Details of a Researcher - Akiyama, Takenori

Papers - Akiyama, Takenori

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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

HORIGUCHI TAKASHI

脳卒中の外科 45 ( 5 ) 370 - 377 2017.10

Accepted

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 2017.10

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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The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery

Ryosuke Tomio, Takenori Akiyama, Masahiro Toda, Takayuki Ohira, Kazunari Yoshida

Journal of Neurosurgery (American Association of Neurological Surgeons) 127 ( 3 ) 543 - 552 2017.09

ISSN 1933-0693

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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 2017.03

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.

Nobuhiko Arai, Takenori Akiyama, Kazunari Yoshida

World neurosurgery 98 877.e1-877.e7 - 877.e7 2017.02

Accepted, ISSN 1878-8750

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 2017.01

Accepted, 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.

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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 2016.12

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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 2016.11

Accepted, 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 2016.11

Accepted, 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

HORIGUCHI TAKASHI

脳卒中の外科 (The Japanese Society on Surgery for Cerebral Stroke) 44 ( 4 ) 307 - 310 2016.08

Accepted

We report a case of subarachnoid hemorrhage due to a rupture of an aneurysm at the right internal carotid artery-posterior communicating artery in a patient with Marfan syndrome. Since the patient had a history of aortic dissection that was treated conservatively, we selected clipping rather than coil embolization as the surgical strategy for the patient. She was surgically treated successfully, and discharged from our hospital without neurological sequelae 18 days postoperatively. From the findings of the present case in combination with a review of the literature, cerebral aneurysms in patients with Marfan syndrome may be developed due to the fragility of elastic membranes of major cerebral arteries, and we emphasize the importance of developing surgical strategy based on the fragility of elastic membranes.

経過観察となった5 mm未満の未破裂脳動脈瘤に対する治療方針ー治療介入を決定する因子と時期についてー

HORIGUCHI TAKASHI

脳卒中の外科 (The Japanese Society on Surgery for Cerebral Stroke) 44 ( 4 ) 276 - 282 2016.08

Accepted

To clarify the optimal timing of surgical or endovascular treatment for patients with small-sized (<5 mm) unruptured intracranial aneurysms (UIA) with conventional follow-up, we retrospectively evaluated the characteristics of UIA that ruptured or enlarged during observation. From 1999 to 2014, 316 UIA (271 cases) were initially treated without surgical or endovascular intervention. Four ruptured and 17 grown UIAs were treated with clipping or coil embolization. In these cases, the ratio of the internal carotid to the posterior communicating artery and that of the anterior cerebral artery to the anterior communicating artery was 71%. Intraoperative findings revealed that the bleb formed during follow-up was observed as a very thin wall. Ruptured UIAs are prone to rapid growth. We conclude that location, growth rate, and bleb formation are useful to estimate the risk of rupture of smallsized UIAs during follow-up.

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

Katsuhiro Mizutani, Takenori Akiyama, Kazunari Yoshida

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 22 ( 4 ) 452 - 6 2016.08

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

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

Katsuhiro Mizutani, Takenori Akiyama, Dai Kamamoto, Hideaki Nagashima, Kazunari Yoshida

BJR case reports 2 ( 3 ) 20160004 - 20160004 2016

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

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頭蓋頸椎移行部Vasa corona上に形成された破裂脳脊髄動脈瘤の一例

水谷克洋, 秋山武紀, 釜本大, 堀越知, 吉田一成

JNET: Journal of Neuroendovascular Therapy ((NPO)日本脳神経血管内治療学会) 9 ( 6 ) S322 - S322 2015.11

ISSN 1882-4072

The process of change in hemodynamics after revascularization in the ischemic brain

Shidoh, Satoka, Akiyama, Takenori, Horiguchi, Takashi, Ohira, Takayuki, Yoshida, Kazunari

NEUROREPORT (LIPPINCOTT WILLIAMS & WILKINS) 26 ( 11 ) 629 - 633 2015.08

Research paper (scientific journal), Joint Work, ISSN 0959-4965

In patients with a high-degree of internal carotid artery stenosis, cerebral hemodynamics and metabolism are compromised during ischemia. Revascularization improves cortical hemodynamics and oxygen metabolism during functional activity, but the process by which it occurs is still controversial. Therefore, using functional near-infrared spectroscopy (fNIRS), we investigated the process by which cerebral hemodynamics improve after revascularization surgery. Eight patients with severe carotid artery stenosis were examined using fNIRS during a motor task before and after surgery. We evaluated postoperative changes in total hemoglobin and deoxyhemoglobin (HbR), at 2 weeks after surgery, and again at 3 months after surgery. Parameters measured were the TTP0.7 (time to peak) value, defined as the time taken to reach 70% of the maximum total hemoglobin concentration, and the increase in HbR during the motor task. TTP0.7 was higher in four patients preoperatively, but this was no longer evident in two of the patients at 2 weeks after surgery. An increase in HbR during the task was observed in six patients before surgery, and was maintained at 2 weeks after surgery. However, in three of these patients, this increase was no longer evident 3 months later. These changes observed using fNIRS suggest that the increase in cerebral blood flow after revascularization surgery is followed by improvement in parenchymal vasodilation and neuronal oxygen metabolism. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

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Clinical utility of triptans in the management of headache attributed to dural arteriovenous fistula involving the cavernous sinus

Osaka, Mayuko, Shibata, Mamoru, Oki, Koichi, Yamada, Satoshi, Kufukihara, Kenji, Akiyama, Takenori, Yoshida, Kazunari, Suzuki, Norihiro

JOURNAL OF THE NEUROLOGICAL SCIENCES (ELSEVIER SCIENCE BV) 349 ( 1-2 ) 260 - 261 2015.02

Research paper (scientific journal), Joint Work, ISSN 0022-510X

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Endovascular embolization of an external carotid-retromandibular arteriovenous fistula using the Amplatzer vascular plug

TOMIO Ryosuke, AKIYAMA Takenori, NAKATSUKA Seishi, NAGASHIMA Hideaki, YAMADA Satoshi, YOSHIDA Kazunari

Journal of Neuroendovascular Therapy (The Japanese Society for Neuroendovascular Therapy) 2015

ISSN 1882-4072

Objective: The Amplatzer vascular plug (AVP) is a new embolic device with advantages in embolization of high-flow vessels. We report a case involving implantation of an AVP into the retromandibular vein and coil-embolization of an arteriovenous fistula (AVF).Case presentation: We present the case of a 31-year-old woman with an external carotid artery (ECA)-retromandibular vein AVF. She complained of pulsatile tinnitus after a sagittal split-ramus osteotomy. The high-flow left ECAretromandibular vein AVF was depicted in the arterial phase using selective external carotid angiography (ECAG). Endovascular embolization treatment of the fistula using an AVP and coils was planned. We initially intended to introduce the AVP into the fistula via a transvenous route through the left external jugular vein, but could not pass the 5-Fr guiding catheter round the hairpin curve between the fistula and ECA. We therefore changed treatment strategy, placing an 8 mm AVP into the retromandibular vein. Fistula closure was almost obtained after implantation, but shunt flow from a narrow channel remained. We then embolized the fistula using coils, from the AVP to the fistula inlet. The fistula was occluded using five coils.Conclusion: We treated the patient with implantation of an AVP in the retromandibular vein and coil-embolization of the AVF. Advantages of the AVP are its stability for high-flow vessel occlusion and its cost-effectiveness when compared with coils. However, this device has disadvantages in the ease of its delivery to distal vessels. Therefore, using this device in craniofacial lesions needs technical refinement.

Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach

Tomio, Ryosuke, Akiyama, Takenori, Ohira, Takayuki, Horikoshi, Tomo, Yoshida, Kazunari

ACTA NEUROCHIRURGICA (SPRINGER WIEN) 156 ( 10 ) 1847 - 1852 2014.10

Research paper (scientific journal), Joint Work, Accepted, ISSN 0001-6268

The greater superficial petrosal nerve (GSPN) is especially important in anterior transpetrosal approach (ATPA) as the most reliable superficial landmark of Kawase's triangle. The GSPN can be considered as the superficial lateral border of anterior petrosectomy on the middle fossa to avoid internal carotid artery (ICA) injury. Although experienced operators can find the GSPN, its confirmation is not always easy to achieve.
We introduce our recent GSPN confirmation methods using facial nerve monitoring. In 10 recent cases, antidromic GSPN stimulation and free-running facial muscle electromyography (EMG) monitoring were performed.
Facial nerve evoked-EMG by antidromic GSPN stimulation confirmed the location of the GSPN course with precision in all cases. Free-running facial muscle EMG informed the mechanical stress of facial nerves through the GSPN. There was no postoperative facial palsy or dry eye in these cases.
GSPN confirmation and preservation are not always easy to achieve. These monitoring methods are useful for the confirmation of the GSPN, which is a landmark for safe extradural anterior petrosectomy, and for the preservation of the GSPN itself.

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Cerebral Perfusion Change of Venous Hypertension on Near-Infrared Spectroscopy Signals after Operation for Dural Arteriovenous Fistula

Shidoh, Satoka, Akiyama, Takenori, Ohira, Takayuki, Yoshida, Kazunari

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES (ELSEVIER SCIENCE BV) 23 ( 5 ) 823 - 828 2014.01

Research paper (scientific journal), Joint Work, Accepted, ISSN 1052-3057

A dural arteriovenous fistula (AVF) is an arteriovenous shunt in the dura and is associated with a risk of intracranial hemorrhage and neurologic deficit. The morbidity of this disease depends on venous hypertension, and the classification of this disease is based on the pattern of venous drainage. The pattern of venous drainage relates to the clinical features of the disease, especially to the probability of intracranial hemorrhage. We report 1 case of dural AVF with retrograde leptomeningeal venous drainage. Cerebral hemodynamics were monitored using near-infrared spectroscopy imaging before, during, and after the 2-stage operative treatment. Preoperative functional near-infrared spectroscopy (fNIRS) showed an increase in deoxyhemoglobin (HbR) during a motor task. After partial coil embolization of the shunt points (stage 1), HbR increased during the first half of the task and decreased later, whereas oxyhemoglobin (HbO(2)) decreased in the first half of the task and increased later. After complete embolization (stage 2), fNIRS showed a pattern similar to that of a normal adult. The patient's symptoms improved gradually, and angiography showed a reduction of the retrograde venous drainage and venous congestion after this 2-stage operation. The reduction in venous hypertension may be the underlying mechanism behind the changes observed with fNIRS.

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Procalcitonin as an Early Diagnostic Marker for Ventriculoperitoneal Shunt Infections

Tomio, Ryosuke, Akiyama, Takenori, Shibao, Shunsuke, Yoshida, Kazunari

SURGICAL INFECTIONS (MARY ANN LIEBERT, INC) 14 ( 5 ) 433 - 436 2013.10

Research paper (scientific journal), Joint Work, ISSN 1096-2964

Background: Procalcitonin (PCT) has been considered a more reliable marker than others because of its specificity for bacterial infection. Methods: Case report and review of the literature. Results: A 50-year-old male was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage. We performed a ruptured aneurysm clipping and left unilateral external ventricular drainage. We also performed ventriculoperitoneal (VP) shunt placement in the course; however, VP shunt infection was indicated by fever, increased C-reactive protein concentration and leukocytosis. The cerebrospinal fluid culture showed methicillin-resistant Staphylococcus epidermidis but the serum PCT concentration was quite low. Conclusions: Although PCT is considered a more reliable serological marker of bacterial meningitis in several reports, the serum PCT concentration did not reflect the bacterial VP shunt infection that was present in our case.

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