研究者詳細 - 水谷　克洋

論文 - 水谷　克洋

分割表示 >> ／全件表示 48 件中 1 - 48 件目

"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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

“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

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.

Access to Document (DOI)

A case of refractory chronic subdural hematoma and internal carotid artery stenosis sequentially treated with surgical drainage, middle meningeal artery embolization, and …

R Imai, T Akiyama, K Mizutani, M Toda

Surgical Neurology International 13 2022年

A case of refractory chronic subdural hematoma and internal carotid artery stenosis sequentially treated with surgical drainage, middle meningeal artery embolization, and carotid artery stenting.

Imai R, Akiyama T, Mizutani K, Toda M

Surgical neurology international （Surgical Neurology International） 13 342 - 342 2022年

ISSN 2229-5097

Background: Both chronic subdural hematoma (CSDH) and ischemic cerebrovascular disease are commonplace in the clinical context, and their combination is sometimes experienced. We describe a unique and challenging case in which both therapeutic interventions were indispensable and performed in a sequential manner. This report aims to discuss the management of hemorrhagic and ischemic conditions where CSDH and carotid artery stenosis coexist. Case Description: An 83-year-old male presented with the left cerebral infarction due to the left internal carotid artery (ICA) stenosis. The coexisting left CSDH was surgically drained first. Then, the left middle meningeal artery (MMA) was endovascularly embolized to prevent hematoma recurrence under antiplatelet therapy, before the left carotid artery stenting (CAS) was successfully conducted. The subdural hematoma gradually grew but remained asymptomatic. However, he later presented with another stroke due to the progressive right ICA stenosis that had been conservatively treated initially. Emergency right CAS was required eventually. Conclusion: Under the circumstances where CSDH is present but antiplatelet therapy is inevitable, MMA embolization could be a reasonable treatment option to avoid additional surgical procedures. Furthermore, early intervention should be considered even for asymptomatic carotid stenosis in terms of shortening the administration period of antiplatelet agents.

Access to Document (DOI)

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

The Cerebral Arterial Wall in the Development and Growth of Intracranial Aneurysms

PM Abbate, ATMH Hasan, A Venier, V Vauclin, S Pizzuto, A Sgreccia, ...

Applied Sciences 12 (12), 5964 （Applied Sciences (Switzerland)） 12 （ 12 ） 2022年

A considerable number of people harbor intracranial aneurysms (IA), which is a focal or segmental disease of the arterial wall. The pathophysiologic mechanisms of IAs formation, growth, and rupture are complex. The mechanism also differs with respect to the type of aneurysm. In broad aspects, aneurysms may be considered a disease of the vessel wall. In addition to the classic risk factors and the genetic/environmental conditions, altered structural and pathologic events along with the interaction of the surrounding environment and luminal flow dynamics contribute to the aneurysm’s development and growth. In this review, we have tried to simplify the complex interaction of a multitude of events in relation to vessel wall in the formation and growth of IAs.

Access to Document (DOI)

Meningiomas Involving the Hypoglossal Canal: A Case Report and Literature Review.

Shibao S, Yoshida K, Sogano J, Mizutani K, Tomita H

NMC case report journal 9 171 - 176 2022年

ISSN 2188-4226

Access to Document (DOI)

Molecular investigation of brain tumors progressing during pregnancy or postpartum period: the association between tumor type, their receptors, and the timing of presentation

Ichimura S., Ohara K., Kono M., Mizutani K., Kitamura Y., Saga I., Kanai R., Akiyama T., Toda M., Kohno M., Yoshida K., Sasaki H.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 207 2021年08月

ISSN 03038467

Objective: Brain tumors often become clinically evident during pregnancy; however, the mechanism has not been well elucidated. Purpose of this study is to investigate the influence of molecular genetic factors on the progression of brain tumors during pregnancy or the postpartum period. Methods: Twelve cases of brain tumors that presented during pregnancy or postpartum period were included: five gliomas, three meningiomas, two vestibular schwannomas, and two chordomas. Tumor samples were investigated by metaphase comparative genomic hybridization and immunohistochemistry, for chromosomal copy number aberration (CNA) and receptor expression of sex hormones and growth factors. Results: The results were correlated with the timing of tumor presentation in relation to the stage of pregnancy. EGFR, VEGFR-1/2, AR, and c-Myc were expressed in gliomas, PgR, ER, HER-2, VEGFR-1, EGF and VEGFR2 in meningiomas, VEGFR-1 in vestibular schwannomas, and EGFR, VEGFR-1/2, and c-Myc in chordomas. The CNAs of the tumors varied. Four of the five gliomas presented in the 2nd trimester, all three meningiomas in the 3rd trimester or postpartum period, and both of the two schwannomas in the late 2nd trimester. Expression of VEGFR-1/2 and EGFR was observed regardless of the timing of tumor presentation, whereas female hormone receptors and HER-2 were exclusively found in meningiomas. Interestingly, one anaplastic astrocytoma (IDH mut, non-codeleted) that progressed from precedent grade 2 tumor harbored amplification of the MYC locus. Conclusion: Progression of brain tumors during pregnancy is associated with various growth factors as well as sex hormones. The timing of presentation is likely dependent on molecular receptors specific to each tumor type.

Access to Document (DOI)

Mechanical Thrombectomy in Distal Residual Occlusions of the Middle Cerebral Artery after Large Vessel Recanalization in Acute Stroke: 2b or not 2b? A Pragmatic Approach in Real-Life Scenarios

Russo R., Del Sette B., Mizutani K., Coskun O., Di Maria F., Lapergue B., Wang A., Bergui M., Rodesch G., Consoli A.

World Neurosurgery （World Neurosurgery） 151 e793 - e802 2021年07月

ISSN 18788750

Background /Objective: Recent studies have suggested that a recanalization grade of modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2c is strongly related with good clinical outcome rather than the current therapeutic angiography target ≥2b. To achieve better recanalization, additional further maneuvers on distal residual vessel occlusion (RVO) may be required. The aim of this study was to evaluate the safety and efficacy of rescue treatment in RVOs after recanalization of large vessel occlusions in the anterior circulation. Methods: A single-center retrospective review of a prospectively maintained stroke databank was performed. Patients presenting with RVOs after mechanical thrombectomy on the M1/internal carotid artery terminus were included and further divided into treated and untreated groups: the former underwent additional maneuvers on RVOs, whereas the latter did not. Baseline and posttreatment clinical, radiologic, and angiographic data were compared between the 2 groups. End points included good functional outcome (modified Rankin Scale [mRS] score ≤2) rates of hemorrhagic transformations, neurologic deterioration and mortality. Results: RVOs were observed in 183/488 patients (37.5%). 74/183 (40.4%) underwent rescue treatment, showing a better outcome in terms of median 24 hours National Institutes of Health Stroke Scale score (13 vs. 18; P < 0001), 24 hours Alberta Stroke Programme Early CT Score (6 vs. 5; P < 0.001) and 3 months mRS score 0–2 (47.3% vs. 33.1%; P = 0.06). Recanalization of the superior (frontal) branch of the middle cerebral artery was particularly critical in terms of outcome. Hemorrhagic transformation was higher in the untreated group (53.6% vs. 66.6%; P = 0.1) as well as symptomatic intracranial hemorrhage (13.1% vs. 29.4%; P = 0.01). Neurologic deterioration occurred more often among untreated patients (16.2% vs. 25.7%; P = 0.1). Three complications (1.3%) occurred during rescue treatment. Conclusions: When feasible, improving mTICI score 2a-2b recanalization to mTICI 2c/3 is safe and associated with a better clinical outcome, particularly for residual occlusions involving the superior branch of bifurcation.

Access to Document (DOI)

Intradural spinal cord arteriovenous shunts in a personal series of 210 patients: novel classification with emphasis on anatomical disposition and angioarchitectonic distribution, related to spinal cord histogenetic units

Mizutani K., Consoli A., Di Maria F., Auliac S.C., Boulin A., Coskun O., Gratieux J., Rodesch G.

Journal of Neurosurgery: Spine （Journal of Neurosurgery: Spine） 34 （ 6 ） 920 - 930 2021年06月

ISSN 15475654

OBJECTIVE Few classifications of intradural spinal arteriovenous shunts (ID-SAVSs) have considered their anatomical localization in relation to their phenotype and angioarchitectonics. The authors propose another vision of ID-SAVSs allowing a reappraised classification based on analysis of the anatomical disposition, angioarchitecture, and histogenetic location of these vascular malformations. METHODS The radiological and clinical records of 210 patients with ID-SAVSs were retrospectively reviewed, considering their localization, vascular architectonics, and correlation with the 5 histogenetic units of the spinal cord. Among these, 183 files with complete data allowed precise analysis of the ID-SAVSs. RESULTS Among these 183 files (162 and 21 cases with single and multiple lesions, respectively), different entities were identified: 13 pial macro arteriovenous fistulas (MAVFs), 92 pial micro arteriovenous fistulas (mAVFs), 33 superficial pial niduses, and 69 intramedullary niduses. Thirteen sulcal shunts (either fistulas or niduses) were considered subtypes of pial lesions. Among the 21 multiple cases, 11 were monomyelomeric while 10 were multimyelomeric. Pial lesions, either fistulas or niduses, were dominantly vascularized by pial arteries (anterior or posterior depending on the localization of the shunt) and occasionally (except for MAVFs) by transmedullary arteries. Pial niduses occasionally extended into the funiculus by recruiting intrinsic veins or by extension of the nidus itself inside the white matter. Intramedullary niduses were always vascularized by both centrifugal and centripetal feeders, respectively, from sulcal arteries (SAs) and pial arteries. Sulcal lesions are pial lesions located within the ventral median sulcus and vascularized by SAs and veins. Single or multiple ID-SAVSs can be part of various syndromes such as hereditary hemorrhagic telangiectasia, Parkes-Weber, RASA1, CLOVES, and spinal arteriovenous metameric syndromes. Histogenetic analyses revealed a specific distribution of each ID-SAVS in the 5 histogenetic units of the spinal cord: Intramedullary niduses were found almost equally from cervical to thoracic units, while MAVFs and mAVFs were mostly found from thoracic to postcrural ones. Pial niduses showed intermediate features between intramedullary and fistulous lesions and were mostly distributed from brachial to crural segments. CONCLUSIONS Precise analysis of the anatomical disposition of ID-SAVSs in relation to functional histogenetic units allows a better understanding of these lesions and improved therapeutic management.

Access to Document (DOI)

De novo arteriovenous shunts after endovascular cure of cerebrospinal macro arteriovenous fistulas. A role for the vasa vasorum?

Tsang C.P., Mizutani K., Trenkler J., Holmin S., Rodesch G.

Journal of Neuroradiology （Journal of Neuroradiology） 48 （ 2 ） 127 - 131 2021年03月

ISSN 01509861

Background and purpose: Macro-arteriovenous fistulas (MAVFs) are arteriovenous shunts draining into a giant venous ectasia. They can be treated by surgery or embolisation. Angiographic controls are usually performed rapidly after treatment in order to prove the cure of the lesion but no long term angiographies are generally scheduled. We wanted to control the stabilities of such lesions at follow-up. Method: Clinical history and imaging of ninety-five patients with high flow shunts draining into venous ectasias (MAVFs, Vein of Galen malformations and dilatations) were reviewed. Results: De novo arteriovenous shunts related to angiogenesis involving vasa vasorum developed in three patients with MAVFs at various intervals. Genetic underlying conditions as HHT or RASA 1 mutations were suspected in each patient. Conclusions: Neo-angiogenesis can occur after cure of MAVFs. Long term imaging follow-ups should be considered as the natural history of such recurrent shunts is currently unknown.

Access to Document (DOI)

Corrigendum to ‘Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase’ [Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 10 (October), 2020: 105052] (Journal of Stroke and Cerebrovascular Diseases (2020) 29(10), (S1052305720304705), (10.1016/j.jstrokecerebrovasdis.2020.105052))

Hebert S., Clavel P., Maier B., Mizutani K., Delvoye F., Lapergue B., Maacha M.B., Fahed R., Escalard S., Desilles J.P., Redjem H., Ciccio G., Smajda S., Gory B., Richard S., Blanc R., Piotin M., Mazighi M.

Journal of Stroke and Cerebrovascular Diseases （Journal of Stroke and Cerebrovascular Diseases） 30 （ 2 ） 105465 - 105465 2021年02月

ISSN 10523057

Access to Document (DOI)

Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase (vol 29, 105052, 2020)

S Hebert, P Clavel, B Maier, K Mizutani, F Delvoye, B Lapergue, ...

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 30 (2) 2021年

Mechanical thrombectomy in distal residual occlusions of the middle cerebral artery after large vessel recanalization in acute stroke: 2b or not 2b? A pragmatic approach in …

R Russo, B Del Sette, K Mizutani, O Coskun, F Di Maria, B Lapergue, ...

World neurosurgery 151, e793-e802 2021年

Intradural spinal cord arteriovenous shunts in a personal series of 210 patients: novel classification with emphasis on anatomical disposition and angioarchitectonic …

K Mizutani, A Consoli, F Di Maria, SC Auliac, A Boulin, O Coskun, ...

Journal of Neurosurgery: Spine 34 (6), 920-930 2021年

Corrigendum to ‘Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase’[Journal of Stroke and Cerebrovascular Diseases …

S Hebert, P Clavel, B Maier, K Mizutani, F Delvoye, B Lapergue, ...

Journal of Stroke and Cerebrovascular Diseases 30 (2), 105465 2021年

Anatomical disposition of the anterior spinal artery and vein: Subpial or subarachnoid?

Katsuhiro Mizutani, Georges Rodesch

Interventional Neuroradiology （{SAGE} Publications） 26 （ 6 ） 159101992092862 - 159101992092862 2020年12月

Access to Document (DOI)

4D-CTAを用いた頭蓋内静脈の血流方向と血流速度の推定

水谷克洋, 荒井信彦, 戸田正博, 秋山武紀, 藤原広和, 陣崎雅弘, 吉田一成

脳血管内治療（(NPO)日本脳神経血管内治療学会） 5 （ Suppl. ） 64 - 64 2020年11月

ISSN 2423-9119

Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase

Hebert S., Clavel P., Maier B., Mizutani K., Delvoye F., Lapergue B., Maacha M.B., Fahed R., Escalard S., Desilles J.P., Redjem H., Ciccio G., Smajda S., Blanc R., Piotin M., Mazighi M.

Journal of Stroke and Cerebrovascular Diseases （Journal of Stroke and Cerebrovascular Diseases） 29 （ 10 ） 105052 - 105052 2020年10月

ISSN 10523057

Backround and Purpose: Role of peri-procedural heparin as an adjuvant treatment during mechanical thrombectomy (MT) for patients contra-indicated for alteplase remains a source of debate. Methods: We included patients from the multicenter French register ETIS that underwent MT without administration of alteplase, and compared patients who received heparin during MT with patients who did not. Heparin impact on outcome were analyzed regarding final TICI score, NIHSS at day one, modified rankin scale (mRS) and intracranial hemorrhagic transformation on imaging at day one. Results: Over 1031 patients, 751 were included between January 2015 and June 2018 in 6 different centers, and 223 (26.69%) received heparin. Heparin administration was associated with a significant deleterious effect on NIHSS at 24h [adjusted OR = 1.2; p = 0.02], mRS at 3 months [adjusted OR 1.58; p = 0.03], and on complete reperfusion [TICI 3 adjusted OR 0.68; p = 0.02]. Heparin administration was associated with a significant reduction of hemorrhagic transformation [adjusted OR 0.48; p = 0.00005]. Conclusions: Heparin administration during MT seems deleterious for reperfusion and functional outcome. Randomized trials are needed to identify the role of antithrombotic treatments, such as heparin, in the setting of acute ischemic stroke management.

Access to Document (DOI)

Novel method to evaluate the risk of tumor adhesions and post-operative hemorrhage of meningiomas using 320 row CT-DSA: A clinical research study

Arai N., Mizutani K., Horiguchi T., Akiyama T., Takahashi S., Yanagisawa K., Koike K., Yoshida K.

Acta Neurochirurgica （Acta Neurochirurgica） 162 （ 9 ） 2145 - 2153 2020年09月

ISSN 00016268

Objective: Meningioma is an extra-axial tumor that forms adhesions toward the brain surface in the course of its growth. Predicting adhesions between the tumor and the brain surface leads to better predictions of surgical results. There are few studies on brain–tumor adhesions or postoperative hemorrhage. This study aimed to assess tumor vascularity of the dura and cerebral surface, and predict surgical outcomes using four-dimensional computed tomography angiography (4D CTA). Patients and methods: Using a dynamic contrast CT, we conducted a retrospective study of 27 patients with convexity (n = 15), falx (n = 6), and parasagittal (n = 6) meningiomas treated in our hospital from January 2016 to September 2018. We set the region of interest on the dural layer and cerebral surface side of meningiomas and calculated the mean CT value in each region. Distribution of blood flow in the tumor was classified into two groups: A, which has a higher CT value of the dural side than that of the brain surface side at every timing, and B, which meets the criteria other than those in group A. Demographic data, preoperative characteristic images, and postoperative complications were compared between the groups. Results: Twelve and 15 patients were classified into groups A and B, respectively. The extent of adhesions against the cerebral cortex in group A was significantly less severe compared with that in group B (p = 0.038). The rate of postoperative hemorrhage occurrence in group B (53%) was significantly higher than that in group A (8%) (p = 0.04). There were no significant differences in the other preoperative characteristic images or perioperative parameters between groups A and B. Conclusion: A 320-row dynamic contrast CT scanner can detect meningiomas with a high probability of severe adhesion toward the brain surface and postoperative intraparenchymal hematoma.

Access to Document (DOI)

Analysis of the superficial middle cerebral vein in sphenoid ridge meningioma using contrast-enhanced dynamic computed tomography angiography

Murase M., Mizutani K., Kawata K., Fujiwara H., Jinzaki M., Toda M., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 191 105683 - 105683 2020年04月

ISSN 03038467

Objective: The superficial middle cerebral vein (SMCV) is of clinical importance because of its contribution to the venous drainage of the superficial part of the cerebrum. Sphenoid ridge meningioma (SRM) grows adjacent to the SMCV and its drainage routes, and is thought to occasionally influence the hemodynamics of the SMCV, although this has seldom been suggested in the literature. We investigated the effect of SRM on the SMCV via blood flow analysis using multi-detector computed tomography. Patients and Methods: Overall, 22 patients with SRM who preoperatively underwent contrast-enhanced dynamic computed tomography at our institution were included in this study. We serially measured the Hounsfield units at each point of the SMCV and its adjacent veins on the side on which the tumor was located. We then obtained a time-density curve for each point via gamma distribution fitting. We determined the time-to-peak at each point by calculating the derivative of the time-density curve function and deduced the direction of blood passing through each vein by comparing the time-to-peak values between several points. Results: In total, 26 SMCVs were measured in 19 out of 22 cases. Of the 26 SMCVs, 16 were patent in the medial portion and contributed to normal venous drainage: 4 of them emptied into the cavernous sinus (CS), and 12 of them into the para-cavernous sinus (ParaCS). Out of the 10 that had their medial portions occluded because of the effects of the tumor, 6 SMCVs mainly drained into the vein of Labbé and/or the vein of Trolard retrogradely. However, in 2 of these, the small medial portions of the SMCVs near the occluded portion were maintained anterogradely by the collateral venous structures. In 4 SMCVs, the blood flow through the collateral veins remained anterograde; this was considered to contribute to normal venous drainage. Conclusion: The SRM is likely to cause occlusion or stenosis in the SMCV and influence its hemodynamics. In cases in which the connection between the SMCV and the CS or the ParaCS has been lost, the SMCV may still be involved in normal venous drainage via the collateral veins in some of those cases. Thus, the contribution of these veins to normal venous drainage in the brain should be analyzed preoperatively in careful detail.

Access to Document (DOI)

Clipping versus coiling in unruptured anterior cerebral circulation aneurysms

Mohammad F., Horiguchi T., Mizutani K., Yoshida K.

Surgical Neurology International （Surgical Neurology International） 11 （ 50 ） 50 - 50 2020年03月

ISSN 2229-5097

Background: Unruptured intracranial aneurysms (UIAs) are not uncommon, especially in Japan. Treatment strategy for UIAs has evolved in the past decades in Western countries with the increased use of endovascular treatment as the primary option, but in Japan, clipping still has the upper hand. Methods: This study retrospectively included 200 patients treated by clipping or coiling for UIAs located in the anterior cerebral circulation. Postoperative angiographic and clinical outcomes were evaluated. Results: Of 200 UIAs, 147 and 53 were treated by surgery and coiling, respectively. The average follow-up duration was 30.2 ± 18.8 months for clipping and 29.3 ± 17.6 months for coiling. Complete occlusion was greater in the surgery group (78.9%) than the endovascular group (18.8%). Regrowth occurred in 1.4% of the clipping group and 13.2% of the coiling group. Ischemic events were encountered in both groups; asymptomatic ones were higher in the coiling group (24.5%) than in the clipping group (2%), while symptomatic ischemic complications were equal (7.5%) in both groups. The deterioration of modified Rankin scale was detected totally in 13 UIAs (6.5%) with no statistical difference between groups. Postoperative hospital period was longer in clipping (P = 0.01). Conclusion: Clipping and coiling were both safe and feasible in the treatment of unruptured aneurysms. The clipping was advantageous in durability, while the rate of morbidity was lower, and hospitalization period was shorter in the coiling group. The clipping and coiling should coexist while complementing each other by understanding the advantages and disadvantages of both.

Access to Document (DOI)

A Novel Flow Dynamics Study of the Intracranial Veins Using Whole Brain Four-Dimensional Computed Tomography Angiography

Mizutani K., Arai N., Toda M., Akiyama T., Fujiwara H., Jinzaki M., Yoshida K.

World Neurosurgery （World Neurosurgery） 131 e176 - e185 2019年11月

ISSN 18788750

Background: The flow dynamics of the intracranial venous channels are fundamentally important for understanding intracranial physiology and pathophysiology. However, the method clinically applicable to the evaluation of the flow dynamics of the intracranial venous system has not been well described in the reported data. We have developed a new method to evaluate intracranial venous flow direction and velocity using 4-dimensional (4D) computed tomography angiography (CTA). The aim of the present study was to verify the accuracy and validity of 4D-CTA in a clinical setting. Methods: We retrospectively analyzed 97 veins from 26 patients (16 cases of arteriovenous shunt disease, 9 intracranial tumor cases, and 1 cerebral aneurysm case) who had undergone both 4D-CTA and conventional digital subtraction angiography (DSA). Using 4D-CTA, we analyzed the time-density curve with gamma distribution extrapolation and obtained the direction of the flow and flow velocity of each vein. The direction of the flow in 4D-CTA was also collated with that obtained using conventional DSA to verify the experimental method. Results: The direction of the flow determined by 4D-CTA was consistent with that of conventional DSA in 94.8% of cases. The average venous flow velocity was 64.3 mm/second and 81.8 mm/second, respectively, in the antegrade and retrograde channels affected by arteriovenous shunts. Conclusions: The present flow analysis using 4D-CTA enabled us to evaluate the direction and velocity of intracranial venous flow. Other than some limitations, the presented method is reliable and its potential for application in clinical settings is promising.

Access to Document (DOI)

Aberrant trans-osseous venous drainage of the superficial middle cerebral vein: case report

Mizutani K., Consoli A., Di Maria F., Coskun O., Rodesch G.

Acta Neurochirurgica （Acta Neurochirurgica） 161 （ 4 ） 807 - 810 2019年04月

ISSN 00016268

The superficial middle cerebral veins (SMCVs) are large veins to drain the brain and therefore anatomical knowledge of them is important for neurosurgeons and neuroradiologists. In a patient with a ruptured blister aneurysm, we incidentally found during angiography an aberrant drainage of the SMCVs, which penetrated the lateral part of the greater sphenoid wing and directly connected the SMCVs with the deep facial vein. Neurosurgeons usually need to remove that part of the greater sphenoid wing during the fronto-temporal approach. The existence of a well-developed current channel could be a contraindication for this type of procedure.

Access to Document (DOI)

Thrombosis of the draining vein causes intracranial haemorrhage in the natural history of brain arteriovenous malformation: case report

Fukaya R., Mizutani K., Fukuchi M., Fujii K.

British Journal of Neurosurgery （British Journal of Neurosurgery） 33 （ 1 ） 94 - 95 2019年01月

ISSN 02688697

Access to Document (DOI)

Skull Base Venous Anatomy Associated with Endoscopic Skull Base Neurosurgery: A Literature Review

Mizutani K., Akiyama T., Yoshida K., Toda M.

World Neurosurgery （World Neurosurgery） 120 405 - 414 2018年12月

ISSN 18788750

An understanding of the anatomy and function of the skull base venous channels is fundamentally important for safe performance of endoscopic surgery for skull base lesions. This review focuses on 4 skull base venous channels—namely, the intercavernous sinuses, basilar plexus, osseous veins, and inferior petroclival vein—because these have been less recognized by neurosurgeons than other major venous channels such as the inferior petrosal sinus. We reviewed the literature concerning these 4 venous channels and discussed their anatomy and function. The literature review was mainly based on an electronic search in PubMed using the following terms: “intercavernous sinus,” “basilar plexus,” “emissary veins,” “diploic vein,” “basilar plexus,” “intraosseous vein,” “inferior petroclival/petro-occipital vein,” and “transclival.” A total of 50 articles were included in this review. Detailed anatomic features of the 4 structures have been elucidated in the literature. All of these venous channels run along the skull base and have multiple connections with surrounding venous structures. Because of their location, they occasionally obstruct the surgical view and are sometimes implicated in intraoperative hemorrhage, air embolism during endoscopic skull base surgery, and postoperative hematoma. They usually function as a venous reservoir of cranial venous drainage; however, they are less often directly involved in normal brain perfusion. Knowledge about the functional and morphologic anatomy of the skull base venous channels is important for neurosurgeons to avoid unexpected complications during endoscopic skull base surgery.

Access to Document (DOI)

An analysis of the anatomic route of the hypoglossal nerve within the hypoglossal canal using dynamic computed tomography angiography in patients with anterior condylar arteriovenous fistulas

Oishi Y., Akiyama T., Mizutani K., Horiguchi T., Imanishi N., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 174 207 - 213 2018年11月

ISSN 03038467

Objective: The venous outlet of anterior condylar arteriovenous fistulas (AC-AVFs) often empties into the anterior condylar vein (ACV). Hypoglossal nerve palsy is one of the major complications after transvenous embolization (TVE) for the AC-AVF within the hypoglossal canal. However, no studies have investigated the route of the hypoglossal nerve within the hypoglossal canal in AC-AVF. The aim of the current study is to retrospectively verify the anatomical route of the hypoglossal nerve within its canal using dynamic computed tomography angiography (CTA) in order to facilitate the safe TVE for AC-AVF. Patients and methods: We included five patients with AC-AVF from 2011 to 2017. Dynamic CTA was performed on all patients. When the ACV was well-visualized by dynamic CTA, the hypoglossal nerve could be recognized as a less-intense structure within the surrounding enhanced vasculatures and the nerve route within the canal was analyzed. We also analyzed the location of the fistulas by digital subtraction angiography and cone-beam computed tomography. Results: In all five patients, the filling defect of the hypoglossal nerve ran through the most caudal portion of the hypoglossal canal. The fistulous pouches were located in the hypoglossal canal in three cases, and in the jugular tubercle venous complex in two cases. In all three cases with AC-AVF in the hypoglossal canal, the fistulous pouches were located in the superior wall of the hypoglossal canal, which means superior to the ACV. We performed TVE in four patients and none developed post-therapeutic hypoglossal nerve palsy. Conclusion: In the current study, dynamic CTA is useful for detecting the hypoglossal nerve within the hypoglossal canal. The hypoglossal nerve usually ran the bottom of its canal and the fistulous pouches were usually located at the superior aspect of the canal opposite side to the hypoglossal nerve. Accordingly, the selective embolization within the fistulous pouch located in the superior aspect of the ACV including jugular tubercle venous complex can reduce the risk of hypoglossal nerve palsy.

Access to Document (DOI)

Preoperative Assessment of Pathologic Subtypes of Meningioma and Solitary Fibrous Tumor/Hemangiopericytoma Using Dynamic Computed Tomography: A Clinical Research Study

Arai N., Mizutani K., Takahashi S., Morimoto Y., Akiyama T., Horiguchi T., Mami H., Yoshida K.

World Neurosurgery （World Neurosurgery） 115 e676 - e680 2018年07月

ISSN 18788750

Background: Solitary fibrous tumors (SFTs)/hemangiopericytomas (HPCs) are highly vascularized tumors well known for malignant, invasive, and highly vascular features. To date, several studies have reported the preoperative imaging findings of SFTs/HPCs. In this study, computed tomography (CT) tumor values acquired from dynamic CT scan were selected to determine the tumor pathology of highly vascular tumors, such as SFTs/HPCs. Methods: We conducted a retrospective study on patients with pathologically diagnosed meningiomas and SFTs/HPCs who had undergone a dynamic contrast CT scan. We assessed and compared the CT values of these tumors according to the pathology. Results: From a total of 34 patients, 30 patients with meningiomas and 4 patients with HPCs were included. The mean CT values of SFTs/HPCs and angiomatous meningioma were statistically significantly higher than those of the other meningioma subtypes (P = 0.003). We also performed receiver operating characteristic curve analyses to detect an appropriate cutoff point for the CT value to differentiate tumor pathology, and the calculated threshold was 161 Hounsfield units (HU) (sensitivity, 100%; specificity, 75%; area under the curve, 0.87; 95%, CI 0.75–0.99). Conclusions: This study showed that obtaining a CT value is useful in determining highly vascular tumor pathology preoperatively. When considering neurosurgical extra-axial tumor removal, and when the CT value of tumors is >161 HU, then highly vascular tumors such as SFTs/HPCs or angiomatous meningiomas are likely, and this should be considered prior to surgical intervention and for risk assessment.

Access to Document (DOI)

Intraosseous venous structures adjacent to the jugular tubercle associated with an anterior condylar dural arteriovenous fistula

Mizutani K., Akiyama T., Minami Y., Toda M., Fujiwara H., Jinzaki M., Yoshida K.

Neuroradiology （Neuroradiology） 60 （ 5 ） 487 - 496 2018年05月

ISSN 00283940

Purpose: Although involvement of the osseous component with an anterior condylar dural arteriovenous fistula (AC-DAVF) has been frequently described, osseous venous structures in which AC-DAVFs develop have not been fully elucidated. We investigated osseous venous structures adjacent to the hypoglossal canal in normal controls and patients with AC-DAVFs. Methods: The study included 50 individuals with unruptured aneurysms as normal controls and seven patients with AC-DAVFs. Osseous venous structures adjacent to the hypoglossal canal in normal controls were analyzed using computed tomography (CT) digital subtraction venography. In patients with AC-DAVFs, the fistulous pouches, draining veins, and surrounding venous structures were examined using cone beam CT. Results: In 46.0% of laterals in normal controls, osseous venous structures were visualized within the jugular tubercle superomedially to the hypoglossal canal. We named these structures the jugular tubercle venous complex (JTVC). The JTVC was always continuous with the anterior condylar vein and was sometimes connected to surrounding venous channels. We detected nine fistulous pouches in the seven patients with AC-DAVFs. The fistulous pouches were in the JTVC (33.3%), anterior condylar vein (33.3%), and other venous channels within the exoccipital region (33.3%). Conclusion: Although the JTVC is a venous structure frequently found in normal people, it had not been investigated until now. The venous channel between the anterior condylar vein and JTVC is a common origin site for AC-DAVFs, and it was associated with 66.6% of the AC-DAVF cases in the current study.

Access to Document (DOI)

The analysis of the cerebral venous blood volume in cavernous sinus using 320 row multi-detector CT

Mizutani K., Toda M., Yajima Y., Akiyama T., Fujiwara H., Yoshida K., Jinzaki M.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery） 167 11 - 16 2018年04月

ISSN 03038467

Objectives: : Functional venous anatomy in the brain has been mostly understood from the morphological and embryological points of view and no published study has directly evaluated the blood flow volume of cerebral small veins. We developed a method to directly evaluate the relative blood volume in small venous channels using multi-detector computed tomography (CT) and applied it to evaluate the blood volume in each tributary of the cavernous sinus, which plays an important role in cerebral venous drainage. Patients and Methods: : Ten patients with small brain tumors who had normal venous anatomy were included in the present study. All of them underwent preoperative 320-row multi-detector CT. After injecting the contrast bolus, we measured the Hounsfield units (HUs) at 10 time point over 60 s in each tributary of the cavernous sinus. The gamma distribution fitting to each HU enabled us to obtain a time-density curve and determine the relative venous volume in each venous channel. Results: : In terms of blood volume, the superficial middle cerebral vein and inferior petrosal sinus were the largest inflow and outflow channels of the cavernous sinus and accounted for 36.1% and 24.7% of its inflow and outflow on average, respectively. The superior orbital vein did not contribute to the blood volume passing through the cavernous sinus in the current study. Conclusions: : The present study allowed us to determine the relative blood volume in each tributary of the cavernous sinus, which was very useful to understand the physiological actual venous drainage pattern concerning the cavernous sinus in normal anatomy.

Access to Document (DOI)

Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus

Mizutani K., Miwa T., Akiyama T., Sakamoto Y., Fujiwara H., Yoshida K.

Neuroradiology （Neuroradiology） 60 （ 3 ） 325 - 333 2018年03月

ISSN 00283940

Purpose: The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. Methods: We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. Results: The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. Conclusions: The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

Access to Document (DOI)

Postnatal delayed exacerbation of dural sinus malformation associated with brainstem cavernous malformations: A case report.

Mizutani K, Miwa T, Akiyama T, Kanazawa T, Nagashima H, Miyakoshi K, Niimi Y, Yoshida K

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 23 （ 5 ） 510 - 515 2017年10月

ISSN 1591-0199

Dural sinus malformation (DSM) is a rare paediatric vascular malformation characterised by abnormal dilation of the posterior dural sinus. Owing to its rarity, the pathophysiology of DSM has not been fully elucidated. We report a case of prenatally diagnosed DSM with an unusual clinical course. We detected DSM in a male foetus in the 26th week of gestation by using foetal ultrasonography. Although the DSM regressed during the foetal stage and the arteriovenous shunt was insignificant in the neonate, the shunt rapidly developed four months after birth. The neonate also had postnatal de novo brainstem cavernous malformation (CM), which also developed rapidly, supposedly due to the aggravated venous hypertension resulting from the DSM. We successfully treated the aggravated shunts by endovascular transarterial and transvenous embolisation six times over two years and, subsequently, the clinical condition and the size of the brainstem CM became stable. The DSM and CM seemed to have a metameric origin. Such aberrant cases could help to further the understanding of DSM.

Access to Document (DOI)

Analysis of the venous channel within the clivus using multidetector computed tomography digital subtraction venography.

Mizutani K, Toda M, Kurasawa J, Akiyama T, Fujiwara H, Jinzaki M, Yoshida K

Neuroradiology （Springer Nature） 59 （ 3 ） 213 - 219 2017年03月

ISSN 0028-3940

PURPOSE: Although neuroradiologists and skull base neurosurgeons are aware of the existence of veins within the clivus, such vessels have seldom been described in the literature. The aim of the present study is to elucidate the detailed venous structure of the clivus. METHODS: Computed tomography digital subtraction venography (CT-DSV) images of 50 unruptured aneurysm cases were examined retrospectively. RESULTS: Eighteen emissary veins were identified in 14 (28.0%) cases. A half of the emissary veins connected the inferior petrosal sinus with the inferior petro-occipital vein (IPOV) in the middle clivus. The clival diploic vein (CDV) was identified in 14.0% of cases, 42.9% of which had the clivus of the presellar type. The CDV was connected to the posterior intercavernous sinus or the rostral end of the basilar plexus superiorly, and was connected to the IPOV, anterior condylar vein, marginal sinus, or the anterior condylar confluence. CONCLUSION: The CDV provides collateral channels between the cavernous sinus and the internal jugular vein and the inferior petrosal sinus and the IPOV. Understanding of the emissary veins in the clivus and the CDV is valuable for skull base surgery, especially for endonasal endoscopic skull base procedures.

Access to Document (DOI)

Transvenous Embolization of the Basilar Plexus Before Endoscopic Transsphenoidal Transclival Surgery.

Mizutani K, Akiyama T, Toda M, Kanazawa T, Kamamoto D, Yoshida K

World neurosurgery （Elsevier {BV}） 97 756.e13 - 756.e18 2017年01月

ISSN 1878-8750

BACKGROUND: The endoscopic transclival approach is a method for reaching the anterior side of the brainstem. In making this approach, bleeding from the basilar plexus is often observed when cutting the dura overlying the clivus. Controlling such bleeding is essential. CASE DESCRIPTION: We performed a transvenous embolization of the basilar plexus before making the transclival approach. After embolization, bleeding from the basilar plexus during the operation decreased considerably. CONCLUSIONS: To our knowledge, this is the first report of transvenous embolization of the basilar plexus. If the basilar plexus is well developed on preoperative computed tomographic venography or digital subtraction angiography, this procedure is useful for controlling bleeding during endoscopic transclival surgery.

Access to Document (DOI)

頸椎硬膜外動静脈瘻と軟部組織動静脈奇形が同一metamere内に発生した一例

荒井信彦, 秋山武紀, 美原貫, 水谷克洋, 吉田一成

脳血管内治療（(NPO)日本脳神経血管内治療学会） 1 （ Suppl. ） S148 - S148 2016年11月

ISSN 2423-9119

A case of papillary tumor of the pineal region with a long clinical history: molecular characterization and therapeutic consideration with review of the literature.

Kamamoto D, Sasaki H, Ohara K, Mizutani K, Yoshida K

Brain tumor pathology 33 （ 4 ） 271 - 275 2016年10月

ISSN 1433-7398

Access to Document (DOI)

The Analysis of the Petrosal Vein to Prevent Venous Complications During the Anterior Transpetrosal Approach in the Resection of Petroclival Meningioma.

Mizutani K, Toda M, Yoshida K

World neurosurgery （Elsevier {BV}） 93 175 - 82 2016年09月

ISSN 1878-8750

BACKGROUND: The anterior transpetrosal approach (ATPA) has been used in the resection of petroclival meningioma (PCM) for more than 20 years. Although PCM sometimes involves the petrosal vein and its preservation has been an important issue, the precise risk of petrosal vein sacrifice and subsequent venous complications associated with the use of the ATPA in patients with PCM has not yet been elucidated. METHODS: We used computed tomographic (CT) digital subtraction venography (DSV) in the retrospective analysis of the petrosal vein and its tributaries in patients with PCM before and after surgery. We also examined the incidence of postoperative venous complications in each of the patients. RESULTS: The detection rate of the petrosal vein and some of its tributaries on CT-DSV in patients with PCM was significantly lower than that in controls. Preoperatively, CT-DSV detected the petrosal vein in 71.8% of patients with PCM. The detected petrosal veins were preserved after the operation in 64.3% of these patients. No venous complications involving petrosal vein were observed in any of the patients. Anastomosis between the petrosal vein and the basal vein via the pontotrigeminal vein was found to be significantly more developed in the patients with PCM compared with the controls. CONCLUSIONS: Our study demonstrated that the ATPA could be performed safely on patients with PCM from the viewpoint of venous preservation. Preoperative CT-DSV is important for assessing the petrosal vein and its tributaries to facilitate a safer operation.

Access to Document (DOI)

Histopathological investigation of glioblastomas resected under bevacizumab treatment.

Tamura R, Tanaka T, Miyake K, Tabei Y, Ohara K, Sampetrean O, Kono M, Mizutani K, Yamamoto Y, Murayama Y, Tamiya T, Yoshida K, Sasaki H

Oncotarget 7 （ 32 ） 52423 - 52435 2016年08月

To date, no clinical observations have been reported for histopathological changes in human gliomas under antiangiogenic treatment.We collected six glioblastomas resected under bevacizumab treatment. Histopathological investigation was performed by hematoxilyn-eosin staining and immunohistochemistry for CD34, VEGF, VEGFR1/2, HIF-1α, CA9, and nestin as compared to eleven control glioblastomas to assess the differences in histological features, microvessel density, expression of VEGF and its receptors, tumor oxygenation, and status of glioma stem-like cells.In the six tumors resected under bevacizumab, microvascular proliferation was absent, and microvessel density had significantly decreased compared with that of the controls. The expressions of VEGF and its receptors were downregulated in two cases of partial response. HIF-1α or CA9 expression was decreased in five of the six tumors, whereas the decreased expression of these markers was noted in only one of the 11 control glioblastomas. The expression of nestin significantly decreased in the six tumors compared with that of the controls, with the remaining nestin-positive cells being relatively concentrated around vessels.We provide the first clinicopathological evidence that antiangiogenic therapy induces the apparent normalization of vascular structure, decrease of microvessel density, and improvement of tumor oxygenation in glioblastomas. These in situ observations will help to optimize therapy.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

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.

Access to Document (DOI)

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

Access to Document (DOI)

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

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.

Access to Document (DOI)

　前のページ - 次のページ　

水谷 克洋

論文 - 水谷 克洋

水谷　克洋

論文 - 水谷　克洋