研究者詳細 - 小松　克也

論文 - 小松　克也

分割表示 68 件中 41 - 60 件目／全件表示 >>

Intraoperative Mapping and Monitoring of the Pyramidal Tract Using Endoscopic Depth Electrodes.

Yukinori Akiyama, Shunya Ohtaki, Katsuya Komatsu, Kentaro Toyama, Rei Enatsu, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery ( ELSEVIER SCIENCE INC ) 105 14 - 19 2017年09月 [査読有り] [国際誌]

OBJECTIVE: To evaluate motor function during neuroendoscopic resectioning of deep-seated brain tumors using endoscopically guided depth electrodes. METHODS: For 12 cases of thalamic tumors, including high-grade gliomas, germinomas, and malignant lymphomas, depth electrodes were inserted using endoscopic guides between the tumor and the pyramidal tract in the thalamus. Motor-evoked potentials (MEPs) were continuously recorded during neuroendoscopic resectioning of the tumors. RESULTS: Monitoring of MEP responses using depth electrodes in all 12 cases was successful. The minimum stimulus intensity threshold required to induce MEP responses was 3 mA. Gross total or subtotal resections were successful with this technique for all patients with glioma. No additional neurologic impairments were found after surgery in any of the cases. CONCLUSIONS: Continuous MEP measurement using depth electrodes can serve as a new monitoring technique for endoscopic resectioning of deep-seated brain tumors.

Prevalence of and risk factors for enlarged perivascular spaces in adult patients with moyamoya disease.

Tomoyoshi Kuribara, Takeshi Mikami, Katsuya Komatsu, Hime Suzuki, Hirofumi Ohnishi, Kiyohiro Houkin, Nobuhiro Mikuni

BMC neurology ( BIOMED CENTRAL LTD ) 17 ( 1 ) 149 - 149 2017年08月 [査読有り] [国際誌]

BACKGROUND: Enlarged perivascular spaces (EPVS) are often observed with magnetic resonance imaging in patients with small vessel disease. However, the risk factors, radiological features, and clinical relevance of EPVS in patients with moyamoya disease are poorly understood. The purpose of this study was to evaluate EPVS, the risk factors of many EPVS, and the pathophysiology of EPVS in adult patients with moyamoya disease. METHODS: One hundred cerebral hemispheres of 50 adult patients with moyamoya disease were examined. The control group consisted of 50 age/sex-matched patients without ischemic disease. The numbers of EPVS at the level of the centrum semiovale per hemisphere were compared between the moyamoya disease and control groups. In each hemisphere, the total numbers of EPVS were categorized into five grades (0-4), and the clinical and radiological characteristics of the predictive factors in patients in the high EPVS grade group (EPVS grade = 4) were assessed. RESULTS: The EPVS counts and grades were significantly higher in the moyamoya disease group. Analyses of the background characteristics of the patients with moyamoya disease revealed that significantly higher prevalence of high EPVS grades were associated with the female sex, hypertension, high magnetic resonance angiography scores, high numbers of flow voids in the basal ganglia, high brain atrophy scores, ivy signs, and white matter lesions. A logistic multivariate analysis of the patients with high EPVS grades revealed significant associations with the female sex, hypertension, and flow voids in the basal ganglia. CONCLUSIONS: Increased EPVS were confirmed in adult patients with moyamoya disease, and the associated clinical and radiological factors were identified. The presence of hypertension, the female sex, and flow voids in the basal ganglia were important for predicting high EPVS grades in patients with moyamoya disease. Reductions in arterial pulsations with steno-occlusive changes can inhibit the flow of interstitial fluid, which can increase the number of EPVS in patients with moyamoya disease. Other clinical factors, such as the female sex and hypertension, may promote secondary brain damage in patients with moyamoya disease. Further evaluations of EPVS in patients with moyamoya disease are needed to better understand their pathophysiological importance.

Complementary Relation Between Direct and Indirect Bypass in Progress of Collateral Circulation in Moyamoya Disease.

Shoichi Komura, Takeshi Mikami, Toshiya Sugino, Yuto Suzuki, Katsuya Komatsu, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery ( ELSEVIER SCIENCE INC ) 104 197 - 204 2017年08月 [査読有り] [国際誌]

BACKGROUND: One of the important aims of surgery for moyamoya disease is to establish indirect revascularization. The purpose of this study was to assess the progress of the middle meningeal artery (MMA) after our novel preservation method and to evaluate the relation between direct and indirect bypass in the chronic stage. METHODS: A total of 24 hemispheric sides of 19 patients with moyamoya disease were included in this study. Craniotomy was performed with preservation of the MMA during the procedure, then direct bypass was carried out. The relationship between anatomic variations of the MMA and success rate of preserving the MMA during craniotomy was noted. The alteration of the MMA and superficial temporal artery (STA) diameters was then evaluated using magnetic resonance imaging, and the correlation between the MMA and the STA in the chronic stage was examined. RESULTS: In total, the MMA was preserved during craniotomy in 20 hemispheric sides (83.3%). During the 3-year follow-up period, the MMA and STA diameters were significantly increased. At 3 years after surgery, the alteration of the MMA diameter was significantly more marked in pediatric cases than in adult cases, and MMA diameter was moderately but significantly negatively correlated with STA diameter. CONCLUSIONS: In moyamoya disease, the MMA could be developed as a pathway for indirect revascularization even after simple preservation, especially in pediatric patients. The progress of the MMA and the STA occurs through their synergistic interaction, and the balance might be decided based on their complementary relations in the chronic stage.

Meandering flow void around the splenium in moyamoya disease.

Takeshi Mikami, Tomoyoshi Kuribara, Katsuya Komatsu, Yusuke Kimura, Masahiko Wanibuchi, Kiyohiro Houkin, Nobuhiro Mikuni

Neurological research ( TAYLOR & FRANCIS LTD ) 39 ( 8 ) 702 - 708 2017年08月 [査読有り] [国際誌]

OBJECTIVES: Meandering flow void around the splenium, which can be recognized on conventional T2-weighted images, implicates collateral flow in the splenial artery in patients with moyamoya disease. In this report, curves of flow voids around the splenium (SFVs) were evaluated in patients with moyamoya disease, and their diagnostic value and pathophysiology were verified. METHODS: A total of 65 consecutive patients with moyamoya disease were included in this analysis. The number of SFV curves was counted on each side. The numbers of SFV curves in patients with moyamoya disease was compared with those in the control group. The clinical features of patients with large numbers of flow voids were analyzed. RESULTS: The mean number of SFVs was significantly higher in the moyamoya disease group than in the control group or the atherosclerotic disease group. The cut-off SFV count for a diagnosis of moyamoya disease should be set to 2.25 in consideration of receiver operating characteristic curve analysis. A multivariate logistic analysis of SFV data in moyamoya disease revealed significant differences between the high SFV count group (≥2.25) and the low SFV count group (<2.25) in age, flow voids in the basal ganglia, and magnetic resonance angiography score of the internal carotid artery and anterior cerebral artery. CONCLUSION: Based on this study, number of SFV curves on conventional T2-weighted imaging could be a useful measurement for confirming a diagnosis of moyamoya disease. Increased number of SFV curves was associated with age and progress of disease.

Exposure of titanium implants after cranioplasty: A matter of long-term consequences

Takeshi Mikami, Kei Miyata, Katsuya Komatsu, Ken Yamashita, Masahiko Wanibuchi, Nobuhiro Mikuni

Interdisciplinary Neurosurgery ( Elsevier {BV} ) 8 64 - 67 2017年06月 [査読有り]

Although the use of titanium implants in cranioplasty has recently become common, long-term results of this strategy are sometimes difficult to manage. The aim of this study was to clarify the characteristics of patients developing exposure of titanium implants. Records of eight patients with exposure of titanium implants were reviewed. Patient ages ranged from 41 to 77 (mean, 56.8) years. Two patients were male, and six were female. The periods from implantation to exposure of titanium implants ranged from 5 to 87 (mean, 30.5) months. In seven cases, titanium mesh cranioplasty was performed after postcraniotomy infections. The titanium implants were removed in all cases. Scalp tissue was closed by applying a primary closure technique in five cases, though scalp reconstruction was performed with a rotation flap in the other three cases involving large scalp ulceration. Although the use of titanium implants is convenient, the indications should be carefully considered, especially in cases with postoperative surgical site infections and in patients with thin scalp skin. For these patients, long-term follow up is necessary.

Pathophysiological consideration of medullary streaks on FLAIR imaging in pediatric moyamoya disease.

Hime Suzuki, Takeshi Mikami, Tomoyoshi Kuribara, Kazuhisa Yoshifuji, Katsuya Komatsu, Yukinori Akiyama, Hirofumi Ohnishi, Kiyohiro Houkin, Nobuhiro Mikuni

Journal of neurosurgery. Pediatrics ( AMER ASSOC NEUROLOGICAL SURGEONS ) 19 ( 5 ) 560 - 566 2017年05月 [査読有り] [国際誌]

OBJECTIVE Medullary streaks detected on fluid-attenuated inversion recovery (FLAIR) imaging have been considered to be reflected ischemic regions in pediatric moyamoya disease. The purpose of this study was to evaluate these medullary streaks both clinically and radiologically and to discuss associated pathophysiological concerns. METHODS The authors retrospectively reviewed data from 14 consecutive pediatric patients with moyamoya disease treated between April 2009 and June 2016. Clinical and radiological features and postoperative imaging changes were analyzed. In 4 patients, hyperintense medullary streaks on FLAIR imaging (HMSF) at the level of the centrum semiovale were detected. RESULTS The HMSF were coincident with hyperintense medullary streaks on a T2-weighted image, though they were not completely coincident with the vasculature on either a T2*-weighted image or contrast-enhanced CT. Analysis revealed significantly higher values in terms of MR angiography scores, number of flow voids of the basal ganglia, and the presence of the medullary artery in the group with HMSF than in those without. In contrast, the presence of white matter damage was significantly less frequent in the HMSF group. All HMSF disappeared after surgery, and the mean apparent diffusion coefficient at the same level was significantly reduced postoperatively. CONCLUSIONS Although HMSF should be associated with collateral circulation in moyamoya disease, other factors may be involved, including stagnated cerebrospinal fluid or vasogenic edema that is relevant to the impaired state of the white matter. Findings in this study provide insight into the pathophysiological basis of the perivascular space in moyamoya disease.

Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report.

Masayasu Arihara, Kei Miyata, Satoshi Iihoshi, Hiroyuki Yamaguchi, Kentaro Toyama, Katsuya Komatsu, Atsumu Hashimoto, Masahiko Wanibuchi, Nobuhiro Mikuni

NMC case report journal 4 ( 2 ) 59 - 62 2017年04月 [査読有り] [国内誌]

A nearly 80-year-old man with a history of radiotherapy (RT) and total laryngectomy for laryngeal cancer 25 years previously presented with a rapidly growing mass on the right side of his neck. A huge pseudoaneurysm (pseudoAN) was detected at the right carotid bifurcation, though angiography performed four years previously had shown total occlusion of the internal carotid artery. Stent-assisted coil embolization enabled aneurysm sac shrinkage. Clinicians must be aware that the stump of an arterial occlusion associated with RT can change into a pseudoAN over the long term and must provide follow-up in such cases.

Assessment of the cortical artery using computed tomography angiography for bypass surgery in moyamoya disease.

Hime Suzuki, Takeshi Mikami, Katsuya Komatsu, Shouhei Noshiro, Kei Miyata, Toru Hirano, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurosurgical review ( SPRINGER ) 40 ( 2 ) 299 - 307 2017年04月 [査読有り] [国際誌]

Computed tomography angiography (CTA) is often used to assess the vascular status in moyamoya disease. The purpose of the study is to identify the characteristics of cortical arteries (M4) of moyamoya disease on CTA; the clinical significance of which is also discussed. A total of 38 hemispheric sides of 27 patients with moyamoya disease were included in this study. The number of M4 was visualized on CTA using cortical surface imaging and compared between the moyamoya disease group and the non-moyamoya disease group or the control group. Then, the clinical and radiological factors associated with the number of M4, the distribution of M4, and collateral circulation were examined. The number of M4 was lower in the moyamoya disease group than in the non-moyamoya disease group and in the control group (p < 0.05). There are few predictive clinical factors of the number of M4 except male sex. The prefrontal artery, precentral artery, central artery, and angular artery had a significantly higher prevalence in moyamoya disease (p < 0.05). The durocortical and periventricular anastomosis had a significantly higher prevalence in moyamoya disease (p < 0.05). The prevalence and distribution pattern of cortical arteries in moyamoya disease differed from that of the non-moyamoya disease group, and the distribution patterns of M4 might be influenced by collateral circulation. It is thus essential to recognize M4 to assess the recipient artery so as to ensure superficial temporal artery-middle cerebral artery bypass.

Assessment of Hemodynamic Compromise Using Computed Tomography Perfusion in Combination with 123I-IMP Single-Photon Emission Computed Tomography without Acetazolamide Challenge Test.

Atsumu Hashimoto, Takeshi Mikami, Katsuya Komatsu, Shouhei Noshiro, Tohru Hirano, Masahiko Wanibuchi, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( Elsevier {BV} ) 26 ( 3 ) 627 - 635 2017年03月 [査読有り] [国際誌]

OBJECTIVES: The acetazolamide challenge test in conjunction with 123I-IMP single-photon emission computed tomography (SPECT) is a known method of assessing cerebrovascular reserve capacity. In this study, we investigated whether CT perfusion in combination with resting state 123I-IMP SPECT could be used instead of the acetazolamide challenge test to evaluate hemodynamic compromise in patients with atherosclerotic occlusive disease. METHODS: Twenty consecutive patients with unilateral internal carotid artery or middle cerebral artery steno-occlusive disease were enrolled. 123I-IMP SPECT was performed with and without the acetazolamide challenge test, and with CT perfusion. Cerebral blood flow (CBF), cerebral blood volume, and mean transit time (MTT) obtained by CT perfusion were compared with CBF and cerebrovascular reactivity (CVR) obtained by 123I-IMP SPECT. RESULTS: The asymmetry ratio of MTT as measured by CT perfusion showed a strong correlation with the CVR to acetazolamide as measured by 123I-IMP SPECT (ρ = -.780, P <.001). Based on the CBF obtained through 123I-IMP SPECT and the MTT obtained through CT perfusion, hemodynamic compromise was detected with high sensitivity (1.000) and specificity (.929), and a cutoff value of 30% was found to be suitable for the asymmetry ratio of MTT. MTT prolongation was significantly improved after revascularization surgery in hemodynamic compromise (P = .028). CONCLUSION: MTT as measured by CT perfusion in combination with CBF as measured by resting state 123I-IMP SPECT may be useful for evaluating hemodynamic compromise as an alternative to the acetazolamide challenge test.

[Bone Flap Resorption after Cranioplasty in Pediatric Patients:Report of 2 Cases].

Rintaro Yokoyama, Takeshi Mikami, Shouhei Noshiro, Kei Miyata, Kentaro Toyama, Katsuya Komatsu, Noriaki Kikuchi, Tadashi Hasegawa, Nobuhiro Mikuni

No shinkei geka. Neurological surgery 45 ( 1 ) 47 - 52 2017年01月 [査読有り] [国内誌]

Aseptic bone flap resorption, a rare complication after cranioplasty following decompressive craniectomy, is more likely to develop in children. We experienced two cases of aseptic bone flap resorption and identified potential pathophysiological mechanisms through histological findings. In the first case, an 11-year-old girl underwent decompressive craniectomy due to brain swelling with contusion. An autologous bone flap was cryopreserved for four months. Twenty-five months after cranioplasty with autologous bone flap, aseptic bone flap resorption was observed, and cranioplasty was performed with ceramic bone. Most of the histological findings in this case showed mature osseous tissue, while some showed osteoclasts and new bone formation due to endochondral ossification. In the second case, a 10-year-old girl underwent frontal craniectomy and removal of contusional hematoma. Fourteen months after cranioplasty with autologous bone flap, aseptic bone flap resorption was observed, and cranioplasty was performed with ceramic bone paste. The progression of bone flap resorption was not recognized for 12 months. In these cases, new bone formation was not necessarily linked to pathological bone flap resorption. It is supposed that the balance between bone destruction and new bone formation was disrupted by unknown factors.

Erdheim-Chester Disease Involving the Central Nervous System with the Unique Appearance of a Coated Vertebral Artery.

Hime Suzuki, Masahiko Wanibuchi, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Shintaro Sugita, Tadashi Hasegawa, Mitsunori Kaya, Kohichi Takada, Nobuhiro Mikuni

NMC case report journal 3 ( 4 ) 125 - 128 2016年10月 [査読有り] [国内誌]

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis. It is characterized by multiple xanthogranulomatous masses throughout the body, predominantly in the tibia. One of the characteristic radiological findings of the lesions associated with ECD is a "coated artery," which is often observed in the aorta. Although approximately one-fourth of ECD cases involve the central nervous system (CNS), an intracranial-coated artery has only been reported in four cases. We report a case of ECD that involves the CNS and has the unique appearance of a coated vertebral artery (VA). These tumors entirely encase the bilateral VAs without stenosis and are attached to the dura. Cranial magnetic resonance imaging also showed multiple extra-axial tumors in the cavernous sinus, the frontal convexity, and the orbital cavity. Further investigation revealed additional extracranial lesions around the cervical carotid artery, at the bilateral tibia, and at the elbow joint. A biopsy of the cervical and tibial lesions confirmed ECD. Steroid therapy resulted in a month-long improvement of preoperative symptoms. However, the patient's condition gradually progressed and he died of pneumonia 1 year after ECD diagnosis. The encasement of the intracranial artery by the tumor without stenosis and the dural attachment suggest ECD, which requires whole body investigation.

[Pediatric Iatrogenic Vertebral Arteriovenous Fistula Successfully Treated with Endovascular Treatment:A Case Report].

Rintaro Yokoyama, Satoshi Iihoshi, Kei Miyata, Kentaro Toyama, Katsuya Komatsu, Masahiko Wanibuchi, Nobuhiro Mikuni

No shinkei geka. Neurological surgery ( Igaku-Shoin Ltd ) 44 ( 10 ) 857 - 861 2016年10月 [査読有り] [国内誌]

OBJECT: We report a relatively rare case of pediatric iatrogenic extradural vertebral arteriovenous fistula. CASE: A five-year-old boy with a history of multiple surgeries for Total Anomalous Pulmonary Venous Return(TAPVR)exhibited vascular engorgement of his right neck from about 4 years old. We thought that this was caused by his past operations. He demonstrated swollen blood vessels in the right neck and pulmonary hypertension with increased right heart load. A right extradural vertebral arteriovenous fistula was seen on angiography. A high flow shunt was present at the V1 segment, at the level of the sixth cervical vertebra, and a 12 mm venous pouch was present anterior to the vertebral artery. We recognized the outlet passages of the cranial tract were the vertebral venous plexus, internal jugular vein, and right atrium. We performed endovascular transarterial embolization using a hydrogel coil. As a result, we treated with a high volume embolization ratio. Following treatment, the arteriovenous fistula disappeared while anterograde blood flow of the vertebral artery was preserved. The patient demonstrated no neurological deficits, improved right heart load, and his venous pouch of the neck. He has had no recurrence in the two years after treatment. CONCLUSION: Endovascular surgery is effective and safe for the treatment of iatrogenic vertebral arteriovenous fistula.

Quantitative Assessment of Flow Reduction After Feeder Embolization in Meningioma by Using Pseudocontinuous Arterial Spin Labeling.

Masahiko Wanibuchi, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Nobuhiro Mikuni

World neurosurgery ( ELSEVIER SCIENCE INC ) 93 237 - 45 2016年09月 [査読有り] [国際誌]

BACKGROUND: Meningioma is a hypervascular tumor of the central nervous system. Angiographic disappearance of tumor blush after preoperative feeder embolization allows qualitative, but not quantitative, assessment of flow reduction. Pseudocontinuous arterial spin labeling (PCASL), which has evolved from magnetic resonance imaging techniques, allows noninvasive measurement of cerebral blood flow (CBF) using water protons in the arterial blood flow. OBJECTIVE: We applied PCASL for assessment of blood flow in meningioma and its reduction on preoperative embolization. METHODS: Forty-one consecutive patients (11 males, 30 females) with histologically proven meningioma were evaluated by PCASL. Quantitative assessment by an absolute value of tumor blood flow (TBF) and a relative value of tumor vascular index (tVI; calculated as TBF divided by CBF) were calculated. In 8 cases, in which preoperative embolization was achieved, flow reduction rate was evaluated. RESULTS: TBF of meningiomas, 155.8 mL/100 g·min(-1) on average, was 2.6 times higher than CBF, 59.9 mL/100 g·min(-1) (P < 0.001). Patients who underwent feeder embolization showed statistically greater flow reduction rate, which was calculated as 42.7% (P < 0.05). Mean tVI before embolization was 4.1, which was reduced to 2.1 after embolization. CONCLUSION: PCASL could yield quantitative assessment of blood flow in meningioma including flow reduction rate in cases of feeder embolization.

Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology

Masahiko Wanibuchi, Shouhei Noshiro, Toshiya Sugino, Yukinori Akiyama, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Katsuya Komatsu, Nobuhiro Mikuni

World Neurosurgery ( Elsevier {BV} ) 91 66 - 72 2016年07月 [査読有り] [国際誌]

OBJECTIVE: A 3-dimensional temporal bone model for skull base surgical training was reconstructed via the use of a selective laser sintering technique, which is one of the 3-dimensional printing technologies. METHODS: The temporal bone model was created in 2 pieces to remove powder material in the mastoid air cells and to place dye into the semicircular canal and the Fallopian canal. RESULTS: The powder material was minimal, and the decisive structures were identified in color. CONCLUSIONS: This artificial model will pave the way to a "new era" in surgical training and medical education.

Neuromodulatory Role of Revascularization Surgery in Moyamoya Disease.

Shouhei Noshiro, Takeshi Mikami, Katsuya Komatsu, Aya Kanno, Rei Enatsu, Shogo Yazawa, Takashi Nagamine, Masao Matsuhashi, Nobuhiro Mikuni

World neurosurgery ( Elsevier {BV} ) 91 473 - 82 2016年07月 [査読有り] [国際誌]

BACKGROUND: To evaluate the effectiveness of bypass surgery for moyamoya disease, electrocorticography was first evaluated. METHODS: A total of 13 hemispheres in 9 patients with moyamoya disease were included in this study. To record the spectral power of electrocorticography continuously during the bypass procedure, a 4 × 5 subdural electrode grid was placed on the middle frontal gyrus. The changes in spectral power before and after bypass surgery were evaluated and compared with those in a control group. The correlation between changes in spectral power and regional cerebral blood flow was analyzed. RESULTS: The average spectral power ratio of the beta band per total band in moyamoya disease before bypass surgery was lower than that of controls (P = 0.027), and the significance disappeared after bypass surgery (P = 0.800). The spectral power levels of the beta band and gamma band were increased in moyamoya disease after bypass surgery (P < 0.001). Changes in spectral power of the beta band correlated with changes in regional cerebral blood flow (P = 0.002). CONCLUSIONS: The spectral power of the beta band on electrocorticography was focally suppressed in patients with moyamoya disease, and the suppression was reversible by revascularization surgery. Steno-occlusive ischemic changes in moyamoya disease might cause suppression of neurophysiologic activity, and the present results provide insight into the potential neuromodulatory role of revascularization surgery.

Reversibility of White Matter Hyperintensity by Revascularization Surgery in Moyamoya Disease.

Katsuya Komatsu, Takeshi Mikami, Shouhei Noshiro, Kei Miyata, Masahiko Wanibuchi, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( Elsevier {BV} ) 25 ( 6 ) 1495 - 502 2016年06月 [査読有り] [国際誌]

BACKGROUND: White matter lesions (WMLs) indicate progressive cerebral small vessel disease and are frequently observed in aging people and stroke patients. The purpose of this study was to evaluate WMLs and the influence of revascularization surgery for WMLs in patients with moyamoya disease. METHODS: A total of 42 hemispheres in 21 patients with moyamoya disease were included in this analysis. WMLs were detected on fluid-attenuated inversion recovery (FLAIR) imaging in 24 hemispheres. The distribution pattern of WMLs was categorized. WMLs were measured by manually creating a region of interest, and the total WML volume in the hemisphere was estimated and compared with the control group. Clinical features of patients with WMLs and postoperative changes were analyzed. RESULTS: The total WML volume in moyamoya disease was significantly higher than that of controls (P = .014). WMLs were observed in the internal watershed zone, especially in the watershed zone between the anterior cerebral artery and the middle cerebral artery. Patients with WMLs had significantly higher magnetic resonance angiography scores compared with controls (P = .015). A given patient's total WML volume per hemisphere was significantly decreased after surgery (P = .001). CONCLUSIONS: WMLs on FLAIR imaging increase in patients with moyamoya disease and are reversible by revascularization surgery. Improvement of cerebral blood flow is partly related to the decrease in WMLs. The present results provide insight into the potential role of revascularization surgery.

Intraoperative Mapping and Monitoring for Rootlets of the Lower Cranial Nerves Related to Vocal Cord Movement.

Masahiko Wanibuchi, Yukinori Akiyama, Takeshi Mikami, Katsuya Komatsu, Toshiya Sugino, Kengo Suzuki, Aya Kanno, Shunya Ohtaki, Shouhei Noshiro, Nobuhiro Mikuni

Neurosurgery ( OXFORD UNIV PRESS INC ) 78 ( 6 ) 829 - 34 2016年06月 [査読有り] [国際誌]

BACKGROUND: Damage to the motor division of the lower cranial nerves that run into the jugular foramen leads to hoarseness, dysphagia, and the risk of aspiration pneumonia; therefore, its functional preservation during surgical procedures is important. Intraoperative mapping and monitoring of the motor rootlets at the cerebellomedullary cistern using endotracheal tube electrodes is a safe and effective procedure to prevent its injury. OBJECTIVE: To study the location of the somatic and autonomic motor fibers of the lower cranial nerves related to vocal cord movement. METHODS: Twenty-four patients with pathologies at the cerebellopontine lesion were studied. General anesthesia was maintained with fentanyl and propofol. A monopolar stimulator was used at amplitudes of 0.05 to 0.1 mA. Both acoustic and visual signals were displayed as vocalis muscle electromyographic activity using endotracheal tube surface electrodes. RESULTS: The average number of rootlets was 7.4 (range, 5-10); 75% of patients had 7 or 8 rootlets. As many as 6 rootlets (2-4 in most cases) were responsive in each patient. In 23 of the 24 patients, the responding rootlets congregated on the caudal side. The maximum electromyographic response was predominantly in the most caudal or second most caudal rootlet in 79%. CONCLUSION: The majority of motor fibers of the lower cranial nerves run through the caudal part of the rootlets at the cerebellomedullary cistern, and the maximal electromyographic response was elicited at the most caudal or second most caudal rootlet. ABBREVIATION: EMG, electromyographic.

Cortical and subcortical vascular hypointensity on T2* weighted imaging in moyamoya disease.

Shouhei Noshiro, Takeshi Mikami, Katsuya Komatsu, Kei Miyata, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurological research ( TAYLOR & FRANCIS LTD ) 38 ( 2 ) 110 - 6 2016年02月 [査読有り] [国際誌]

OBJECTIVES: Decreased cortical and subcortical vascular signals in gradient echo T2* weighted imaging have been reported in acute stroke due to major artery occlusion. The purpose of this study was to evaluate this cortical and subcortical vascular hypointensity (CSVH) in patients with moyamoya disease. METHODS: Subjects were 20 consecutive patients with moyamoya disease. The numbers of CSVH in each hemisphere were counted and the numbers were compared between patients with moyamoya disease and controls. The distribution of CSVH, clinical features of cases exhibiting large numbers of CSVH and post-operative changes were analysed. RESULTS: Patients with moyamoya disease had significantly more CSVH in the middle cerebral artery territory (p < 0.001) and the anterior cerebral artery territory (p < 0.001) compared with controls. The number of CSVH was correlated significantly with regional cerebral blood flow, as shown through simple regression analysis (R = 0.461, p = 0.006), and the numbers of CSVH were significantly higher in patients with higher magnetic resonance angiography scores (p = 0.017). A given patient's total number of CSVH per hemisphere was significantly decreased after surgery (p = 0.018). CONCLUSION: CSVH on T2* WI may be a useful tool for diagnosing and evaluating the extent of moyamoya disease. Our small series study shows that revascularization surgery can decrease the number of CSVH.

Transfemoral Carotid Artery Stenting Using Proximal Balloon Protection for Patients with Severe Elongation of the Aortic Arch: Inner-catheter Exchange with the Balloon Guide Catheter Anchored ("BGA Exchange")

Miyata Kei, Iihoshi Satoshi, Yokoyama Rintaro, Toyama Kentaro, Komatsu Katsuya, Wanibuchi Masahiko, Mikuni Nobuhiro

脳神経血管内治療 ( 特定非営利活動法人日本脳神経血管内治療学会 ) 10 ( 4 ) 225 - 230 2016年

Objective: Anatomical factors such as aortic arch elongation or angulation in elderly patients with arteriosclerotic change often make it difficult to perform carotid artery stenting (CAS) via the transfemoral approach under proximal balloon protection (PBP). We report a novel technique of transfemoral CAS using the inner catheter exchange method for a patient with a type III aortic arch.

Case Presentations: A 78-year-old man presented with symptomatic left carotid artery stenosis. A balloon guide catheter (BGC) was needed for PBP via the transfemoral approach. Initially, the modified Simmons-shaped inner catheter could not follow the half-stiff long guidewire to the external carotid artery (ECA) by the co-axial method. Accordingly, the inner catheter was safely exchanged with a flexible JB2 catheter with the balloon of the BGC fully inflated on the way to the left common carotid artery (CCA). Following the half-stiff long guidewire and with the JB2 catheter advanced into the distal portion of the left ECA beforehand, the BGC was successfully navigated into the left CCA below the bifurcation. Further procedures were performed without any complications.

Conclusion: This technique might be useful in patients with high risk of distal thromboembolic complications in transfemoral CAS with severe elongation of the aortic arch.

Vascular remodeling of the circle of Willis in moyamoya disease.

Takeshi Mikami, Shouhei Noshiro, Katsuya Komatsu, Kei Miyata, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurological research ( MANEY PUBLISHING ) 37 ( 10 ) 880 - 5 2015年10月 [査読有り] [国際誌]

OBJECTIVES: A positive (outward) remodelling pattern in patients with typical atherosclerotic disease was recognised using magnetic resonance imaging (MRI). In this report, the outer diameter of the circle of Willis was evaluated in patients with moyamoya disease, and its remodelling pattern was verified. METHODS: A total of 18 consecutive patients with moyamoya disease were included in this analysis. The diameter of the terminal portion of the internal carotid artery (ICA) (C1), proximal portion of the middle cerebral artery (MCA) (M1) and proximal portion of the anterior cerebral artery (A1) was evaluated using fast imaging employing steady-state acquisition (FIESTA) imaging. The outer diameter was estimated using these images, and compared with the control group, and the correlation with magnetic resonance angiography (MRA) scores was calculated for patients with moyamoya disease. RESULTS: The mean diameter of the moyamoya patient group on FIESTA was significantly lower than that of the control group in the C1, M1 and A1 (P < 0.0001). The M1 diameter on the FIESTA image showed a strong correlation with the moyamoya disease MRA score (y = (0.53x+2.31; R = 0.72), whereas the C1 diameter on the FIESTA image showed only a weak correlation (y = (0.16x+2.47; R = 0.21). CONCLUSION: We found that the outer diameter of all the vessels around the C1 was generally reduced in patients with moyamoya disease. Diameter of the MCA especially decreases as the disease progresses, similar to the negative (constrictive) remodelling pattern.

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