Purpose: The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction(MPR) images for sylvian dissection during microsurgical treatment of ...middle cerebral artery (MCA) aneurysms.
Materials and Methods: Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MDTM imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings.
Results: Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicularimages to the sylvian surface in the same orientation as the surgeon’s view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs.
Conclusion: In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms. KCI Citation Count: 0
Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at ...the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.
Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction ...has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1. 척추기저동맥의 혈류공급감소로 인한 뇌간 경색은 매우 드문 전신성 루푸스 환자의 초기 증상으로, 경색의 직접적인 원인으로 매우 작은 기저동맥 분지인 교뇌공급혈관의 박리성 동맥류는 보고된 사례가 없다. 이에 저자들은 디지털감산 혈관조영술과 고해상도 혈관벽 자기공명영상를 이용하여 작은 교뇌공급혈관의 박리성 동맥류의 진단과 추적관찰 중 치유된 20세 여성의 사례를 보고하고자 한다. 전신성 루푸스의 진단은 신경학적장애의 유무와 혈액화학검사 결과를 바탕으로 하였다. 추적 고해상도 혈관벽 자기공명영상에서 환자의 교뇌천공지의 박리성동맥류는 폐색되어 있었고 우측 척추동맥의 박리성동맥류는 치유되어 보이지 않았다. 환자는 퇴원 시 수정랭킨척도 점수가 1점으로 증상 개선을 보였으며 3개월과 12개월 추적관찰에서도 증상이 악화되지 않고 1점을 유지하였다.
Common carotid artery occlusion (CCAO) is a very rare disorder that has rarely been studied. CCAO causes several neurological symptoms but can sometimes be asymptomatic due to the development of ...various anastomoses. Herein, we report the case of a 70-year-old male patient diagnosed with asymptomatic CCAO due to anastomotic flow. The patient underwent transfemoral cerebral angiography (TFCA) and was found to have CCAO with two collateral pathways, including an occipital artery-vertebral artery anastomosis. We emphasize the importance of TFCA when CCAO is suspected and review the types and anastomotic pathways of CCAO. 총경동맥 폐쇄는 비교적 드물고 거의 연구되지 않은 질병이다. 총경동맥 폐쇄는 여러 신경학적 증상을 유발하지만 다양한 문합의 발달 덕분에 때때로 무증상일 수 있다. 저자들은 문합을 통한 혈류로 인한 무증상 총경동맥 폐쇄 환자의 증례를 보고하고자 한다. 환자는 경대퇴동맥 뇌혈관 조영술을 시행하여 총경동맥 폐쇄와 후두 동맥-척추 동맥 연결을 포함한 두 가지 측부 경로가 있는 것으로 확인되었다. 저자들은 총경동맥 폐쇄가 의심되는 경우 경대퇴동맥 뇌혈관 조영술 시행이 중요함을 강조하고, 총경동맥 폐쇄의 유형 및 문합 경로를 문헌고찰하였다.
Recently developed flow diverters, such as the pipeline embolization device (PED), allow for safe and efficacious treatment of giant intracranial aneurysms, with high occlusion rates and a low ...incidence of complications. However, incomplete obliteration after PED treatment may lead to aneurysm regrowth and delayed rupture. Herein, we report a case of a partially thrombosed giant aneurysm of the cavernous internal carotid artery that showed progressive recanalization at 1-3 months after application of a PED. We monitored inflow volume in the aneurysm by computed tomographic angiography (CTA) and computed tomographic volumetric imaging (CTVI). Based on the imaging results, rather than applying additional PED, we decided to make the switch from a dual antiplatelet medication to low-dose aspirin alone at 3 months after the treatment; complete obliteration of the aneurysm was noted at 21 months. Similar to the findings in this unusual case, CTA and CTVI may be useful follow-up methods for optimal management of patients with giant intracranial aneurysms after PED treatment.
Sleepiness while driving has been regarded as a major cause of death due to traffic accidents. We compared the degree of sleepiness across five different working time periods (first, morning, ...post-lunch, afternoon, and last) among Korean bus drivers with different shift types (Daily two shift/Alternating day shift).
We interviewed 332 bus drivers with two shift types (Daily two shift, 128; Alternating day shift, 204). The questionnaire included demographic information (age, alcohol consumption and history of disease), a sleep disorder diagnosed by a doctor, job duration, the number of workdays in the past month, average working hours per workday and week, sleepiness while driving (Karolinska Sleepiness Scale), and sleeping time for both workdays and off-days. We conducted log-binomial regression analyses and produced prevalence ratios (PRs) of severe sleepiness (KSS ≥ 7) while driving with 95% confidence intervals (95% CI) to identify the difference in sleepiness for five working times between both groups.
For the first and morning periods, there were no statistically significant differences in the KSS scores between the two groups. However, from lunch to last driving, drivers with Alternating day shift had a much larger proportion of severe sleepiness than those on Daily two shift. Thirteen (10.2%), 2 (1.6%) and 7 (5.5%) Daily two shift workers reported severe sleepiness in the post-lunch, afternoon and last periods. In contrast, 81 (39.7%), 63 (30.9%) and 64 (31.4%) of Alternating day shift drivers experienced severe sleepiness during the post-lunch, afternoon and last driving periods (
< 0.0001). According to the log-binomial regression analyses, Alternating day shift was associated with severe sleepiness from lunch to last driving. After adjusting for job duration, alcohol consumption and sleeping time on workdays, the PRs were 3.97 (95% CI: 2.29-6.90) post-lunch, 18.26 (95% CI: 4.51-73.89) in the afternoon and 5.71 (95% CI: 2.51-12.99) for the last driving period.
We found that Alternating day shift bus drivers suffered from more sleepiness while driving from lunch to last driving than Daily two shift bus drivers. This difference may be because Alternating day shift drivers had more irregular work schedules and longer working hours per day and week.
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