Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.
An eighty-year-old man who had subarachnoid hemorrhage and large intracerebral hematoma caused by a ruptured aneurysm of the left middle cerebral artery was treated with acute dome embolization using Guglielmi detachable coil and subacute CT guided stereotactic aspiration of the hematoma. As a result of these less invasive treatments, he returned to his regular daily life without any neurological deficits or complications.
We previously reported the usefulness of three-dimensional (3D) CT angiography for perioperative evaluation of carotid endarterectomy (CEA). Calcification depicted well in the modality has also been studied pathologically. We have pointed out that the microscopically granular type might be relatively softer than the lump/luminar type and that this factor may affect the result of carotid angioplasty and stenting. The aim of the study was to determine the surgical option by analyzing hardness of calcification with calcium scores obtained by 3DCT angiography. Seventy carotid arteries were examined with 3DCT angiography and 35 plaques were extracted in CEA. Volume, Hounsfield units and calcium scores of calcified lesions were calculated and analyzed by a 3D workstation. Calcified lesions were classified into 4 groups according to their volume and Hounsfield units. Though large calcification tended to have a relatively bigger difference between maximum and mean CT values, the calcium score seemed to be plotted in proportion to overall hardness of calcification and to enable comprehensive evaluation, which might affect the choice for surgical treatments.
A rare case of brain metastasis of thyroid papillary carcinoma is reported. The cerebral metastasis was surgically treated without irradiation despite the presence of a spinal metastasis. No recurrence was demonstrated by computed tomography 1 year postoperatively. We suggest that surgery is indicated for a brain metastasis of thyroid papillary carcinoma even if other metastatic lesions are present.
