論文 - 秋山　武紀

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

共著,  ISSN  18788750

　概要を見る

© 2018 Elsevier Inc. 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.

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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

研究論文（学術雑誌）, 共著,  ISSN  00283940

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© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. 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.

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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

研究論文（学術雑誌）, 共著,  ISSN  03038467

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© 2018 Elsevier B.V. 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.

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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

研究論文（学術雑誌）, 共著,  ISSN  00283940

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© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. 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.

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High detectability of non-contrast-enhanced MR angiography using a silent scan for screening of cerebral arteriovenous malformations in HHT patients

Akiyama Takenori, Fujiwara Hirokazu, Jinzaki Masahiro, Yoshida Kazunari

ANGIOGENESIS 21 （ 1 ） 138 - 138 2018年02月

共著,  ISSN  0969-6970

Advantages of Staged Angioplasty in a Patient with Internal Carotid Artery Pseudo-Occlusion Besides Prevention of Cerebral Hyperperfusion Syndrome

Takahashi S., Akiyama T., Nakahara J., Yoshizaki T., Suzuki N., Yoshida K.

World Neurosurgery （World Neurosurgery）  109   409 - 412 2018年01月

研究論文（学術雑誌）, 共著,  ISSN  18788750

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© 2017 Elsevier Inc. Background Staged angioplasty for carotid artery stenosis has been reported to be effective in preventing postoperative cerebral hyperperfusion syndrome (CHS) in patients with severe carotid stenosis; thus, it is also recommended for patients with internal carotid artery (ICA) pseudo-occlusion, the treatment strategy for which is controversial. Case Description This study reports the case of an Asian man in his 50s who had motor aphasia and right-side weakness caused by pseudo-occlusion of the left ICA. After medical treatment, he underwent a staged angioplasty. After the first stage of percutaneous transluminal angioplasty, anterograde blood flow to the left ICA increased but the distal ICA remained partially collapsed. Initially, the second stage of carotid artery stenting (CAS) was planned for 2 weeks after the first stage; however, hemorrhagic infarction was observed the day before the CAS, and it was postponed by 2 weeks, after adjustment of antiplatelet therapy. At the time of the CAS, the diameter of the initially collapsed left distal ICA was remodeled and it was fully dilated; thus, we used a balloon-type embolic protection device and conducted CAS successfully without apparent embolic complications. The postoperative course was uneventful. The patient did not develop CHS. Conclusions Besides preventing CHS, staged angioplasty has advantages when used for treating patients with ICA pseudo-occlusions in that the extent of dilation of the distal ICA after percutaneous transluminal angioplasty can be confirmed and the development of a possible hemorrhagic infarction can be assessed before stent placement.

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Hybrid operating room（HOR）における複雑な脳血管障害に対する開頭および血管内複合治療の有用性 ─Hybrid operating room導入前後の検討─

堀口 崇, 秋山 武紀, 高橋 里史, 大平 貴之, 吉田 一成

脳卒中の外科 （一般社団法人 日本脳卒中の外科学会）  46 （ 6 ） 453 - 461 2018年

ISSN  0914-5508

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Here we investigated the changes in utility and limits of combined microsurgical and endovascular treatment for complex cerebrovascular disease before and after the introduction of the hybrid operating room (HOR) in our department. Since 2006, a total of 17 patients (cerebral aneurysm in 12, cerebral arteriovenous malformation in 5) underwent integrated microsurgery with endovascular treatment. In 3 of 11 patients treated before the introduction of HOR, certain problems such as time consumption during patient transfer, disconnected workflow, and complicated operation due to poor quality of support equipment occurred. In contrast, all 6 operations in the HOR were uncomplicated. All therapeutic steps including anesthesia management were planned in a single session. In conclusion, HOR provides a safe and smooth workflow in combined microsurgical and endovascular treatment for complex cerebrovascular diseases.

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The analysis of the cerebral venous blood volume in small channels- application to the tributaries of cavernous sinus

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

CEREBROVASCULAR DISEASES 45   472 - 472 2018年

共著,  ISSN  1015-9770

microRNA expression profiling in serum of patients with subarachnoid hemorrhage

Takahashi S., Akiyama T., Horiguchi T., Mizutani K., Mihara K., Yanagisawa K., Akaji K., Mihara B., Yoshida K.

CEREBROVASCULAR DISEASES 45   247 - 247 2018年

共著,  ISSN  1015-9770

Hybrid operating room (HOR)における複雑な脳血管障害に対する開頭および 血管内複合治療の有用性ーHybrid operating room 導入前後の検討ー

堀口崇, 秋山武紀, 高橋里史, 大平貴之, 吉田一成

脳卒中の外科 46   453 - 461 2018年

研究論文（学術雑誌）, 共著, 査読有り

Micro AVMの検出におけるultra-short TE MRI(silent MRA)の有用性

荒井 信彦, 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）  2 （ Suppl. ） S235 - S235 2017年11月

査読有り,  ISSN  2423-9119

再狭窄、最大内膜中膜複合体圧(max-IMT)、全身他臓器疾患合併から検討したCEAの長期成績

堀口 崇, 秋山 武紀, 高橋 里史, 吉田 一成

脳卒中の外科 45 （ 5 ） 370 - 377 2017年10月

査読有り

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

Katsuhiro Mizutani, Tomoru Miwa, Takenori Akiyama, Tokunori Kanazawa, Hideaki Nagashima, Kei Miyakoshi, Yasunari Niimi, Kazunari Yoshida

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

　概要を見る

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.

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

Katsuhiro Mizutani, Masahiro Toda, Jun Kurasawa, Takenori Akiyama, Hirokazu Fujiwara, Masahiro Jinzaki, Kazunari Yoshida

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

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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.

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The Coexistence of Extradural Arteriovenous Fistula and Soft Tissue Arteriovenous Malformation Within the Same Metamere.

Arai N, Akiyama T, Yoshida K

World neurosurgery 98   877.e1-877.e7 - 877.e7 2017年02月

査読有り,  ISSN  1878-8750

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BACKGROUND: Spinal arteriovenous shunts are a common spinal vascular disorder. However, they can have a misleading clinical presentation and poor prognosis. They are classified into 4 types according to shunt points and drainage route, among which extradural arteriovenous fistula (eAVF) is the most rare, comprising only 1% of all spinal arteriovenous shunts. We report an extremely rare case of coexistent eAVF at the craniocervical junction and soft tissue arteriovenous malformation within the same metamere. CASE DESCRIPTION: A 30-year-old man presented with neck pain. T2-weighted magnetic resonance imaging revealed a flow void at the right craniocervical junction compressing the spinal cord. Angiography revealed eAVF at the craniocervical junction. The patient was treated via transvenous embolization. After the procedure, shunt flow and symptoms markedly decreased. During the operation, an extracranial arteriovenous malformation under the occipital skin was detected immediately after occluding the shunt point. CONCLUSIONS: This case indicates that transvenous embolization can be an effective treatment for eAVF and supports some hypotheses of arteriovenous malformation development. Additionally, it emphasizes the importance of examining a lesion with multiple modalities, including angiography, three-dimensional angiography, and cone-beam computed tomography, to understand the anatomy of the lesion.

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Transvenous Embolization of the Basilar Plexus Before Endoscopic Transsphenoidal Transclival Surgery

Katsuhiro Mizutani, Takenori Akiyama, Masahiro Toda, Tokunori Kanazawa, Dai Kamamoto, Kazunari Yoshida

WORLD NEUROSURGERY （ELSEVIER SCIENCE INC）  97 2017年01月

査読有り,  ISSN  1878-8750

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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.

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Endonasal endoscopic approach for a giant cavernous sinus meningioma that extended to the middle cranial fossa with preoperative embolization

Tamura R, Toda M, Kohno M, Ozawa H, Tomita T, Akiyama T, Ogawa K, Yoshida K

Interdisciplinary Neurosurgery 6   20 - 22 2016年12月

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硬膜動静脈瘻診療におけるultra-short TE MRI(silent MRA)の有用性

荒井 信彦, 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）  1 （ Suppl. ） S293 - S293 2016年11月

査読有り,  ISSN  2423-9119

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

査読有り,  ISSN  2423-9119

Marfan症候群に生じたくも膜下出血に対し開頭クリッピングを施行した1例ー症例報告と文献的考察ー

高橋里史, 堀越知, 金澤徳典, 秋山武紀, 堀口 崇, 吉田一成

脳卒中の外科 44 （ 4 ） 307 - 310 2016年08月

査読有り