論文 - 水谷　克洋

The remnant of primary head sinus found in the case of dural arteriovenous fistula: A case report.

Mizutani K, Akiyama T, Yoshida K

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 22 （ 4 ） 452 - 6 2016年08月

ISSN  1591-0199

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In the embryo, the primary head sinus (PHS) is the first venous drainage channel in the craniocervical region. During embryonic development, this channel regresses and usually disappears completely; accordingly, a remnant of the PHS is an extremely rare condition and has been described in only a few previous studies. Here, we report a case of remnant of the PHS with a dural arteriovenous fistula (dAVF) in an adult. The remnant of the PHS had penetrated the petrous bone to run from the middle fossa to the jugular bulb and served as a drain for the middle fossa dAVF. We used digital subtraction angiography and reconstructed cone-beam computed tomography in 3D rotational angiography to obtain detailed anatomic information about the remnant PHS and additionally scrutinised and discussed its features.

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Giant Cell Tumor of the Skull: Review of the Literature.

Tamura R, Miwa T, Shimizu K, Mizutani K, Tomita H, Yamane N, Tominaga T, Sasaki S

Journal of neurological surgery. Part A, Central European neurosurgery 77 （ 3 ） 239 - 46 2016年05月

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BACKGROUND: Giant cell tumors (GCTs) are rare in the skull. The present report describes a case with a primary GCT located in the temporal bone and reviews the relevant literature. We also propose a treatment strategy for GCT of the skull. CLINICAL PRESENTATION: A 41-year-old man presented with headache and auditory disturbance. Radiologic images showed a lytic expansive extradural lesion originating primarily from the right temporal bone and expanding into the middle cranial fossa and the infratemporal fossa. A biopsy specimen of the lesion was obtained from the external auditory meatus. Total removal was performed with temporal craniectomy, mandibular condylar process removal, tympanoplasty, and mastoidectomy. DISCUSSION: The rate of recurrence of GCTs is related to complete resection and location of the GCT rather than to the degree of invasiveness. Some of the mononuclear cells and stromal cells in GCT express receptor activator of nuclear factor κ-β ligand (RANKL). Because inhibition of RANKL and bisphosphonate therapy might eliminate giant cells, this approach might be useful for recurrent or unresectable GCTs of the skull. CONCLUSIONS: Preoperative diagnosis by biopsy is important in determining the therapeutic strategy of GCTs. Complete resection is important to reduce the recurrence rate of GCTs in the skull.

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Analysis of the Intercavernous Sinus in Sellar Lesions Using Multidetector Computed Tomography Digital Subtraction Venography.

Mizutani K, Toda M, Yoshida K

World neurosurgery 86   336 - 40 2016年02月

ISSN  1878-8750

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OBJECTIVE: The intercavernous sinuses (ICSs) connect the cavernous sinuses on both sides. Although the management of ICSs is an important aspect in extended transsphenoidal surgery (eTSS), there has been no report to evaluate ICSs in sellar lesions. In this study, we analyzed ICSs using computed tomographic digital subtraction venography (CT-DSV) in sellar lesions. METHODS: We retrospectively analyzed ICSs in 52 cases of pituitary adenoma and 13 cases of tuberculum sellae meningioma using CT-DSV. RESULTS: In pituitary adenomas, the detection rate of ICSs was lower than that of normal sellae controls. When the tumor volume of pituitary adenomas was greater than 5 ml, we could not detect any ICSs. In tuberculum sellae meningiomas, the detection rate of the anterior intercavernous sinus was high, but this finding was not significant. Meningioma tumor sizes did not have any influence on ICSs. CONCLUSION: CT-DSV can be useful for evaluating ICSs in sellar lesions. Preoperative evaluation of ICSs may provide important information for eTSS.

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A ruptured aneurysm in the vasa corona at the craniocervical junction with dysgenesis of the posterior inferior cerebellar artery.

Mizutani K, Akiyama T, Kamamoto D, Nagashima H, Yoshida K

BJR case reports 2 （ 3 ） 20160004 - 20160004 2016年

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This paper reports the case of a ruptured aneurysm in the vasa corona at the craniocervical junction with dysgenesis of the posterior inferior cerebellar artery (PICA). Dysgenesis of the proximal PICA in the present case caused the development of a pial anastomosis in the vasa corona, resulting in the formation of an aneurysm because of increased haemodynamic stress at the vasa corona. The aneurysm was successfully treated with transarterial coil embolization. The clinical entity in the present case is extremely rare and it is important to consider an aberrant vascular anomaly as the cause of an isolated spinal aneurysm.

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Analysis of the intercavernous sinuses using multidetector computed tomography digital subtraction venography (CT-DSV).

Mizutani K, Toda M, Yoshida K

Clinical neurology and neurosurgery （Elsevier {BV}）  131   31 - 4 2015年04月

ISSN  0303-8467

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PURPOSES: The intercavernous sinuses (ICSs) connect both sides of the cavernous sinus. Knowledge of the ICSs is useful when employing the endoscopic endonasal transsphenoidal approach. Although there were some studies concerning the anatomy of ICSs using cadavers, there is no well-recognized method of the radiological evaluation of the ICSs. Therefore, we evaluate the ICSs using computed tomography digital subtraction venography (CT-DSV) in the cases of unruptured aneurysm that had the normal sellae anatomy. METHODS: We retrospectively analyzed 97 cases of unruptured cerebral aneurysm that had normal parasellar and sellar anatomy except for the aneurysms. The analysis was performed using the multi-planar reconstruction images obtained by CT-DSV in these cases. RESULTS: The anterior ICS (AICS), inferior ICS (IICS) and posterior ICS (PICS) were detected in 51 cases (52.6%), 28 cases (28.9%) and 76 cases (78.4%) respectively. In the cases older than 51 years old, the AICS was detected significantly less often than in those younger than 50 years old. CONCLUSIONS: The CT-DSV images directly reflected the blood flow. Most of the past research on the ICSs was obtained using cadavers, which could therefore not directly assess the normal human blood flow. The present study showed the usefulness of CT-DSV for evaluating the ICSs and to understand the normal anatomy of the ICSs.

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Steroid psychosis caused by perioperative steroid replacement for pituitary adenoma: a case report.

Mizutani K, Toda M, Kikuchi R, Uchida H, Yoshida K

The Keio journal of medicine 64 （ 1 ） 11 - 5 2015年

ISSN  0022-9717

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Steroid psychosis is a frequent complication of steroid treatment. Although perioperative steroid replacement therapy is generally administered in patients undergoing pituitary surgery, there are no previous reports concerning the development of steroid psychosis after perioperative steroid replacement therapy following pituitary surgery. We herein report a case of steroid psychosis induced by perioperative steroid replacement therapy for pituitary surgery. A 35-year-old man presented with a visual disturbance that had persisted for 1 year. A magnetic resonance imaging scan showed a large pituitary tumor, and a laboratory study revealed slight dysfunction of the hypothalamo-pituitary-adrenal axis. The patient was diagnosed with a non-functioning pituitary tumor and underwent tumor resection via the endoscopic endonasal approach. The initial dose of perioperative steroid replacement therapy was 200 mg of hydrocortisone administered immediately before the operation. The replacement dose was gradually tapered and discontinued over a 7-day period. On postoperative day 4, the patient exhibited an elated mood, grandiose delusions, anxiety, and agitation. We diagnosed these psychiatric symptoms as steroid psychosis induced by steroid replacement and we prescribed risperidone as a treatment. The symptoms gradually improved and did not recur. This case highlights the risk of steroid psychosis following treatment with perioperative steroid replacement therapy for pituitary adenoma and raises questions regarding the appropriateness of perioperative steroid replacement for pituitary adenoma.

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The perioperative management of antiplatelet agents for chronic subdural hematoma.

Mizutani K, Miwa T, Tamura R, Tomita H

Clinical neurology and neurosurgery 117   100 - 101 2014年02月

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The importance of amyloid β protein in cerebrospinal fluid when you recognize convexal subarachnoid hemorrhage.

Tamura R, Tomita H, Mizutani K, Miwa T

European neurology 71 （ 5-6 ） 283 - 7 2014年

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BACKGROUND: Convexal subarachnoid hemorrhage (cSAH) is sometimes experienced in cerebral amyloid angiopathy (CAA), but ones that are repeated within a brief time period are not common. Also, it is often difficult to diagnose CAA when you experience a case of cSAH. METHODS: We examined the clinical course of 2 cases that showed cSAH repeatedly. We examined cerebrospinal fluid (CSF) concentrations of amyloid β protein (Aβ) 40 and 42 and tau protein as additional evidence for a diagnosis of CAA. RESULTS: Case 1 presented with transient motor paresis of the left hand and case 2 with transient sensory disturbance of the left hand. CT scans showed cSAH on the right central sulcus in both patients. Case 1 showed development of intracerebral hemorrhage on the frontal lobe near the right central sulcus. Case 2 showed relapse of cSAH with recurrence of the same symptoms. These cases could not be diagnosed by image analysis, but were considered CAA by Aβ40, Aβ42 and tau protein in CSF. CONCLUSION: Aβ in CSF can be presented here as support for the diagnosis of CAA that is difficult to diagnose by Boston criteria.

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