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• "Missing-piece" sign with dural arteriovenous fistula at craniocervical junction: A case report.

  Toshiki Tezuka, Tomonori Nukariya, Masahiro Katsumata, Tsubasa Miyauchi, Daiki Tokuyasu, Shunpei Azami, Yoshikane Izawa, Narihito Nagoshi, Hirokazu Fujiwara, Katsuhiro Mizutani, Takenori Akiyama, Masahiro Toda, Jin Nakahara, Yoshinori Nishimoto

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 32 （ 7 ） 107152 - 107152 2023年07月

  　概要を見る

  OBJECTIVES: Spinal dural arteriovenous fistula (sDAVF) is a rare and often underdiagnosed spinal disease. Early diagnosis is required because the deficits are reversible and delays in treatment cause permanent morbidity. Although the abnormal vascular flow void is a critical radiographic feature of sDAVF, they are not always present. A characteristic enhancement pattern of sDAVF has been recently reported as the "missing-piece" sign which can lead to the early and correct diagnosis. METHODS: We presented imaging findings, treatment decisions, and the outcome of a rare case of sDAVF, in which the "missing-piece" sign appeared atypical. RESULTS: A 60-year-old woman developed numbness and weakness in her extremities. Spinal MRI revealed longitudinal hyperintensity in the T2-weighted image, extending from the thoracic level to medulla oblongata. At first, myelopathy with inflammation or tumor was suspected because of the lack of flow voids and vascular abnormalities in CT-angiography and MR-DSA. However, we administered intravenous methylprednisolone and her symptom got worse with the appearance of the "missing-piece" sign. Then, we successfully diagnosed sDAVF by angiography. The "missing-piece" sign was considered to derive from inconsistency of the intrinsic venous system of spinal cord, with the abrupt segments without enhancement. The same etiology was considered in our case. CONCLUSIONS: Detecting the "missing-piece" sign can lead to the correct diagnosis of sDAVF, even if the sign appeared atypical.

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• A Case of Neurofibromatosis Type 1 Diagnosed after Idiopathic Rupture of Superficial Temporal Artery Pseudoaneurysm Requiring Endovascular Treatment

  T Iwama, K Mizutani, H Kubo, M Katsumata, T Akiyama, M Toda

  NMC Case Report Journal 10, 125-130 2023年

• Perfusion gradients promote delayed perihaematomal oedema in intracerebral haemorrhage

  E Fainardi, G Busto, E Scola, I Casetta, K Mizutani, A Consoli, G Boulouis, ...

  Brain Communications 5 (3), fcad133 （Brain Communications)  5 （ 3 ）  2023年

  　概要を見る

  Perihaematomal oedema is a potential therapeutic target to improve outcome of patients with intracerebral haemorrhage, but its pathophysiology remains poorly elucidated. We investigated the longitudinal changes of cerebral perfusion and their influence on perihaematomal oedema development in 150 patients with intracerebral haemorrhage who underwent computed tomography perfusion within 6 h from onset, at 24 h and at 7 days. Perfusion parameters were measured in haemorrhagic core, perihaematomal rim, surrounding normal appearing and contralateral brain tissue. Computed tomography perfusion parameters gradually improved from the core to the periphery in each time interval with an early increase at 24 h followed by a delayed decline at 7 days compared with admission values (P < 0.001). Multivariable linear regression analysis showed that haematoma volume and cerebral blood flow gradient between normal appearing and perihaematomal rim were independently associated with absolute perihaematomal oedema volume in the different time points (within 6 h, B = 0.128, P = 0.032; at 24 h, B = 0.133, P = 0.016; at 7 days, B = 0.218, P < 0.001). In a secondary analysis with relative perihaematomal oedema as the outcome of interest, cerebral blood flow gradient between normal appearing and perihaematomal rim was an independent predictor of perihaematomal oedema only at 7 days (B = 0.239, P = 0.002). Our findings raise the intriguing hypothesis that perfusion gradients promote perihaematomal oedema development in the subacute phase after intracerebral haemorrhage.

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• “Missing-piece” sign with dural arteriovenous fistula at craniocervical junction: A case report

  T Tezuka, T Nukariya, M Katsumata, T Miyauchi, D Tokuyasu, S Azami, ...

  Journal of Stroke and Cerebrovascular Diseases 32 (7), 107152 （Journal of Stroke and Cerebrovascular Diseases)  32 （ 7 ）  2023年

  ISSN  10523057

  　概要を見る

  Objectives: Spinal dural arteriovenous fistula (sDAVF) is a rare and often underdiagnosed spinal disease. Early diagnosis is required because the deficits are reversible and delays in treatment cause permanent morbidity. Although the abnormal vascular flow void is a critical radiographic feature of sDAVF, they are not always present. A characteristic enhancement pattern of sDAVF has been recently reported as the “missing-piece” sign which can lead to the early and correct diagnosis. Methods: We presented imaging findings, treatment decisions, and the outcome of a rare case of sDAVF, in which the “missing-piece” sign appeared atypical. Results: A 60-year-old woman developed numbness and weakness in her extremities. Spinal MRI revealed longitudinal hyperintensity in the T2-weighted image, extending from the thoracic level to medulla oblongata. At first, myelopathy with inflammation or tumor was suspected because of the lack of flow voids and vascular abnormalities in CT-angiography and MR-DSA. However, we administered intravenous methylprednisolone and her symptom got worse with the appearance of the “missing-piece” sign. Then, we successfully diagnosed sDAVF by angiography. The “missing-piece” sign was considered to derive from inconsistency of the intrinsic venous system of spinal cord, with the abrupt segments without enhancement. The same etiology was considered in our case. Conclusions: Detecting the “missing-piece” sign can lead to the correct diagnosis of sDAVF, even if the sign appeared atypical.

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• Application of Deep Learning Techniques for Automated Diagnosis of Non–Syndromic Craniosynostosis Using Skull

  K Mizutani, T Miwa, Y Sakamoto, M Toda

  Journal of Craniofacial Surgery 33 (6), 1843-1846 2022年

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• Bridging veins at the craniocervical junction: from anatomy to clinical significance in dural arteriovenous shunts

  T Miyauchi, K Mizutani, T Akiyama, M Toda

  Neuroradiology (Neuroradiology)   2023年10月

  ISSN  00283940

  　概要を見る

  Purpose: Bridging veins (BVs) serve as a route of pial venous reflux, and its anatomy is essential to understand the pathophysiology of dural arteriovenous shunts (dAVSs) around the craniocervical junction (CCJ) (from the jugular foramen level to the atlantal level). However, the anatomical variations of the BVs and their proximal connections remained poorly elucidated. This study aimed to radiologically investigate the anatomy of the bridging veins around CCJ and discuss the clinical significance of these BVs in the dAVS. Methods: We investigated normal venous anatomy of the BVs from the jugular foramen level to the atlantal level using preoperative computed tomography digital subtraction venography in patients undergoing elective neurosurgery. BVs affected by the dAVSs in the same region were also evaluated. The three types of dAVS, craniocervical junction, anterior condylar, and proximal sigmoid sinus, were investigated. Results: We identified six BV groups: superolateral, anterolateral, lateral, posterior, inferolateral, and inferoposterior. The superolateral and inferolateral groups, connected with the proximal sigmoid sinus and suboccipital cavernous sinus, respectively, were the largest groups. Each group has a specific downstream venous connection. The association with dVASs was observed only in the inferolateral group, which was typically the sole venous drainage in most dAVSs at the CCJ. Conclusion: We reported detailed anatomy of BVs from the jugular level to the atlantal level, which enhanced our understanding of the pathophysiology of dAVSs in the corresponding region.

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• Detailed Anatomy of Bridging Veins Around the Foramen Magnum: a Multicenter Study Using Three-dimensional Angiography

  M Hiramatsu, T Ozaki, S Tanoue, K Mizutani, H Nakamura, K Tokuyama, ...

  Clinical Neuroradiology (Clinical Neuroradiology)   2023年08月

  ISSN  18691439

  　概要を見る

  Background and Purpose: There has been limited literature regarding the bridging veins (BVs) of the medulla oblongata around the foramen magnum (FM). The present study aims to analyze the normal angioarchitecture of the BVs around the FM using slab MIP images of three-dimensional (3D) angiography. Methods: We collected 3D angiography data of posterior fossa veins and analyzed the BVs around the FM using slab MIP images. We analyzed the course, outlet, and number of BVs around the FM. We also examined the detection rate and mean diameter of each BV. Results: Of 57 patients, 55 patients (96%) had any BV. The median number of BVs was two (range: 0–5). The BVs originate from the perimedullary veins and run anterolaterally to join the anterior condylar vein (ACV), inferior petrosal sinus, sigmoid sinus, or jugular bulb, inferolaterally to join the suboccipital cavernous sinus (SCS), laterally or posterolaterally to join the marginal sinus (MS), and posteriorly to join the MS or occipital sinus. We classified BVs into five subtypes according to the draining location: ACV, jugular foramen (JF), MS, SCS, and cerebellomedullary cistern (CMC). ACV, JF, MS, SCS, and CMC BVs were detected in 11 (19%), 18 (32%), 32 (56%), 20 (35%), and 16 (28%) patients, respectively. The mean diameter of the BVs other than CMC was 0.6 mm, and that of CMC BV was 0.8 mm. Conclusion: Using venous data from 3D angiography, we detected FM BVs in most cases, and the BVs were connected in various directions.

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• Role of endovascular treatment for ruptured aneurysms involving the anterior spinal artery at the craniocervical junction

  Mizutani K, Akiyama T, Tomita H, Toda M

  Journal of Neuroradiology (Journal of Neuroradiology)  50 ( 1 ) 44 - 49 2023年02月

  ISSN  0150-9861

  　概要を見る

  Ruptured aneurysms at the craniocervical junction (CCJ) involving the anterior spinal artery (ASA) are rare and consist of heterogenous lesions with variable clinical entities. However, the standard therapeutic strategy for the lesions has not been well-established. Moreover, despite advances in modern neurointervention, reports describing endovascular treatment for this specific lesion have been few. Here, we report three cases of ruptured aneurysms on the pial tributary of the ASA at the CCJ, which were subsequently treated by transarterial glue injection or coil embolization. Endovascular treatment can be a therapeutic option, particularly for these ruptured aneurysms. Either transarterial glue injection or coil embolization can be effective depending on the type of etiology and the surrounding vasculature anatomy.

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• Extracranial prevertebral venous network of the craniocervical junction: CT-digital subtraction venography analysis

  Yamada H, Mizutani K, Akiyama T, Toda M

  Neuroradiology (Neuroradiology)  64 ( 12 ) 2227 - 2233 2022年12月

  ISSN  0028-3940

  　概要を見る

  Purpose: Although the craniocervical junction has a complex anatomical structure associated with clinical diseases, its ventral venous network has not been well studied. This study aimed to clarify the extracranial ventral venous structure at the craniocervical junction. Methods: Head computed tomography digital subtraction venography (CT-DSV) images of 273 patients (age 6 months to 93 years) taken at our department were retrospectively analyzed. We analyzed the frequency and anatomical features of the venous channels, as well as their upstream and downstream connections with the surrounding channels at the ventral craniocervical junction, from the level of the hypoglossal canal to the second cervical vertebra. Results: In 54% of the cases, the vein descended from the anterior condylar confluence, running medially along the basioccipital and fusing with its counterpart in the midline at the level of the atlanto-occipital membrane. Furthermore, 24% of this vein was connected caudally to the anterior external vertebral venous plexus. We also identified venous channels, either as a sole vein or venous plexus, on the tip of the odontoid process (10%), which has not been well described previously. The vein around the odontoid process was connected to several veins, including the aforementioned vein anterior to the condyle and the anterior internal vertebral venous plexus. Conclusions: CT-DSV analysis revealed a detailed venous architecture ventral to the craniocervical junction. Venous structures identified in this study may be involved in diseases in this area.

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• Imaging of the venous plexus of Rektorzik using CT-digital subtraction venography: a retrospective study

  Ryotaro Imai and Katsuhiro Mizutani and Takenori Akiyama and Takashi Horiguchi and Yoshifumi Takatsume and Masahiro Toda

  Neuroradiology (Springer Science and Business Media {LLC})  64 ( 10 ) 1961 - 1968 2022年04月

  ISSN  0028-3940

  　概要を見る

  Purpose: The venous plexus of Rektorzik (VPR), first described by Rektorzik in 1858, is a venous plexus around the internal carotid artery in the carotid canal. However, the VPR has never been investigated using the recently developed imaging modalities. In this study, we analyzed the VPR using computed tomography-digital subtraction venography (CT-DSV). Methods: This study included 253 patients who had undergone head CT-DSV. The presence or absence of the right and left VPRs and their connecting veins were visually examined by two researchers. Results: The VPR was observed in 60 patients (24%), 39 of which showed VPR only on the right side, 10 only on the left side, and 11 on both sides. VPR was significantly more common on the right side (p = 0.0002) and was observed more frequently around the horizontal segment of the internal carotid artery than around the vertical segment. The most common veins identified as distal and proximal VPR connections were the cavernous sinus (63/71, 89%) and the anterior condylar confluence (27/71, 38%), respectively. The mean age was significantly lower in patients with the VPR than in those without (53 vs. 57 years, p = 0.02). Conclusion: The VPR was significantly more frequent on the right side and in younger patients but was not a radiographically constant structure. In most cases, the VPR connected the cavernous sinus and anterior condylar confluence. Preoperative evaluation of VPR may lead to refined surgical procedures.

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• 脳動脈瘤壁の炎症をターゲットとしたコイル塞栓術後の再発抑制

  2023年04月

  -

  2026年03月

  水谷 克洋, 若手研究, 補助金,  研究代表者

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• 日本頭蓋底外科学会優秀論文賞

  2016年, 日本頭蓋底外科学会

  受賞区分： 国内学会・会議・シンポジウム等の賞

• 日本頭蓋底外科学会優秀論文賞

  2016年, 日本頭蓋底外科学会, The Analysis of the Petrosal Vein to Prevent Venous Complications During the Anterior Transpetrosal Approach in the Resection of Petroclival Meningioma

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• メディカル・プロフェッショナリズムⅥ

  2024年度

• 脳神経外科学講義

  2024年度

• メディカル・プロフェッショナリズムⅥ

  2023年度

• メディカル・プロフェッショナリズムⅥ

  2022年度