is found to be a good treatment method for ruptured aneurysms during pregnancy. The cerebral angiogram is the gold standard diagnostic method for detecting cerebral aneurysms. However, 1.8–20% of the cases are reported to be false negative in initial angiography, and only up to 20% can be diagnosed even with the additional angiographies. A special attention for a hidden aneurysm should also be required while managing the patients.