著者

Yoichi Morofuji Minoru Morikawa Nobutaka Horie Yuki Matsunaga Tsuyoshi Izumo Takayuki Matsuo

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.ra.2023-0023, (Released:2023-09-05)

参考文献数

41

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The clinical manifestations of dural arteriovenous fistulas (dAVFs) are highly variable and dependent on the hemodynamic properties and location of the fistula. The locations of the fistula are numerous and include the cavernous sinus, transverse–sigmoid sinus, superior sagittal sinus, inferior and superior petrosal sinuses, anterior condylar confluence, tentorium, anterior cranial fossa, middle fossa, foramen magnum, cranio-cervical junction, convexity, and spinal cord. These dAVFs can be divided into two types, “sinus type” and “non-sinus type,” based on their communication with dural shunts and cerebral veins. The sinus type involves direct communication between the arterial dural branch and one dural sinus, sometimes leading to recruitment of cortical veins. On the other hand, the non-sinus type is embedded into the dura, with the drainage always involving a cerebral vein and no communication with any sinus. Treatment options for these types of dAVFs differ; sinus-type dAVFs require normally sinus obliteration and occlusion of recruited veins, while non-sinus-type dAVFs require embolization of the drainage vein. Accurately classifying the type of fistula, sinus type or non-sinus type, is critical for developing a proper treatment plan. This review describes clinical characteristics and treatment of those non-sinus-type dAVFs involving unusual locations with illustrative cases.

著者

Novita Ikbar KHAIRUNNISA Fumiyuki YAMASAKI Vishwa Jeet AMATYA Takeshi TAKAYASU Ushio YONEZAWA Akira TAGUCHI Shumpei ONISHI Nobutaka HORIE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.395-400, 2022-12-31 (Released:2022-11-15)

参考文献数

22

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Temozolomide is an oral alkylating agent with moderate side effects compared to other agents. However, the development of secondary malignancies following temozolomide has been reported. We describe the first case of primary central nervous system lymphoma (PCNSL) occurrence following glioblastoma treatment. A 69-year-old male was admitted to our hospital with a chief complaint of headache and dysnomia for six months. A ring-enhanced mass of the left temporal lobe was observed and gross total removal was performed. The tumor was pathologically diagnosed as isocitrate dehydrogenase (IDH) -wildtype glioblastoma and he received 60 Gy of local irradiation in 30 fractions, with concurrent temozolomide at a dose of 75 mg/m2. Grade 2 lymphopenia was discovered during treatment. Within 6 months, the patient developed a right parietal intra-axial tumor without local recurrence and was given 150-200 mg/m2 oral temozolomide for five consecutive days of a 28-day cycle. Within five cycles of temozolomide, complete remission was observed; however, after the eighth cycle, a new lesion in the right temporal lobe was discovered. Surgical removal was performed and histological findings were consistent with diffuse large B-cell lymphoma, and the final diagnosis of Epstein-Barr virus negative PCNSL was established.

著者

Masahiro Hosogai Takahito Okazaki Shigeyuki Sakamoto Daizo Ishii Masashi Kuwabara Nobutaka Horie

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.2022-0045, (Released:2022-11-18)

参考文献数

23

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Objective: We report a case of dolichoectatic vertebrobasilar aneurysms treated with multiple low-profile visualized intraluminal support (LVIS) stents followed by flow redirection endoluminal device (FRED) flow diverter to prevent the growth of the thrombosed aneurysm.Case Presentation: A 71-year-old man developed diplopia due to oculomotor nerve palsy after 11 years of follow-up for an enlarging thrombosed dolichoectatic vertebrobasilar artery aneurysm. He initially had a fusiform thrombosed aneurysm from the right vertebral artery to the basilar artery. This lesion was tortuous and strongly compressed the pons. A total of 11 LVISs were deployed from the right posterior cerebral artery to the right vertebral artery. Six months after surgery, there was no enlargement of the thrombosed aneurysm on MRI and the contrast leakage out of the stent was markedly reduced in DSA compared to immediately after surgery. One year and seven months after surgery, contrast leakage out of the stent was increased in DSA. The FRED was placed within the overlapped LVISs, and contrast leakage was somewhat reduced. After 2 years and 7 months from the initial treatment, the contrast leakage was still observed. However, there was no enlargement of the aneurysm and no complications related to treatments were observed.Conclusion: Treatment with multiple LVIS stents followed by FRED flow diverter treatment for dolichoectatic vertebrobasilar aneurysms (DVAs) may be one of the treatment options for controlling the growth of thrombotic aneurysms without complications, but the long-term prognosis of this case is unclear, and careful follow-up is mandatory.

著者

Mikako ENOKIZONO Minoru MORIKAWA Takayuki MATSUO Tomayoshi HAYASHI Nobutaka HORIE Sumihisa HONDA Reiko IDEGUCHI Izumi NAGATA Masataka UETANI

出版者

Japanese Society for Magnetic Resonance in Medicine

雑誌

Magnetic Resonance in Medical Sciences (ISSN:13473182)

巻号頁・発行日

vol.13, no.4, pp.251-260, 2014-12-01 (Released:2014-12-22)

参考文献数

29

被引用文献数

15 21

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Purpose: We evaluated the rim patterns of intracranial meningiomas on nonenhanced (NE) and contrast-enhanced (CE) 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) imaging on 3-tesla magnetic resonance (MR) imaging to clarify the associated imaging and pathological findings and the value of the rims in predicting tumor cleavability.Methods: Thirty-two patients with meningioma underwent tumor excision. We classified the rim patterns on 3D FLAIR, subdivided into “rim-NE,” a rim with relatively low signal intensity on NE 3D FLAIR and “rim-CE,” a rim with relatively high signal intensity on CE 3D FLAIR, into 4 grades by their extent from 0 (no rim visible) to 3 (rim visible over most of the tumor-brain interface) and correlated them with tumor size, grade of peritumoral brain edema, presence/absence of pial supply, grade of tumor-brain adhesion, and histological findings.Results: On NE 3D FLAIR, “rim-NE” was graded 0 in 5 patients, one in 5, 2 in 6, and 3 in 16. On CE 3D FLAIR, “rim-CE” was graded 0 in one patient, one in 13, 2 in 4, and 3 in 14. The grade of “rim-NE” correlated negatively with the grade of brain edema (P = 0.023) and positively with surgical tumor-brain cleavability (P < 0.001). It also correlated with the amount of connective tissue at the tumor-brain interface histologically (P = 0.041). Furthermore, a lower grade of “rim-NE” was more often seen in atypical than benign meningioma (P = 0.003). Although “rim-CE” was more prominent in tumors with pial supply on digital subtraction angiography (DSA) (P = 0.002), it was not useful in predicting tumor-brain adhesion or histological tumor grading.Conclusion: The rim pattern of meningioma on NE 3D FLAIR can predict surgical cleavability and histological tumor grading. A higher grade of rim pattern on CE 3D FLAIR suggests prominent pial supply to the tumor but has no added value in predicting tumor-brain adhesion and histological tumor grading.