著者

Tomoaki Murakami Shingo Toyota Motohide Takahara Kazuhiro Touhara Tatsuya Hagioka Yuhei Hoshikuma Takamune Achiha Takeshi Shimizu Maki Kobayashi Haruhiko Kishima

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.2023-0020, (Released:2023-07-04)

参考文献数

18

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Objective: Extracranial internal carotid artery aneurysms (ECAAs) are rare. We herein describe a case of overlapped stenting with two double-layer micromesh stents for a giant ECAA.Case Presentation: A 73-year-old man presented to our hospital with an enlarged right posterior cervical mass. A right internal carotid artery (ICA) angiogram revealed a giant aneurysm of 50 × 60 mm. We chose a carotid double-layer micromesh stent for stenting. With the patient under general anesthesia, the first double-layer micromesh stent (CASPER Rx, 10 × 30 mm; Terumo, Tokyo, Japan) was deployed between the ICA distal to the aneurysm and the common carotid artery (CCA). The second stent was also deployed from a site more proximal than the first one. Ten coils were then placed from a microcatheter that had been placed in the aneurysm. A right CCA angiogram after the procedure revealed a flow-diversion effect for the aneurysm. The patient was discharged with no complications. At the 6-month follow-up angiogram, blood flow into the aneurysm had completely disappeared.Conclusion: A flow-diversion effect using overlapped double-layer micromesh stents can result in thrombosis and healing of giant ECAAs.

著者

Tatsuya HAGIOKA Takeshi SHIMIZU Shingo TOYOTA Tomoaki MURAKAMI Takamune ACHIHA Motohide TAKAHARA Kazuhiro TOUHARA Yuhei HOSHIKUMA Maki KOBAYASHI Haruhiko KISHIMA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.241-245, 2023-12-31 (Released:2023-09-29)

参考文献数

12

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A 54-year-old man with no medical history presented to our hospital with vomiting, left hemiplegia, and seizures. On arrival, he was experiencing generalized tonic-clonic seizures, which required him to be intubated and deeply sedated. Contrast-enhanced computed tomography revealed extensive venous sinus obstruction from the superior sagittal sinus to the bilateral sigmoid sinus and cerebral edema with intracranial hemorrhage. An intracranial pressure (ICP) monitor was immediately placed intracranially, and mechanical thrombectomy (MT) was performed under ICP monitoring. MT was immediately terminated when the venous sinus was partially recanalized enough to decrease the ICP; then, anticoagulation therapy was initiated. Postoperative follow-up angiography revealed that venous sinus obstruction and intracranial venous perfusion improved over time. Although he had intracranial hemorrhage-induced left hemiplegia and sensory deficits, his condition improved with rehabilitation, and the patient was eventually discharged home. The indication criteria and techniques for MT for cerebral venous sinus thrombosis are yet to be established. As in this case, in patients with impaired consciousness due to intracranial hemorrhage or epilepsy, preoperative ICP monitor placement is deemed useful to evaluate venous perfusion during MT and decide the treatment goal.

著者

Takeshi SHIMIZU Shingo TOYOTA Motohide TAKAHARA Kazuhiro TOUHARA Tatsuya HAGIOKA Yuhei HOSHIKUMA Takamune ACHIHA Tomoaki MURAKAMI Maki KOBAYASHI Haruhiko KISHIMA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2023-0070, (Released:2023-09-23)

参考文献数

15

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There have been a number of anastomosis methods of bypass techniques reported for moyamoya disease. However, there are yet no randomized controlled trials conducted on the anastomosis method. Retrograde blood flow of the superficial temporal artery (STA) may be used as one of the donor options. Here, we examined the tolerability of retrograde bypass using a distal stump of the parietal STA (dsPSTA). Anastomosis between the dsPSTA and middle cerebral artery (MCA) was performed for consecutive patients with moyamoya disease whose parietal STA was visualized to be longer than 10 cm using contrast-enhanced computed tomography preoperatively. Retrospectively, we have examined its patency and clinical outcome. Retrograde dsPSTA-MCA bypass was performed in 22 hemispheres of 17 patients. The patency of retrograde dsPSTA-MCA bypass in all 22 anastomoses could be confirmed during follow-up periods (mean: 5.5, range: 2-15 years). No recurrence of ischemic events was observed. The dsPSTA-MCA bypass using retrograde blood flow has been determined as one of the many promising anastomosis methods, and long-term patency was achieved in moyamoya disease.

著者

Tatsuya HAGIOKA Takeshi SHIMIZU Kazuhiro TOUHARA Motohide TAKAHARA Yuhei HOSHIKUMA Takamune ACHIHA Tomoaki MURAKAMI Maki KOBAYASHI Shingo TOYOTA Haruhiko KISHIMA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.343-347, 2022-12-31 (Released:2022-10-13)

参考文献数

18

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A 72-year-old man who had undergone a lumboperitoneal shunt for idiopathic normal pressure hydrocephalus was admitted to our emergency department with fever and disturbance of consciousness 8 days after placement. Computed tomography scan showed pneumocephalus and a right-sided temporal porencephalic cyst with a small bone defect in the right petrous bone. Shunt valve pressure was raised from 145 mmH2O to "virtual off" setting. After 2 weeks, follow-up computed tomography showed improvement of pneumocephalus, and the shunt valve pressure was lowered to 215 mmH2O. Since that time, the patient has a good clinical course without recurrence.Tension pneumocephalus following shunt placement for idiopathic normal pressure hydrocephalus is rare and has never been reported in the early postoperative stage after lumboperitoneal shunt, except for the present one. Temporary raising shunt valve pressure is effective in improving the pneumocephalus. Preoperative screening for congenital bone defects by thin-slice computed tomography may be useful for selecting types of shunt valve and determining postoperative pressure setting.