Shushi Kominami

Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate

IntroductionWe aim to present and discuss clinical outcomes of preoperative liquid embolization of hemangioblastomas (HB) using N-butyl cyanoacrylate (NBCA).MethodsFrom 1999 through 2010, 19 patients presenting with symptoms of vertigo and/or headaches were diagnosed with HB based on preoperative magnetic resonance imaging and cerebral angiographic findings at our institution. Preoperative embolization with NBCA was performed on tumors in 10 of 21 operations for 19 patients. For each of these patients, the lesion was pathologically confirmed as HB.ResultsEmbolization had a favorable outcome in all patients. No permanent neurological complications were observed after preoperative embolization using NBCA. However, thalamic infarction and minor hemorrhage were observed in two patients with cerebellar HB.ConclusionThe authors recommend NBCA as an embolization material for large cerebellar HB.

Impact of polyunsaturated fatty acid consumption prior to ischemic stroke

The Japanese have higher levels of n‐3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in their diets. These facts may contribute to the lower rates of atherosclerosis in Japanese. The purposes of this study were to assess the PUFA levels in patients with subtypes of acute ischemic stroke and to assess the relationship between severity and PUFA levels.

The meningeal branches of the superior cerebellar artery: a surgical observation study

OBJECT The tentorial branch of the posterior cerebral artery was first identified in a cadaver dissection study. However, the tentorial branch of the superior cerebellar artery (SCA) has not been clearly described in autopsy or normal anatomical studies. In this study, a dural branch of the SCA that was found during the surgical treatment of trigeminal neuralgia is described. METHODS Between April 2011 and March 2014, 70 patients with idiopathic trigeminal neuralgia underwent microvascular decompression. The records of 58 patients were reviewed to investigate the meningeal branch of the SCA. RESULTS The meningeal branch of the SCA was visualized in 15 of the 58 patients (25.9%). In 4 patients, it was necessary to divide this branch in order to achieve decompression of the trigeminal nerve without eliciting postoperative neurological deficits. CONCLUSIONS This is the first identification of the meningeal branch of the SCA in living subjects, and such branches were rather frequently found. Recognition of this branch is important for the management of lesions in the cerebellopontine angle and tentorial lesions, using either an open microsurgical or endovascular method.

Superficial temporal arteriovenous fistula as a complication of rhytidectomy.

A 67-year-old woman who had undergone rhytidectomy 5 years before her presentation experienced increasing pulsatile tinnitus on the left side that had begun 2 years earlier. Angiography revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in front of her left ear. There was a scar from the earlier cosmetic surgery at the site. The fistula was embolized with N-butyl cyanoacrylate, and her tinnitus disappeared. We posit that the fistula was a complication of rhytidectomy and that a small arteriovenous fistula formed at the time of surgery and enlarged over time. This case indicates that arteriovenous fistulae can occur as a delayed complication of cosmetic surgery.

Striatal Distribution of Dopamine Transporters and Dopamine D2 Receptors at Different Stages of Parkinson's Disease A CFT and RAC PET Study

We investigated the alteration of dopaminergic system in striata of Parkinsons disease (PD) at different stages using positron emission tomography (PET), [11C]2β-carbomethoxy-3β-(4-fluorophenyl)tropane (CFT) for dopamine transporter (DAT), and [11C]raclopride (RAC) for dopamine D2 receptor (D2R). We studied eight elderly healthy volunteers (Group A), 13 drug naïve patients with PD (Group B), and seven advanced PD patients with mild dyskinesia (Group D). Six patients in Group B were re-examined after antiparkinsonian therapy (Group C). Regions of interest were drawn on the cerebellar hemisphere, head of the caudate nucleus (CN), and anterior (AP) and posterior putamen (PP) in the PET images. We calculated uptake ratio index (URI), asymmetry index (AI) and presynapse-to-postsynapse ratio (PPR) to evaluate dopaminergic function. DAT was smaller in the three PD groups than the Group A. URI of RAC in the PP was significantly larger in Group B than in Groups A and C. AI of CFT in the putamen was larger in the PD groups than in normal subjects, and AI of RAC in the PP was the largest in the Group B. PPRs in the AP and PP were smaller in the three PD groups than in Group A. DAT decreased with disease progression in patients with PD. Binding of RAC was largest in the putamen of drug-naïve PD patients, but the enhanced binding could not be detected in the therapeutic patients with PD because of weak D2R affinity of RAC.

Ambient Temperature Change Increases in Stroke Onset: Analyses Based on the Japanese Regional Metrological Measurements

BACKGROUND Relationships between various climate factors and stroke have long been a subject of investigation. The present study investigated in a single medical center the effects of periodic temperature changes on the onset of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), atherothrombotic infarction (AI), lacunar infarction (LI), cardiogenic embolism (CE), and transient ischemic attack (TIA). METHODS The subjects were 4,310 patients who had been hospitalized because of hemorrhagic or ischemic stroke from January 2000 through December 2005. Ambient temperature data were collected from the Japan Meteorological Agency Database. The following factors were analyzed: number of stroke onsets per day; mean, maximum, and minimum ambient temperatures; and differences between the mean temperatures on the onset day and the previous week. Relationships between temperature factors and totals based on stroke subtypes were assessed by means of regression analyses with a standard least squares model controlling for specific covariates. RESULTS The daily admissions for ICH, SAH, AI, LI, and CE increased when the mean temperature on the onset day was 1°C lower than that of the previous week. Decreases in minimum ambient temperature predicted increased numbers of admissions for ICH and for SAH. Conversely, a 1°C increase in maximum ambient temperature significantly affected ICH, AI, and CE admissions. There was no definitive relationship between temperature change and admissions for TIA. CONCLUSION Both absolute and comparative changes in ambient temperature are related to increased onsets of hemorrhagic and ischemic stroke in Japan.

Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature

Background: No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.

Cerebral artery restenosis following transluminal balloon angioplasty for vasospasm after subarachnoid hemorrhage.

Background: Although percutaneous transluminal angioplasty (PTA) is a widely used less invasive method to treat coronary artery stenosis, 10% of treated patients experience restenosis. Restenosis also occurs in approximately 5% of patients subjected to carotid artery stenting. Animal and human data suggested that restenosis is a response to injury incurred during PTA. As PTA has come into wide use to manage symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH) we studied the incidence of restenosis after PTA for cerebral vasospasm. Methods: Our study population consisted of 32 patients who had undergone PTA. They were followed by cerebral or 3DCT angiography or MRA for 6 126 months post-PTA (mean 48.65 months) to diagnose restenosis of the cerebral artery. We compared the size of the cerebral artery on the PTA and the contralateral side. Results: All 32 patients underwent successful PTA of 38 vascular territories and all manifested angiographic improvement of vasospasm. None suffered restenosis during the follow up period. Conclusion: PTA resulted in a significant improvement in the vessel diameter in patients with vasospasm after SAH and they did not suffer restenosis in the course of prolonged follow-up.

Endovascular Repair of a Middle Meningeal Artery Aneurysm after Cranial Surgery

This report describes a case of middle meningeal artery aneurysm caused after cranial surgery. A 55-year-old woman who experienced a ruptured internal carotid artery anterior wall aneurysm was treated by internal carotid artery trapping and high-flow bypass using a radial artery graft. Eight days after surgery, we performed cerebral angiography to confirm patency of the radial artery graft and discovered a middle meningeal artery aneurysm, which was not identified in preoperative angiography. The aneurysm was treated by endovascular embolization using n-butyl cyanoacrylate and complete obliteration was confirmed by angiography. This middle meningeal artery aneurysm was associated with prior surgical procedures, particularly craniotomy or dural tenting sutures. Our study suggests that middle meningeal artery aneurysms can be a rare complication associated with brain surgery. Endovascular embolization using a liquid material may provide an effective and safe treatment for such cases.