Tsuyoshi Kuriyama

Preoperative embolization of meningiomas fed by ophthalmic branch arteries

BACKGROUND The efficacy of preoperative embolization for hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries was examined. CASES AND METHODS Five hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries, four posterior ethmoidal arteries, one anterior falx artery, and one recurrent middle meningeal artery were embolized with Gel-foam powder, polyvinyl alcohol (PVA) particles, and/or microcoils as a preoperative treatment using a microcatheter. RESULTS Catheterization of the ophthalmic and tumor feeding artery was possible and feeding arteries and lesion embolization were effective to reduce the bleeding during surgery in all cases. In three cases, visual acuity and visual field were preserved. However, in one case, visual acuity and visual field defect appeared due to the migration of Gelfoam powder (Upjohn, Kalamazoo, MI) into the retinal artery. In another case, the retinal artery was embolized with the feeding arteries since the patient was already blind. CONCLUSION Embolization of hypervascular meningioma feeding vessels arising from the ophthalmic artery is possible and effective with preservation of vision, if embolic agents are injected gently enough not to reflux into the central retinal artery.

Spontaneous subperiosteal hematoma of the orbit

Spontaneous subperiosteal hematoma of the orbit is extremely rare. This is a case of an 81-year-old woman. The presenting symptom was protrusion of the right eye with severe intraorbital pain. Computed tomography scanning showed a high-density area in the upper part of the right orbit, which, at operation, was found to be a subperiosteal hematoma of the orbit.

Percutaneous transluminal angioplasty for the M2 portion vasospasm following SAH : development of the new microballoon and report of cases

A new silicone microballoon was developed for the percutaneous transluminal angioplasty of smaller intracranial vessels, such as A1, A2 and M2. This balloon was 0.5 x 2.0 mm in the deflated condition and became 2.2 x 6.5 mm inflated with 0.02 mL of fluid, and its bursting pressure was 2 atm. Two illustrative cases are presented. The first case was not treated in the M2 distribution. The second case of vasospasm of the left M2 portion was successfully treated with this new balloon, with prompt improvement of the neurological condition and cerebral circulation. The usefulness of our microballoon in treating a patient with vasospasm of small intracranial arteries is discussed.

Moyamoya disease associated with craniopharyngioma.

A case of coexisting moyamoya disease and craniopharyngioma in an 8-year-old boy is reported. The patient had been suffering from recurrence of transient right hemiparesis with headache and vomiting during the three years before admission. After the diagnosis of both moyamoya disease and craniopharyngioma, evacuation of the cystic fluid of the craniopharyngioma, encephalomyosynangiosis , and internal irradiation through an Ommaya drainage system were carried out. The symptoms gradually improved after these procedures. The relation of moyamoya disease to craniopharyngioma is discussed. We consider that internal irradiation is one of the best means of treatment for a cystic craniopharyngioma associated with moyamoya disease.