KISEP Clinical Article J Korean Neurosurg Soc 33472-476, 2003 재발한 뇌동맥류의 치료 박종수 임만빈 김일만 이창영 손은익 김동원 Treatment for Recurrent Cerebral Aneurysm Joung-Soo Park, M.D., Man-Bin Yim, M.D., IL-Man Kim, M.D., Chang-Young Lee, M.D., Eun-Ik Son, M.D., Dong-Won Kim, M.D. Department of Neurosurgery, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea Objective:The aim of this study is to make a management strategy for the patients with recurrent cerebral aneurysm after surgery. Methods:Over a 19-year period, 1,546 patients were treated for a ruptured intracranial aneurysm surgically. Twenty-six of these patients(1.7%) were subsequently treated for regrowing aneurysm(8) or de novo aneurysm formation(26). Among them, twenty-three individuals who presented with recurrent subarachnoid hemorrhage underwent conventional angiography to detect the aneurysm recurrence. Three-dimensional computed tomographic angiography was performed in the remaining three patients who complained chronic headache. The mean age at the first surgery was 48.6 years. An interval ranging from 1 to 192 months(mean, 76.1 months) since the original treatment. Results:Total 34 recurrent aneurysms in 26 patients were treated by microsurgical clipping(29 cases), wrapping(1 case), and endovascular coiling(4 cases) as a second procedure. A satisfactory outcomes were achieved in twenty-one patients(80.8%) during a mean 69.5 months follow-up period. The most common site of the recurrence was the internal carotid-posterior communicating artery. Patients with de novo aneurysms are frequently hypertensive(61.1%) and younger in age(55.6%). Conclusion:The treatment of recurrent cerebral aneurysm could be performed effectively using direct operations and/or endovascular procedures. KEY WORDS:Cerebral aneurysm Recurrence Three dimensional computed tomographic angiography Subarachnoid hemorrhage Coil embolization Clipping. 서 론 ReceivedJanuary 22, 2003 AcceptedMarch 10, 2003 Address for reprintsman-bin Yim, M.D., Department of Neurosurgery, Keimyung University Dongsan Medcial Center, 194 Dongsan-Dong, Jung- Gu, Daegu 700-712, Korea Tel053 250-7332, Fax053 250-7356 E-maily760111@dsmc.or.kr 472 대상 및 방법 J Korean Neurosurg SocVolume 33May, 2003
A Fig. 1. This 37-year-old woman underwent neck clipping for the ruptured left posterior communicating artery aneurysm 12 years ago. The follow-up three-dimensional computed tomographic angiographya demonstrates a large recurrent aneurysmarrow head at the initial operation site and the proximally slipped cliparrow. Conventional angiography immediately after near total obliteration of the aneurysmal sac with Guglielmi Detachable CoilsB. de novo 결 과 B 고 찰 J Korean Neurosurg SocVolume 33May, 2003 473
Table 1. Clinical summary of 26 patients with recurrent intracranial aneurysms Age/Sex Original site Hypertension Interval mo Regrowth De novo Treatment Outcome 01. 59/F Lt MCA 091 C G 02. 46/M Acom 001 C E 03. 70/F Acom 002 C E 04. 51/F Rt MCA 001 C F 05. 37/F Lt Pcom 168 * Co E 06. 50/F Lt MCA 002 Lt A2 C P 07. 60/F Rt ICA 011 Rt P1P2 jx C D 08. 45/M Lt Pcom 180 Rt MCA C F 09. 51/F Rt MCA 043 Lt MCA C E 10. 35/F Rt MCA 052 Acom C E 11. 59/F Lt MCA 060 Lt PICA C E 12. 61/F Rt Pcom 087 Lt Pcom C E 13. 60/F Lt MCA/Lt Opthalmic 062 Lt A2 C G 14. 53/M Lt ant.choroidal 069 Rt Pcom C E 15. 56/F Acom 079 Rt Pcom C E 16. 57/F Acom/Lt ant.choroidal 117 Lt PICA AcomC/ Lt ant.choroidalc G 17. 51/F Rt MCA 056 Acom C E 18. 62/F Acom/Lt MCA 106 Lt A2/Rt MCA* Rt Pcom* Lt A2C/Rt MCAC Rt PcomCo 19. 62/F Acom 079 Lt MCA C E 20. 45/F Rt MCA 023 Acom C E 21. 77/F Lt Pcom 054 Rt Pcom C G 22. 47/F Lt A2 128 Acom/Lt ICA* Lt MCA*/Lt M2* AcomC/Lt ICAC Lt MCAC/Lt M2:C 23. 47/F Both MCA/Acom Rt cavernous/rt A2 154 Lt SCA* Co E Lt ant.choroidal 24. 54/F Rt Pcom 192 * Lt Pcom Rt PcomW/Lt PcomC E 25. 63/F Acom 027 BA* AcomC/BAC F 26. 64/F Lt Pcom 135 * Rt Pcom* Lt PcomCo/Rt PcomC E Unruptured aneurysm, MCAMiddle cerebral artery bifurcation, ICAInternal cerebral artery bifurcation, jxjunction, BABasilar artery, AcomAnterior communicating artery, PcomPosterior communicating artery, SAHSubarachnoid hemorrhage, PICAPosterior inferior cerebellar artery, SCASuperior cerebellar artery, DSADigital subtraction angiography, 3DCTA3 dimensional computed tomographic angiography, CClipping, Co:Coiling, WWrapping, EExcellent, GGood, FFair, PPoor, DDeath G E 474 J Korean Neurosurg SocVolume 33May, 2003
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