- 著者
- Masaki Komiyama
- 出版者
- 一般社団法人日本脳神経外科コングレス
- 雑誌
- 脳神経外科ジャーナル (ISSN:0917950X)
- 巻号頁・発行日
- vol.26, no.7, pp.488-495, 2017 (Released:2017-07-25)
- 参考文献数
- 40
- 被引用文献数
- 3 14
A thorough knowledge of the functional vascular anatomy of the brain is becoming increasingly required in neuro-interventional procedures. Similarly, this knowledge is also required in neurosurgery, especially when a particular artery or vein is to be sacrificed during surgery. Permanent occlusion of a major artery can be challenged by a balloon occlusion test, but for venous sacrifice, such a procedure is practically not applicable. Up to now, reliable methods to judge the safety of such destructive procedures were lacking. Knowledge of the basic angioarchitecture of the cerebral veins, in other words, the “functional anatomy of the cerebral veins” may help us to better understand the safety or risk of sacrificing cerebral veins. Today, 3D-CT angiography, digital subtraction angiography and cone-beam CT provide detailed information on the precise cerebral venous anatomy to help us understand the functional venous anatomy and to make informed decisions.
- 著者
- Masaki KOMIYAMA Aiko TERADA Tomoya ISHIGURO
- 出版者
- The Japan Neurosurgical Society
- 雑誌
- Neurologia medico-chirurgica (ISSN:04708105)
- 巻号頁・発行日
- vol.56, no.3, pp.132-140, 2016 (Released:2016-03-15)
- 参考文献数
- 22
- 被引用文献数
- 6 17
Neonatal neuro-intervention is challenging. The purpose of this article is to report the neuro-intervention for the neonates with brain arteriovenous fistulas (AVFs), with special reference to access routes. Fifteen neonates (12 boys and 3 girls) who underwent neuro-intervention within the first 14 days of life were ‐included. Their diagnoses included vein of Galen aneurysmal malformation (6), dural sinus malformations with arteriovenous (AV) shunts (6), pial AVF (2), and epidural AVF (1). Birth weight ranged from 1,538 g to 3,778 g (mean 2,525 g). Neuro-interventions, especially access routes, in the neonatal periods (< 1 month) were retrospectively reviewed. All neonates presented with severe cardiac failure. In total, 29 interventions (mean 1.9) were performed within 1 month. Although 12 neonates with birth weight more than 2,700 g could be treated through transfemoral arterial routes, 3 neonates with birth weight less than 2,200 g could not be treated successfully by femoral arterial routes. Interventions were performed through 19 femoral arterial, 3 femoral venous, 2 umbilical arterial, 3 umbilical venous, 3 transcardiac, and 2 direct carotid routes. Their overall outcomes were six good recovery, one moderate disability, two severe disabilities, one vegetative state, and five deaths with a mean follow-up period of 7 years 2 months. Neuro-intervention for the neonates with birth weight more than 2,700 g can be performed by femoral arterial routes using a 4F sheath. For those with birth weight less than 2,200 g, however, alternative access routes are required.
- 著者
- Masaki KOMIYAMA
- 出版者
- The Japan Neurosurgical Society
- 雑誌
- Neurologia medico-chirurgica (ISSN:04708105)
- 巻号頁・発行日
- vol.56, no.6, pp.317-325, 2016 (Released:2016-06-15)
- 参考文献数
- 78
- 被引用文献数
- 14 28
Brain arteriovenous malformations (bAVMs) represent a high risk of intracranial hemorrhages, which are substantial causes of morbidity and mortality of bAVMs, especially in children and young adults. Although a variety of factors leading to hemorrhages of bAVMs are investigated extensively, their pathogenesis is still not well elucidated. The author has reviewed the updated data of genetic aspects of bAVMs, especially focusing on clinical and experimental knowledge from hereditary hemorrhagic telangiectasia, which is the representative genetic disease presenting with bAVMs caused by loss-of-function in one of the two genes: endoglin and activin receptor-like kinase 1. This knowledge may allow us to infer the pathogensis of sporadic bAVMs and in the development of new medical therapies for them.