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Kamiyama H, Nonaka C, Saitoh H, Ohno M, Shimizu Y, Isoda K. Anatase and rutile titanium oxide nanoparticles induce acute kidney injury by coadministration with paraquat, cisplatin or 5-aminosalicylic acid. Pharmazie 2024; 79:2-5. [PMID: 38509631 DOI: 10.1691/ph.2024.3655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Nanoparticles are used in a variety of fields; for example, titanium oxide nanoparticles are used in paints, food additives, cosmetics, and sunscreen materials. Although the use of titanium oxide nanoparticles is regulated, their safety has not been established. Furthermore, the interaction between titanium oxide nanoparticles and various chemical substances and pharmaceuticals is unknown. We co-administered rutile-type titanium oxide nanoparticles (nTR) or anatase-type titanium oxide nanoparticles (nTA) to mice together with paraquat (PQ), cisplatin (CDDP), or anti-5-aminosalicylic acid (5-ASA), and investigated the extent, if any, of liver and kidney injury. As a result, when nTA and nTR were administered alone, no increases were observed in aspartate aminotransferase (AST) and alanine aminotransferase (ALT), which are indicators of liver damage, or urea nitrogen (BUN), which is an indicator of kidney damage. Next, nTA and nTR were co-administered with PQ, CDDP or 5-ASA. Although no increase in ALT or AST was observed, BUN levels increased significantly and acute kidney injury was induced. The findings suggested that titanium oxide nanoparticles induce acute kidney injury through their interaction with chemicals and drugs.
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Affiliation(s)
- H Kamiyama
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan;
| | - C Nonaka
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan
| | - H Saitoh
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan
| | - M Ohno
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan
| | - Y Shimizu
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan
| | - K Isoda
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano-ku, Tokyo 164-8530, Japan
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Shima Y, Sasagawa S, Ota N, Oyama R, Tanaka M, Kubota-Sakashita M, Kawakami H, Kobayashi M, Takubo N, Ozeki AN, Sun X, Kim YJ, Kamatani Y, Matsuda K, Maejima K, Fujita M, Noda K, Kamiyama H, Tanikawa R, Nagane M, Shibahara J, Tanaka T, Rikitake Y, Mataga N, Takahashi S, Kosaki K, Okano H, Furihata T, Nakaki R, Akimitsu N, Wada Y, Ohtsuka T, Kurihara H, Kamiguchi H, Okabe S, Nakafuku M, Kato T, Nakagawa H, Saito N, Nakatomi H. Increased PDGFRB and NF-κB signaling caused by highly prevalent somatic mutations in intracranial aneurysms. Sci Transl Med 2023; 15:eabq7721. [PMID: 37315111 DOI: 10.1126/scitranslmed.abq7721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
Intracranial aneurysms (IAs) are a high-risk factor for life-threatening subarachnoid hemorrhage. Their etiology, however, remains mostly unknown at present. We conducted screening for sporadic somatic mutations in 65 IA tissues (54 saccular and 11 fusiform aneurysms) and paired blood samples by whole-exome and targeted deep sequencing. We identified sporadic mutations in multiple signaling genes and examined their impact on downstream signaling pathways and gene expression in vitro and an arterial dilatation model in mice in vivo. We identified 16 genes that were mutated in at least one IA case and found that these mutations were highly prevalent (92%: 60 of 65 IAs) among all IA cases examined. In particular, mutations in six genes (PDGFRB, AHNAK, OBSCN, RBM10, CACNA1E, and OR5P3), many of which are linked to NF-κB signaling, were found in both fusiform and saccular IAs at a high prevalence (43% of all IA cases examined). We found that mutant PDGFRBs constitutively activated ERK and NF-κB signaling, enhanced cell motility, and induced inflammation-related gene expression in vitro. Spatial transcriptomics also detected similar changes in vessels from patients with IA. Furthermore, virus-mediated overexpression of a mutant PDGFRB induced a fusiform-like dilatation of the basilar artery in mice, which was blocked by systemic administration of the tyrosine kinase inhibitor sunitinib. Collectively, this study reveals a high prevalence of somatic mutations in NF-κB signaling pathway-related genes in both fusiform and saccular IAs and opens a new avenue of research for developing pharmacological interventions.
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Affiliation(s)
- Yasuyuki Shima
- Biomedical Neural Dynamics Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
- Neurodegenerative Disorders Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
| | - Shota Sasagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Nakao Ota
- Biomedical Neural Dynamics Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
| | - Rieko Oyama
- Biomedical Neural Dynamics Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
| | - Minoru Tanaka
- Biomedical Neural Dynamics Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
- Division of Innovative Cancer Therapy and Department of Surgical Neuro-Oncology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Mie Kubota-Sakashita
- Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Hirochika Kawakami
- Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Mika Kobayashi
- Isotope Science Center, University of Tokyo, Tokyo 113-0032, Japan
| | - Naoko Takubo
- Isotope Science Center, University of Tokyo, Tokyo 113-0032, Japan
| | | | - Xiaoning Sun
- Isotope Science Center, University of Tokyo, Tokyo 113-0032, Japan
| | - Yeon-Jeong Kim
- Department of Biochemistry, Faculty of Medicine and Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Yoichiro Kamatani
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Tokyo 108-8639, Japan
| | - Koichi Matsuda
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Tokyo 108-8639, Japan
| | - Kazuhiro Maejima
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Masashi Fujita
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo 181-8611, Japan
| | - Junji Shibahara
- Department of Pathology, Faculty of Medicine, Kyorin University, Mitaka, Tokyo 181-8611, Japan
| | - Toru Tanaka
- Laboratory of Medical Pharmaceutics, Kobe Pharmaceutical University, Kobe, Hyogo 658-8558, Japan
| | - Yoshiyuki Rikitake
- Laboratory of Medical Pharmaceutics, Kobe Pharmaceutical University, Kobe, Hyogo 658-8558, Japan
| | - Nobuko Mataga
- Support Unit for Bio-Material Analysis, Research Resources Division, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
| | - Satoru Takahashi
- Department of Anatomy and Embryology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-0005, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University Faculty of Medicine, Tokyo 160-0016, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Tokyo 160-0016, Japan
- Laboratory for Marmoset Neural Architecture, Center for Brain Science, RIKEN, Wako, Saitama 351-0198, Japan
- International Center for Brain Science, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Tomomi Furihata
- Laboratory of Clinical Pharmacy and Experimental Therapeutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | | | | | - Youichiro Wada
- Isotope Science Center, University of Tokyo, Tokyo 113-0032, Japan
| | - Toshihisa Ohtsuka
- Department of Biochemistry, Faculty of Medicine and Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroki Kurihara
- Department of Molecular Cell Biology, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo 113-8654, Japan
| | - Hiroyuki Kamiguchi
- Laboratory for Neural Cell Dynamics, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
| | - Shigeo Okabe
- Department of Cellular Neurobiology, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo 113-8654, Japan
- Brain Medical Science Collaboration Division, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
| | - Masato Nakafuku
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Tadafumi Kato
- Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Hidewaki Nakagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo 113-8654, Japan
| | - Hirofumi Nakatomi
- Biomedical Neural Dynamics Collaboration Laboratory, RIKEN Center for Brain Science, Wako, Saitama 351-0198, Japan
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo 181-8611, Japan
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo 113-8654, Japan
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Suzuki Y, Noda K, Yasuda S, Okada Y, Ono S, Kiko K, Yoshikawa K, Miyoshi N, Kondo T, Haraguchi K, Oda J, Ota N, Kamiyama H, Tokuda S, Tanikawa R. A case of anterior choroidal artery occlusion test under MEP monitoring for a recurrent internal carotid artery-anterior choroidal artery bifurcation aneurysm clipping. J Surg Case Rep 2023; 2023:rjac639. [PMID: 36727118 PMCID: PMC9880138 DOI: 10.1093/jscr/rjac639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
A 59-year-old female with recurrent Anterior Choroidal Artery (AchA) aneurysm was elected for surgery at our institution through a standard pterional approach. Two thin perforating branches were found to origin from the dome of the aneurysm during operation, and therefore complete aneurysm clipping preserving these branches was not feasible. These perforating branches were temporarily occluded under motor-evoked potential (MEP) monitoring. The MEPs remained stable during 10 min of temporary clipping, and we concluded that these branches could be sacrificed, and therefore neck clipping was performed occluding these tiny AchA perforators. Although postoperative magnetic resonance imaging with diffusion-weighted images showed ischemic signs in left AchA territory after the operation, the patient remained asymptomatic and was discharged home with mRS 0.
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Affiliation(s)
- Yosuke Suzuki
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Souichirou Yasuda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Syun Ono
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Katsunari Kiko
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kohei Yoshikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Norio Miyoshi
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kenichi Haraguchi
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Jyunpei Oda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Correspondence address. Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, 3-1, Kita 33-jo Higashi 1-chome, Higashi-ku, Sapporo, Hokkaido, Japan. Tel: 011-712-1131; Fax: 011-751-0239; E-mail:
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Suzuki Y, Noda K, Ota N, Kondo T, Haraguchi K, Miyoshi N, Kiko K, Yoshikawa K, Ono S, Mizuno H, Okada Y, Takano T, Yasuda S, Oda J, Kamiyama H, Tokuda S, Tanikawa R. A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach. Surg Neurol Int 2023; 14:47. [PMID: 36895239 PMCID: PMC9990793 DOI: 10.25259/sni_995_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
Background Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial. Case Description A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle. Conclusion Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.
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Affiliation(s)
- Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kenichi Haraguchi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norio Miyoshi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kohei Yoshikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shun Ono
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyuki Mizuno
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takuma Takano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Soichiro Yasuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Jumpei Oda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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Ota N, Noda K, Chida D, Kiko K, Miyoshi N, Kondo T, Haraguchi K, Kamiyama H, Tokuda S, Tanikawa R. Emergent Subarachnoid Clot Removal with Aneurysm Repair for Subarachnoid Hemorrhage Might Improves Clinical Outcome. World Neurosurg 2022; 167:e100-e109. [PMID: 35953044 DOI: 10.1016/j.wneu.2022.07.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The goal in treating patients with subarachnoid hemorrhage (SAH) is shifting to preventing early brain injury. Intracranial pressure must be controlled to manage such an injury. We retrospectively analyzed the impact of aggressive removal of cisternal subarachnoid clots with simultaneous aneurysm repair for all grades of SAH. METHODS Our study included 260 consecutive patients with SAH treated through aggressive subarachnoid clot removal with simultaneous aneurysm repair. Baseline patient characteristics, history, radiographic findings, and time of SAH onset to arrival in the operating room were retrospectively collected. Factors related to poor outcome (modified Rankin Scale score >2) were analyzed. RESULTS Multivariate analysis revealed several characteristics were significantly associated with poor outcome: advanced age (adjusted odds ratio [aOR] 1.07, 95% confidence interval [CI] 1.04-01.10); time of SAH onset to operating room per 1-hour increments (aOR 1.03, 95% CI 1.01-01.05; postoperative hematoma volume (aOR 1.04, 95% CI 1.01-01.06); and poorer World Federation of Neurosurgical Societies grade (aOR 2.18, 95% CI 1.63-02.92). According to a receiver operating characteristic analysis, the cut-off time of SAH onset to operating room was 6.0 hours (area under the curve 0.61, P = 0.01, 95% CI 0.52-0.69, sensitivity = 0.79, specificity = 0.43) as the threshold between modified Rankin Scale scores of 0-2 and 3-6. CONCLUSIONS Prognostic factors of SAH in patients undergoing emergent aneurysm repair with simultaneous removal of a cisternal subarachnoid clot are advanced age, poorer World Federation of Neurosurgical Societies grade, postoperative hematoma volume, and a longer time from SAH onset to operating room. The clinical outcome may improve with emergent reduction of intracranial pressure through removal of the subarachnoid clot as soon as possible.
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
| | - Kosumo Noda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Daiki Chida
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Katsunari Kiko
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Norio Miyoshi
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kenichi Haraguchi
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. In Reply: Impact of Anterior Clinoidectomy on Visual Function After Paraclinoid Carotid Artery Aneurysm Surgery: Power-Drill Versus No-Drill Technique. Neurosurg open 2021. [DOI: 10.1093/neuopn/okab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marani W, Mannará F, Noda K, Kondo T, Ota N, Perrini P, Montemurro N, Kinoshita Y, Tsuji S, Kamiyama H, Tanikawa R. Management of an Uncommon Complication: Anterior Choroidal Artery Occlusion by Posterior Clinoid Process Detected Through Intraoperative Monitoring After Clipping of Paraclinoid Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E124-E125. [PMID: 33861341 DOI: 10.1093/ons/opab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022] Open
Abstract
Despite technological advances in endovascular therapy, surgical clipping of paraclinoid aneurysms remains an indispensable treatment option and has an acceptable profile risk. Intraoperative monitoring of motor and somatosensory evoked potentials has proven to be an effective tool in predicting and preventing postoperative motor deficits during aneurysm clipping.1,2 We describe the case of a 61-yr-old Japanese woman with a history of hypertension and smoking. During follow-up for bilateral aneurysms of ophthalmic segment of the internal carotid artery (ICA), left-sided aneurysm growth was detected. A standard pterional approach with extradural clinoidectomy was used to approach the aneurysm. After clipping, a significant intraprocedural change in motor evoked potential (MEP) amplitude was observed despite native vessel patency was confirmed through micro-Doppler and indocyanine green video angiography.3-5 After extensive dissection of the sylvian fissure and exposure of the communicating segment of ICA, the anterior choroidal artery was found to be compressed and occluded by the posterior clinoid because of an inadvertent shift of the ICA after clip application and removal of brain retractors. Posterior clinoidectomy was performed intradurally with microrongeur and MEP amplitude returned readily to baseline values. Computed tomography (CT) angiogram demonstrated complete exclusion of the aneurysm, and magnetic resonance imaging (MRI) was negative for postoperative ischemic lesions on diffusion weighted images. The patient tolerated the procedure well and was discharged home on postoperative day 3 with modified Rankin Scale (mRS) 0. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
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Affiliation(s)
- Walter Marani
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.,Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Francisco Mannará
- Department of Neurosurgery, Hospital Fernández, Buenos Aires, Argentina
| | - Kosumo Noda
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tomomasa Kondo
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.,Department of Translational Research and of New Surgical and Medical Technologies, Department of Neurosurgery, University of Pisa, Pisa, Italy
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.,Department of Translational Research and of New Surgical and Medical Technologies, Department of Neurosurgery, University of Pisa, Pisa, Italy
| | - Yu Kinoshita
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shoichiro Tsuji
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
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Ota N, Morita A, Tominari S, Nakayama T, Nozaki K, Tominaga T, Noda K, Kamiyama H, Tanikawa R. Differences Between Subarachnoid Hemorrhage Seen in Daily Practice and Aneurysms That Rupture During Follow-Up. Stroke 2021; 52:e491-e493. [PMID: 34310178 DOI: 10.1161/strokeaha.121.035278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital (N.O., K.N., H.K., R.T.)
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo (A.M.)
| | - Shinjiro Tominari
- Department of Health Informatics, Kyoto University School of Public Health (S.T., T.N.)
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health (S.T., T.N.)
| | - Kazuhiko Nozaki
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital (N.O., K.N., H.K., R.T.)
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (T.T.)
| | - Kosumo Noda
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan (K.N.)
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital (N.O., K.N., H.K., R.T.)
| | - Rokuya Tanikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital (N.O., K.N., H.K., R.T.)
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9
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. Impact of Anterior Clinoidectomy on Visual Function After Paraclinoid Carotid Artery Aneurysm Surgery: Power-Drill Versus No-Drill Technique. Neurosurgery Open 2021. [DOI: 10.1093/neuopn/okab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT
BACKGROUND
Few studies have attempted to make a direct comparison of the risk of visual impairment following extradural anterior clinoidectomy (EAC) with and without the use of a power drill.
OBJECTIVE
To evaluate postoperative visual outcomes between groups of patients with paraclinoid carotid artery aneurysms (PCAAs) who underwent surgical clipping with and without the use of a power drill during EAC.
METHODS
Between January 2010 and November 2019, 90 patients, 7 with ruptured and 83 with unruptured PCAAs, underwent clipping surgery at our hospital. The authors retrospectively analyzed postoperative visual complications from the medical records of these patients.
RESULTS
Among the 85 patients (excluding 3 patients with disturbance of consciousness caused by subarachnoid hemorrhage and 2 patients with preoperative visual disturbance) evaluated, EAC was conducted using a power drill in 64 patients and using a microrongeur in 21 patients. Permanent postoperative visual impairment developed in 14 (21.9%) patients in the drill group: 9 patients had ipsilateral lower nasal quadrant hemianopsia (ILNQH) and 5 patients had ipsilateral visual acuity reduction. Transient ILNQH developed in only 1 patient in the no-drill group. The incidence of permanent postoperative visual impairments was significantly lower in the no-drill group than in the drill group (P = .020). Seventeen (26.6%) patients developed transient oculomotor nerve palsy in the drill group, while no patients developed oculomotor nerve palsy in the no-drill group.
CONCLUSION
EAC using a microrongeur versus a power drill significantly improved visual outcomes after clipping surgery for PCAAs.
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Affiliation(s)
- Takeya Niibo
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Jurou Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Seizi Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Koizumi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Toru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Rina Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Kouta Kuris
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Syusuke Gotou
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Ryousuke Tsuchiya
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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10
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Nakatomi H, Kiyofuji S, Ono H, Tanaka M, Kamiyama H, Takizawa K, Imai H, Saito N, Shiokawa Y, Morita A, Flemming KD, Link MJ. Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction-Clinicopathological and Surgical Outcome. Neurosurgery 2021; 88:82-95. [PMID: 32745190 PMCID: PMC7891276 DOI: 10.1093/neuros/nyaa317] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Giant fusiform and dolichoectatic aneurysms of the basilar trunk and
vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat. OBJECTIVE To evaluate factors influencing survival and outcome of BTVBJ-GFDA by
performing a retrospective multicenter cohort study. METHODS A total of 32 patients with BTVBJ-GFDA were included in this study.
Clinicopathological characteristics, treatment measures, and outcomes were
collected from medical records and imaging studies. Autopsy and histological
findings of the aneurysm and adjacent brain tissue were also obtained in 9
cases. RESULTS A total of 11 patients did not undergo surgery, of whom 10 died; 3 from
progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from
brainstem infarction, and 1 from associated atherosclerotic disease. The
remaining 21 patients underwent a surgical treatment, consisting of
immediately proximal parent artery occlusion, remotely proximal parent
artery occlusion, clip reconstruction, and distal bypass and achieved
significantly longer overall survival compared with those who received
conservative therapy (adjusted hazard ratio 1.508, 95% CI
1.058-2.148, P = .02). Histological
examination of the aneurysms demonstrated staged clots, open lumen, and
intrathrombotic channels with endothelial lining. The patients younger than
45 yr of age showed statistically longer survival than those equal and older
than 45 yr (P = .03). CONCLUSION Surgical intervention achieved greater survival than conservative management
in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the
aneurysm to maintain sufficient but not excess supply should be targeted
based on the hemodynamics of both the posterior communicating arteries and
perforating vessel collaterals.
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Affiliation(s)
- Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.,Division of Collaborative Laboratory for Medical Science of Neural Dynamics, RIKEN Center for Brain Science, Saitama, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideaki Ono
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery and Stroke, Teishinkai Hospital, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Hideaki Imai
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Akio Morita
- Department of Neurosurgery, Nippon Medical University, Tokyo, Japan
| | | | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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11
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Marani W, Montemurro N, Tsuji S, Perrini P, Noda K, Ota N, Kinoshita Y, Kamiyama H, Tanikawa R. Microsurgical resection of unruptured cerebellar arteriovenous malformation presenting with trigeminal neuralgia. Neurosurgical Focus: Video 2021; 4:V13. [PMID: 36284621 PMCID: PMC9542384 DOI: 10.3171/2020.10.focvid2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Cerebellar arteriovenous malformations (AVMs) represent 10%–15% of all intracranial AVMs and are associated with a greater risk for hemorrhagic presentation compared with supratentorial AVMs. When they reach the cerebellopontine angle cistern, neurovascular compression syndromes, including trigeminal neuralgia and hemifacial spasm, can occur. Due to the aggressive natural history of cerebellar AVM, an effective treatment strategy is required. In this video, the authors demonstrate the technical nuances of microsurgical resection of an unruptured cerebellar AVM in a 24-year-old female presenting with trigeminal neuralgia. The patient underwent right retrosigmoid craniotomy and complete resection of the AVM with resolution of trigeminal neuralgia. The video can be found here: https://youtu.be/6GmNjgFQwx8
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Affiliation(s)
- Walter Marani
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa; and
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa; and
- Department of Translational Research on New Surgical and Medical Technologies, University of Pisa, Italy
| | - Shoichiro Tsuji
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa; and
- Department of Translational Research on New Surgical and Medical Technologies, University of Pisa, Italy
| | - Kosumo Noda
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan
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12
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Ota N, Petrakakis I, Noda K, Miyazaki T, Kondo T, Kinoshita Y, Kamiyama H, Tokuda S, Tanikawa R. Predictor of Visual Impairment Following Paraclinoid Aneurysm Surgery: Special Consideration of Surgical Microanatomy Related to Paraclinoid Structures. Oper Neurosurg (Hagerstown) 2020; 20:45-54. [PMID: 33047135 DOI: 10.1093/ons/opaa298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Microsurgical clipping with extradural anterior clinoidectomy (EDAC) for paraclinoid aneurysm is an established technique with good angiographic outcomes, although postoperative worsening of visual acuity remains a concern. Multiple reports show visual acuity deteriorating after clipping, yet the cause remains unclear. OBJECTIVE To analyze results of asymptomatic paraclinoid aneurysm surgeries treated with EDACs, specifically focusing on the microanatomy of paraclinoid structure dissection. This determined the causes of delayed visual impairment and microsurgical indications. METHODS Results of the treatment with EDAC of 94 patients with cerebral aneurysm and normal preoperative visual acuity but also full visual fields were retrospectively analyzed. RESULTS The mean aneurysm size was 6.2 (±3.3) mm. Clipping was performed in 87 cases and trapping in 7 cases. Complete angiographic occlusion was observed in 91 patients. In 26 cases, a postoperative visual deficit occurred. A total of 20 cases exhibited partial visual field deficits, including 5 who were asymptomatic. Visual deficits were only detectable by postoperative ophthalmologic testing. Six showed light perception impairment or blinding. Of the 15 patients with symptomatic partial visual field deficits, 5 showed improvement at follow-up. Visual deficits persisted in 22 patients at the last follow-up. Multivariate logistic regression analysis revealed that medial projecting aneurysm (adjusted odds ratio [OR]: 10.43) and the opening of the carotidoculomotor membrane (adjusted OR: 5.19) were significantly related to visual impairment. CONCLUSION Excess dissection of carotidoculomotor membranes causes postoperative delayed visual worsening. For treating small, asymptomatic paraclinoid aneurysms, carotidoculomotor membranes should not be opened, and microsurgical clipping should not be performed for preoperative asymptomatic medial projecting aneurysms.
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Ioannis Petrakakis
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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13
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Tamura T, Tanikawa R, Pirayesh A, Kinoshita Y, Ota N, Noda K, Kamiyama H. Modified micro-scissors as stimulation-dissection tool – Technical note. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Tamura T, Ota N, Okada Y, Valenzuela J, Noda K, Kamiyama H, Tanikawa R. Sylvian Hematoma Removal after the Stent-Retriever Thrombectomy Accompanied by Arteriole Avulsion: Case Report. J Neuroendovasc Ther 2020; 15:94-99. [PMID: 37502806 PMCID: PMC10370804 DOI: 10.5797/jnet.cr.2020-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 07/29/2023]
Abstract
Objective We describe an instructive case of post-thrombectomy subarachnoid hemorrhage (PTSAH) by sylvian hematoma removal. Case Presentations An 83-year-old female presented with an acute cardiogenic right M1 occlusion. After the thrombectomy with combined stent retriever and aspiration technique with total five passes, TICI 2b reperfusion was achieved; however, CT imaging displayed subarachnoid hematoma (SAH) along the right sylvian fissure. Throughout the approach, contrast extravasation was not confirmed. The SAH grew up to become the sylvian hematoma; therefore, removal of the sylvian hematoma was conducted. An abrupt arteriole tear around the distal M2 of parietal artery was confirmed as bleeding point and those teared arteriole's stumps were electrically coagulated not to re-bleed. Conclusion We suggest that the PTSAH is possible even in invisible-extravasation cases and the sylvian hematoma removal is effective to elucidate the etiology of the PTSAH, and is a reliable method to prevent the re-bleeding and is anticipated to improve the prognosis. Craniotomy is required for medically resistant PTSAH after thrombectomy, and avulsion of the pial artery can be the cause.
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Affiliation(s)
- Takamitsu Tamura
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | | | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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15
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. Prediction of the difficulty of proximal vascular control using 3D-CTA for the surgical clipping of internal carotid artery-posterior communicating artery aneurysms. J Neurosurg 2020; 134:1165-1172. [PMID: 32276244 DOI: 10.3171/2020.1.jns192728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During surgical clipping of internal carotid artery (ICA)-posterior communicating artery (PCoA) aneurysms, proximal vascular control (PVC) is difficult to achieve in some cases because of variations in the anatomy of this type of aneurysm and its parent arteries. The authors investigated morphometric features that may be predictive for the necessity of anterior clinoidectomy (ACL) or cervical ICA exposure for PVC. METHODS The authors retrospectively reviewed 65 patients with an ICA-PCoA aneurysm treated with clipping during the previous 3 years. The factors considered for assessing the difficulty of attaining PVC included the following: the maximum diameter of the aneurysm; the distance between the tip of the anterior clinoid process (ACP) and the proximal aneurysmal neck; the presence of calcification at the ophthalmic segment of the ICA; and the angles between the communicating segment of the ICA and the ophthalmic segment of the ICA and a line perpendicular to the cranial base, which reflect the tortuosity of the ICA. These parameters were measured based on preoperative CTA results. RESULTS In a total of 21 patients (32.3%), PVC was difficult to perform with the usual pterional approach. In 6 patients, temporary artery occlusions (TAOs) were difficult to achieve because of severe atherosclerotic wall changes in the ophthalmic segment of the ICA. For 15 patients, the ACPs overhanging the ophthalmic segment of the ICA obstructed the ability to secure a space for TAO. In the 21 patients with PVC difficulty, ACL alone, cervical ICA exposure alone, and both ACL and cervical ICA exposure were conducted in 6, 8, and 7 patients, respectively. Multivariate analysis with binary logistic regression revealed that the maximum diameter of the aneurysm (p = 0.041), the distance between the proximal neck of the aneurysm and the ACP tip (p = 0.002), and calcification of the ICA ophthalmic segment (p = 0.001) were significant predictive factors for difficulties with PVC. A receiver operating characteristic curve analysis revealed that a distance between the proximal aneurysmal neck and the ACP tip of ≤ 5.4 mm was the best cutoff value for predicting the difficulty of attaining PVC (area under the curve 0.800, sensitivity 80.0%, specificity 80.0%). CONCLUSIONS A short distance between the proximal aneurysmal neck and the ACP tip and the presence of calcification at the ophthalmic segment of the ICA on preoperative CTA are helpful for predicting the difficulty of achieving PVC.
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Affiliation(s)
- Takeya Niibo
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Katsumi Takizawa
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Jurou Sakurai
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Seizi Takebayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Hiroyasu Koizumi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Toru Kobayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Rina Kobayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Kouta Kuris
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Syusuke Gotou
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Ryousuke Tsuchiya
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Hiroyasu Kamiyama
- 2Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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16
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Pirayesh A, Ota N, Noda K, Petrakakis I, Kamiyama H, Tokuda S, Tanikawa R. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization - a quest for the ultimate therapy. Neurosurg Rev 2020; 44:1031-1051. [PMID: 32212048 DOI: 10.1007/s10143-020-01290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
The long-term stability of coil embolization (CE) of complex intracranial aneurysms (CIAs) is fraught with high rates of recanalization. Surgery of precoiled CIAs, however, deviates from a common straightforward procedure, demanding sophisticated strategies. To shed light on the scope and limitations of microsurgical re-treatment, we present our experiences with precoiled CIAs. We retrospectively analysed a consecutive series of 12 patients with precoiled CIAs treated microsurgically over a 5-year period, and provide a critical juxtaposition with the literature. Five aneurysms were located in the posterior circulation, 8 were large-giant sized, 5 were calcified/thrombosed. One presented as a dissecting-fusiform aneurysm, 9 ranked among wide neck aneurysms. Eight lesions were excluded by neck clipping (5 necessitating coil extraction); 1 requiring adjunct CE. The dissecting-fusiform aneurysm was resected with reconstruction of the parent artery using a radial artery graft. Three lesions were treated with flow alteration (parent artery occlusion under bypass protection). Mean interval coiling-surgery was 4.6 years (range 0.5-12 years). Overall, 10 aneurysms were successfully excluded; 2 lesions treated with flow alteration displayed partial thrombosis, progressing over time. Outcome was good in 8 and poor in 4 patients (2 experiencing delayed neurological morbidity), and mean follow-up was 24.3 months. No mortality was encountered. Microsurgery as a last resort for precoiled CIAs can provide-in a majority of cases-a definitive therapy with good outcome. Since repeat coiling increases the complexity of later surgical treatment, we recommend for this subgroup of aneurysms a critical evaluation of CE as an option for re-treatment.
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Affiliation(s)
- Ariyan Pirayesh
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan.
| | - Nakao Ota
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Kosumo Noda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Ioannis Petrakakis
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery - Stroke Center, Sapporo Teishinkai Hospital, 3-1 Higashi 1, Kita 33, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan
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17
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach. J Neurosurg 2020; 134:999-1005. [PMID: 32197247 DOI: 10.3171/2020.1.jns192823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)-posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique. METHODS The authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed. RESULTS With the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed. CONCLUSIONS The SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.
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Affiliation(s)
- Takeya Niibo
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Katsumi Takizawa
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Jurou Sakurai
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Seizi Takebayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Hiroyasu Koizumi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Toru Kobayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Rina Kobayashi
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Kouta Kuris
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Syusuke Gotou
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Ryousuke Tsuchiya
- 1Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa; and
| | - Hiroyasu Kamiyama
- 2Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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Ota N, Petrakakis I, Kondo T, Kinoshita Y, Noda K, Kamiyama H, Tokuda S, Tanikawa R. Complex Bypass Surgery for Multiple Fusiform Aneurysms, Including a Thrombosed Giant Aneurysm of the Middle Cerebral Artery. World Neurosurg 2020; 138:284. [PMID: 32173549 DOI: 10.1016/j.wneu.2020.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022]
Abstract
Treatment of complex middle cerebral artery (MCA) aneurysms are challenging; however, an appropriate surgical strategy can ensure favorable outcomes. Notably, a protective bypass strategy is essential to treat complex aneurysms and involves the creation of a bypass channel distal to the aneurysm before repairing it. A protective bypass enables the surgeon to establish adequate distal blood flow during the approach to the aneurysm, as well as during additional revascularization. This Video 1 describes complex bypass surgery that successfully treated multiple fusiform aneurysms, including a thrombosed giant aneurysm of the MCA. A 12-year-old girl presented with a history of chronic headache and incidentally diagnosed multiple fusiform aneurysms along the course of the right internal carotid artery to the MCA, including a thrombosed giant aneurysm of the M2 segment of the MCA (M2) superior trunk. The aneurysms were treated by trapping and excision along with a superficial temporal artery to MCA triple bypass, and an M2-radial artery graft-M2 bypass. The patient developed mild left hemiparesis postoperatively but recovered well and was discharged with a modified Rankin Scale score of 0. The pathophysiology of this patient should be different from common saccular aneurysm because of young age and multiple fusiform shape. Hence continuous follow-up is essential. The next surgical strategy should be reconsidered according to the situation if the recurrence is occurred. This surgical video shows the surgical strategy and stepwise procedure to treat complex aneurysms and will be useful to vascular neurosurgeons to devise a surgical approach utilizing a "protective bypass strategy."
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan.
| | - Ioannis Petrakakis
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Tomomasa Kondo
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Yu Kinoshita
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Hokkaido, Japan
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Matsukawa H, Tanikawa R, Kamiyama H, Noda K, Uchida K, Shirakawa M, Yoshimura S. Outcome of retreatment for recurrent saccular cerebral aneurysms: a propensity score-matched analysis. Neurosurg Rev 2020; 44:935-944. [PMID: 32086690 DOI: 10.1007/s10143-020-01259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 11/25/2022]
Abstract
Although endovascular or surgical treatment has been performed for preventing the rupture of saccular cerebral aneurysms (sCA), in some patients, the aneurysms may recur and require retreatment. We aimed to investigate the clinical and radiological outcomes of treating recurrent sCA. We retrospectively evaluated the data of 52 patients with 60 recurrent sCAs who were retreated and 1534 patients with 1817 sCAs who received initial treatment. The primary outcome was a recurrence of the aneurysm. Secondary outcomes were an additional treatment, rupture after treatment, and a neurological worsening, which was defined as an increase of 1 or more scores using the modified Rankin Scale at 12-month. Safety outcomes included postoperative ischemic and hemorrhagic complications. We compiled the 120 (60 each) propensity score-matched cohort based on a propensity score for the treatment of recurrent sCA. In the propensity score-matched cohort, recurrence after treatment was observed in 25% and 6.7% of cases in the retreatment and initial treatment groups, respectively. The odds ratio of recurrence after treatment was 4.7 (95% CI, 1.4-15; P = 0.011). The secondary and safety outcomes were not significantly different between the two groups. This study showed that the treatment of recurrent sCA was a risk factor for recurrence after treatment but not for additional treatment, rupture after treatment, or neurological worsening. Although decision-making regarding the treatment varies depending on the institutional protocols and personal experience of the physicians, endovascular or surgical retreatment could be performed without hesitation.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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Hatano Y, Ota N, Noda K, Okada Y, Suzuki Y, Fukuyama S, Tanada S, Hashimoto A, Kondo T, Miyazaki T, Kinoshita Y, Kamiyama H, Tokuda S, Tanikawa R. Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction. Surg Neurol Int 2019; 10:127. [PMID: 31528463 PMCID: PMC6744747 DOI: 10.25259/sni-16-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.
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Affiliation(s)
- Yuto Hatano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shusei Fukuyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Shuichi Tanada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Atsumu Hashimoto
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
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Sato H, Miyachi S, Hashimoto A, Kinoshita Y, Wada H, Kamada K, Tanikawa R, Kamiyama H. [Transarterial Embolization of Intraorbital Dural Arteriovenous Fistula:A Case Report]. No Shinkei Geka 2019; 47:777-783. [PMID: 31358697 DOI: 10.11477/mf.1436204022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intraorbital dural arteriovenous fistula(dAVF)is a very rare disease; therefore, an optimal treatment strategy has not yet been established. Here, we describe a case of successful dAVF treatment by performing transarterial embolization(TAE)with n-butyl-2-cyanoacrylate(NBCA). A 66-year-old male presented with right conjunctival injection, with no history of trauma. Magnetic resonance imaging(MRI)demonstrated a flow void in the right orbit. Digital subtraction angiography(DSA)revealed an AVF fed by a branch of the right ophthalmic artery(OA)and draining into the dilated right superior ophthalmic vein(SOV). A transvenous embolization(TVE)was planned, but it could not be performed because the facial vein was meandering. Hence, TAE with NBCA was performed, and the AVF was successfully occluded by this method. There has been no recurrence of intraorbital dAVF in three months since the treatment. Several recent studies have reported that TAE is an effective treatment for intracranial dAVF. However, there are insufficient reports of TAE with NBCA for intraorbital dAVF treatment. The anatomy of the OA needs to be known for the success of TAE in treating intraorbital dAVF, because TAE is a high-risk treatment. In this paper, we report a case wherein TAE with NBCA was performed for intraorbital dAVF and further review the other treatment options.
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Affiliation(s)
- Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University
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22
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Ota N, Noda K, Hatano Y, Hashimoto A, Miyazaki T, Kondo T, Kinoshita Y, Kamiyama H, Tokuda S, Kamada K, Tanikawa R. Preoperative Predictors and Prognosticators After Microsurgical Clipping of Poor-Grade Subarachnoid Hemorrhage: A Retrospective Study. World Neurosurg 2019; 125:e582-e592. [DOI: 10.1016/j.wneu.2019.01.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Ota N, Noda K, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Comprehensive analysis of perforator territory infarction on postoperative diffusion-weighted imaging in patients with surgically treated unruptured intracranial saccular aneurysms. J Neurosurg 2019; 132:1088-1095. [PMID: 30835684 DOI: 10.3171/2018.11.jns181235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perforator territory infarction (PTI) is still a major problem needing to be solved to achieve good outcomes in aneurysm surgery. However, details and risk factors of PTI diagnosed on postoperative MRI remain unknown. The authors aimed to investigate the details of PTI on postoperative diffusion-weighted imaging (DWI) in patients with surgically treated unruptured intracranial saccular aneurysms (UISAs). METHODS The data of 848 patients with 1047 UISAs were retrospectively evaluated. PTI was diagnosed on DWI, which was performed the day after aneurysm surgery. Clinical and radiological characteristics were compared between UISAs with and without PTI. Poor outcome was defined as an increase in 1 or more modified Rankin Scale scores at 12 months after aneurysm surgery. RESULTS Postoperative DWI was performed in all cases, and it revealed PTI in 56 UISA cases (5.3%). Forty-three PTIs occurred without direct injury and occlusion of perforators (43 of 56, 77%). Poor outcome was more frequently observed in the PTI group (17 of 56, 30%) than the non-PTI group (57 of 1047, 5.4%) (p < 0.0001). Thalamotuberal arteries (p < 0.01), lateral striate arteries (p < 0.01), Heubner's artery (p < 0.01), anterior median commissural artery (p < 0.05), terminal internal carotid artery perforators (p < 0 0.01), and basilar artery perforator (p < 0 0.01) infarctions were related to poor outcome by adjusted residual analysis. On multivariate analysis, statin use (OR 10, 95% CI, 3.3-31; p < 0.0001), specific aneurysm locations (posterior communicating artery [OR 4.1, 95% CI 2.1-8.1; p < 0.0001] and basilar artery [OR 3.1, 95% CI 1.1-8.9; p = 0.031]), larger aneurysm size (OR 1.1, 95% CI 1.1-1.2; p = 0.043), and permanent decrease of motor evoked potential (OR 38, 95% CI 3.1-468; p = 0.0045) were related to PTI. CONCLUSIONS Despite efforts to avoid PTI, it occurred even without direct injury, occlusion of perforators, or evoked potential abnormality. Therefore, surgical treatment of UISAs, especially with the aforementioned risk factors of PTI, should be more carefully considered. The evaluation of PTI in the territory of the above-mentioned perforators could be useful in helping predict the clinical course in patients after aneurysm surgery.
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Affiliation(s)
| | | | | | | | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, and
| | | | - Osamu Takahashi
- 3Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
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Matsukawa H, Miyazaki T, Kiko K, Kamiyama H, Ota N, Noda K, Takahashi O, Shonai T, Fujisawa T, Tokuda S, Tanikawa R. Thick Clot in the Inferior Limiting Sulcus on Computed Tomography Image as an Indicator of Sylvian Subpial Hematoma in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 125:e612-e619. [PMID: 30716497 DOI: 10.1016/j.wneu.2019.01.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Sylvian subpial hematoma (SSH) is occasionally observed in aneurysm subarachnoid hemorrhage (aSAH) when accompanied with the thick clot in the inferior limiting sulcus (ILS). We aimed to determine whether the thickness of the clot in the ILS (TCILS) was an indicator of SSH. METHODS Data from 150 consecutive patients with aSAH were retrospectively analyzed. The relationship between TCILS on axial computed tomography (CT) image and intraoperatively confirmed SSH was reviewed. In patients without SSH, the average of the clot thickness in the bilateral ILS was used. The primary outcome was SSH. RESULTS The median TCILS of the SSH group (n = 18, 12%) was larger than that of the non-SSH group (n = 132, 88%) (21 vs. 2.1 mm, respectively; P < 0.001). The intraclass correlation coefficients for clot thickness in the right and left ILS between 2 observers were 0.97 (P < 0.001) and 0.85 (P < 0.001). The TCILS threshold of ≥6.0 mm was associated with SSH, with a sensitivity of 89% and specificity of 99%. The unadjusted and adjusted odds ratios of the SSH of clot thickness in the affected ILS ≥6 mm relative to clot thickness in the affected ILS <6 mm were 263 (95% confidence interval [CI], 46-5063) and 137 (95% CI, 19-3029), respectively. CONCLUSIONS The clot thickness in the ILS on CT image was easily measured and could be a marker of SSH. SSH assessment could be useful in helping us predict the clinical course in patients with aSAH.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- St.Luke's International University Graduate School of Public Health, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takaharu Shonai
- Department of Radiology, Teishinkai Hospital, Sapporo, Japan
| | | | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
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Matsukawa H, Kamiyama H, Noda K, Ota N, Takahashi O, Shonai T, Tokuda S, Tanikawa R. Embryological basilar apex disposition as a risk factor of basilar apex aneurysm. J Clin Neurosci 2018; 58:79-82. [PMID: 30327221 DOI: 10.1016/j.jocn.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 09/10/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
The pathogenesis of basilar apex aneurysm (BAA) are still poorly understood. Embryologically, basilar apex anatomical disposition is formed by the fusion of both caudal internal carotid divisions on the midline. To compare basilar apex morphology by embryological classification among patients with BAAs, anterior circulation aneurysms (ACAs), and controls. Prospectively collected data of 47 consecutive patients with unruptured BAAs (42 females and five males), age- and gender-matched 47 patients with unruptured ACAs, and 47 controls without any aneurysms were analyzed. Based on embryology, basilar apex morphology was classified into symmetric cranial fusion (SCrF), symmetric caudal fusion, and asymmetric fusion type. Posterior communicating artery (Pcom) was classified into hypoplastic, adult, or fetal type. The asymmetrical Pcom was defined as bilaterally different type Pcom. The ACAs located at the anterior communicating artery (n = 18), paraclinoid portion (n = 12), middle cerebral artery (n = 8), anterior cerebral artery (n = 5), the top of internal carotid artery (n = 2), and anterior choroidal artery (n = 2). Compared with the ACA group and controls, smoking, asymmetrical Pcom (fetal and adult type), and SCrF type were more prevalent in patients with BAAs by residual analysis. The multinomial logistic regression comparative analysis demonstrated that SCrF type was associated with BAAs (vs. ACA group; odds ratio, 13; 95% confidence interval, 3.8-41 and vs. controls; odds ratio, 25; 95% confidence interval, 5.4-121). The assessment of basilar apex morphology may aid in the understanding of the pathogenesis of BAA and the prediction of BAA formation.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takaharu Shonai
- Department of Radiology, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
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Kamiyama H, Yoshida Y, Yoshida H, Kosugi C, Ishibashi K, Ihara K, Takahashi M, Kuramochi H, Fukazawa A, Sonoda H, Yoshimatsu K, Matsuda A, Yamaguchi S, Ishida H, Hasegawa S, Yamada T, Sakamoto K, Koda K. The combination of TAS-102 and bevacizumab as the third line chemotherapy for metastatic colorectal cancer (TAS-CC3 Study). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Matsukawa H, Kamiyama H, Kinoshita Y, Saito N, Hatano Y, Miyazaki T, Ota N, Noda K, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Morphological parameters as factors of 12-month neurological worsening in surgical treatment of patients with unruptured saccular intracranial aneurysms: importance of size ratio. J Neurosurg 2018; 131:852-858. [PMID: 30239320 DOI: 10.3171/2018.4.jns173221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is well known that larger aneurysm size is a risk factor for poor outcome after surgical treatment of unruptured saccular intracranial aneurysms (USIAs). However, the authors have occasionally observed poor outcome in the surgical treatment of small USIAs and hypothesized that size ratio has a negative impact on outcome. The aim of this paper was to investigate the influence of size ratio on outcome in the surgical treatment of USIAs. METHODS Prospectively collected clinical and radiological data of 683 consecutive patients harboring 683 surgically treated USIAs were evaluated. Dome-to-neck ratio was defined as the ratio of the maximum width of the aneurysm to the average neck diameter. The aspect ratio was defined as the ratio of the maximum perpendicular height of the aneurysm to the average neck diameter of the aneurysm. The size ratio was calculated by dividing the maximum aneurysm diameter (height or width, mm) by the average parent artery diameter (mm). Neurological worsening was defined as an increase in modified Rankin Scale score of 1 or more points at 12 months. Clinical and radiological variables were compared between patients with and without neurological worsening. RESULTS The median patient age was 64 years (IQR 56-71 years), and 528 (77%) patients were female. The median maximum size, dome-to-neck ratio, aspect ratio, and size ratio were 4.7 mm (IQR 3.6-6.7 mm), 1.2 (IQR 1.0-1.4), 1.0 (IQR 0.76-1.3), and 1.9 (IQR 1.4-2.8), respectively. The size ratio was significantly correlated with maximum size (r = 0.83, p < 0.0001), dome-to-neck ratio (r = 0.69, p < 0.0001), and aspect ratio (r = 0.74, p < 0.0001). Multivariate logistic regression analysis showed that the specific USIA location (paraclinoid segment of the internal carotid artery: OR 6.2, 95% CI 2.6-15, p < 0.0001; and basilar artery: OR 8.4, 95% CI 2.8-25, p < 0.0001), size ratio (OR 1.3, 95% CI 1.1-1.6, p = 0.021), and postoperative ischemic lesion (OR 9.4, 95% CI 4.4-19, p < 0.0001) were associated with neurological worsening (n = 52, 7.6%), and other characteristics showed no significant differences. CONCLUSIONS The present study showed that size ratio, and not other morphological parameters, was a risk factor for 12-month neurological worsening in surgically treated patients with USIAs. The size ratio should be further studied in a large, prospective observational cohort to predict neurological worsening in the surgical treatment of USIAs.
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Affiliation(s)
| | | | | | | | - Yuto Hatano
- 1Department of Neurosurgery, Stroke Center, and
| | | | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, and
| | | | - Osamu Takahashi
- 3Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
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Ota N, Matsukawa H, Noda K, Sato H, Hatano Y, Hashimoto A, Miyazaki T, Kondo T, Kinoshita Y, Saito N, Kamiyama H, Tokuda S, Kamada K, Tanikawa R. Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study. World Neurosurg 2018; 115:e190-e199. [DOI: 10.1016/j.wneu.2018.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Ota N, Noda K, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Surgical Treatment of Middle Cerebral Artery Aneurysms: Aneurysm Location and Size Ratio as Risk Factors for Neurologic Worsening and Ischemic Complications. World Neurosurg 2018; 117:e563-e570. [PMID: 29929026 DOI: 10.1016/j.wneu.2018.06.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Regardless of acceptable surgical results of middle cerebral artery aneurysms (MCAs), MCA territory infarction (MCATI) remains a major obstacle to achieving a good outcome. We investigated the MCATI in patients with surgically treated MCA aneurysms. METHODS The data of 286 consecutive patients with 322 MCA aneurysms were evaluated retrospectively. The aneurysm location was classified as early frontal cortical branch (EFCB), early temporal cortical branch (ETCB), bifurcation or trifurcation (M1-2), and distal aneurysms on the insular, opercular, or cortical segments of the MCA (distal MCA). Neurologic worsening was defined as an increase in 1 or more modified Rankin Scale (mRS) scores. RESULTS Multivariate analysis identified EFCB location as the sole risk factor for MCATI (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.2-12; P = 0.021) and MCATI (OR, 18; 95% CI, 2.8-117; P = 0.002) and a larger size ratio (OR, 1.4; 95% CI, 1.1-1.8; P = 0.019) were related to 12-month neurologic worsening (n = 6; 1.9%). During follow-up (median, 885 days; interquartile range, 485-1229 days), posttreatment rupture and aneurysm recurrence were not observed. CONCLUSIONS In the present study, compared with M1-2 aneurysms, MCATIs were observed more frequently in EFCB aneurysms, and the presence of MCATI and a larger size ratio were related to 12-month neurologic worsening in patients with surgically treated MCA aneurysms.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takaharu Shonai
- Department of Radiology, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
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Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takeda R, Tokuda S. Graft Occlusion and Graft Size Changes in Complex Internal Carotid Artery Aneurysm Treated by Extracranial to Intracranial Bypass Using High-Flow Grafts with Therapeutic Internal Carotid Artery Occlusion. Neurosurgery 2018; 81:672-679. [PMID: 28368487 DOI: 10.1093/neuros/nyx075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/06/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although the extracranial-to-intracranial high-flow bypass (EC-IC HFB) continues to be indispensable for complex aneurysms, the risk factors for the graft occlusion and whether the graft size changes after the bypass have not been well established. OBJECTIVE To evaluate the risk factors for the graft occlusion and to confirm whether graft diameters changed over time. METHODS The data of 75 patients who suffered from complex internal carotid artery (ICA) aneurysms and were treated by EC-IC HFB using radial artery graft (RAG) or saphenous vein graft (SVG) with therapeutic ICA occlusion were evaluated. Clinical and radiological characteristics were compared in patients with and without the graft occlusion by the log-rank test. Graft diameters measured preoperatively, postoperatively, at 6 months, and at 1 year were compared by paired t-test. RESULTS During a follow-up period (median 26.2 months), graft occlusions were seen in 4 patients (5.3%), and these were the SVGs. Only SVG was related to graft occlusion (P < .001). There was a significant increase with time in RAG diameters (preoperative, 3.1 ± 0.41 mm; postoperative, 3.6 ± 0.65 mm; 6 months, 4.3 ± 1.0 mm; 1 year, 4.4 ± 1.0 mm), while there were no significant diameter changes in SVGs. CONCLUSION The present study showed that the SVG was related to the graft occlusion and RAGs gradually enlarged. Unless Allen test is negative, RAG may be better to be used as a graft in EC-IC HFB if therapeutic ICA occlusion is needed.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Noda K, Ota N, Saito N, Takeda R, Tokuda S, Tanikawa R. Impacts of a Size Ratio on Outcome in Patients with Surgically Treated Unruptured Nondissecting Anterior Cerebral Artery Aneurysms. World Neurosurg 2018; 111:e250-e260. [DOI: 10.1016/j.wneu.2017.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
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Ota N, Matsukawa H, Kamiyama H, Tsuboi T, Noda K, Hashimoto A, Miyazaki T, Kinoshita Y, Saito N, Tokuda S, Kamada K, Tanikawa R. Preventing Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage with Aggressive Cisternal Clot Removal and Nicardipine. World Neurosurg 2017; 107:630-640. [DOI: 10.1016/j.wneu.2017.08.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 11/24/2022]
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Matsukawa H, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Miyazaki T, Kinoshita Y, Saito N, Takahashi O, Takeda R, Tokuda S, Tanikawa R. Subarachnoid hemorrhage after surgical treatment of unruptured intracranial aneurysms. J Neurosurg 2017; 129:490-497. [PMID: 29076778 DOI: 10.3171/2017.3.jns162984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Only a few previous studies have investigated subarachnoid hemorrhage (SAH) after surgical treatment in patients with unruptured intracranial aneurysms (UIAs). Given the improvement in long-term outcomes of embolization, more extensive data are needed concerning the true rupture rates after microsurgery in order to provide reliable information for treatment decisions. The purpose of this study was to investigate the incidence of and risk factors for postoperative SAH in patients with surgically treated UIAs. METHODS Data from 702 consecutive patients harboring 852 surgically treated UIAs were evaluated. Surgical treatments included neck clipping (complete or incomplete), coating/wrapping, trapping, proximal occlusion, and bypass surgery. Clippable UIAs were defined as UIAs treated by complete neck clipping. The annual incidence of postoperative SAH and risk factors for SAH were studied using Kaplan-Meier survival analysis and Cox proportional hazards regression models. RESULTS The patients' median age was 64 years (interquartile range [IQR] 56-71 years). Of 852 UIAs, 767 were clippable and 85 were not. The mean duration of follow-up was 731 days (SD 380 days). During 1708 aneurysm years, there were 4 episodes of SAH, giving an overall average annual incidence rate of 0.23% (95% CI 0.12%-0.59%) and an average annual incidence rate of 0.065% (95% CI 0.0017%-0.37%) for clippable UIAs (1 episode of SAH, 1552 aneurysm-years). Basilar artery location (adjusted hazard ratio [HR] 23, 95% CI 2.0-255, p = 0.0012) and unclippable UIA status (adjusted HR 15, 95% CI 1.1-215, p = 0.046) were significantly related to postoperative SAH. An excellent outcome (modified Rankin Scale score of 0 or 1) was achieved in 816 (95.7%) of 852 cases overall and in 748 (98%) of 767 clippable UIAs at 12 months. CONCLUSIONS In this large case series, microsurgical treatment of UIAs was found to be safe and effective. Aneurysm location and unclippable morphologies were related to postoperative SAH in patients with surgically treated UIAs.
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Affiliation(s)
- Hidetoshi Matsukawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Hiroyasu Kamiyama
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Toshiyuki Tsuboi
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Shiro Miyata
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Takanori Miyazaki
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Yu Kinoshita
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Norihiro Saito
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Osamu Takahashi
- 2Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Rihee Takeda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Sadahisa Tokuda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Rokuya Tanikawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Tsuboi T, Noda K, Ota N, Saito N, Takeda R, Tokuda S, Tanikawa R. Surgical treatment of unruptured distal basilar artery aneurysm: durability and risk factors for neurological worsening. Acta Neurochir (Wien) 2017. [PMID: 28638945 DOI: 10.1007/s00701-017-3239-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Distal basilar artery aneurysms (DBAs) consist of basilar apex and basilar artery-superior cerebellar artery bifurcation (BA-SCA) aneurysms. The authors aimed to investigate clinical and radiological differences between two locations and to evaluate the 12-month surgical outcome in unruptured DBAs. METHODS Fifty-six consecutive patients who underwent surgical treatment (37 basilar apex and 19 BA-SCA aneurysms) between April 2012 and February 2016 were retrospectively evaluated. In patients with a preoperative modified Rankin Scale score (mRS) of more than 1, neurological worsening (NW) was defined as an increase in one or more mRS. In patients without symptoms, NW was defined as mRS ≥2. RESULTS The mean age of the patient population was 64 ± 9.6 years, and 48 (86%) were female. Mean follow-up period was 2.6 ± 0.94 years. An excellent (mRS 0 to 1) outcome was archived in 31 (55%), 45 (82%), and 48 (87%) patients at 30 days, 6 months, and 12 months, respectively. Clinical and radiological characteristics showed no differences between two locations. One early death (1.8%) and one severe morbidity (1.8%) due to rupture were observed. The postoperative annual rupture rate was 1.4% overall (145 patient-years). After adjustment for age and location, large or giant DBA was related to 30-day and 12-month NW [n = 22 (39%) and n = 6 (11%); p = 0.009 and 0.002, respectively], aneurysm localization in the interpeduncular cistern (LIC) and perforator territory infarction were related to 30-day NW (p = 0.002 and 0.002), and DBA that needed bypass surgery and previously treated recurrent DBA were related to NW at 12 months (p = 0.017 and 0.001). Multivariate analysis showed that LIC was significantly related to perforator territory infarction (p = 0.003). CONCLUSIONS Clinical and radiological characteristics were not different between basilar apex and BA-SCA aneurysms; therefore, they should not be discussed separately. To avoid neurological worsening, results of surgical treatment for unruptured DBAs should be improved.
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Saito N, Tanikawa R, Tsuboi T, Noda K, Ota N, Miyata S, Matsukawa H, Yanagisawa T, Sakakibara F, Kinoshita Y, Miyazaki T, Kamiyama H, Tokuda S. Posterior Inferior Cerebellar Artery Thrombosed Aneurysm Associated with Persistent Primitive Hypoglossal Artery Successfully Treated with Condylar Fossa Approach. NMC Case Rep J 2017; 4:93-96. [PMID: 28840087 PMCID: PMC5566692 DOI: 10.2176/nmccrj.cr.2016-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/23/2017] [Indexed: 11/20/2022] Open
Abstract
A 68-year-old woman presented with generalized seizure due to the left internal carotid artery (ICA) aneurysmal compression of the ipsilateral medial temporal lobe. Computed tomography angiography (CTA) revealed multiple aneurysms of the right persistent primitive hypoglossal artery (PPHA), the right ICA, and the right anterior cerebral artery (ACA). The right PPHA originated from the ICA at the level of the C1 and C2 vertebral bodies and passed through the hypoglossal canal (HC). The PPHA aneurysm was large and thrombosed, which was located at the bifurcation of the right PPHA and the right posterior inferior cerebellar artery (PICA), projecting medially to compress the medulla oblongata. Since this patient had no neurological deficits, sequential imaging studies were performed to follow this lesion, which showed gradual growth of the PPHA aneurysm with further compression of the brain stem. Although the patient remained neurologically intact, considering the growing tendency clipping of the aneurysm was performed. Drilling of the condylar fossa was necessary to expose the proximal portion of the PPHA inside the HC. The key of this surgery was the preoperative imaging studies to fully understand the anatomical structures. The PPHA was fully exposed from the dura to the corner its turning inferiorly without damaging the occipital condylar facet. Utilizing this technique, the neck ligation of the aneurysm was safely achieved without any surgical complications.
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Affiliation(s)
- Norihiro Saito
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosmo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Shirou Miyata
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Yanagisawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Matsukawa H, Miyata S, Tsuboi T, Noda K, Ota N, Takahashi O, Takeda R, Tokuda S, Kamiyama H, Tanikawa R. Rationale for graft selection in patients with complex internal carotid artery aneurysms treated with extracranial to intracranial high-flow bypass and therapeutic internal carotid artery occlusion. J Neurosurg 2017; 128:1753-1761. [PMID: 28574313 DOI: 10.3171/2016.11.jns161986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE After internal carotid artery (ICA) sacrifice without revascularization for complex aneurysms, ischemic complications can occur. In addition, hemodynamic alterations in the circle of Willis create conditions conducive to the formation of de novo aneurysms or the enlargement of existing untreated aneurysms. Therefore, the revascularization technique remains indispensable. Because vessel sizes and the development of collateral circulation are different in each patient, the ideal graft size to prevent low flow-related ischemic complications (LRICs) in external carotid artery (ECA)-middle cerebral artery (MCA) bypass with therapeutic ICA occlusion (ICAO) has not been well established. Authors of this study hypothesized that the adequate graft size could be calculated from the size of the sacrificed ICA and the values of MCA pressure (MCAP) and undertook an investigation in patients with complex ICA aneurysms treated with ECA-graft-MCA bypass and therapeutic ICAO. METHODS In the period between July 2006 and January 2016, 80 patients with complex ICA aneurysms were treated with ECA-MCA bypass and therapeutic ICAO. Preoperative balloon test occlusion (BTO) was performed, and the BTO pressure ratio was defined as the mean stump pressure/mean preocclusion pressure. Low flow-related ischemic complications were defined as new postoperative neurological deficits and ipsilateral cerebral blood flow reduction. Initial MCAP (iMCAP), MCAP after clamping the ICA (cMCAP), and MCAP after releasing the graft (gMCAP) were intraoperatively monitored. The MCAP ratio was defined as gMCAP/iMCAP. Based on the Hagen-Poiseuille law, the expected MCAP ratio ([expected gMCAP]/iMCAP) was hypothesized as follows: (1 - cMCAP/iMCAP)(graft radius/ICA radius)2 + (cMCAP/iMCAP). Correlations between the BTO pressure ratio and cMCAP/iMCAP, and between the actual and expected MCAP ratios, were evaluated. Risk factors for LRICs were also evaluated. RESULTS The mean BTO pressure ratio was significantly correlated with the mean cMCAP/iMCAP (r = 0.68, p < 0.0001). The actual MCAP ratio correlated with the expected MCAP ratio (r = 0.43, p < 0.0001). If the expected MCAP ratio was set up using the BTO pressure ratio instead of cMCAP/iMCAP (BTO-expected MCAP ratio), the mean BTO-expected MCAP ratio significantly correlated with the expected MCAP ratio (r = 0.95, p < 0.0001). During a median follow-up period of 26.1 months, LRICs were observed in 9 patients (11%). An actual MCAP ratio < 0.80 (p = 0.003), expected MCAP ratio < 0.80 (p = 0.001), and (M2 radius/graft radius)2 < 0.49 (p = 0.002) were related to LRICs according to the Cox proportional-hazards model. CONCLUSIONS Data in the present study indicated that it was important to use an adequate graft to achieve a sufficient MCAP ratio in order to avoid LRICs and that the adequate graft size could be evaluated based on a formula in patients with complex ICA aneurysms treated with ICAO.
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Affiliation(s)
- Hidetoshi Matsukawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Shiro Miyata
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Toshiyuki Tsuboi
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Osamu Takahashi
- 2Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Rihee Takeda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Sadahisa Tokuda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Hiroyasu Kamiyama
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Rokuya Tanikawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
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Ota N, Tanikawa R, Yoshikane T, Miyama M, Miyazaki T, Kinoshita Y, Matsukawa H, Yanagisawa T, Sakakibara F, Suzuki G, Saito N, Miyata S, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S, Kamada K. Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach. Oper Neurosurg (Hagerstown) 2017; 13:382-391. [PMID: 28521354 DOI: 10.1093/ons/opw038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is essential to identify and be aware of the anatomy of the posterior condylar emissary vein (PCEV) for achieving an adequate operative field for the transcondylar fossa approach (TCFA). OBJECTIVE To describe the variations in the drainage patterns of PCEVs and the technical issues encountered in such cases. METHODS This was a retrospective analysis of the anatomy of PCEVs in 104 sides in 52 cases treated by the TCFA. Preoperative findings of multidetector-row computed tomography (CT) and CT venography (CTV) were compared with the intraoperative findings. The drainage patterns were classified as 5 types: the sigmoid sinus (SS), jugular bulb (JB), occipital sinus (OS), anterior condylar emissary vein (ACEV), and marginal sinus (MS). RESULTS The SS, JB, ACEV, and OS types were observed in 33 (31.7%), 42 (40.3%), 8 (7.7%), and 1 (1.0%) side(s), respectively. One side (1.0%) each had combined drainage from MS and JB, and ACEV and JB, respectively. In 17 sides (16.3%), the PCEVs and posterior condylar canals could not be identified on CT and CTV. CONCLUSIONS Preoperative CT and CTV findings correlated well with the intraoperative findings. To make a sufficient operative field for TCFA, PCEVs should be appropriately dealt with based on the preoperative knowledge of their running course, pattern, and origin.
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tsutomu Yoshikane
- Department of Neuro-surgery, Shimane University School of Medicine, Matsue, Japan
| | - Masataka Miyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hidetoshi Matsukawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takeshi Yanagisawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Fumihiro Sakakibara
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Go Suzuki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norihiro Saito
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
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Tokugawa J, Ogura K, Yatomi K, Kudo K, Hishii M, Tanikawa R, Kamiyama H. Bipolar Cutting Method: Another Technique for Harvesting Donor Artery With Histological Investigation. Oper Neurosurg (Hagerstown) 2017; 14:16-19. [DOI: 10.1093/ons/opx086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/23/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Safe and appropriate harvesting of the donor scalp vessel is the first key procedure in any type of bypass surgery.
OBJECTIVE
To use the so-called bipolar cutting method to harvest donor arteries, in which the donor arteries are skeletonized with bipolar cautery. The surgical procedure and the preparation of the equipment of the bipolar cutting method are described. The surgical results and histological assessment are presented.
METHODS
The bipolar generator was set at 50 Malis units in the coagulation mode. Under the surgical microscope, the surrounding tissue of the donor artery was divided and coagulated with the bipolar forceps. The donor artery was completely skeletonized to provide adequate length. After the recipient artery was chosen and the anastomosis site was decided, the distal end of the donor artery was cut to the appropriate length. The remnant fragment of the donor artery was histologically investigated for any damage to the arterial wall. The specimen was cut longitudinally to observe the entire length of the arterial wall and stained with hematoxylin and eosin and elastica van Gieson.
RESULTS
A total of 30 bypass surgeries were performed and 38 histological specimens were obtained between February 2015 and June 2016. The success rate of the bypass was 96%. No arterial wall damage such as thermal injury or dissection of the wall was recognized in any of the specimens.
CONCLUSION
The bipolar cutting method is a useful and safe method for harvesting donor scalp artery.
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Affiliation(s)
- Joji Tokugawa
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kanako Ogura
- Department of Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kentaro Kudo
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Makoto Hishii
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Matsukawa H, Miyama M, Miyazaki T, Uemori G, Kinoshita Y, Sakakibara F, Saito N, Tsuboi T, Noda K, Ota N, Tokuda S, Kamiyama H, Tanikawa R. Impacts of pressure bonding fixation on a bone flap depression and resorption in patients with craniotomy. J Clin Neurosci 2017; 41:162-167. [PMID: 28262399 DOI: 10.1016/j.jocn.2017.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/10/2017] [Indexed: 12/01/2022]
Abstract
Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. Common problems encountered are bone flap depression and resorption. Authors performed the pressure-bonding bone flap fixation (PBFF) using absorbable craniofix (AC) and hydroxyapatite wedge (HW). The aim of the present study is to evaluate the efficacy of PBFF to prevent a bone flap depression and resorption in patients treated with craniotomy. Four-hundred fifty-four patients underwent craniotomies. Authors collected the following data: age, sex, type of craniotomy, what kind of surgery, whether bypass surgery was performed, whether surgery was the initial, whether AC and the HW were used, bone flap depression and resorption at 6-month after the craniotomy. PBFF was defined as a bone flap fixation using both AC and HW to impress a bone flap to forehead. The mean age was 62±13years and 404 (89%) patients were women. PBFF was performed in 71 patients (16%), either AC or HW was used in 141 (31%), only AC was used in 116 (25%), and only HW was used in 25 (5.5%). At 6-month after the surgery, a bone flap depression was seen in 38 patients (8.4%), and a bone flap resorption was seen in 66 (15%). Multivariate analysis showed that only a PBBF showed a negative correlation with bone flap depression (p=0.044) and resorption (p=0.011). The results of the present study showed that PBFF reduced a bone flap depression and resorption and provided excellent postoperative cosmetic results.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Masataka Miyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Genki Uemori
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Norihiro Saito
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Matano F, Murai Y, Mizunari T, Tamaki T, Tateyama K, Koketsu K, Tanikawa R, Kamiyama H, Kobayashi S, Morita A. Recovery of Visual and Ophthalmologic Symptoms After Treating Large or Giant Internal Carotid Artery Aneurysm by High-Flow Bypass with Cervical Ligation. World Neurosurg 2017; 98:182-188. [DOI: 10.1016/j.wneu.2016.10.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022]
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41
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Matano F, Murai Y, Tanikawa R, Kamiyama H, Tateyama K, Tamaki T, Mizunari T, Mizumura S, Kobayashi S, Teramoto A, Morita A. Intraoperative middle cerebral artery pressure measurements during superficial temporal artery to middle cerebral artery bypass procedures in patients with cerebral atherosclerotic disease. J Neurosurg 2016; 125:1367-1373. [DOI: 10.3171/2015.10.jns151305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
No previous study has monitored middle cerebral artery (MCA) pressure during the superficial temporal artery (STA)-MCA bypass procedure for cerebral atherosclerotic disease. In this paper, the authors describe their method of monitoring MCA pressure and report their initial data on intraoperative MCA pressure and its relationship with hemodynamics prior to and after the bypass procedures.
METHODS
The results from a total of 39 revascularization procedures performed between 2004 and 2014 were analyzed. The patient group included 27 men and 12 women, and their mean age at surgery was 67.6 years (range 39–83 years). The authors investigated the MCA pressure via the STA during STA-MCA bypass procedures. After one branch of the STA was anastomosed to the MCA, the other branch was connected to an arterial line, and a clip was placed temporally on the main STA trunk to monitor the pre-anastomosis MCA pressure. Simultaneously, the radial artery (RA) pressure was determined before removing the temporal clip to measure the post-anastomosis MCA pressure. The relationship between MCA pressures and single photon emission computed tomography findings and the risk factors for hyperperfusion after STA-MCA bypass were analyzed.
RESULTS
The MCA/RA (%) pressure was significantly correlated with that of the resting stenotic/normal side cerebral blood flow (CBF) ratio (%) in the linear regression analysis (slope 1.200, r2 = 0.3564, F = 20.49, p < 0.0001). The intraoperative MCA pressure was 39.3% of RA pressure in patients with Powers' Stage 2 cerebral atherosclerotic disease. After 1 branch of the STA was anastomosed, the intraoperative MCA pressure increased to 75.3% of the RA pressure. The rate of increase in pressure was significantly correlated with the increase in the STA diameter in the linear regression analysis (slope 2.59, r2 = 0.205, F = 9.549, p = 0.0038). Hyperperfusion occurred in 2 cases. When mean values for these 2 patients were compared with those for the 37 patients without hyperperfusion, significant differences were found in the stenotic/normal side CBF ratio (p = 0.0001), pre-anastomosis MCA pressure (p = 0.02), rate of increase in pressure (p = 0.02), pre-anastomotic MCA/RA pressure ratio (p = 0.01), vascular reserve (p = 0.0489), and STA diameter (p = 0.0002).
CONCLUSIONS
The measurement of intraoperative MCA pressure may be a useful technique to assess cerebral perfusion and for predicting the risk of hyperperfusion. Monitoring MCA pressure is recommended during STA-MCA bypass procedures for atherosclerotic disease.
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Affiliation(s)
| | - Yasuo Murai
- 1Department of Neurological Surgery, Nippon Medical School
| | - Rokuya Tanikawa
- 2Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan
| | | | | | | | | | - Sunao Mizumura
- 3Department of Radiology, Toho University Omori Medical Center, Tokyo; and
| | | | - Akira Teramoto
- 1Department of Neurological Surgery, Nippon Medical School
| | - Akio Morita
- 1Department of Neurological Surgery, Nippon Medical School
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Ota N, Tanikawa R, Eda H, Matsumoto T, Miyazaki T, Matsukawa H, Yanagisawa T, Suzuki G, Miyata S, Oda J, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S. Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery. J Neurosurg 2016; 125:953-963. [DOI: 10.3171/2015.8.jns15362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Bilateral vertebral artery dissecting aneurysms (VADAs) have a poor prognosis because progressive enlargement of the aneurysms compresses the brainstem or causes subarachnoid hemorrhage. The trapping of 1 vertebral artery (VA) places increased hemodynamic stress on the contralateral VA and may lead to enlargement and rupture. Therefore, management strategies are controversial. This study describes a radical treatment for bilateral VADAs using bypass surgery.
METHODS
Seven patients with bilateral VADAs were included. Three patients were treated by trapping of 1 VA via coiling or clipping at another hospital; the previously treated VA in 1 patient and the contralateral untreated VA in 2 patients subsequently enlarged. The other 4 patients presented without previous intervention and progressive enlargement of the aneurysms.
RESULTS
The post–coil embolization patients underwent V3–posterior cerebral artery (PCA) bypass and trapping. The other 4 patients underwent VA reconstruction via V3–V4 or V4–V4 bypass, with contralateral trapping on a separate day in 3 patients and observation in 1 patient. Perioperative complications included 1 case of cerebrospinal fluid leakage for which the patient required an additional operation, 1 case of dysphagia and facial palsy due to sigmoid sinus thrombosis, and 1 case of dysphagia. The long-term outcomes of these patients were favorable.
CONCLUSIONS
Patients with bilateral VADAs require treatment on both sides. If VA trapping is performed first, the treatment options for the other side are limited to V3-PCA bypass and trapping. This procedure is effective; however, it is also invasive and technically difficult. In cases of bilateral VADAs in which it is feasible to reconstruct 1 side, the best approach is to begin by reconstructing the VA that appears technically easiest, followed by trapping of the contralateral VADA. This strategy allows enough time to suture vessels because contralateral reverse flow is maintained.
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Ota N, Tanikawa R, Miyama M, Miyazaki T, Kinoshita Y, Matsukawa H, Yanagisawa T, Sakakibara H, Saito N, Miyata S, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S. Radical Resection of a Craniopharyngioma via the Extradural Temporopolar Approach. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1592606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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44
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Kivelev J, Tanikawa R, Noda K, Hernesniemi J, Niemelä M, Takizawa K, Tsuboi T, Ohta N, Miyata S, Oda J, Tokuda S, Kamiyama H. Open Surgery for Recurrent Intracranial Aneurysms: Techniques and Long-Term Outcomes. World Neurosurg 2016; 96:1-9. [PMID: 27506404 DOI: 10.1016/j.wneu.2016.07.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND After occlusion of an aneurysm, a patient may experience aneurysm regrowth at the same site or develop de novo aneurysms. We present our experience in microsurgery of recurrent aneurysms with analysis of long-term results. METHODS The senior authors (R. T. and H. K.) performed recurrent aneurysm clipping on 44 patients at Teishinkai Hospital and Asahikawa Red Cross Hospital in Sapporo, Japan. Operative techniques included clipping only, clipping and protective bypass, trapping of aneurysm with bypass, proximal occlusion, and bypass. Postoperative outcome was analyzed retrospectively using the modified Rankin Scale. RESULTS Our series included 10 men (23%) and 34 women (77%), with a mean patient age of 63 years (range, 7-82 years). Before primary treatment, 11 patients (25%) had a ruptured aneurysm, while 33 patients (75%) had an unruptured aneurysm. The mean follow-up time after primary surgery was 7.6 years (range, 0.8-25 years). At our department the treatment of recurrent aneurysm included the clipping in 19 patients (43%), clipping with bypass in 6 patients (14%), aneurysm trapping with bypass in 10 patients (23%), and proximal occlusion and bypass in 9 patients (20%). The mean follow-up time after surgical treatment of recurrent aneurysms stood at 3.5 years (range 0.1-9 years). Altogether, 37 patients (84%) experienced favorable outcomes at last follow-up examination (modified Rankin Scale scores 0 and 1). CONCLUSIONS Microsurgery of recurrent aneurysms may be performed safely and effectively, as shown by our study, in which 84% of patients experienced favorable results.
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Affiliation(s)
- Juri Kivelev
- Department of Neurosurgery, Turku University Hospital, Turku, Finland; Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Rokuya Tanikawa
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Toshiyuki Tsuboi
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ohta
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Junpei Oda
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Neurosurgical Department, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Oda J, Takeda R, Tokuda S, Kamada K. Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft. J Neurosurg 2016; 125:239-46. [DOI: 10.3171/2015.5.jns142524] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The revascularization technique, including bypass created using the external carotid artery (ECA), radial artery (RA), and M2 portion of middle cerebral artery (MCA), has remained indispensable for treatment of complex aneurysms. To date, it remains unknown whether diameters of the RA, superficial temporal artery (STA), and C2 portion of the internal carotid artery (ICA) and intraoperative MCA blood pressure have influences on the outcome and the symptomatic watershed infarction (WI). The aim of the present study was to evaluate the factors for the symptomatic WI and neurological worsening in patients treated by ECA-RA-M2 bypass for complex ICA aneurysm with therapeutic ICA occlusion.
METHODS
The authors measured the sizes of vessels (RA, C2, M2, and STA) and intraoperative MCA blood pressure (initial, after ICA occlusion, and after releasing the RA graft bypass) in 37 patients. Symptomatic WI was defined as presence of the following: postoperative new neurological deficits, WI on postoperative diffusion-weighted imaging, and ipsilateral cerebral blood flow reduction on SPECT. Neurological worsening was defined as the increase in 1 or more modified Rankin Scale scores. First, the authors performed receiver operating characteristic curve analysis for continuous variables and the binary end point of the symptomatic WI. The clinical, radiological, and physiological characteristics of patients with and without the symptomatic WI were compared using the log-rank test. Then, the authors compared the variables between patients with and without neurological worsening at discharge and at the 12-month follow-up examination or last hospital visit.
RESULTS
Symptomatic WI was observed in 2 (5.4%) patients. The mean MCA pressure after releasing the RA graft (< 55 mm Hg; p = 0.017), mean (MCA pressure after releasing the RA graft)/(initial MCA pressure) (< 0.70 mm Hg; p = 0.032), and mean cross-sectional area ratio ([RA/C2 diameter]2 < 0.40 mm [p < 0.0001] and [STA/C2 diameter]2 < 0.044 mm [p < 0.0001]) were related to the symptomatic WI. All preoperatively independent patients remained independent (modified Rankin Scale score < 3). After adjusting for age and sex, left operative side (p = 0.0090 and 0.038) and perforating artery ischemia (p = 0.0050 and 0.022) were related to neurological worsening at discharge (11 [29%] patients) and at the 12-month follow-up or last hospital visit (8 [22%] patients).
CONCLUSIONS
Results of the present study showed that the vessel diameter and intraoperative MCA pressure had impacts on the symptomatic WI and that operative side and perforating artery ischemia were related to neurological worsening in patients with complex ICA aneurysms treated by ECA-RA-M2 bypass.
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Affiliation(s)
- Hidetoshi Matsukawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Rokuya Tanikawa
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Hiroyasu Kamiyama
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Toshiyuki Tsuboi
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Kosumo Noda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Nakao Ota
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Shiro Miyata
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Jumpei Oda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Rihee Takeda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Sadahisa Tokuda
- 1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and
| | - Kyousuke Kamada
- 2Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
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Kazumata K, Kamiyama H, Saito H, Maruichi K, Ito M, Uchino H, Nakayama N, Kuroda S, Houkin K. Direct Anastomosis Using Occipital Artery for Additional Revascularization in Moyamoya Disease After Combined Superficial Temporal Artery–Middle Cerebral Artery and Indirect Bypass. Oper Neurosurg (Hagerstown) 2016; 13:213-223. [DOI: 10.1227/neu.0000000000001346] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 05/19/2016] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: The posterior cerebral artery (PCA) is involved in approximately 30% of moyamoya disease (MMD) cases. However, there have been insufficient reports describing revascularization techniques in the posterior portion of the brain, particularly of direct anastomosis.
OBJECTIVE: To perform a technical assessment in patients with MMD who underwent either occipital artery (OA)–PCA bypass or OA–middle cerebral artery (MCA) bypass.
METHODS: A total of 428 revascularization procedures in 368 patients were retrospectively assessed by reviewing clinical charts and radiological data.
RESULTS: Ten patients (3.5%) were treated with direct bypass after the anterior revascularization with a median interval of 30 months (range, 5 months-16 years). Seven patients were < 18 years of age (average age, 17.5 ± 15.6 years). Preoperative symptoms included transient motor deficits involving the lower extremities (n = 5), visual disturbances (n = 6), and cerebral infarctions (n = 6). A favorable outcome (modified Rankin Scale score < 3) was achieved in 9 of these 10 patients. Direct anastomosis was performed in 3 hemispheres with an OA-MCA bypass and in 8 hemispheres with an OA-PCA bypass. Patency of the direct bypass was confirmed on angiogram in 7 of 7 patients who underwent conventional angiogram performed within 1 year after the surgery. None of the 10 patients demonstrated cerebral infarctions after the posterior revascularization.
CONCLUSION: In MMD, symptomatic PCA regression after anterior revascularization was found predominantly in children and young adults. Direct anastomosis in the posterior portion of the brain can be successfully achieved and is effective in preventing ischemic events.
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Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Hisayasu Saito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Katsuhiko Maruichi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Takeuchi S, Tanikawa R, Tsuboi T, Noda K, Miyata S, Ota N, Hamada F, Kamiyama H. Surgical case of intracranial osteoma arising from the falx. Oncol Lett 2016; 12:1949-1952. [PMID: 27588144 DOI: 10.3892/ol.2016.4833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/02/2016] [Indexed: 12/29/2022] Open
Abstract
Intracranial osteomas completely unrelated to osseous tissues are extremely rare. In the present study, the case of a 40-year-old female who presented with persistent headache is reported. Computed tomography (CT) and bone window CT revealed an ossified lesion in the frontal area. Fast imaging employing steady-state acquisition (FIESTA)/CT venography fusion imaging demonstrated that the mass was located just below the superior sagittal sinus and cortical veins, and had adhered partially to these veins. Surgery achieved complete tumor removal with preservation of the cortical veins and superior sagittal sinus. The histological examination findings were compatible with osteoma. The present postoperative course was uneventful. The present rare case of intracranial osteoma originating from the falx was successfully treated surgically. Preoperative FIESTA/CT venography fusion imaging was very useful to demonstrate adhesion between the tumor mass and the superior sagittal sinus and cortical veins.
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Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Saitama 359-8513, Japan; Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Nakao Ota
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Fumihiro Hamada
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Teishinkai Hospital, Hokkaido 065-0033, Japan
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Matsukawa H, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takahashi O, Tokuda S, Tanikawa R. Is Age a Risk Factor for Poor Outcome of Surgical Treatment of Unruptured Intracranial Aneurysms? World Neurosurg 2016; 94:222-228. [PMID: 27392889 DOI: 10.1016/j.wneu.2016.06.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Advanced age is known to be a significant risk factor for the rupture of intracranial aneurysms. The impact of age on outcomes of surgically treated patients with unruptured intracranial aneurysms (UIAs) is less clear. METHODS A total of 663 consecutive patients with 823 surgically treated UIAs were evaluated. UIAs, which need bypass surgery including low-flow or high-flow bypass, were defined as complex aneurysms. Aneurysm size was categorized as small (<15 mm), large (15-24 mm), and giant (≥25 mm). In patients without symptoms, a poor outcome is defined as a modified Rankin Scale (mRS) score of 2-6. In those with mRS score higher than 1 as a result of UIA-related symptoms or other comorbidities, a poor outcome is defined as an increase of 1 or more on the mRS. Outcomes were evaluated at the 6-month and 12-month follow-up examinations. RESULTS The mean age was 62 ± 12 years and 650 UIAs (78%) were observed in women. Previously treated aneurysm (P = 0.009), posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.011), and perforator territory infarction (P < 0.0001) were related to poor outcome at 6 months, and posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.035), and perforator territory infarction (P = 0.013) were related to poor outcome at 12 months. Age was not associated with poor outcome in patients with UIAs who undertook direct surgery. CONCLUSIONS Although risks and benefits of aneurysm treatment in older patients should be carefully considered, surgical treatment of UIAs in the elderly should be considered positively.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Yaginuma Y, Unotoro J, Kamiyama H, Ishido Y, Kasamaki S, Sakamoto K, Shindo T, Ishibasi Y, Kamano T. Genomic Copy-number Aberrations Related to Lymph-node Metastasis of Colon Cancer. J Int Med Res 2016; 34:390-6. [PMID: 16989495 DOI: 10.1177/147323000603400408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lymph-node metastasis is an important indicator in the diagnosis of colon cancer. In order to determine the genes involved in metastasis, genomic copy-number aberrations in the primary tumours and lymph-node metastases were analysed in 12 patients using comparative genomic hybridization. This method detects genomic copy-number changes at the chromosomal level and the identification of the regions of aberration on any chromosome. Copy-number gains at 6p12 and losses at 8p12 were observed in a greater number of the primary tumours than in the metastases. These aberrations appear to be involved in lymph-node metastasis of colon cancer, and may allow measurement of the risk of lymph-node metastasis from a given colon cancer.
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Affiliation(s)
- Y Yaginuma
- Department of Coloproctological Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Sakarunchai I, Tanikawa R, Ota N, Noda K, Matsukawa H, Kamiyama H. Toward a more rationalized use of a special technique for repair of frontal air sinus after cerebral aneurysm surgery: The most effective technique. Interdisciplinary Neurosurgery 2016. [DOI: 10.1016/j.inat.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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