We have 32 university hospitals and 18 general hospitals for neurosurgical training in Korea. Recently I have analyzed intracranial aneurysm cases which had an operation in 28 university hospitals and nine general hospitals. I have reported 2863 aneurysm operation cases. The location of aneurysm consisted of 865 aneurysms (30.2%) in the anterior communicating artery, 724 aneurysms (25.3%) in the internal carotid artery, 687 aneurysms (24.0%) in the middle cerebral artery, 129 aneurysms (4.5%) in the anterior cerebral artery, 152 aneurysms (5.3%) in the posterior circulation, and 306 (10.7%) multiple aneurysms. The overall approximation of the operation rate of aneurysm is approximately 6.6 cases per 100,000 population in 1996 in Korea. (+info)
Aneurysmal subarachnoid hemorrhage in Taiwan.
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In 1993, the annual report about prospective survey and registry of stroke revealed there were 439 cases of ruptured intracranial aneurysms in Taiwan area. Thirty-two of them had multiple aneurysms; therefore, totally 476 aneurysms occurred in these cases. The anatomic distribution of these aneurysms were as the following: internal carotid artery-posterior communicating artery 32%, anterior communicating artery 30%, middle cerebral artery 18%, carotid bifurcation 6%, anterior cerebral artery 4%, carotid-ophthalmic artery 2%, intracavernous carotid artery 2%, and vertebrobasilar system 6%. 364 cases received surgical or interventional treatment, which 88% was clipping procedure, 8% was interventional procedure with coil, and 4% was wrapping. The surgical mortality was 13%. (+info)
Intracranial aneurysm surgery in Bangladesh.
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In this study of 1000 cerebrovascular disease patients, the commonest age are 50 to 70 years with male predominance. The urban patients are large in number and the risk factors are sedentary life, stress and strain, smoking, and hypertension. The patients are more chronic than acute and transport facilities are poor. Fifteen percent are hemorrhagic stroke, some of them may be due to intracranial aneurysm. In the absence of proper diagnostic facilities and adequate neurosurgeons, infrequent surgical treatment, and lack of statistics of intracranial aneurysm, this study may be a basis for further study of aneurysmal surgery in Bangladesh. (+info)
Aneurysm surgery in Pakistan.
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The purpose of this study was to find out the incidence and outcome of aneurysms being operated in Pakistan. The data was collected from various neurosurgical centers in Pakistan where facilities for aneurysm surgery are available. The population of Pakistan is 130 million, with 28 neurosurgical centers in the country but only eight are equipped with facilities for performing aneurysm surgery. The period of study extended from January 1994 to December 1996. During this period 350 patients presented with subarachnoid hemorrhage (SAH). Diagnosis of SAH was confirmed by computed tomography (CT) brain scan, diagnostic lumbar puncture was performed in few patients only where CT scan was negative. After angiography, 240 patients had intracranial aneurysms, 79 had arteriovenous malformations, and three had bled in brain tumors. Of the 240 patients with proven intracranial aneurysms, 122 (51%) were male and 118 (49%) were female. The mean age at presentation was 40.5 years with a range from 7 to 68 and a peak incidence between 41 and 50 years. Subarachnoid bleeding was noticed in 179 (74.6%) patients, 52 (21.7%) had SAH associated with intracerebral hemorrhage, and nine (4%) patients presented with the third cranial nerve palsy. Anterior communicating artery was the commonest site for aneurysms (120, 50%), followed by posterior communicating artery (46, 19%) and middle cerebral artery (45, 19%). Aneurysm surgery was performed in 134 (56%) patients. Operative mortality was about 10%. At 3 months follow up 49% patients were in grade I Glasgow Outcome Scale. We conclude that intracranial aneurysms occur with equal frequency in both sexes with a peak incidence between 41-50 years and anterior communicating artery is the commonest site. SAH is the most common mode of presentation and is still a neglected from of stroke in Pakistan. Medical specialists and family physicians require education for early diagnosis and timely referral of patients with SAH to neurosurgical centers. (+info)
Angioarchitecture related to hemorrhage in cerebral arteriovenous malformations.
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A retrospective study was conducted to determine the angioarchitecture related to hemorrhage in patients with cerebral arteriovenous malformations (AVMs), who underwent conservative treatment and long-term follow-up. The average observation period was 9.3 years, and the annual bleeding rate was estimated at 3.6%. In all cases angiographic findings were reviewed in detail. The average AVM grade by Spetzler-Martin was 3.5. Higher bleeding rate was observed in large AVM (5.4%) compared with small (2.1%) or medium AVM (2.9%). Deep venous drainage (8.6%/year) was strongly correlated to hemorrhage. Concerning location of nidus, hemorrhage was frequently found in insular, callosal, and cerebellar AVMs. Venous ectasia, feeder aneurysm, and external carotid supply were commonly demonstrated on angiograms. Comparison of annual bleeding rate revealed that AVMs with intranidal aneurysm (8.5%) and venous stenosis (5.5%) had a high propensity to hemorrhage. Therapeutic strategy should be focused on these potentially hazardous lesions by the use of endovascular embolization or stereotactic radiosurgery, even if surgical resection is not indicated. (+info)
Increased brain tissue oxygenation during arteriovenous malformation resection.
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The purpose of this study was to determine if baseline oxygen pressure (PO2), carbon dioxide pressure (PCO2), and pH in brain tissue adjacent to an arteriovenous malformation (AVM) is different from measures in control patients. In addition, PO2, PCO2, and pH changes were measured during the course of AVM resection. Two groups were studied. Group 1 (n = 8) were non-ischemic patients scheduled for cerebral aneurysm clipping. Group 2 (n = 13) were patients undergoing neurosurgery for AVM resection. Following craniotomy, the dura was retracted and a PO2, PCO2, pH sensor inserted into non-ischemic brain tissue in Group 1. In Group 2, the sensor was inserted into tissue adjacent to the AVM. Following equilibration, tissue gases and pH were measured during steady state anesthetic conditions in Group 1 and during AVM resection in Group 2. The results show that under baseline conditions before the start of surgery, tissue PO2 was decreased in AVM compared to control patients but PCO2 and pH were not changed. During AVM resection, PO2 increased, PCO2 decreased, and pH increased compared to baseline measures. These parameters did not change in control patients over a similar time period. The results suggest that chronic cerebrovascular adaptation occur in AVM patients with decreased tissue perfusion pressure as an adjustment for decreased oxygen delivery. During AVM resection, this adaptation produces a hyperemic environment with relative tissue hyperoxia, hypocapnia, and alkalosis which is not corrected by the end of surgery. (+info)
Neurosurgical tools and techniques--modern image-guided surgery.
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Cushing and other great neurosurgeons made their mental preparations for surgical procedures through extensive, beautiful drawings. Three-dimensional visualization was in those days supported through interpretation of pneumoencephalograms with displacements of structures indicating where a space-occupying process might be located. Today this visualization necessary for each neurosurgeon is partly lost in the teaching process due to axial magnetic resonance imaging and computed tomography scans and of minimal invasive techniques. Microsurgical navigation on the brain surface is like sailing along a coastline. Navigating in the brain is like sailing in fog and tools for navigation must be developed accordingly. The robotic microscope Surgiscope enables the surgeon to have at the same time a microscope, a pointing devise and a bidirectional tool for automatic maneuverability in the brain. A neurosurgeon may be distracted and thereby perform less adequate. Computer technology and virtual reality models enhances possibilities for rehearsal of difficult operations and of controlling the surgical performance. Computer technology is thus a supporter of future neurosurgeons and a part of quality control. Future education must be linked to this fact. (+info)
Tissue response of a small saccular aneurysm after incomplete occlusion with a Guglielmi detachable coil.
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A 49-year-old woman had a small saccular aneurysm that was incompletely occluded with a Guglielmi detachable coil (GDC). She died from rupture of another aneurysm 42 days after the treatment. Autopsy for the embolized aneurysm revealed no neoendothelium at the aneurysmal neck, but an organized thrombus was observed limited to the periphery of the aneurysmal lumen. Although isolation of the aneurysm was not apparent, loose embolization with this method may help to reinforce the aneurysmal wall. (+info)