著者

Ryohei Ono Masayuki Sato Sho Okune Tenyu Hino Taisuke Akimoto Yoshiro Ito Aiki Marushima Mikito Hayakawa Eiichi Ishikawa Yuji Matsumaru

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2022-0029, (Released:2022-12-15)

参考文献数

15

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Objective: To report a case of symptomatic large cerebral aneurysm of the internal carotid artery (ICA), associated with a primitive trigeminal artery variant (PTAv), which was treated with a balloon occlusion test (BOT) to evaluate ischemic tolerance.Case Presentation: A 79-year-old woman was diagnosed with a symptomatic large cerebral aneurysm of the ICA bifurcating the PTAv due to diplopia. After confirming the ischemic tolerance of the perfusion area and PTAv by BOT, we performed ICA parent artery occlusion with selective embolization of the PTAv. Postoperative MRI showed no ischemic lesion and the diplopia was resolved.Conclusion: ICA parent artery occlusion with PTAv selective embolization after evaluation by BOT is useful in the treatment of large aneurysms.

著者

Satoshi MIYAMOTO Hisayuki HOSOO Eiichi ISHIKAWA Yuji MATSUMARU

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.81-85, 2023-12-31 (Released:2023-03-24)

参考文献数

14

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Middle meningeal arteriovenous fistula (MMAVF) is a shunt between the middle meningeal artery and the vein surrounding the artery. We report an extremely rare case of spontaneous MMAVF; then, we evaluated the effectiveness of trans-arterial embolization for spontaneous MMAVF and the possible cause of spontaneous MMAVF.A 42-year-old man with tinnitus, a left temporal headache, and pain surrounding the left mandibular joint was diagnosed with MMAVF on digital subtraction angiography. Trans-arterial embolization with detachable coils was conducted, which resulted in a fistula closure and symptoms' diminishment. The cause of MMAVF was thought to be the rupture of the middle meningeal artery aneurysm.A middle meningeal artery aneurysm can be a cause of spontaneous MMAVF, and trans-arterial embolization might be an optimal treatment.

著者

Toshitsugu TERAKADO Akibumi OMI Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.93-98, 2023-12-31 (Released:2023-04-10)

参考文献数

19

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Both chronic subdural hematoma (CSDH) and spontaneous intracranial hypotension (SIH) cause headaches. However, the etiologies are different: SIH headache is caused by decreased intracranial pressure (ICP), whereas CSDH headache results from increased ICP. Moreover, CSDH is treated by hematoma drainage, while SIH is treated by epidural blood patch (EBP). Treatment for the cases of combined SIH and CSDH is not well-established. Herein, we report two cases wherein ICP was monitored and safely controlled by EBP after hematoma drainage. Case 1: A 55-year-old man with progressive consciousness disturbance was diagnosed with bilateral CSDH. He underwent bilateral hematoma drainage; however, the headache became apparent during standing. We diagnosed SIH by diffuse pachymeningeal enhancement on brain MRI and epidural contrast medium leakage on CT myelography. Due to the re-enlargement of bilateral CSDH, we performed EBP after hematoma drainage and ICP monitor insertion. Finally, the headache and bilateral CSDH were resolved. Case 2: A 54-year-old man with persistent headache was diagnosed with bilateral CSDH. He underwent multiple hematoma drainage sessions. However, headache on standing persisted. We diagnosed SIH by diffuse pachymeningeal enhancement on brain MRI and epidural contrast medium leakage on CT myelography. Due to the re-enlargement of the left CSDH, we performed EBP after left hematoma drainage and ICP monitor insertion. Finally, the headache and bilateral CSDH were resolved. EBP after hematoma drainage and ICP monitoring was useful for SIH with bilateral CSDH. By monitoring ICP before EBP, the ICP was safely controlled and CSDH was resolved.

著者

Noriyuki WATANABE Masashi MIZUMOTO Taishi AMANO Hisayuki HOSOO Akinari YAMANO Alexander ZABORONOK Masahide MATSUDA Shingo TAKANO Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.337-342, 2023-12-31 (Released:2023-11-29)

参考文献数

17

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Cavernous sinus hemangioma (CSH) is a rare vascular malformation, arising from the cavernous sinus. Because of its anatomically complex location, a large lesion can cause a variety of symptoms due to cranial nerve compression. A 69-year-old woman with an unsteady gait was admitted to our hospital, and magnetic resonance imaging revealed an extra-axial giant tumor in the cavernous sinus and enlarged ventricles. A radiographic diagnosis of CSH was made. As the risk of surgical removal was considered high, the patient underwent intensity-modulated radiation therapy of 50.4 Gy in 28 fractions. The size of the tumor decreased markedly over time, and the symptoms improved soon after treatment. A 61.8% reduction in tumor size was confirmed immediately after irradiation, and a 75.9% reduction was revealed at a follow-up visit one year later. We reported a case of a giant CSH with hydrocephalus, where tumor shrinkage was confirmed immediately after radiation therapy, and the symptoms of hydrocephalus improved without surgical intervention.

著者

Junzo NAKAO Aiki MARUSHIMA Keisi FUJITA Hiroyuki FUJIMORI Ryota MASHIKO Takao KAMEZAKI Naoaki SATO Yasushi SHIBATA Shingo TAKANO Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0229, (Released:2022-10-25)

参考文献数

19

被引用文献数

3

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Most asymptomatic patients with chronic subdural hematoma (CSDH) are followed conservatively but can require surgical treatment if the hematoma expands. We conducted a retrospective evaluation of the effect of Gorei-san on CSDH. This study included patients treated between April 2013 and March 2015. In total, 289 patients were diagnosed with CSDH and 110 patients received conservative management. Finally, 39 patients who met the requirements were registered. We retrospectively examined the age, gender, medical history, hematoma thickness, clarity of sulci below hematomas, and midline shift of the patients. The primary outcome was the median surgery-free interval, and the secondary results were the rate of CSDH shrinkage and surgery avoidance. A comparison of patient characteristics between the Gorei-san (G) and non-Gorei-san (NG) groups found no significant differences in the percentage of men, average ages, past history, thickness of CSDH (15.0 ± 3.1 mm vs. 15.3 ± 2.6 mm, p = 0.801), or midline shift (2.0 ± 2.7 mm vs. 4.0 ± 5.0 mm, p = 0.230). The median surgery-free interval was significantly different between the G and NG groups [n. r. vs. 41 days (95% CI: 5-79), log-rank p = 0.047]. The CSDH avoidance rate was not significantly different between the two groups (70.0% vs. 34.4%, p = 0.071). Additionally, the CSDH shrinkage rate was significantly different between the two groups (60.0% vs. 10.3%, p = 0.004). This retrospective study demonstrated that CSDH treatment with Gorei-san reduces hematoma significantly more than treatment that does not include Gorei-san.

著者

Yoshiro ITO Hisayuki HOSOO Masayuki SATO Aiki MARUSHIMA Mikito HAYAKAWA Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0361, (Released:2023-09-23)

参考文献数

25

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In the transsylvian (TS) approach, as characterized by clipping surgery, the presurgical visualization of the superficial middle cerebral vein (SMCV) can help change the surgical approach to ensure safe microsurgery. Nevertheless, identifying preoperatively the venous structures that are involved in this approach is difficult. In this study, we investigated the venous structures that are involved in the TS approach using three-dimensional (3D) rotational venography (3D-RV) and evaluated the effectiveness of this method for presurgical simulation. Patients who underwent 3D-RV between August 2018 and June 2020 were involved in this retrospective study. The 3D-RV and partial maximum intensity projection images with a thickness of 5 mm were computationally reconstructed. The venous structures were subdivided into the following three portions according to the anatomic location: superficial, intermediate, and basal portions. In the superficial portion, predominant frontosylvian veins were observed on 31 (41%) sides, predominant temporosylvian veins on seven (9%) sides, and equivalent fronto- and temporosylvian veins on 28 (37%) sides. The veins in the intermediate (deep middle cerebral and uncal veins) and basal portions (frontobasal bridging veins) emptied into the SMCV on 57 (75%) and 34 (45%) sides, respectively. The 3D-RV images were highly representative of the venous structures observed during microsurgery. In this study, 3D-RV was utilized to capture the details of the venous structures from the superficial to the deep portions. Presurgical simulation of the venous structures that are involved in the TS approach using 3D-RV may increase the safety of microsurgical approaches.

著者

Satoshi Miyamoto Mikito Hayakawa Sho Okune Ryosuke Shintoku Akinari Yamano Takato Hiramine Toshihide Takahashi Hisayuki Hosoo Yoshiro Ito Aiki Marushima Masao Koda Eiichi Ishikawa Yuji Matsumaru

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1386-22, (Released:2023-06-07)

参考文献数

9

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Hidden bow hunter's syndrome (HBHS) is a rare disease in which the vertebral artery (VA) occludes in a neutral position but recanalizes in a particular neck position. We herein report an HBHS case and assess its characteristics through a literature review. A 69-year-old man had repeated posterior-circulation infarcts with right VA occlusion. Cerebral angiography showed that the right VA was recanalized only with neck tilt. Decompression of the VA successfully prevented stroke recurrence. HBHS should be considered in patients with posterior circulation infarction with an occluded VA at its lower vertebral level. Diagnosing this syndrome correctly is important for preventing stroke recurrence.

著者

Sho Okune Mikito Hayakawa Tenyu Hino Takato Hiramine Taisuke Akimoto Masayuki Sato Yoshiro Ito Aiki Marushima Tomoya Takada Eiichi Ishikawa Akira Tamaoka Yuji Matsumaru

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0633-22, (Released:2023-07-05)

参考文献数

17

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Hemichorea-hemiballism (HCHB) due to transient ischemic attacks (TIAs) is rare. An 83-year-old woman had repeated episodes of right-sided HCHB for 3 months. Magnetic resonance (MR) angiography demonstrated occlusion of the left carotid and middle cerebral arteries and severe stenosis of the innominate artery, and 24-h ambulatory blood pressure monitoring showed a blood pressure decrease of >20 mmHg after each meal. We speculated that HCHB developed as TIAs due to hemodynamic failure in the left cerebral hemisphere, caused by a combination of severe stenosis of the innominate artery concomitant with occlusion of the left carotid and middle cerebral arteries as well as postprandial hypotension.

著者

Takuma HARA Hiroyoshi AKUTSU Shuho TANAKA Hiroyoshi KINO Hidetaka MIYAMOTO Rieko II Shingo TAKANO Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0132, (Released:2022-11-25)

参考文献数

25

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This study analyzed risk factors for postoperative cerebrospinal fluid (CSF) leak after graded multilayer cranial base repair method with dural suturing. We performed surgery via the endoscopic endonasal approach (EEA) from 2012.6 to 2018.4, and those consecutive clinical data were prospectively accumulated and retrospectively analyzed. We tailored the repair method according to the intraoperative CSF leak grade. Among 388 surgeries via the EEA, there were 10 (2.6%) cases of postoperative CSF leak after graded repair with suturing. Postoperative CSF leak occurred in two of the 150 cases without intraoperative CSF leak (grade 0), one of the 104 cases with small (grade 1) intraoperative CSF leak, two of the 60 cases with moderate (grade 2) leak, and five of the 74 cases with large (grade 3) leak. Univariate analysis indicated that chordoma (P = 0.023), estimated tumor volume ≥ 7400 mm3 (P = 0.003), and maximum tumor diameter ≥ 32.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Additionally, among cases with intraoperative grade 3 CSF leak, chordoma (P = 0.021), estimated tumor volume ≥ 23000 mm3 (P = 0.003), and maximum tumor diameter ≥ 45.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Maximum tumor diameter, estimated tumor volume, and chordoma tumor pathology are related to a higher risk of postoperative CSF leak.

著者

Yusuke MORINAGA Hiroyoshi AKUTSU Hiroyoshi KINO Shuho TANAKA Hidetaka MIYAMOTO Masahide MATSUDA Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.55-61, 2022-12-31 (Released:2022-04-01)

参考文献数

18

被引用文献数

1

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We report the use of endoscopic endonasal surgery for dural reconstruction following a cerebrospinal fluid leak in a 33-year-old patient with recurrent meningitis since at age of 2 years. Magnetic resonance imaging showed osteolytic changes in the left temporal and sphenoid bones, including the left pterygoid plate, a few left temporal encephaloceles, and cerebrospinal fluid-like fluid in the expanded Meckel's cave and the parapharyngeal space. After endoscopic endonasal surgery, Gorham-Stout disease was diagnosed. No recurrence of cerebrospinal fluid leakage or meningitis has been observed. Thus, endoscopic endonasal surgery might improve clinical outcomes in patients with Gorham-Stout disease and skull base defects.

著者

Masahide MATSUDA Tetsuya YAMAMOTO Eiichi ISHIKAWA Kei NAKAI Hiroyoshi AKUTSU Kuniyuki ONUMA Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.9, pp.749-755, 2015 (Released:2015-09-15)

参考文献数

21

被引用文献数

2 5

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Temozolomide (TMZ) as a concomitant and adjuvant chemotherapy to radiotherapy following maximal surgical resection is the established standard therapy for patients with newly diagnosed high-grade glioma. However, detailed analysis of chemotherapy-induced nausea and vomiting (CINV) associated with concomitant TMZ has not been sufficiently described. We prospectively analyzed the profile of CINV associated with concomitant TMZ. Eighteen consecutive patients with newly diagnosed high-grade glioma treated with concomitant chemoradiotherapy including TMZ were enrolled. CINV was recorded using a daily diary including nausea assessment, emetic episodes, degree of appetite suppression, and antiemetic medication use. The observed incidence rates of all grade nausea, moderate/severe (CTC grade 2, 3) nausea, emetic episodes, and appetite suppression for the overall period were 89%, 39%, 39%, and 83%, respectively. Moderate/severe nausea and severe (CTC grade 3) appetite suppression were frequently observed during the delayed phase of the treatment. Emetic episodes and moderate/severe nausea were significantly correlated with female gender. Moderate/severe nausea and severe appetite suppression were significantly correlated with low lymphocyte counts before chemoradiotherapy. For CINV associated with concomitant TMZ, enhanced antiemetic therapy focused on the delayed phase of the treatment will likely be beneficial, especially in female patients with a low lymphocyte count before chemoradiotherapy.

著者

Satoru OSUKA Hironori IMAI Eiichi ISHIKAWA Akira MATSUSHITA Tetsuya YAMAMOTO Hiroki NOZUE Tatsuyuki OHTO Kousaku SAOTOME Yoji KOMATSU Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.50, no.12, pp.1118-1122, 2010 (Released:2010-12-25)

参考文献数

13

被引用文献数

9 23

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Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome with a very particular clinical course. Three patients with MERS were evaluated by various sequences of magnetic resonance imaging with diffusion tensor imaging. Initial diffusion-weighted imaging showed reduction in the apparent diffusion coefficient values in the lesions, which completely resolved with the elimination of symptoms. However, diffusion anisotropy of the lesions showed no remarkable abnormalities in the early or delayed phases. These results may indicate that white matter architecture is preserved in both early and delayed phases in MERS.

著者

Noriaki SAKAMOTO Eiichi ISHIKAWA Yasunobu NAKAI Hiroyoshi AKUTSU Tetsuya YAMAMOTO Kei NAKAI Masanari SHIIGAI Hideo TSURUSHIMA Tomonori ISOBE Shingo TAKANO Koji TSUBOI Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.12, pp.878-884, 2012 (Released:2012-12-25)

参考文献数

27

被引用文献数

9 30 5

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Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.

著者

Satoru OSUKA Shingo TAKANO Shinya WATANABE Eiichi ISHIKAWA Tetsuya YAMAMOTO Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.4, pp.186-193, 2012 (Released:2012-04-23)

参考文献数

31

被引用文献数

14 52

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Antiangiogenic strategy is promising for malignant glioma. Histone deacetylase inhibitors (HDACIs) are unique anticancer agents that exhibit antiangiogenic effects. The in vitro and in vivo antiangiogenic effects of HDACIs, valproic acid (VPA), were investigated in malignant glioma in the brain. In vitro, VPA preferentially inhibited endothelial cell proliferation compared to glioma cell proliferation at the optimum concentration in a dose-dependent manner. VPA reduced vascular endothelial growth factor (VEGF) secretion of glioma cells in a dose-dependent manner under both normoxic and hypoxic conditions. VPA was also found to inhibit tube formation in the angiogenesis assay. In vivo, treatment with VPA combined with irinotecan reduced the number of vessels expressing factor VIII in the brain tumor model. VPA inhibits glioma angiogenesis by direct (inhibition of endothelial cell proliferation and tube formation) and indirect (decreased secretion of VEGF by glioma cells) mechanisms. These data suggest a potential role for VPA as an adjuvant therapy for patients with malignant glioma.