재발성 파열성 뇌동맥류의 원인과 치료 전략

초록

PURPOSE : The result of the cerebral aneurysm treatment has been improved with the advance of aneurysm clipping and emboilization technique. But, in rare cases, repeated subarachnoid hemorrhage was occurred in patients who were treated with clips or embolization, and the re-treatment was needed. We analyzed the re-treated cases and reviewed the literature of the cause, treatment plan and prevention of these cases. MATERIALS AND METHODS : From January 2003 to May 2008 in our hospital, total 410 ruptured cerebral aneurysm patients had operation with aneurismal neck clipping or coiling embolization, and retrograde analysis was done with medical records and radiologic reports(including CT angiography and catheter angiography). Five patients had been re-treated due to the aneurismal symptome, such as re-bleeding or cranial nerve symptom because of compression, at the previously treated aneurysm site. RESULTS : Four patients of re-treatment group were presented as re-bleeding and the episode was occurred within 1 month after the treatment in 3 patients. Another 1 patient was presented as visual disturbance. The aneurysm is located on anterior communicatiing artery in 2 patients of re- treatment group, posterior communicating artery in 2 patients, and posterior inferior cerebellar artery in 1 patient. The male was 2 in 5 patients and the mean age was 56 years. The previous treatment was the clipping in 3 cases(A-com : P-com : PICA = 1 case : 1 case : 1 case) and coil embolization was 2 cases(A-com : P-com = 1 case : 1 case). On the other hand, modality of re-treatment was clipping except for one case in which coil embolization was done at the site of coiled P-com aneurysm. From previously embolized 2 cases, we found out that the cause of re-treatment needed aneurysm was regrowth. Also, remnant neck brought about rebleeding in 3 clipped cases. Remnant neck were resulted from Incompleted clip for saved the perforating artery or the mobilzed clip due