RESUMEN
We report a case of a large vestibular schwannoma in an 80-year-old female patient that shrank after palliative Gamma Knife radiosurgery (GKS). Neurological symptoms included hearing deterioration and facial palsy. The tumor volume was 21.9 mL. Craniotomy was considered high-risk, and conventional GKS was risky, owing to the risk of transient enlargement. Therefore, GKS was performed on only a portion of the tumor. The marginal dose (12 Gy) volume was 3.8 mL (17.4%). The tumor began to shrink after transient enlargement. Sixty months later, the tumor volume was only 3.1 mL, and the patient was able to maintain independent activities of daily living without salvage treatment.
Asunto(s)
Neuroma Acústico , Radiocirugia , Humanos , Radiocirugia/métodos , Femenino , Anciano de 80 o más Años , Neuroma Acústico/cirugía , Neuroma Acústico/radioterapia , Neuroma Acústico/diagnóstico por imagen , Cuidados Paliativos/métodosRESUMEN
OBJECTIVES: The characteristics and clinical implications of posterior cerebral artery (PCA) involvement in unilateral moyamoya disease (U-MMD), such as laterality, frequency of the RNF213 p.R4810K mutation, and clinical outcomes, have not been well studied. POPULATION AND METHODS: We analyzed a cohort of 93 patients with U-MMD who participated in the SUPRA Japan study. Clinical characteristics and radiological examinations were collected from medical records. The presence of the p.R4810K mutation was determined using a TaqMan assay. The clinical outcome was assessed using the modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were performed to assess the associations. RESULTS: Among the patients with U-MMD, PCA involvement was observed in 60.0 % (3/5) of patients with homozygous mutation, 11.3 % (7/62) of those with heterozygous mutation, and 3.8 % (1/26) of those with wild type, showing a significant linear trend (p < 0.001 for trend). PCA involvement was observed exclusively on the same side as the affected anterior circulation. Dyslipidemia and cerebral infarction at initial onset were independently associated with mRS ≥1. Hypertension was associated with mRS ≥1 and it was also linked to infarction at initial onset, suggesting a potential confounding effect. Although PCA involvement showed a trend for higher mRS, it was not statistically significant. CONCLUSIONS: Our findings indicate a gene dose effect of the p.R4810K mutation on PCA involvement, with the homozygous state showing the most significant effect. Both genetic and modifiable factors such as dyslipidemia may influence the progression of U-MMD.
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Dislipidemias , Enfermedad de Moyamoya , Humanos , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/genética , Enfermedad de Moyamoya/complicaciones , Arteria Cerebral Posterior/diagnóstico por imagen , Japón , Predisposición Genética a la Enfermedad , Mutación , Dislipidemias/complicaciones , Adenosina Trifosfatasas/genética , Ubiquitina-Proteína Ligasas/genéticaRESUMEN
BACKGROUND: Long-term outcomes are unknown in patients with asymptomatic moyamoya disease. In this report, we aimed to clarify their 5-year risk of stroke and its predictors. METHODS: We are conducting a multicenter, prospective cohort study (Asymptomatic Moyamoya Registry) in Japan. Participants were eligible if they were 20 to 70 years, had bilateral or unilateral moyamoya disease, experienced no episodes suggestive of TIA and stroke; and were functionally independent (modified Rankin Scale score 0-1). Demographic and radiological information was collected at enrollment. In this study, they are still followed up for 10 years. In this interim analysis, we defined the primary end point as a stroke occurring during a 5-year follow-up period. Independent predictors for stroke were also determined, using a stratification analysis method. RESULTS: Between 2012 and 2015, we enrolled 109 patients, of whom 103 patients with 182 involved hemispheres completed the 5-year follow-up. According to the findings on DSA and MRA, 143 hemispheres were judged as moyamoya disease and 39 hemispheres as questionable manifestations (isolated middle cerebral artery stenosis). The patients with questionable hemispheres were significantly older, more often male, and more frequently had hypertension than those with moyamoya hemisphere. Moyamoya hemispheres developed 7 strokes, including 6 hemorrhagic and 1 ischemic stroke, during the first 5 years. The annual risk of stroke was 1.4% per person, 0.8% per hemisphere, and 1.0% per moyamoya hemisphere. Independent predictor for stroke was Grade-2 choroidal anastomosis (hazard ratio, 5.05 [95% CI, 1.24-20.6]; P=0.023). Furthermore, microbleeds (hazard ratio, 4.89 [95% CI, 1.13-21.3]; P=0.0342) and Grade-2 choroidal anastomosis (hazard ratio, 7.05 [95% CI, 1.62-30.7]; P=0.0093) significantly predicted hemorrhagic stroke. No questionable hemispheres developed any stroke. CONCLUSIONS: The hemispheres with asymptomatic moyamoya disease may carry a 1.0% annual risk of stroke during the first 5 years, the majority of which are hemorrhagic stroke. Grade-2 choroidal anastomosis may predict stroke, and the microbleeds and Grade-2 choroidal anastomosis may carry the risk for hemorrhagic stroke. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: UMIN000006640.
Asunto(s)
Accidente Cerebrovascular Hemorrágico , Enfermedad de Moyamoya , Accidente Cerebrovascular , Humanos , Masculino , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/epidemiología , Estudios Prospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Hemorragia Cerebral , Sistema de RegistrosRESUMEN
BACKGROUND: The patients with ruptured vertebral artery dissecting aneurysm (rVADA) should be treated as early as possible because VADA carries extremely high risk of rebleeding in the acute phase. We have established a mobile endovascular strategy for the patients with rVADA between our flagship center and its affiliated local hospitals. We introduced and reviewed our mobile endovascular therapy in this study. METHODS: We retrospectively evaluated 98 consecutive patients who underwent endovascular surgery for rVADA from 2000 to 2018 at our institution or five affiliated hospitals. When each patient was initially transported to the local affiliated hospitals, neuroendovascular surgeons traveled directly to the affiliated hospital from the flagship center in order to treat the patient there. Clinical outcomes using modified Rankin Scale at 6 months after treatment, radiological results, and procedure-related complications were reviewed to justify our mobile endovascular strategy. RESULTS: All aneurysms were cured successfully by internal trapping. Favorable outcome was achieved in 61 patients (62.2%) even though 53 patients (54.1%) had presented with severe subarachnoid hemorrhage. Overall mortality rate, treatment-related mortality rate, and treatment related complication rate were 18.4% (18/98), 0%, and 16% (16/98), respectively. There were no differences in clinical and radiological outcomes between the patients treated in the flagship center and those who treated in the affiliated hospitals. Treatment in the affiliated hospital was not a predictive factor of unfavorable outcome in our multivariate analysis, and elderly age (≥ 60) was negatively associated with favorable outcome. CONCLUSIONS: Our results prove the efficacy and safety of mobile endovascular therapy for the treatment of rVADA in the ultra-acute stage. Mobile endovascular therapy may work well in the acute treatment of rVADAs in the certain circumstance.
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Aneurisma Roto , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Hemorragia Subaracnoidea , Disección de la Arteria Vertebral , Anciano , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/cirugía , Embolización Terapéutica/efectos adversos , Procedimientos Endovasculares/efectos adversos , Hospitales , Humanos , Aneurisma Intracraneal/complicaciones , Estudios Retrospectivos , Hemorragia Subaracnoidea/complicaciones , Resultado del Tratamiento , Arteria Vertebral , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/cirugíaRESUMEN
OBJECTIVE: The morphological changes of the pipeline embolization device (PED; Medtronic, Minneapolis, MN, USA), such as delayed migration or foreshortening, can relate to the incomplete occlusion of aneurysms. CASE PRESENTATION: A 30-year-old man with a giant cavernous carotid artery aneurysm was treated with two PEDs using the overlapping technique. Six months after treatment, follow-up angiography showed morphological changes of the PEDs and residual flow into the aneurysm. Chronological cone-beam computed tomography fusion imaging clearly revealed the dynamic foreshortening of the first PED and the disconnection of both PEDs, so we decided to implant an additional PED. CONCLUSION: This case illustrates that a three-dimensional understanding can be useful for assessing the cause of treatment failure or recurrence.
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Enfermedades de las Arterias Carótidas , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Adulto , Angiografía Cerebral , Tomografía Computarizada de Haz Cónico , Embolización Terapéutica/métodos , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: In recent years, endovascular treatment has become the treatment of choice for distal anterior cerebral artery (DACA) aneurysms. In this study, we report the outcomes of coil embolization for DACA aneurysms. METHODS: Eighteen DACA aneurysms in 16 patients treated with endovascular treatment between January 2010 and December 2020 were included in this study. We retrospectively analyzed patient characteristics, data on aneurysms, the reason for the selection of endovascular treatment, treatment technique, and treatment outcomes. RESULTS: There were 18 procedures in 16 patients. The average age was 65.7 years and 56% of patients were male. The average diameter of the dome was 5.5 mm, and the location of aneurysm was A3 in 83% and A4 in 17%. We mainly selected endovascular treatment for patients with a past history of craniotomy and head trauma, or with systemic comorbidities. The technical success rate was 94%, and adequate obliteration immediately after treatment was achieved in 72%. There were no symptomatic periprocedural complications. The retreatment rate was 11.1%. CONCLUSION: Coil embolization for DACA aneurysms yielded good treatment outcomes. Endovascular treatment for DACA aneurysms will become more common with advances in endovascular devices and the establishment of stable perioperative antiplatelet therapy.
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Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Masculino , Anciano , Femenino , Aneurisma Intracraneal/terapia , Aneurisma Intracraneal/cirugía , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Estudios Retrospectivos , Prótesis Vascular , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Angiografía Cerebral , Arteria Cerebral Anterior/diagnóstico por imagenRESUMEN
The Japanese EC-IC Bypass Trial(JET)Study demonstrated that a superficial temporal artery-middle cerebral artery(STA-MCA)bypass is effective in preventing the recurrence of ischemic stroke in cases of atherosclerotic internal carotid artery or MCA steno-occlusive lesions with symptoms. The JET-2 Study revealed that the hemodynamic criteria for STA-MCA bypass in the JET Study(rest cerebral blood flow < 80% and cerebrovascular reactivity < 10%)were adequate. An STA-MCA bypass was ranked as recommendation B; the level of evidence was moderate under the conditions of quantitative evaluation of cerebral hemodynamics and low frequency of perioperative complications, as described in the Japanese Guidelines for the Management of Stroke 2021. An education system for the accurate assessment of cerebral hemodynamics, meticulous surgical procedures, and perioperative management for STA-MCA bypass is necessary to hand over evidence of STA-MCA bypass efficacy in Japan to future generations. Simultaneously, new evidence of STA-MCA bypass efficacy should be explored with the advancement of medicine and should be disseminated worldwide.
Asunto(s)
Revascularización Cerebral , Arterias Temporales , Revascularización Cerebral/métodos , Circulación Cerebrovascular/fisiología , Humanos , Japón , Arteria Cerebral Media/cirugía , Arterias Temporales/cirugíaRESUMEN
In this paper, we will discuss the relationship between neuroendovascular therapy and infection in two parts: the risk of infectious complications in neuroendovascular therapy and neuroendovascular therapy for infectious diseases. The risk of infectious complications associated with neuroendovascular therapy is rare but should not be ignored. We must comply with clean procedures and consider prophylactic antibiotic administration in selected cases. Neuroendovascular therapy for infectious diseases is a high-risk treatment, and a safer treatment strategy should be considered for each case.
Asunto(s)
Enfermedades Transmisibles , Procedimientos Endovasculares , Procedimientos Endovasculares/métodos , Humanos , Procedimientos Neuroquirúrgicos , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan. METHODS: We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated. RESULTS: Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018. CONCLUSIONS: In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.
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Fístula Arteriovenosa/epidemiología , Malformaciones Arteriovenosas Intracraneales/epidemiología , Médula Espinal/anomalías , Humanos , Incidencia , Japón/epidemiología , Estudios Retrospectivos , Médula Espinal/irrigación sanguíneaRESUMEN
PURPOSE: Arteriovenous fistulas (AVFs) located in the cavernous sinus (CS), clivus, and condyle can be osseous shunts in nature. Here, we reviewed the angioarchitecture, clinical characteristics, and treatment results of AVFs in these lesions. METHODS: Twenty-five patients with 27 lesions who underwent rotational angiography in our department between May 2013 and December 2019 were reviewed. We examined 20 CS AVFs, 2 clival AVFs, and 5 condylar AVFs. We divided the anatomical shunted pouches into five locations: the dorsum sellae (posteromedial of the CS), posterolateral wall of the CS, lateral wall of the CS, clivus, and condyle. We divided the AVFs into three categories: intraosseous, transitional, and nonosseous shunts. We analyzed the characteristics and treatment results. RESULTS: A total of 33 shunted pouches or points were identified in 27 lesions. The dorsum sellae (n = 16) was the most frequent location. Fourteen AVFs (88%) in the dorsum sellae were osseous (intraosseous or transitional) shunts. All AVFs in the clivus or condyle were also osseous shunts. Eleven lesions (92%) of intraosseous and all lesions of transitional shunts exhibited bilateral external carotid artery involvement as feeders. Ten lesions (83%) of intraosseous shunts were treated with selective transvenous embolization of the shunted pouch with or without additional partial embolization of the sinus. Eleven (92%) intraosseous shunts were completely occluded, and symptom resolution was achieved in all intraosseous shunts. CONCLUSION: Most of the CS AVFs with shunted pouches in the dorsum sellae and all of the AVFs in the clivus and condyle share similar characteristics.
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Fístula Arteriovenosa , Seno Cavernoso , Embolización Terapéutica , Fístula Arteriovenosa/terapia , Fosa Craneal Posterior/diagnóstico por imagen , Humanos , Silla TurcaRESUMEN
CT angiography(CTA)plays a crucial role in the diagnosis of intracerebral hemorrhage(ICH). An 85-year-old woman presented with a disturbance of consciousness and right hemiparesis. Non-contrast CT of the brain revealed intracerebral hemorrhage in the left thalamus spreading to the internal capsule, corona radiata, and midbrain and a "swirl sign." CTA revealed no vascular anomaly. The early and delayed CTA phases revealed the"spot sign" and "leakage sign," respectively. Non-contrast CT three hours after the initial CT showed the enlargement of the hematoma. After the detection of ICH by initial non-contrast CT, CTA should be performed to differentiate between the causes of secondary ICH and detect the imaging markers of hematoma expansion or rebleeding. Previous studies have demonstrated that the "spot sign" detected by CTA is a valid imaging marker for hematoma expansion. In this article, the differential diagnosis of ICH and the detection of the imaging markers of hematoma expansion using non-contrast CT and CTA have been discussed.
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Hemorragia Cerebral , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Femenino , Hematoma/diagnóstico por imagen , HumanosRESUMEN
Malignant glioma is one of the most common brain cancers in humans, which is very devastating. The expression of reduced expression in immortalized cells/Dickkopf-3 (REIC/Dkk-3) is decreased in various human cancers. Lately, we have developed a novel second-generation adenoviral vector that expresses REIC/Dkk-3 (Ad-SGE-REIC) and revealed its antiglioma efficacy. The present investigator-initiated clinical trial is a single-arm, prospective, nonrandomized, noncomparative, open-label, single-center trial performed at Okayama University Hospital, Okayama, Japan. The primary end points are dose-limiting toxicities and the incidence of adverse events. The secondary end points are the objective response rate and immunological assessment. Use of Ad-SGE-REIC will help to improve the prognosis of patients with malignant brain tumors.
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Proteínas Adaptadoras Transductoras de Señales/genética , Adenoviridae/genética , Neoplasias Encefálicas/terapia , Terapia Genética , Glioma/terapia , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Vectores Genéticos/administración & dosificación , Vectores Genéticos/efectos adversos , Vectores Genéticos/genética , Glioma/genética , Glioma/patología , Humanos , Pronóstico , Proyectos de Investigación , SeguridadRESUMEN
PURPOSE: Intracranial hemorrhage following hyperperfusion syndrome (HPS) is a rare but potentially fatal complication after carotid artery stenting (CAS). Staged angioplasty (SAP) is a two-stage form of CAS that can prevent the abrupt increase of cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. METHODS: One hundred thirty-four patients who underwent CAS for high-grade carotid artery stenosis between January 2010 and December 2018 were enrolled. Patients who showed severe impairment of hemodynamic reserve in 123I-IMP SPECT with acetazolamide received SAP (SAP group), while the others received regular CAS (RS group). RESULTS: Twenty-six (19.4%) patients at risk for HPS received SAP. HPS was not observed in either group. Diffusion-weighted image (DWI)-positive lesions on postoperative MRI were observed in 56 (52.3%) cases in the RS group and 16 (64.0%) cases in the SAP group. Symptomatic procedure-related complications occurred in 5 (4.6%) cases in the RS group and 1 (3.8%) case in the SAP group. These differences were not statistically significant. Modified Rankin Scale score had declined 30 days after discharge in 4 (3.0%) cases. Distal filter protection was significantly correlated to the occurrence of new DWI-positive lesions. CONCLUSIONS: For patients at high risk of HPS, SAP was a reasonable treatment strategy to prevent HPS. SAP did not increase the rate of DWI-positive lesions or procedure-related complications compared with regular CAS.
Asunto(s)
Angioplastia de Balón/métodos , Estenosis Carotídea/cirugía , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Stents , Acetazolamida , Anciano , Anciano de 80 o más Años , Angiografía Cerebral , Trastornos Cerebrovasculares/cirugía , Femenino , Humanos , Hemorragias Intracraneales/cirugía , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/cirugía , Flujo Sanguíneo Regional , Estudios Retrospectivos , Síndrome , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
PURPOSE: Endovascular therapy to the spinal dural arteriovenous fistula (SDAVF) with a common origin of the radiculomedullary artery and the feeder of the shunt has the risk of spinal cord infarction. This study aimed to retrospectively assess the detection rate of normal spinal arteries from the feeder of SDAVF. METHODS: We retrospectively collected the angiographic and clinical data of SDAVFs. This study included 19 patients with 20 SDAVF lesions admitted to our department between January 2007 and December 2018. We assessed the detection rate of normal radiculomedullary artery branched from the feeder of SDAVF between the period using the image intensifier (II) and flat panel detector (FPD) and evaluated the treatment results. RESULTS: The detection rates of the radiculomedullary artery branched from the feeder of SDAVF were 10% (1/10 lesions) during the II period and 30% (3/10 lesions) during the FPD period. During the FPD period, all normal radiculomedullary arteries branched from the feeder were only detected on slab maximum intensity projection (MIP) images of rotational angiography, and we could not detect them in 2D or 3D digital subtraction angiography. All lesions that had a common origin of a normal radiculomedullary artery and the feeder were completely obliterated without complications. There was no recurrence during the follow-up period. CONCLUSIONS: The flat panel detector and slab MIP images seem to show the common origin of the normal radiculomedullary arteries from the feeder more accurately. With detailed analyses, SDAVF can be safety treated.
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Angiografía de Substracción Digital , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Médula Espinal/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Medios de Contraste , Femenino , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: The aim of the present study was to assess image quality improvement using a metal artifact reduction (MAR) algorithm in cases of medium or large cerebral aneurysms treated with stent-assisted coil embolization (SAC), and to analyze factors associated with the usefulness of the MAR algorithm. METHODS: We retrospectively evaluated the cone-beam computed tomography (CBCT) data sets of 18 patients with cerebral aneurysms treated with SAC. For subjective analysis, images of all cases with and without MAR processing were evaluated by five neurosurgeons based on four criteria using a five-point scale. For objective analysis, the CT values of all cases with and without MAR processing were calculated. In addition, we assessed factors associated with the usefulness of the MAR by analyzing the nine cases in which the median score for criterion 1 improved by more than two points. RESULTS: MAR processing improved the median scores for all four criteria in 17/18 cases (94.4%). Mean CT values of the region of interest at the site influenced by metal artifacts were significantly reduced after MAR processing. The maximum diameter of the coil mass (< 17 mm; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.2-13.9; p = 0.02) and vessel length covered by metal artifacts (< 24 mm; OR, 2.3; 95% CI, 1.1-4.7; p = 0.03) was significantly associated with the usefulness of the MAR. CONCLUSIONS: This study suggests the feasibility of a MAR algorithm to improve the image quality of CBCT images in patients who have undergone SAC for medium or large aneurysms.
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Algoritmos , Artefactos , Tomografía Computarizada de Haz Cónico , Embolización Terapéutica , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad , Intensificación de Imagen Radiográfica , Estudios Retrospectivos , StentsRESUMEN
Crossed cerebellar diaschisis (CCD) is a state of hypoperfusion and hypometabolism in the contralesional cerebellar hemisphere caused by a supratentorial lesion, but its pathophysiology is not fully understood. We evaluated chronological changes in cerebellar blood flow (CbBF) and gene expressions in the cerebellum using a rat model of transient middle cerebral artery occlusion (MCAO). CbBF was analyzed at two and seven days after MCAO using single photon emission computed tomography (SPECT). DNA microarray analysis and western blotting of the cerebellar cortex were performed and apoptotic cells in the cerebellar cortex were stained. CbBF in the contralesional hemisphere was significantly decreased and this lateral imbalance recovered over one week. Gene set enrichment analysis revealed that a gene set for "oxidative phosphorylation" was significantly upregulated while fourteen other gene sets including "apoptosis", "hypoxia" and "reactive oxygen species" showed a tendency toward upregulation in the contralesional cerebellum. MCAO upregulated the expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) in the contralesional cerebellar cortex. The number of apoptotic cells increased in the molecular layer of the contralesional cerebellum. Focal cerebral ischemia in our rat MCAO model caused CCD along with enhanced expression of genes related to oxidative stress and apoptosis.
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Corteza Cerebelosa/patología , Enfermedades Cerebelosas/fisiopatología , Circulación Cerebrovascular/fisiología , Infarto de la Arteria Cerebral Media/genética , Animales , Corteza Cerebelosa/fisiología , Enfermedades Cerebelosas/sangre , Enfermedades Cerebelosas/diagnóstico por imagen , Expresión Génica , Hemo Oxigenasa (Desciclizante)/metabolismo , Infarto de la Arteria Cerebral Media/sangre , Masculino , Factor 2 Relacionado con NF-E2/metabolismo , Estrés Oxidativo , Ratas Wistar , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
We herein report a case of ruptured arterio-venous malformation(AVM)detected using three-dimensional digital subtraction angiography(3DDSA)fusion images and successfully treated with target embolization for pseudoaneurysm. A 50-year-old man with a history of AVM was admitted to our department for the treatment of ruptured high-grade AVM in the right parietal lobe. Although a bleeding point was not evident on DSA, the patient had re-rupture in the right ventricle, one month after admission. Chronological 3DDSA fusion images generated from 3DDSA images taken on admission and after re-rupture revealed a newly visualized intranidal pseudoaneurysm near a hematoma. Contrast-enhanced magnetic resonance imaging showed vessel wall enhancement along the posterior horn of the right ventricle;this enhancement corresponded to the location of the pseudoaneurysm. We planned target embolization for the intranidal pseudoaneurysm to prevent re-bleeding. The origin of the feeder was so steep that a microcatheter could not be advanced deeply, and embolization with 20% n-butyl-2-cyanoacrylate resulted in proximal occlusion. Follow-up angiography 1 week after embolization showed complete disappearance of the pseudoaneurysm, and the patient had no recurrence of aneurysm until one year.
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Aneurisma Falso , Aneurisma Roto , Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales , Aneurisma Falso/diagnóstico , Aneurisma Falso/terapia , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Angiografía de Substracción Digital , Humanos , Imagenología Tridimensional , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Malformaciones Arteriovenosas Intracraneales/terapia , Masculino , Persona de Mediana EdadRESUMEN
The persistent primitive trigeminal artery (PPTA) is the most common carotid-basilar anastomosis, and the incidence of cerebral aneurysms associated with the PPTA is approximately 4%. Since PPTA aneurysms often have a wide neck and other vascular anomalies, endovascular treatment using an adjunctive technique is the current first-line therapy. Here, we report a case of PPTA aneurysm treated by coil embolization with a stent-assisted technique. A detailed evaluation of the size and course of all vessels and collateral flow, including the Allcock test and balloon test occlusion, is necessary when deciding on the treatment strategy.
Asunto(s)
Embolización Terapéutica/métodos , Aneurisma Intracraneal/terapia , Anciano , Arteria Carótida Interna/patología , Embolización Terapéutica/instrumentación , Femenino , Humanos , StentsRESUMEN
BACKGROUND: The Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and 3 (JR-NET3) were nationwide surveys that evaluated clinical outcomes after neuroendovascular therapy in Japan. The aim of this study was to compare the prevalence and risk factors of complications of intracranial tumor embolization between JR-NET2 and JR-NET3. METHODS: A total of 1018 and 1545 consecutive patients with intracranial tumors treated with embolization were enrolled in JR-NET2 and JR-NET3, respectively. The prevalence of complications in intracranial tumor embolization and related risk factors were compared between JR-NET2 and JR-NET3. RESULTS: The prevalence of complications in JR-NET3 (3.69%) was significantly higher than that in JR-NET2 (1.48%) (p = 0.002). The multivariate analysis in JR-NET2 showed that embolization for tumors other than meningioma was the only significant risk factor for complication (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.13-12.10; p = 0.032), and that in JR-NET3 revealed that embolization for feeders other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03-6.25; p < 0.001) and use of liquid materials (OR, 2.65; 95% CI, 1.50-4.68; p < 0.001) were significant risks for complications. The frequency of embolization for feeders other than ECA in JR-NET3 (15.3%) was significantly higher than that in JR-NET2 (9.2%) (p < 0.001). Also, there was a significant difference in the frequency of use of liquid materials between JR-NET2 (21.2%) and JR-NET3 (41.2%) (p < 0.001). CONCLUSIONS: Embolization for feeders other than ECA and use of liquid materials could increase the complication rate in intracranial tumor embolization.
Asunto(s)
Embolización Terapéutica/efectos adversos , Neoplasias Meníngeas/terapia , Meningioma/terapia , Sistema de Registros/normas , Adulto , Anciano , Embolización Terapéutica/estadística & datos numéricos , Femenino , Humanos , Japón , Masculino , Persona de Mediana EdadRESUMEN
We present the case of a de novo vertebral artery dissecting aneurysm (VADA) after endovascular trapping of a ruptured VADA on the contralateral side. The first ruptured VADA involved the posterior inferior cerebellar artery, which was successfully treated by endovascular internal trapping using a stent. A follow-up study at 3 months revealed a de novo VADA on the contralateral side. The second VADA was successfully embolized using coils while normal arterial flow in the vertebral artery was preserved using a stent. Increased hemodynamic stress may cause the development of a de novo VADA on the contralateral side.