Toshio Kakizaki

Characteristics of intracranial aneurysms associated with moyamoya disease: A review of 111 cases

SummaryA retrospective analysis of 111 patients with aneurysms associated with Moyamoya disease is presented. The subjects comprised of our 12 cases and 99 other well-documented cases. These 111 cases had 131 aneurysms. There were 48 males and 63 females. The average age was 40.3 years. The clinical manifestations were intracranial haemorrhage in 99 cases (89%), and ischaemic events in 9 cases (8%), but no mention was made of these in the last three cases (2%). The Hunt and Kosnik grades were grade 1 in 8%, grade 2 in 23%, grade 3 in 31%, grade 4 in 35%, and grade 5 in 3%. Of the 131 aneurysms, 73 (56%) were found distributed around the circle of Willis, 24 (18%) in the basal ganglia, 29 (22%) on collateral vessels, and 5 (4%) on other vessels. Forty-six percent of the cases were treated surgically, 51% conservatively, and 3% by endovascular procedures. The surgical procedures for the aneurysms were; neck clipping in 49%, aneurysmectomy in 18%, wrapping of the aneurysm in 11%, coating or cautery of the aneurysm in 7%, and revascularization only in 11%. The outcomes were Glasgow Outcome Scale 1 in 30%, 2 in 22%, 3 in 11%, 4 in 1%, and 5 in 25%. The main reasons for the unfavourable outcome were initial poor clinical grade and rebleeding. Follow-up angiography of 25 aneurysms demonstrated that all aneurysms in the basal ganglia or on the collateral vessels disappeared. We recommend surgical intervention for aneurysms associated with Moyamoya disease to prevent rupture or rebleeding, especially for aneurysms around the circle of Willis. However, direct surgery is not recommended for aneurysms found in the basal ganglia or on the collateral vessels.

Use of local cerebral blood flow monitoring to predict brain damage after disturbance to the venous circulation : cortical vein occlusion model by photochemical dye

A rat model of cortical vein occlusion by the photochemical thrombotic technique was used to evaluate whether monitoring the change in the local cerebral blood flow (LCBF) could predict brain damage after cortical vein occlusion. The cortical vein occlusion was attained by using the photochemical thrombotic technique, and the sequential LCBF was measured by using a laser Doppler flowmeter positioned over the middle frontal cortex between two adjacent dorsal veins for 120 minutes after the start of the irradiation to the cortical vein. Rats were assigned to one of three experimental groups. In Group A (n = 10), one dorsal cerebral vein was occluded; in Group B (n = 10), two adjacent dorsal cerebral veins were occluded; and in a sham-operated group (n = 5), the rats also underwent craniotomy and light exposure but received injections of saline rather than the rose bengal dye. After 24 hours, the rats were submitted to perfusion fixation and were examined histopathologically. After irradiation-induced cortical vein occlusion, a gradual and significant decrease of the LCBF was observed in both Group A (significantly different from the LCBF of the sham-operated group after 90 min, P < 0.05, and 120 min, P < 0.01) and Group B (significantly different from the LCBF of the sham-operated group at 30 min, P < 0.05, and at 60, 90, and 120 min, P < 0.01). Significant differences (P < 0.01) in the LCBF were also seen between the two experimental groups at 90 and 120 minutes after the start of the irradiation and the subsequent brain damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Dural arteriovenous fistula of the posterior fossa developing after surgical occlusion of the sigmoid sinus

✓ In this article, the authors present five cases of dural arteriovenous fistula (AVF) that developed in the transverse—sigmoid sinus 2 to 6 years after sacrifice of the sigmoid sinus because of tumor involvement. The original tumor was meningioma in two patients and neurinoma, glomus jugulare tumor, and ameloblastoma in one patient each. The involved sigmoid sinus was resected along with the tumor and ligated at the normal edge; all that remained of the sigmoid sinus was a small stump on the retrosigmoid portion. Serial angiography performed before and after tumor surgery revealed no abnormal arteriovenous communications or dural AVF in any of the cases. Although many reports have suggested that sinus thrombosis is a precipitating factor in the pathogenesis of dural AVFs, this has been difficult to verify because of the small number of cases in which serial angiography was performed before the development of a dural AVF. In all of the cases presented in this article, surgical resection of a dural AVF and...

Use of Local Cerebral Blood Flow Monitoring to Predict Brain Damage after Disturbance to the Venous Circulation

A RAT MODEL of cortical vein occlusion by the photochemical thrombotic technique was used to evaluate whether monitoring the change in the local cerebral blood flow (LCBF) could predict brain damage after cortical vein occlusion. The cortical vein occlusion was attained by using the photochemical thrombotic technique, and the sequential LCBF was measured by using a laser Doppler flowmeter positioned over the middle frontal cortex between two adjacent dorsal veins for 120 minutes after the start of the irradiation to the cortical vein. Rats were assigned to one of three experimental groups. In Group A (n = 10), one dorsal cerebral vein was occluded ; in Group B (n = 10), two adjacent dorsal cerebral veins were occluded ; and in a sham-operated group (n = 5), the rats also underwent craniotomy and light exposure but received injections of saline rather than the rose bengal dye. After 24 hours, the rats were submitted to perfusion fixation and were examined histopathologically. After irradiation-induced cortical vein occlusion, a gradual and significant decrease of the LCBF was observed in both Group A (significantly different from the LCBF of the sham-operated group after 90 min, P 40% decrease at 120 minutes after the irradiation had severe brain damage. We conclude that continuous monitoring of the LCBF could be reliable and useful for predicting brain damage after cortical vein occlusion, and that the rat model of cortical vein occlusion by the photochemical thrombotic technique is useful for studying the pathophysiology of the venous circulation. (Neurosurgery 37 :280-286, 1995)

Clinical features of the haemorrhage type moyamoya disease based on 31 cases

SummaryWe evaluated and analysed our own 31 cases of the haemorrhagic type of moyamoya disease to clarify the clinical features of this disease. The cases were divided into three groups. Group A consisted of 12 cases with aneurysms. Aneurysms on the circle of Willis were treated as ordinary saccular aneurysms. Group B consisted of 14 cases with intracerebral haemorrhage (ICH) without aneurysms. These were managed almost as spontaneous ICH. Group C consisted of 5 cases with intraventricular haemorrhage (IVH) without aneurysms or ICH. Twenty-two surgical procedures for aneurysms, ICH and IVH were done in 19 cases (62%). Nineteen procedures for preventing future strokes were undertaken in 11 cases (35%). The overall initial outcome was excellent in 12 cases (39%), good in 7 cases (23%), poor in 7 cases (23%), and death in 5 cases (15%). During the follow-up period (mean: 6.5 years), rebleeding occurred in two cases (8%), and ischaemic attacks in two cases (8%). The rate of rebleeding or ischaemic attacks was 1.19% per patient-year during the follow-up period. There was no ischaemic or rebleeding episode in cases treated by STA-MCA bypass with encephalomyosynagiosis (EMS) during the follow-up period. Management of the primary haemorrhage should be according to the clinical condition, type of haemorrhage, and source of haemorrhage. When the patient needs to undergo revascularization surgery to prevent future strokes, we recommend STA-MCA bypass with EMS instead of encephaloduro-arteriosynangiosis (EDAS).

Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms: Report of two cases

Two cases of internal carotid aneurysms, trapped and bypassed, by means of radial artery grafts are discussed. Neither case has permanent neurological deficit possibly because of an adequate blood supply via the radial artery graft bypass. Although the radial artery graft has been in common use among cardiac surgeons, it is still rare in the neurosurgical field. The advantage of the radial artery is discussed with comparison to other graft materials such as the saphenous vein and the superficial temporal artery. In properly selected cases, the radial artery graft is useful in preventing the ischemic damage caused by an aneurysm being trapped at the main arterial trunk.

Importance of prevention of intravenous thrombosis and preservation of the venous collateral flow in bridging vein injury during surgery: An experimental study ☆

BACKGROUND Venous infarction (cerebral edema and/or hemorrhage) may occur several hours after sacrifice of the bridging vein during surgery. However, in our experience, severe venous infarction is often produced by prolonged brain retraction in addition to sacrifice of the vein. METHODS The experiment was carried out using 20 adult cats. In five cats, all bridging veins were coagulated near the superior sagittal sinus and 12 hours later the surgical wound was closed (group A). In five other cats, a round plate weighing 45 g was placed on the center of the Sylvian fissure for 12 hours and then the wound was closed (group B). In the remaining 10 cats, both of these interventions were performed (group C). All 20 animals were sacrificed 12 hours after the wound closure. RESULTS The degree of Evans-blue dye leakage and brain edema was much more marked in the group C than in groups A and B. The endothelial intactness of the bridging veins studied by staining with a factor VIII-related antigen was much more disturbed in group C than in the other groups. CONCLUSIONS The endothelium of the cortical veins is damaged much more by the combination of sacrifice of the vein and brain retraction, and this endothelial damage of the cortical vein leads to extensive venous infarction.

Expanding laminoplasty for cervical myelopathy-spinous process roofing technique

SummaryWe have carried out expanding laminoplasty using spinous process roofing technique for patients presenting with cervical myelopathy. The technique is a modified Kurokawas method. The result shows that laminoplasty with this technique provides better postoperative neck movement with a simpler surgical procedure. The clinical material consists of 54 cases with more than 3 years follow-up. Long-term investigation was performed focusing on the following three points, (1) bony fusion rates, (2) radiographic neck movement, (3) neurological improvement. The results indicate good postoperative bony fusion in all cases. Postoperative neck movement was also well preserved in the majority of cases.

The effect of brain compression under venous circulatory impairment.

Abstract It is well known that surgical obliteration of the cerebral veins with additional brain compression by retractors is dangerous. To evaluate the mechanism, we, studied the change in cerebral microcirculation and parenchymal damage following brain compression with venous circulatory impairment using a rat model. The animals were divided into the following four groups (each n = 5) (1) a sham-operated control; (2) group A, one cortical vein occlusion; (3) group B, a 30 mmHg compression pressure; and (4) group C, one cortical vein occlusion with 30 mmHg compression. The cortical vein was occluded photochemically. Local cerebral blood flow (I-CBF) in the compressed area was measured by stationary laser-Doppler (LO) flowmetry and regional CBF (r-CBF) in the surrounding area was also measured by LO scanning technique for 120 min. I-CBF in the compressed area decreased significantly in groups Band C. A gradual and significant increase in group B and decrease in group C in r-CBF of the surrounding area were observed. Histologically, more extensive damage was observed in group C than in group A and B. The degree of hypoperfusion of the affected brain correlated well with the subsequent brain damage in the experiments. We demonstrated that, compared with vein occlusion or brain compression alone, the accumulated episode caused severe ischemia, then increased the vulnerability of the rat brain to tissue damage. [Neural Res 2000; 22: 713-720]