研究者詳細 - 秋山　武紀

論文 - 秋山　武紀

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A Case of Aneurysmal SAH and Stanford Type A Acute Aortic Dissection: A Case Report.

Enomoto T, Mizutani K, Karatsu K, Iwama T, Tamura R, Akiyama T, Ito T, Toda M

NMC Case Report Journal （一般社団法人日本脳神経外科学会） 12 （ 0 ） 459 - 464 2025年12月

査読有り, ISSN 2188-4226

We report a concurrent case of aneurysmal subarachnoid hemorrhage and acute aortic dissection. A 47-year-old woman presented to our hospital unconscious. Subarachnoid hemorrhage was diagnosed by brain computed tomography on arrival. Computed tomography angiography revealed 2 aneurysms in the right internal carotid artery. Computed tomography angiography from the cervical to thoracic regions, which was initially performed to inspect the access route for interventional radiology, demonstrated the presence of Stanford type A acute aortic dissection. Neck clipping and total aortic arch replacement were performed for the 2 aneurysms and the acute aortic dissection, respectively. Only a few reports have described the coexistence of acute aortic dissection and subarachnoid hemorrhage. Managing these 2 pathologies requires a thorough evaluation of each therapeutic strategy and careful management of the patient's systemic and neurological conditions. We believe our case report enhances the understanding of this specific pathological condition and will provide valuable insights for treating future patients with similar conditions.

Comprehensive Genetic Analysis of NF2 in Sporadic Vestibular Schwannoma

Wakabayashi T., Wasano K., Nakamura K., Hosoya M., Kawano R., Takamatsu R., Ueno M., Shimanuki M.N., Tsuzuki N., Nishiyama T., Akiyama T., Toda M., Nishihara H., Ozawa H., Oishi N.

Laryngoscope Investigative Otolaryngology 10 （ 5 ） e70265 2025年10月

査読有り, ISSN 2378-8038

Objective: To elucidate the genetic etiology of sporadic vestibular schwannomas (VSs) and investigate the correlation between NF2 inactivation mechanisms and preoperative clinical characteristics, including hearing function and tumor growth. Methods: Nineteen patients who underwent VS resection at our otorhinolaryngology or neurosurgery department between June 2020 and March 2022 were included in this study. Whole-exome sequencing (WES) was performed to detect somatic changes in NF2. Additionally, NF2 promoter methylation status and copy number changes were evaluated using methylation analysis and multiple ligation-dependent probe amplification (MLPA). Preoperative clinical data, including pure tone audiometry, speech discrimination scores, and tumor growth rates, were collected and analyzed for correlations with genetic findings. Results: WES identified somatic alterations in both NF2 alleles in 16 cases (84.2%). The addition of methylation analysis and MLPA confirmed biallelic NF2 inactivation in all cases. NF2 promoter methylation was suggested to be associated with hearing loss and tumor progression. A weak correlation between NF2 expression levels and tumor growth rate was observed (r = 0.21), while no significant correlation was found between NF2 expression and pure tone audiometry or speech discrimination scores. Conclusion: Comprehensive genetic analyses, including WES, methylation analysis, and MLPA, are essential for identifying NF2 inactivation mechanisms in sporadic VSs. The findings suggest that NF2 methylation may contribute to variations in clinical presentation. Further studies with larger cohorts are necessary to clarify the role of epigenetic modifications in disease progression and their potential impact on patient management strategies. Level of Evidence: 4.

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A Cautionary Note on the Indication for Deep Brain Stimulation in Parkinsonism Patients With SLC9A6 Gene Mutations

Okusa, S; Tezuka, T; Kosugi, K; Yamamoto, Y; Takahata, K; Higuchi, M; Akiyama, T; Kobayashi, M; Toda, M; Ito, D; Nakahara, J; Seki, M

JOURNAL OF MOVEMENT DISORDERS 18 （ 3 ） 268 - 270 2025年07月

ISSN 2005-940X

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ACVRL1 and MTHFR double variants in an adolescent with paradoxical cerebral embolism

Sato, T; Ichihashi, Y; Tsuruta, H; Chu, PS; Akiyama, T; Hishida, T; Hasegawa, T

PEDIATRICS INTERNATIONAL 67 （ 1 ） e70025 2025年01月

査読有り, ISSN 1328-8067

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Angiographical Investigation of Vagal and Carotid Body Paragangliomas

Yamamoto, K; Akiyama, T; Mizutani, K; Ozawa, H; Toda, M

脳神経血管内治療（一般社団法人日本脳神経血管内治療学会） 19 （ 1 ） n/a 2025年

責任著者, ISSN 18824072

Objective: Although vagal paragangliomas (VPs) and carotid body paragangliomas (CBPs) are both neck paragangliomas, they have different surgical risks and clinical courses. In this report, we investigated the feeding arteries of VPs compared with CBPs, with an aim to better differentiate these tumors and improve our understanding of their angioarchitecture.Methods: We conducted a retrospective analysis of angiography data from 3 cases of VPs and 10 tumors from 9 cases of CBP. For each case, we evaluated the level of the vertebral body corresponding to the upper margin of the tumor, the tumor size, the arterial supply of the tumor, the topological relationship between the external carotid artery and internal carotid artery and the tumor, the details of preoperative embolization, and the incidence of postoperative neurological deficits.Results: In all 3 cases of VPs, the blood supply originated from the occipital, vertebral, and ascending pharyngeal arteries. By contrast, among the 10 CBP tumors, 3 were supplied by the occipital artery, 1 was supplied by the vertebral artery, and all 10 were fed by the ascending pharyngeal artery. VPs, when compared to CBPs, exhibited larger tumor sizes, a higher positioning of the upper margin of the tumor, and a lack of splaying of the internal and external carotid arteries, compressing both forward. Additionally, preoperative embolization was frequently performed in cases of VPs. Furthermore, the postoperative occurrence of complications such as hoarseness and vocal cord paralysis was also higher.Conclusion: VPs originate from the inferior ganglion of the vagus nerve, which is chiefly nourished by the vertebral artery. This original arterial distribution may explain the angioarchitecture observed in this study. This study may facilitate the better understanding of the VP angioarchitecture and safe and efficient embolization for them.

Vasa vasorum: The role in intracranial physiology and pathophysiology

Yamamoto K., Mizutani K., Akiyama T., Nogawa H., Toda M.

Surgical Neurology International 15 188 2024年06月

査読有り, ISSN 2229-5097

Background: Vasa vasorum (VVs) is a Latin word representing vessels of vessels. VVs are usually found on the adventitia of the parent vessel and infrequently reach the media and intima, depending on the size and type of the parent vessels and physiological and pathological conditions. The VVs include arteries, capillaries, veins, and lymphatic vessels, involving the oxygenation and nourishment of the vessel’s wall to sustain its healthy state. Accumulated studies have revealed that VVs are involved in various intracranial lesions, including atherosclerotic diseases, aneurysms, and shunt diseases. The current review aims to review and integrate past and recent findings and knowledge on VVs and to facilitate our understanding of VVs and intracranial pathology involving VVs. Methods: A literature review was carried out with a focus on the role of VVs by searching the Pubmed database. Results: We identified 71 articles that discuss the role of VVs. We discussed the anatomical structure, physiological significance, and pathological significance of the VV. Conclusion: VV is not only involved in the nutrition and metabolism of the vascular wall but is also deeply involved in the pathogenesis of inflammation, ischemia, and thrombosis of the vascular wall. In addition, in the central nervous system, intracranial vascular wall nutrient particularities and VVs are closely related to the pathogenesis of cerebral aneurysms, subarachnoid hemorrhage, arteriovenous shunt disease, atherosclerotic lesions, and other conditions.

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運転中発症くも膜下出血の頻度と特徴　慶應義塾大学脳動脈瘤共同研究

稲桝丈司, 秋山武紀, 赤路和則, 稲葉真, 柴尾俊輔, 小嶋篤浩, 寺尾聰, 林拓郎, 釜本大, 倉前卓実, 福永篤志, 金井隆一, 水谷克洋, 戸田正博

脳卒中（(一社)日本脳卒中学会） 46 （ 3 ） 224 - 228 2024年05月

ISSN 0912-0726

【背景および目的】近年,高齢化に伴う高齢者ドライバーの増加,および高齢者ドライバーが運転中に脳卒中に罹患することによる自動車事故の増加が社会的に懸念されている.今回,「慶應義塾大学脳動脈瘤共同研究」データベース解析により,運転中発症くも膜下出血(aneurysmal SAH:aSAH)の全体に占める比率および特徴を解析した.【結果】発症時行動様式が記録されていた623名中,発症時運転中だったのは10名(1.6%).623名を発症時運転群(n=10)と非運転群(n=613)とに分け,臨床因子を比較した.運転時発症群は有意に男性比率が高かったが,それ以外の臨床因子(来院時aSAH重症度,退院時予後等)では有意差を認めなかった.【結論】自動車運転とaSAH発症との因果関係については否定できず,また,運転時に発症した場合事故につながる確率は低くないため,研究継続されるべき課題である.(著者抄録)

Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors

Inamasu J., Akiyama T., Akaji K., Inaba M., Nishimoto M., Kojima A., Terao S., Hayashi T., Mizutani K., Toda M.

Journal of Stroke and Cerebrovascular Diseases 33 （ 4 ） 107591 2024年04月

査読有り, ISSN 10523057

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is known to be triggered by several specific human activities. Sleep, by contrast, has not been considered a triggering activity for aSAH, and clinical characteristics of patients who sustain aSAH during sleep have rarely been reported in the literature. Methods: This is a retrospective analysis on the data acquired through a multicenter aSAH registry. Between January 2019 and December 2021, a total of 732 aSAH patients had been registered into our database. After excluding 109 patients whose activities at aSAH onset had been unidentifiable, the remaining 623 aSAH patients were dichotomized to 59 patients who sustained aSAH during sleep (Sleep group) and 564 patients who sustained aSAH during daytime activities (Awake group). Two-group comparison of demographic variables and multivariate logistic regression analysis were performed to clarify their clinical characteristics and identify potential risk factors. Results: The Sleep group exhibited significantly higher frequencies of diabetes (15.5 % vs. 6.4 %, p = 0.01) and antiplatelet use (13.8 % vs. 4.6 %, p=0.004) than the Awake group. Furthermore, multivariate logistic regression analysis showed that diabetes (OR, 3.051; 95 % CI, 1.281-7.268; p = 0.012) and antiplatelet use (OR, 3.640; 95 % CI, 1.422-9.316; p = 0.007) were correlated with aSAH occurring during sleep. There were no significant inter-group differences in the patient outcomes evaluated at discharge. Conclusion: The current results indicate that risk factors may exist for aSAH occurring during sleep. Further investigations on how comorbidities such as diabetes, antiplatelet use and sleep apnea affect human hemodynamic and hemostatic parameters during sleep is warranted to better understand those relationships.

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

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

Neuroradiology 66 （ 1 ） 55 - 62 2024年01月

査読有り, ISSN 00283940

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

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各種脊髄動静脈瘻の治療における血管内治療医の役割

秋山武紀, 水谷克洋, 高橋里史, 名越慈人, 辻収彦, 中村雅也, 松本守雄, 戸田正博

脳卒中の外科（(一社)日本脳卒中の外科学会） 52 （ 1 ） 1 - 7 2024年01月

筆頭著者, 責任著者, ISSN 0914-5508

脊髄動静脈シャント(SAVS)にはいくつかのサブタイプがあり,病態の正確な理解と的確な診断が求められる.適切な治療のために血管内治療医と直達術者との連携が不可欠である.本報告では,当施設で診療を行ったSAVS49例51病変の各シャントタイプの治療選択と結果について検討した.シャントの部位はdural 19病変,epidural 12病変,perimedullary 10病変,radicular 7病変,ほか3病変であった.治療は直達術29回(65.9%),血管内治療15回(34.1%).直達術の全例で血管内治療医が治療戦略を直達術者と共有,手術では術中シャント同定の支援を行った.直達術で26病変が治癒(89.7%),血管内治療で治癒および有効塞栓が13病変(86.7%)であり,周術期合併症は4.5%,永続する症状は認めなかった.SAVS全体に対し血管内治療医は血管内治療を行うだけでなく,正確な診断の提供,直達術を含めた適切な方針の提案,術中にも支援を行うことで効果的な治療を遂行できる.(著者抄録)

運転中発症くも膜下出血の頻度と特徴: 慶應義塾大学脳動脈瘤共同研究

稲桝丈司, 秋山武紀, 赤路和則, 稲葉真, 柴尾俊輔, 小嶋篤浩, 寺尾聰, 林拓郎, 釜本大, 倉前卓実, 福永篤志, 金井隆一, 水谷克洋, 戸田正博

脳卒中（一般社団法人日本脳卒中学会） 46 （ 3 ） 224 - 228 2024年

ISSN 09120726

【背景および目的】近年，高齢化に伴う高齢者ドライバーの増加，および高齢者ドライバーが運転中に脳卒中に罹患することによる自動車事故の増加が社会的に懸念されている．今回，「慶應義塾大学脳動脈瘤共同研究」データベース解析により，運転中発症くも膜下出血（aneurysmal SAH: aSAH）の全体に占める比率および特徴を解析した．【結果】発症時行動様式が記録されていた623名中，発症時運転中だったのは10名（1.6%）．623名を発症時運転群（n=10）と非運転群（n=613）とに分け，臨床因子を比較した．運転時発症群は有意に男性比率が高かったが，それ以外の臨床因子（来院時aSAH重症度，退院時予後等）では有意差を認めなかった．【結論】自動車運転とaSAH発症との因果関係については否定できず，また，運転時に発症した場合事故につながる確率は低くないため，研究継続されるべき課題である．

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

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

NMC Case Report Journal （一般社団法人日本脳神経外科学会） 10 （ 0 ） 125 - 130 2023年12月

ISSN 2188-4226

Patients with neurofibromatosis type 1 not only have characteristic skin findings but are also known to have vascular disorders due to vascular vulnerability. A 44-year-old man with previously undiagnosed neurofibromatosis type 1 was brought to the emergency room due to a sudden subcutaneous hematoma with no history of trauma. Angiography revealed extravasation from the parietal branch of the right superficial temporal artery, which was embolized with n-butyl-2-cyanoacrylate. However, the next day, the patient exhibited an increased subcutaneous hematoma, and new extravascular leakage was detected at the frontal branch of the superficial temporal artery, which was also embolized with n-butyl-2-cyanoacrylate. The patient had physical findings characteristic of neurofibromatosis type 1, such as café-au-lait spots, and was subsequently diagnosed with neurofibromatosis type 1. No obvious neurofibroma or any other subcutaneous lesion associated with neurofibromatosis type 1 was identified in the affected area. Massive idiopathic arterial bleeding in the scalp, although infrequent, can be fatal. Neurofibromatosis type 1 should be considered when a subcutaneous scalp hematoma is observed without a history of trauma, even if the facial skin structure appears normal. Neurofibromatosis type 1 is also known to have multiple sources of hemorrhage. Thus, it is important to repeatedly evaluate vascular structures via cerebral angiography, contrast-enhanced computed tomography, and magnetic resonance imaging, if necessary.

眼窩血管奇形に対する外科的切除後に形成された動静脈シャントの1例

野川博嗣, 水谷克洋, 秋山武紀, 佐柳太一, 久保創, 戸田正博

脳血管内治療（(一社)日本脳神経血管内治療学会） 8 （ 2 ） 63 - 67 2023年09月

査読有り, ISSN 2423-9119

【目的】我々は,文献上報告のない上眼窩裂周囲に多房性の静脈腔を伴う動静脈シャントを経験したため報告する.【症例】51歳女性で,幼少期に右眼窩内の血管奇形で右前頭側頭開頭による手術歴があった.右眼痛,右眼球突出,右眼球結膜充血を認めた.血管造影検査にて蝶形骨縁から中頭蓋底にかけての上眼窩裂付近に特異的な多房性の静脈腔を認め,その静脈壁に比較的限局した動静脈シャントを認めた.外頸動脈の末梢の分枝から栄養され,上眼静脈へシャント血流は流出していた.動静脈シャントが形成された静脈腔は,上眼静脈や海綿静脈洞に連続していたが,単一の静脈というよりは多房性の静脈構造であり,静脈奇形などに続発した動静脈シャントであると思われた.選択的経静脈的塞栓を行い,動静脈シャントは消失し,眼症状も消失した.【結論】眼窩血管奇形の術後に,動静脈シャントが残存した静脈壁に形成されることがある.経静脈的塞栓術が有効な治療となり得る.(著者抄録)

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

Tezuka T., Nukariya T., Katsumata M., Miyauchi T., Tokuyasu D., Azami S., Izawa Y., Nagoshi N., Fujiwara H., Mizutani K., Akiyama T., Toda M., Nakahara J., Nishimoto Y.

Journal of Stroke and Cerebrovascular Diseases 32 （ 7 ） 107152 - 107152 2023年07月

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.

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Prognostic significance of preoperative neutrophil-to-lymphocyte ratio in surgically resected schwannomas

Takahara K., Tamura R., Kuranari Y., Karatsu K., Akiyama T., Toda M.

Frontiers in Oncology 13 1099384 2023年02月

査読有り, ISSN 2234-943X

Objective: The goal of schwannoma resection is to control the tumor while preserving neurological function. Schwannomas have a variable postoperative growth pattern, therefore preoperative prediction of a schwannoma’s growth pattern is favorable. This study aimed to examine the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and postoperative recurrence and retreatment in patients with schwannoma. Methods: We retrospectively examined 124 patients who underwent schwannoma resection in our institution. Associations between preoperative NLR, other patient and tumor characteristics, and tumor recurrence and retreatment were analyzed. Results: Median follow-up was 2569.5 days. Postoperative recurrence occurred in 37 patients. Recurrence that required retreatment occurred in 22. Treatment-free survival (TFS) was significantly shorter in patients with NLR ≥2.21 (P = 0.0010). Multivariate Cox proportional hazards regression showed that NLR and neurofibromatosis type 2 were independent predictors of retreatment (P = 0.0423 and 0.0043, respectively). TFS was significantly shorter in patients with NLR ≥2.21 in the following subgroups: sporadic schwannoma, primary schwannoma, schwannoma ≥30 mm in size, subtotal resection, vestibular schwannoma, and postoperative recurrence. Conclusions: Preoperative NLR ≥2.21 before surgery was significantly associated with retreatment after schwannoma resection. NLR may be a novel predictor of retreatment and assist surgeons in preoperative surgical decision making.

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

Mizutani K., Akiyama T., Tomita H., Toda M.

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

ISSN 01509861

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

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

Yamada H., Mizutani K., Akiyama T., Toda M.

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

ISSN 00283940

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

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Combined transarterial and transvenous embolization of multi-hole pial arteriovenous fistula with large varix

Yamada H., Akiyama T., Kamamoto D., Yoshida K., Fukumura M., Toda M.

Neuroradiology Journal 35 （ 5 ） 640 - 646 2022年10月

ISSN 19714009

Background: Pial arteriovenous fistula (AVF) is a vascular fistulous disease in which the cerebral pial artery and vein are directly connected without the intervening nidus within a sub-pial space. Multi-hole pial AVFs, wherein multiple feeders flow into one drainer, are usually formed with complex angioarchitecture and are difficult to treat. Methods: A rare case of an adult patient with hereditary hemorrhagic telangiectasia and multi-hole pial AVF was described. A 23-year-old woman was referred to our hospital. She was previously diagnosed with left cerebellar pial AVF with multiple feeders (bilateral superior cerebellar artery and common trunk of the left anterior inferior cerebellar artery and posterior inferior cerebellar) and large varix that had been untreated for 9 years. The enlargement of the large varix with the new second varix formation was revealed by angiography. Although asymptomatic, considered to be a risk for future hemorrhage was the continuous high hemodynamic stress. Results: Endovascular embolization was performed by securing safe transarterial n-butyl-2-cyanoacrylate injection by transarterial and transvenous coil placement to the shunt points and feeders, resulting in total occlusion of the fistula without any complications. Extensive transvenous coil placement inside the varix allowed safe embolization of the entire fistula with multiple high-flow feeders. Moreover, bidirectional (transarterial and transvenous) retrograde coil embolization enabled firm obliteration of the shunt points. Conclusions: Performing combined transarterial and transvenous embolization in a well-balanced manner was considered to treat multi-hole pial AVF to provide a safe and effective embolization.

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

Imai R., Mizutani K., Akiyama T., Horiguchi T., Takatsume Y., Toda M.

Neuroradiology 64 （ 10 ） 1961 - 1968 2022年10月

ISSN 00283940

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

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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年01月

査読有り, ISSN 0914-5508

蝶形骨小翼部に発生する硬膜動静脈瘻はまれである．今回，incidentalに発見された蝶形骨小翼部硬膜動静脈瘻に対し，NBCAを用いた経動脈的塞栓術にて根治を行った症例を経験したため報告する．79歳，男性．腹部大動脈瘤の術前精査の頭部MRIにて前頭蓋底部の硬膜動静脈瘻を指摘され，当科紹介となった．血管撮影を行ったところ，蝶形骨小翼部に硬膜動静脈瘻を認めた．左内頚動脈から反回髄膜動脈・inferolateral trunk，および左外頚動脈から正円孔動脈・副硬膜動脈・中硬膜動脈が流入動脈となっていた．浅中大脳静脈を経由して前頭葉表面の静脈へ，また鉤静脈を経由して深中大脳静脈へ逆流し，静脈瘤を形成していた．出血予防のため経動脈的塞栓術を行った．反回髄膜動脈・inferolateral trunk・正円孔動脈をコイル塞栓し，副硬膜動脈をNBCAにて塞栓，中硬膜動脈よりシャント部までNBCAを流入させ，塞栓を終了した．術後眼症状や他の合併症なく経過し，再発を認めていない．蝶形骨小翼部の硬膜動静脈瘻を経験した．NBCAを用いた経動脈的塞栓術は同部位の治療として有効であった．

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