研究者詳細 - 秋山　武紀

論文 - 秋山　武紀

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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

堀口崇, 秋山武紀, 高橋里史, 吉田一成

脳卒中の外科 44 （ 4 ） 276 - 282 2016年08月

査読有り

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年08月

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年

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

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

秋山武紀

NEUROREPORT （LIPPINCOTT WILLIAMS & WILKINS） 26 （ 11 ） 629 - 633 2015年08月

研究論文（学術雑誌）, 共著, 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

秋山武紀

JOURNAL OF THE NEUROLOGICAL SCIENCES （ELSEVIER SCIENCE BV） 349 （ 1-2 ） 260 - 261 2015年02月

研究論文（学術雑誌）, 共著, 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 （特定非営利活動法人日本脳神経血管内治療学会） 2015年

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.

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

秋山武紀

ACTA NEUROCHIRURGICA （SPRINGER WIEN） 156 （ 10 ） 1847 - 1852 2014年10月

研究論文（学術雑誌）, 共著, 査読有り, 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

秋山武紀

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES （ELSEVIER SCIENCE BV） 23 （ 5 ） 823 - 828 2014年01月

研究論文（学術雑誌）, 共著, 査読有り, 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

秋山武紀

SURGICAL INFECTIONS （MARY ANN LIEBERT, INC） 14 （ 5 ） 433 - 436 2013年10月

研究論文（学術雑誌）, 共著, 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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Optic nerve seeding of atypical meningiomas presenting with subacute visual loss: 2 case reports with genetic characterization

秋山武紀

JOURNAL OF NEUROSURGERY （AMER ASSOC NEUROLOGICAL SURGEONS） 119 （ 2 ） 494 - 498 2013年08月

研究論文（学術雑誌）, 共著, 査読有り, ISSN 0022-3085

Meningiomas rarely cause CSF dissemination, and CSF seeding to the optic nerve (ON) is extremely rare. This is the first report of 2 cases of atypical meningioma with subacute visual loss due to ON seeding. The authors present the genetic characteristics of these atypical meningiomas with CSF dissemination. The patient in Case 1 was a 36-year-old woman with a 1.5-cm mass within the left ON, and the patient in Case 2 was a 70-year-old woman with a 0.9-cm mass around the right ON. Both individuals had undergone multiple surgeries for primary lesions and local recurrent lesions. They presented with subacute visual loss, and both tumors were completely resected. The pathological diagnosis was atypical meningioma with high MIB-1 indices and p53-positive cell ratios in each case. Comparative genomic hybridization showed significant chromosomal copy number alterations similar to the results of previous surgeries, confirming that the tumors were disseminated lesions. The present findings suggest that genetic characteristics, such as 1p and 10qcen-23 losses and 17q and 20 gains, shared by the 2 cases might be associated with CSF dissemination of meningiomas.

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Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

秋山武紀

NEURORADIOLOGY （SPRINGER） 55 （ 7 ） 837 - 843 2013年07月

研究論文（学術雑誌）, 共著, ISSN 0028-3940

The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference.
A total of 29 CTDSA/DSA from 25 patients with dAVF were retrospectively evaluated by two neuroradiologists. The presence, Cognard classification, and feeding arteries of dAVFs on CTDSA were assessed according to DSA.
DSA depicted 33 dAVFs in 28 cases. By consensus reading, CTDSA correctly detected 32 dAVFs in 27 cases and properly graded 31 lesions. The intermodality agreement for the presence and classification of dAVFs was excellent (kappa = 0.955 and 0.921, respectively). CTDSA detected 77 of 109 feeding arteries (70.6 %) in 25 cases. The intermodality agreement for the feeding arteries was good (kappa = 0.713).
Although CTDSA is limited in temporal and spatial resolution in comparison with DSA, it is an effective non-invasive tool for the detection and classification of dAVF.

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Recanalisation of spontaneously occluded vertebral artery dissection after subarachnoid haemorrhage

秋山武紀

NEUROSURGICAL REVIEW （SPRINGER） 35 （ 4 ） 615 - 619 2012年10月

研究論文（学術雑誌）, ISSN 0344-5607

Spontaneous occlusion is a rare manifestation of ruptured vertebral artery dissection (VAD). Its natural history and treatment strategy have yet to be established due to its rarity. Here, we report five lesions involving spontaneous occlusion of VAD after subarachnoid haemorrhage, among which three lesions showed recanalisation. Based on our experience and previous reports, spontaneous occlusion of ruptured VAD can be classified into two groups-one group with occlusion in the acute stage with a high incidence of recanalisation and another group with occlusion in the chronic stage with a relatively low incidence of recanalisation. The underlying mechanism is likely different in each group, and treatment strategies should also be tailored depending on the pathophysiology.

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Optic nerve sheath solitary fibrous tumor

秋山武紀

ACTA NEUROCHIRURGICA （SPRINGER WIEN） 154 （ 4 ） 633 - 635 2012年04月

研究論文（学術雑誌）, 共著, ISSN 0001-6268

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Hemorrhagic onset of cerebellar pilocytic astrocytoma in an adult: a case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage

秋山武紀

BRAIN TUMOR PATHOLOGY （SPRINGER TOKYO） 29 （ 2 ） 96 - 102 2012年04月

研究論文（学術雑誌）, 共著, ISSN 1433-7398

Pilocytic astrocytoma (PA) is a low-grade astrocytic tumor arising predominantly during the first two decades of life. Hemorrhagic onset of PAs is uncommon, and the etiology of hemorrhage remains unclear. Here we report a case of hemorrhagic onset of cerebellar PA in a 29-year-old man who presented with a week-long history of headache and gait instability. Computed tomography and magnetic resonance imaging revealed a hemorrhagic tumor located in the right cerebellar hemisphere, and total resection was performed. Histological examination showed bipolar glial cell proliferation in a biphasic pattern in a compact area and a loose microcystic area with Rosenthal fibers and eosinophilic granular bodies, indicating PA. Prominent changes in tumor vasculature, including aggregation of sclerotic thick-walled and ectatic thin-walled vessels, was observed, and nodules of thrombi containing complex vascular proliferation suggesting recanalized thrombi formed in partially ruptured vessels were also found. Thus, rupture of these abnormal vessels appeared to be the cause of hemorrhage. Review of the literature revealed that age distribution of patients with hemorrhagic PAs tends to be older than that of patients with general PAs. These findings imply a possibility that degenerative changes in blood vessels in long-standing PAs might be related to the mechanisms of spontaneous intratumoral hemorrhage.

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Severe Parkinsonism Following Endoscopic Third Ventriculostomy for Non-communicating Hydrocephalus -Case Report-

秋山武紀

NEUROLOGIA MEDICO-CHIRURGICA （JAPAN NEUROSURGICAL SOC） 51 （ 1 ） 60 - 63 2011年01月

研究論文（学術雑誌）, ISSN 0470-8105

A 23-year-old male with non-communicating hydrocephalus caused by intraventricular hemorrhage from an arteriovenous malformation was treated by endoscopic third ventriculostomy (ETV) after repeated ventricular cerebrospinal fluid drainage and removal of ventriculoperitoneal shunt due to infection. Postoperatively, the patient developed robust rigidity and akinesia with mutism, suggesting secondary parkinsonism. These symptoms showed marked improvement after administration of levodopa, and were not aggravated after discontinuation. The pathophysiology of this case might involve dysfunction of the dopaminergic system caused by repeated compression and release of the paraventricular white matter. Careful perioperative management not leading to excessive dilation of the the ventricles should be considered for ETV for non-communicating hydrocephalus to avoid this unexpected complication.

手術戦略と手術アプローチ破裂性椎骨解離性動脈瘤最重症例に対する超早期塞栓術

赤路和則, 秋山武紀, 平賀健司, 谷崎義生, 小嶋篤浩, 奥井俊一

脳卒中の外科（The Japanese Society on Surgery for Cerebral Stroke） 38 （ 1 ） 24 - 28 2010年

ISSN 0914-5508

We report 5 patients (2 females and 3 males) with endovascular coil embolizations for ruptured dissecting aneurysms of the vertebral artery (VA). The age of the patients varies between 44 and 66 (mean 54.8) years. All patients had a Hunt and Kosnik Grade of V at admission. One patient had a dissecting aneurysm of the VA distal to the PICA. One patient had a dissecting aneurysm of the VA without the PICA. Three patients had a dissecting aneurysm of the VA involving the PICA. One patient with a dissecting aneurysm of the VA involving the PICA underwent proximal occlusion, and the other 4 patients underwent internal trapping. All patients underwent endovascular coil embolizations on the day or the next day of the onset. Subsequent rupture occurred in 4 patients before embolization. The Glasgow Outcome Scale at 3 months after the embolization was good recovery in 3 patients. We had no ruptured aneurysm and no coil compaction at 0 to 40 months (mean 26.2 months) after embolization. Our experience showed that the internal trapping for ruptured dissecting aneurysms of the vertebral artery should be performed as soon as possible, even if the patients have a Hunt and Kosnik Grade of V.<br>

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De novo development of moyamoya disease in an adult female

秋山武紀

JOURNAL OF NEUROSURGERY （AMER ASSOC NEUROLOGICAL SURGEONS） 111 （ 5 ） 943 - 946 2009年11月

研究論文（学術雑誌）, 共著, ISSN 0022-3085

The origin of moyamoya disease remains unknown. The onset of the angiographically apparent changes of typical moyamoya disease occurs in childhood, but de novo development of the disease has not been confirmed angiographically. The authors report on a case of de novo development of moyamoya disease in a middle-aged female whose cerebral angiography demonstrated no abnormal findings 5 years previously. To the best of the authors' knowledge, this case is the first reported instance of de novo development of definite moyamoya disease verified angiographically. This case demonstrates that the de novo development of moyamoya disease in a middle-aged adult did in fact occur, and angiographically visible features of the disease took < 5 years to complete. (DOI: 10.3171/2009.2.JNS081244)

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頸動脈stent留置術における狭窄部通過困難例に対する工夫 0.035 inch guidewireを用いて

植田良, 赤路和則, 秋山武紀, 谷崎義生, 傳法倫久, 篠田純, 小嶋篤浩, 片山正輝, 菅貞郎, 中村芳樹

JNET: Journal of Neuroendovascular Therapy （(NPO)日本脳神経血管内治療学会） 3 （ 4 ） 310 - 310 2009年11月

ISSN 1882-4072

The Possibility of Left Dominant Activation of the Sensorimotor Cortex During Lip Protrusion in Men

秋山武紀

BRAIN TOPOGRAPHY （SPRINGER） 22 （ 2 ） 109 - 118 2009年09月

研究論文（学術雑誌）, 共著, ISSN 0896-0267

Lip protrusion requires bilateral symmetrical movements of the facial muscles, but the laterality of the activated sensorimotor cortex corresponding to the area of the face activated during lip protrusion remains under discussion. In this study, blood-oxygenation-level-dependent (BOLD) responses in the sensorimotor cortex during non-verbal lip protrusion were evaluated in a 3T magnetic field in twenty healthy right-handed subjects. The results showed that the activated sensorimotor area on the left side was larger than that on the right side, and there was a statistically significant difference in the number of activated voxels between the left and right sensorimotor cortex in an individual study of the male group, although approximately symmetrical motor action potentials of facial muscles were recorded during lip protrusion. There was a statistically significant difference in interaction between the hemisphere (right and left) and sex (men and women) and multiple comparison test showed statistical significant differences between "men and right" and "men and left", and between "men and left" and "women and left". The peak value of the percent changes in BOLD signal responses on the left side was approximately twice as high as that on the right side in the males of the group, though the bilateral sensorimotor cortex was almost equally activated in the females in the group. In addition, the left primary sensory area related to the face area was significantly activated as a region where Male was more active than Female in a general linear model (multi-study, multisubject) analysis. This study revealed the possibility that the left sensorimotor cortex was more closely involved in non-verbal mouth movement in men, suggesting sex-related differences in sensorimotor cortex activation.

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頸動脈stent留置術における末梢塞栓保護用deviceの選択 Balloon protectionとReversal flow systemとの併用法の有用性

赤路和則, 秋山武紀, 平賀健司, 谷崎義生, 傳法倫久, 篠田純, 小嶋篤浩, 片山正輝, 菅貞郎, 中村芳樹

JNET: Journal of Neuroendovascular Therapy （(NPO)日本脳神経血管内治療学会） 2 （ 4 ） 161 - 161 2008年11月

ISSN 1882-4072

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論文 - 秋山　武紀