[국내논문]Intentional Sparing of Daughter Sac from Coil Packing in the Embolization of Aneurysms Causing the Third Cranial Nerve Palsy : Initial Clinical and Radiological Results원문보기
Kang, Chang-Woo
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
,
Kwon, Hyon-Jo
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
,
Jeong, Se-Jin
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
,
Koh, Hyeon-Song
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
,
Choi, Seung-Won
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
,
Kim, Seon-Hwan
(Department of Neurosurgery, Chungnam National University Hospital & Medical School)
Objective : Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice ver...
Objective : Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice versa during endosaccular embolization for recovering from CN III palsy, because it may give a greater chance for the daughter sac to shrink by itself later. We reviewed the initial results of our experiences of such cases. Methods : Among 9 aneurysms accompanied by CN III palsy, 7 (6 unruptured, 1 ruptured) showed a daughter sac. We tried to fill the main dome completely and spare the daughter sac from coil filling to increase the possibility of decompression. We evaluated the short-term effectiveness of this concept using medical records and angiograms. Results : After initial embolization, all of CN III palsy caused by unruptured aneurysms (6/6) resolved completely after various periods (3-90 days) of time. No adverse effects were noted during and after the procedures except for one case of harmless coil stretching during coil filling using double microcatheter. Conclusion : During the coil embolization of the cerebral aneurysm causing CN III palsy, sparing the daughter sac from coil packing while tightly packing the main dome, can be helpful in increasing the effectiveness of decompression. However, a long-term follow-up will be required.
Objective : Cerebral aneurysms which cause oculomotor nerve [cranial nerve (CN) III] palsy, are frequently found with a daughter sac of the aneurysm dome. We assumed that CN III might be compressed by the daughter sac and it would be more helpful not to fill the daughter sac with coils than vice versa during endosaccular embolization for recovering from CN III palsy, because it may give a greater chance for the daughter sac to shrink by itself later. We reviewed the initial results of our experiences of such cases. Methods : Among 9 aneurysms accompanied by CN III palsy, 7 (6 unruptured, 1 ruptured) showed a daughter sac. We tried to fill the main dome completely and spare the daughter sac from coil filling to increase the possibility of decompression. We evaluated the short-term effectiveness of this concept using medical records and angiograms. Results : After initial embolization, all of CN III palsy caused by unruptured aneurysms (6/6) resolved completely after various periods (3-90 days) of time. No adverse effects were noted during and after the procedures except for one case of harmless coil stretching during coil filling using double microcatheter. Conclusion : During the coil embolization of the cerebral aneurysm causing CN III palsy, sparing the daughter sac from coil packing while tightly packing the main dome, can be helpful in increasing the effectiveness of decompression. However, a long-term follow-up will be required.
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제안 방법
. Attempts were made not to fill the daughter sac with coils and we used the double microcatheter technique in 4 cases (patient no. 1, 4, 5, 7) and stent-assisted technique in 1 (patient no. 6). The double microcatheter technique was useful for both relatively wide aneurysmal neck and making a stable coil frame for the main dome only.
대상 데이터
All of the aneurysms were located at the distal internal carotid artery and seven of them were composed of daughter sacs presumed to compress directly on CN III. Seven aneurysms with daughter sacs are included in this study. There were 6 women and1 man with a mean age of 67 years (range, 49-86 years) at the time of treatment.
Seven aneurysms with daughter sacs are included in this study. There were 6 women and1 man with a mean age of 67 years (range, 49-86 years) at the time of treatment. Initial complete CN III palsy was seen in 6 patients and partial in one.
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