Details of a Researcher - Akiyama, Takenori

Papers - Akiyama, Takenori

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蝶形骨小翼部硬膜動静脈瘻の1例

菊地亮吾, 秋山武紀, 中村明義, 宮崎宏道

脳卒中の外科 ((一社)日本脳卒中の外科学会) 50 ( 1 ) 64 - 69 2022.01

ISSN 0914-5508

Carotid body tumor with neck metastasis due to germline SDHB variant: a case report and literature review

Mikoshiba Takuya, Yoshihama Keisuke, Ito Fumihiro, Sekimizu Mariko, Nakamura Shintaro, Nagai Ryoto, Akiyama Takenori, Matsubara Kentaro, Obara Hideaki, Ozawa Hiroyuki

INTERNATIONAL CANCER CONFERENCE JOURNAL 11 ( 1 ) 6 - 11 2022.01

ISSN 2192-3183

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特集頭頸部の再建をマスターする!〔特別付録Web動画〕《部位別再建法》頸動脈の再建

小澤宏之, 秋山武紀, 尾原秀明

耳鼻咽喉科・頭頸部外科 (株式会社医学書院) 93 ( 13 ) 1138 - 1143 2021.12

ISSN 0914-3491

Surgical resection of arteriovenous fistula at the cauda equina

Shimizu T, Nagoshi N, Akiyama T, Suzuki S, Nori S, Tsuji O, Okada E, Yagi M, Watanabe K, Nakamura M, Matsumoto M

Spinal Cord Series and Cases (Spinal Cord Series and Cases) 7 ( 1 ) 29 2021.12

Joint Work, ISSN 2058-6124

Introduction: Although spinal arteriovenous fistula (AVF) has been reported widely, AVF at the cauda equina is quite rare. We described a case of AVF at the cauda equina that was fed by the distal radicular artery (DRA). Case presentation: A 50-year-old woman presented with sudden weakness of the lower extremities. Magnetic resonance imaging (MRI) revealed a lesion with a highly intense signal at the conus medullaris, which was surrounded by several low-intensity signals (flow voids). Digital subtraction angiography revealed AVF at the cauda equina and that it was fed by the DRA, which was directly fed by the L3 segmental artery. We performed surgical resection of the AVF while monitoring motor-evoked potentials. The patient’s postoperative course was uneventful, and her neurological symptoms gradually resolved. MRI 2 years after surgery showed the disappearance of both intramedullary edema and the flow voids. Discussion: For the AVF, located at the cauda equina and fed by the DRA in this case, surgical resection or endovascular embolization could have been selected. We performed open surgery to achieve complete obliteration of the AVF, which led to postoperative functional recovery without any adverse events. However, only a limited number of AVFs at the level of the cauda equina have been reported, and treatment standards have not been established. Further studies of AVFs at the cauda equina are necessary to clarify the epidemiological characteristics and clinical outcomes with an appropriate sample size.

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[Mechanisms Underlying Novel Complications Associated with Neuroendovascular Therapy for Cerebrovascular Diseases].

Akiyama T

Brain and nerve = Shinkei kenkyu no shinpo (株式会社医学書院) 73 ( 9 ) 1007 - 1012 2021.09

Single Work, ISSN 1881-6096

Angio-anatomical study of the pterygovaginal artery based on cone-beam computed tomography

Yoshida K, Akiyama T, Raz E, Kamamoto D, Ozawa H, Toda M

Neuroradiology (Neuroradiology) 63 ( 8 ) 1325 - 1333 2021.08

Joint Work, ISSN 00283940

Purpose: To investigate the anatomical characteristics and clinical implications of the pterygovaginal artery (PtVA), a recurrent branch from the distal internal maxillary artery (IMA), which courses through the pterygovaginal canal that connects the pterygopalatine fossa and nasopharynx. Methods: Eighty-two patients with 90 sides of cone-beam computed tomography (CBCT) reconstructed from rotational angiography of the external or common carotid artery with a field of view covering the pterygopalatine fossa were retrospectively reviewed. The origin from the IMA, branching type, distribution, and anastomoses was evaluated. The underlying lesions were 36 hypervascular lesions with possible supply from PtVA (17 cavernous sinus arteriovenous fistulas (AVFs), 6 anterior condylar AVFs, and 13 nasopharyngeal, parasellar, or paraclival tumors) and 46 other diseases. Results: PtVA was identified in 75 sides (83%). It originated from the pterygopalatine segment of the IMA in 45 sides (60%) and from the pterygoid segment in 30 sides (40%). It arose independently (77%), sharing the common trunk with the Vidian artery (15%) or with other branches. It ran posteromedially through the pterygovaginal canal to supply the mucosa over the nasopharyngeal roof, the choanae, and the pharyngeal ostium of the eustachian tube. It anastomosed with the ascending pharyngeal artery (n=37), the accessory meningeal artery (n=7), and the mandibular artery from the petrous internal carotid artery (n=2). It served as a feeder of osseous AVFs and skull base tumors. Conclusion: PtVA was often identified by CBCT even in normal anatomy. Its detailed angio-anatomy could be evaluated in the presence of parasellar or paraclival hypervascular lesions.

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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 106720 2021.08

Joint Work, 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.

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Cone-Beam Computed Tomography Fusion Technique for Vascular Assessment of Skull Base Meningiomas

Yoshida K, Akiyama T, Takahashi S, Miwa T, Horiguchi T, Sasaki H, Toda M

World Neurosurgery (World Neurosurgery) 151 61 - 69 2021.07

Joint Work, ISSN 18788750

Objective: Cone-beam computed tomography (CBCT) images for skull base tumors provide detailed vascular information and localization in regard to surrounding bony structures. We report use of the CBCT fusion technique for skull base meningiomas. Methods: Six patients with petroclival or petrotentorial meningiomas supplied by multiple arterial systems were preoperatively evaluated using CBCT fusion imaging. Fusion images were reconstructed from three-dimensional rotational angiography with contrast agent injections from the internal carotid artery (ICA) and external carotid artery in 4 cases, vertebral artery and external carotid artery in 1 case, and ICA and vertebral artery in 1 case. Results: The feeding pedicles and tumor stains from 2 arterial systems were differentiated by separate colors. The courses and territories of the ICA dural feeders or ICA/vertebral artery pial feeders were easily distinguished from the external carotid artery dural feeders. Anastomoses between thin feeders from different arterial systems could be detected. Mixed stain (stain with both colors) was observed in some tumor compartments, suggesting dual supply from 2 arterial systems and the presence of peritumoral anastomoses. All patients underwent preoperative embolization without complications. Conclusions: CBCT fusion images clearly visualized the feeders from each arterial system, the vascular compartments within the tumor, and possible peritumoral anastomoses. This technique provides a substantial contribution to both preoperative embolization and surgical resection of skull base meningiomas.

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当院における頸部頸動脈瘤に対する治療戦略

堀口崇, 淺田英穂, 寺尾聡, 秋山武紀, 大石裕美子, 吉田一成

脳卒中の外科 ((一社)日本脳卒中の外科学会) 49 ( 4 ) 259 - 264 2021.07

ISSN 0914-5508

当院で頸部頸動脈瘤に対し直達術を行った6例(男性1例、女性5例、平均年齢56.7歳)について検討した。その結果、全例が症候性内頸動脈瘤であり、瘤径は平均35.8mm、動脈瘤内血栓化を2例に認められた。手術法は3例で動脈瘤の切除と内頸動脈の端々吻合による血行再建が行われ、残る3例で母血管閉塞が行われていた。動脈瘤を切除した3例の病理所見はいずれも動脈硬化性動脈瘤であった。5例が転帰良好であったが、1例は内頸動脈閉塞から中大脳動脈塞栓を生じ、広範な脳梗塞により死亡していた。

Resection of a large cavernous hemangioma following preoperative embolization in a child’s Temporal Bone

Torii Y, Hosoya M, Hasebe N, Ogawa S, Akiyama T, Oishi N, Ogawa K

Journal of International Advanced Otology (Journal of International Advanced Otology) 17 ( 3 ) 269 - 274 2021.05

Research paper (scientific journal), Joint Work, ISSN 13087649

Primary intraosseous cavernous hemangiomas (PICHs) in the temporal bone are very rare. Most treated cases are in adult patients, and there are very few reports involving children. To our knowledge, no cases reported have ever actually adopted embolization in children, although several reports recommend preoperative embolization of the feeding arteries. Here, we present a case of a child with a large cavernous hemangioma developing in the temporal bone. The patient was an 11-year-old girl whose chief complaints were hearing loss, aural fullness, and otalgia. Based on imaging, a lymphoma was initially suspected, but extensive arterial bleeding occurred during biopsy under local anesthesia. Angiography was performed to evaluate the blood flow in the tumor, and revealed the middle meningeal artery as a main feeding artery to the tumor. A huge PICH at the temporal bone was successfully resected following preoperative embolization of the feeding artery.

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Comparisons of Characteristics and Outcomes after Mechanical Thrombectomy for Vertebrobasilar Occlusion with Cardioembolism or Atherosclerotic Brain Infarction: Data from the Tokyo-Tama-Registry of Acute Endovascular Thrombectomy (TREAT)

Katsumata M, Ota T, Tsuruta W, Akiyama T, Sakai Y, Shigeta K, Kaneko J, Nogawa S, Ichijo M, Shiokawa Y, Hirano T

World Neurosurgery (World Neurosurgery) 148 e680 - e688 2021.04

Research paper (scientific journal), Joint Work, ISSN 18788750

Background: Some reports suggest the efficacy of mechanical thrombectomy (MT) for acute vertebrobasilar artery (VBA) occlusion. The major causes of VBA occlusion include cardioembolism (CE) and large-artery atherosclerosis (LAA). However, the clinical characteristics of each cause remain unclear, and they might be important for decision making related to the indications and strategy of MT. Objective: This study aimed to compare functional outcomes and factors affecting outcomes between patients with CE and LAA with acute VBA occlusion. Methods: This was a retrospective and prospective observational study using data from TREAT (Tokyo-Tama-Registry of Acute Endovascular Thrombectomy), a multicenter registry of MT for acute large-vessel occlusion in the Tokyo metropolitan area. Patients with VBA occlusion classified into CE and LAA groups were analyzed. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Results: Seventy-nine patients (57 with CE and 22 with LAA) were eligible from January 2015 to March 2020. Despite significantly shorter puncture-to-recanalization and onset-or-last-well-known-to-recanalization times in the CE group, the primary outcome was not significantly different between the 2 groups (CE, 31.6% vs. LAA, 45.5%; P = 0.248). In the subgroup analysis, patients with CE had worse clinical outcomes in the onset-or-last-well-known-to-door time ≥180 minutes, onset-or-last-well-known-to-door time ≥300 minutes, and low posterior circulation Alberta Stroke Program Early CT Score (≤7) subgroups. Conclusions: Functional outcomes of VBA occlusion were not significantly different between CE and LAA. Based on the subgroup analysis, patients with CE might have poorer collateral status than do patients with LAA, and earlier recanalization might therefore be desired.

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Angioarchitecture and Pre-Surgical Embolization of Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma

Akiyama Takenori, Takahashi Satoshi, Nagoshi Narihito, Ozawa Hiroyuki, Sasaki Hikaru, Toda Masahiro

脳神経血管内治療 (特定非営利活動法人日本脳神経血管内治療学会) 15 ( 5 ) 316 - 322 2021

Joint Work, ISSN 1882-4072

Objective: Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) have been categorized as the same disease entity, SFT/HPC, since 2016. SFT/HPC is one of the most highly vascularized brain tumors, distinct from meningioma. The angioarchitecture also differs between these tumors. Understanding these differences can help interventionalists perform presurgical embolization more safely and effectively.Methods: Vascular structures were analyzed in eight patients with central nervous system (CNS) SFT/HPCs, all of whom received presurgical embolization. The type of embolic materials used and the complication rates were compared between the CNS SFT/HPC cases and 39 meningioma cases treated within the same period. Characteristic angiographic features of SFT/HPC were identified, and we present their interpretation and utilization to inform embolization strategies.Results: Four angiographic features of SFT/HPCs were identified. 1) Persistence of tumor stain and 2) feeders from branches of the internal carotid artery or vertebral artery were observed in all cases, while 3) connecting feeders (highly dilated vessels that originate from branches of other feeder vessels and run along the surface of one tumor compartment to feed another compartment) were observed in five out of eight cases. 4) Finally, an intratumoral arteriovenous shunt was identified in one case. The frequency of liquid embolic material use was significantly higher in SFT/HPC cases than in meningioma cases. No complications were observed in SFT/HPC cases, and all tumors were effectively removed.Conclusion: The most appropriate presurgical embolization strategies differ between SFT/HPCs and meningiomas depending on the tumor angioarchitecture. A thorough understanding of the vascular anatomy is necessary for safe and effective embolization of SFT/HPCs.

Pterygovaginal artery as a target of embolization before endoscopic skull base surgery

Yoshida K, Akiyama T, Raz E, Kamamoto D, Ozawa H, Toda M

Neuroradiology Journal (Neuroradiology Journal) 34 ( 6 ) 19714009211013490 - 682 2021

Joint Work, ISSN 19714009

Background: The pterygovaginal artery (PtVA), a recurrent branch of the internal maxillary artery (IMA), can be a feeder of skull base tumors. Preoperative embolization can help endoscopic resection of hypervascular lesions, which is performed under a narrow surgical space with restricted instrumental maneuverability. Methods: We performed preoperative embolization in five cases with hypervascular skull base lesions supplied by the PtVA, four of which were resected via endoscopic endonasal approach. In two cases, selective PtVA embolization through the distal IMA was successfully conducted. Results: In all the cases, intraoperative bleeding during endoscopic resection was easily controlled. The medial and lateral origins of the PtVA from the IMA were demonstrated by cone-beam CT images reconstructed from three-dimensional rotational angiography, and anastomoses around the eustachian tube and soft palate were visualized by superselective angiography. Conclusions: The PtVA embolization can be an effective strategy before endoscopic skull base tumor resection. When embolizing through the PtVA, clinicians should be aware of its anatomical variations and dangerous anastomoses. Understanding the surrounding angioarchitecture by angiographic techniques helps ensure safe embolization.

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Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

Takahara K, Akiyama T, Yoshida K, Yamada H, Oishi Y, Kuranari Y, Katsumata M, Toda M

Neuroradiology Journal (Neuroradiology Journal) 35 ( 2 ) 19714009211036690 - 263 2021

Joint Work, ISSN 19714009

Cerebral hyperperfusion syndrome is a rare but severe complication of carotid artery stenting or carotid endarterectomy. Staged angioplasty is reportedly an effective strategy to avoid cerebral hyperperfusion syndrome. We encountered a case of internal carotid artery stenosis with a rare clinical presentation of limb shaking that was successfully improved by staged angioplasty. To our knowledge, there are no reported cases of limb shaking treated with staged angioplasty. A 76-year-old woman presented with continuous chorea in her left lower limb and shoulder. Medical examination revealed a tiny cerebral infarction in the right corona radiata and severe right internal carotid artery stenosis. Angiography showed near occlusion of the right internal carotid artery. Staged angioplasty was performed to avoid the risk of cerebral hyperperfusion syndrome. The first angioplasty resulted in an expanded diameter of 2.5 mm and was followed by definitive carotid artery stenting using a closed-cell stent 3.5 weeks later. Limb shaking improved in a stepwise manner along with an improvement in internal carotid artery stenosis and distal flow state with no signs of cerebral hyperperfusion syndrome. Patients with internal carotid artery stenosis or occlusion presenting with limb shaking have been suggested to have impaired cerebrovascular reactivity, which is also thought to be a risk factor for cerebral hyperperfusion syndrome. The stepwise improvement in limb shaking observed in this case supports the idea that the pathophysiology of limb shaking is related to cerebral haemodynamic impairment. Measures to prevent cerebral hyperperfusion syndrome, including staged angioplasty, should be actively considered in patients with limb shaking because the symptoms themselves suggest severe hypoperfusion.

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Current Treatments for Cervical Carotid Artery Aneurysms

HORIGUCHI Takashi, ASADA Hideo, TERAO Satoshi, AKIYAMA Takenori, OISHI Yumiko, YOSHIDA Kazunari

Surgery for Cerebral Stroke (The Japanese Society on Surgery for Cerebral Stroke) 49 ( 4 ) 259 - 264 2021

ISSN 0914-5508

We report the clinical features of six patients who underwent direct surgery at our hospital for large or giant cervical internal carotid artery aneurysms (CICAAs). Three patients underwent aneurysm resection with end-to-end anastomosis of the internal carotid artery (ICA), and three patients underwent proximal occlusion of the ICA. Five patients had good outcomes, including one case with transient dysphagia. In one case, a middle cerebral artery embolization occurred due to ICA occlusion, and the patient died due to extensive cerebral infarction. To avoid ischemic complications in direct surgery for CICAA, preoperative cerebral blood flow assessment and perioperative antithrombotic therapy are indispensable. In addition, to avoid lower cranial nerve palsy during dissection of the aneurysm from surrounding structures, a bloodless surgical field; safe, reliable internal shunt insertion and vascular suture techniques; and an accurate understanding of the anatomy of the neck are also necessary.

Role of Surgery in the Management of Intracranial Dural Arteriovenous Fistula

AKIYAMA Takenori, HORIGUCHI Takashi, TAKAHASHI Satoshi, OHIRA Takayuki, AKIYAMA Takekazu, YOSHIDA Kazunari

Surgery for Cerebral Stroke (The Japanese Society on Surgery for Cerebral Stroke) 48 ( 6 ) 420 - 426 2020.11

Joint Work, ISSN 0914-5508

Summary: Following technological advances in endovascular therapy, this approach is preferred over　surgery as the mainstay of treatment for dural arteriovenous fistula (dAVF). However, surgery remains important, and its role should be re-evaluated. In this retrospective study, we investigated the outcomes of surgical treatment for dAVF, focusing on the pitfalls of this approach in 101 patients who underwent surgery for dAVF. We analyzed the characteristics of lesions treated surgically, as well as treatment outcomes including the morbidity, AV shunt occlusion, and recurrence rates. The results included 20 patients who underwent only surgical treatment. The surgical morbidity rate was 5%. All AV shunts were extirpated at radical procedures; however, recurrence occurred in one patient. In conclusion, surgery serves as definitive treatment for specific types of dAVF. Careful decision-making regarding an endovascular vs. an open surgical approach is important, together with preparedness to manage the associated challenges, as observed in this case series.

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

Nobuhiko Arai, Katsuhiro Mizutani, Takashi Horiguchi, Takenori Akiyama, Satoshi Takahashi, Kaoru Yanagisawa, Kazunari Koike, Kazunari Yoshida

Acta neurochirurgica (Acta Neurochirurgica) 162 ( 9 ) 2145 - 2153 2020.09

Joint Work, Accepted, 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.

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Descending musculospinal branch of the ascending pharyngeal artery as a feeder of carotid body tumors: Angio-architecture and embryological consideration

Shibao S, Akiyama T, Ozawa H, Tomita T, Ogawa K, Yoshida K

Journal of Neuroradiology (Journal of Neuroradiology) 47 ( 3 ) 187 - 192 2020.05

Joint Work, ISSN 01509861

Introduction: Although the ascending pharyngeal artery (APhA) is known as a main feeder of carotid body tumors (CBTs), its detailed architecture and embryological consideration have not been described. The objective of this study was to describe the architecture of a descending feeder of the APhA and to consider its origin embryologically through a review of our CBT embolizations. Methods: We retrospectively analyzed data from patients with CBTs who underwent transarterial embolization or angiographic examination–only between July 2010 and February 2017. The arterial supply of the tumors, the number of feeder pedicles, the mean tumor size, embolization materials, complication of embolization, and extent of tumor removal were assessed. The embryological origin of feeding artery was considered based on the literature. Results: Eighteen patients with 20 CBTs underwent preoperative embolization or angiographic examination. The number of feeder pedicles was significantly related to the size of the CBT (P = 0.0002). The main feeding artery was the descending branch of APhA, which was hypertrophied and tortuous (18/20, 90%). Embryologically, this artery originated from the musculospinal branch and is termed the “descending musculospinal branch”. Conclusion: The main feeder of the CBTs was the “descending musculospinal branch” of the APhA and needs special consideration such as dangerous anastomosis for embolization.

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Silent MRA: arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation.

Nobuhiko Arai, Takenori Akiyama, Kazuhiro Fujiwara, Kazunari Koike, Satoshi Takahashi, Takashi Horiguchi, Masahiro Jinzaki, Kazunari Yoshida

Neuroradiology (Neuroradiology) 62 ( 4 ) 455 - 461 2020.04

Joint Work, Accepted, ISSN 00283940

PURPOSE: MR angiography using the silent MR angiography algorithm (silent MRA), which combines arterial spin labeling and an ultrashort time echo, has not been used for the evaluation of cerebral arteriovenous malformations (CAVMs). We aimed to determine the usefulness of silent MRA for the evaluation of CAVMs. METHODS: Twenty-nine CAVMs of 28 consecutive patients diagnosed by 4D CT angiography or digital subtraction angiography, who underwent both time-of-flight (TOF) MRA and silent MRA, were enrolled. Two observers independently assessed the TOF-MRA and silent MRA images of CAVMs. Micro AVM was defined as AVM with a nidus diameter less than 10 mm. The detection rate, visualization of the components, and accuracy of Spetzler-Martin grade were evaluated with statistical software R. RESULTS: For all 29 CAVMs, 23 (79%) lesions were detected for TOF-MRA and all for silent MRA. Of 10 micro AVMs, only 4 (40%) lesions were detectable on TOF-MRA and all (100%) on silent MRA. The visibility of the nidus and drainer was significantly better for silent MRA than TOF-MRA (p < 0.001), while there was no significant difference in the feeder between the two sequences. The accuracy rates of the Spetzler-Martin grade for the TOF and silent MRA were 38% (11/29) and 79.3% (23/29), respectively (p < 0.001). CONCLUSIONS: Silent MRA is useful for evaluating CAVM components and detecting micro AVM.

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Loss of consciousness at ictus and/or poor World Federation of Neurosurgical Societies grade on admission reflects the impact of EBI and predicts poor outcome in patients with SAH

Takahashi S, Akiyama T, Horiguchi T, Miwa T, Takemura R, Yoshida K

Surgical Neurology International (Surgical Neurology International) 11 ( 40 ) 40 - 40 2020.03

Research paper (scientific journal), Joint Work, ISSN 2229-5097

Background: There are many scores and markers that predict poor outcome in patients with subarachnoid hemorrhage (SAH). However, parameters that can predict outcomes in patients with SAH with high specificity and sensitivity, which can be identified in the early postictal state and utilized as a clinical marker of early brain injury (EBI) have not been identified so far. Methods: Thirty-nine patients with SAH due to a saccular intracranial aneurysm rupture were reviewed. We retrospectively analyzed the relationships between patients' baseline characteristics and patients' outcomes to identify parameters that could predict patient outcomes in the early postictal state. Results: In the univariate analysis, older age (>65), loss of consciousness (LOC) at ictus, poor initial World Federation of Neurosurgical Societies (WFNS) grade (3-5), and delayed cerebral ischemia (DCI) were associated with poor outcome (GOS 1-3). Statistical analyses revealed that combined LOC at ictus and/or poor initial WFNS grade (3-5) was a more powerful surrogate marker of outcome (OR 15.2 [95% CI 3.1-75.5]) than either LOC at ictus or the poor initial WFNS grade (3-5) alone. Multivariate logistic regression analyses revealed that older age, combined LOC at ictus and/or poor initial WFNS grade, and DCI were independently associated with poor outcome. Conclusion: Combined LOC at ictus and/or poor initial WFNS grade (3-5) reflects the impact of EBI and was a useful surrogate marker of poor prognosis in SAH patients, independent of patients' age and state of DCI.

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