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Challenges in the treatment of giant cavernous carotid aneurysm associated with hemophilia A: illustrative case 査読

Yuichi Hirata, Masafumi Hiramatsu, Kenji Sugiu, Juntaro Fujita, Yuta Sotome, Masato Kawakami, Ryu Kimura, Yuki Ebisudani, Jun Haruma, Shota Tanaka

Journal of Neurosurgery: Case Lessons 9 ( 8 ) 2025年2月

掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery Publishing Group (JNSPG)

BACKGROUND

Hemophilia A is characterized by a deficiency of factor VIII, leading to severe bleeding disorders. Abnormal blood coagulation can complicate the treatment of cerebral aneurysms.

OBSERVATIONS

A 20-year-old man with congenital hemophilia A presented with abducens nerve palsy caused by a giant cavernous carotid aneurysm (CCA). Because of the coagulopathy, simple internal carotid artery ligation was chosen, and the aneurysm initially shrank following treatment. However, it recurred due to collateral arteries from the posterior communicating artery and branches of the external carotid artery. These arteries were occluded using endovascular techniques, resulting in complete obliteration of the aneurysm.

LESSONS

To the best of the authors’ knowledge, this is the first reported case of treating a giant CCA associated with hemophilia A. In patients with coagulopathy, surgical options are limited, and standard treatments may not achieve a complete cure. Careful consideration of treatment strategies is crucial when managing giant CCA in the context of a coagulation disorder.

https://thejns.org/doi/10.3171/CASE24693

DOI： 10.3171/case24693

その他リンク： https://thejns.org/downloadpdf/journals/j-neurosurg-case-lessons/9/8/article-CASE24693.xml

Classification, angioarchitecture and treatment outcomes of medullary bridging vein-draining dural arteriovenous fistulas in the foramen magnum region: a multicenter study. 査読国際誌

Tomohiko Ozaki, Masafumi Hiramatsu, Hajime Nakamura, Yasunari Niimi, Shuichi Tanoue, Katsuhiro Mizutani, Ichiro Nakahara, Yuji Matsumaru, Yasushi Matsumoto, Timo Krings, Toshiyuki Fujinaka

Neuroradiology 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: This study aimed to classify medullary bridging vein-draining dural arteriovenous fistulas (MBV-DAVFs) located around the foramen magnum (FM) according to their location and characterize their angioarchitecture and treatment outcomes. METHODS: Patients with MBV-DAVFs diagnosed between January 2013 and October 2022 were included. MBV-DAVFs were classified into four groups. Jugular vein-bridging vein (JV-BV) DAVF: located in proximity to jugular fossa, Anterior condylar vein (ACV)-BV DAVF: proximity to anterior condylar canal, Marginal sinus (MS)-BV DAVF: lateral surface of FM and Suboccipital cavernous sinus (SCS)-BV DAVF: proximity to dural penetration of vertebral artery. RESULTS: Twenty patients were included, three JV-BV, four ACV-BV, three MS-BV and ten SCS-BV DAVFs, respectively. All groups showed male predominance. There were significant differences in main feeders between JV (jugular branch of ascending pharyngeal artery) and SCS group (C1 dural branch). Pial feeders from anterior spinal artery (ASA) or lateral spinal artery (LSA) were visualized in four SCS and one MS group. Drainage pattern did not differ between groups. Transarterial embolization (TAE) was performed in three, two, one and two cases and complete obliteration was obtained in 100%, 50%, 100% and 0% in JV, ACS, MS and SCS group, respectively. Successful interventions without major complications were finally obtained in 100%, 75%, 100%, and 40% in JV, ACS, MS and SCS group, respectively. CONCLUSION: JV-BV DAVFs were successfully treated using TAE alone. SCS-BV DAVFs were mainly fed by small C1 dural branches of vertebral artery often with pial feeders from ASA or LSA, and difficultly treated by TAE alone.

DOI： 10.1007/s00234-024-03478-w

Detailed Anatomy of Bridging Veins Around the Foramen Magnum: a Multicenter Study Using Three-dimensional Angiography 査読

Masafumi Hiramatsu, Tomohiko Ozaki, Shuichi Tanoue, Katsuhiro Mizutani, Hajime, Kohei TOKUYAMA, Hiroyuki Sakata, Yuji Matsumaru, Ichiro Nakahara, Yasunari Niimi, Toshiyuki Fujinaka, Hiro Kiyosue

Clinical Neuroradiology 2023年8月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media {LLC}

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background and Purpose</jats:title>
<jats:p>There has been limited literature regarding the bridging veins (BVs) of the medulla oblongata around the foramen magnum (FM). The present study aims to analyze the normal angioarchitecture of the BVs around the FM using slab MIP images of three-dimensional (3D) angiography.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We collected 3D angiography data of posterior fossa veins and analyzed the BVs around the FM using slab MIP images. We analyzed the course, outlet, and number of BVs around the FM. We also examined the detection rate and mean diameter of each BV.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Of 57 patients, 55 patients (96%) had any BV. The median number of BVs was two (range: 0–5). The BVs originate from the perimedullary veins and run anterolaterally to join the anterior condylar vein (ACV), inferior petrosal sinus, sigmoid sinus, or jugular bulb, inferolaterally to join the suboccipital cavernous sinus (SCS), laterally or posterolaterally to join the marginal sinus (MS), and posteriorly to join the MS or occipital sinus. We classified BVs into five subtypes according to the draining location: ACV, jugular foramen (JF), MS, SCS, and cerebellomedullary cistern (CMC). ACV, JF, MS, SCS, and CMC BVs were detected in 11 (19%), 18 (32%), 32 (56%), 20 (35%), and 16 (28%) patients, respectively. The mean diameter of the BVs other than CMC was 0.6 mm, and that of CMC BV was 0.8 mm.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Using venous data from 3D angiography, we detected FM BVs in most cases, and the BVs were connected in various directions.</jats:p>
</jats:sec>

DOI： 10.1007/s00062-023-01327-6

Non-Sinus-Type Dural Arteriovenous Fistula at the Foramen Magnum: A Review of the Literature 招待査読

Masafumi Hiramatsu, Tomohiko Ozaki, Rie Aoki, Shinri Oda, Jun Haruma, Tomohito Hishikawa, Kenji Sugiu, Isao Date

Journal of Neuroendovascular Therapy 2023年7月

Transvenous embolization of the direct carotid-cavernous fistula via the pterygoid plexus: illustrative case. 査読国際誌

Matsuda Y, Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Nishi K, Yamaoka Y, Ebisudani Y, Kimura R, Edaki H, Date I

Journal of neurosurgery. Case lessons 5 ( 11 ) 2023年3月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

<h4>Background</h4>Endovascular treatment is the mainstay of treatment for carotid-cavernous fistulas, but endovascular approaches vary widely. The authors report a rare case of a direct carotid-cavernous fistula with cranial nerve symptoms caused by rupture of a giant aneurysm in which selective transvenous embolization via the pterygoid plexus was performed.<h4>Observations</h4>An 81-year-old man presented with headache and various progressive cranial nerve symptoms due to a direct carotid-cavernous fistula caused by a ruptured giant aneurysm. All the draining veins visualized on preoperative examination immediately before the treatment were occluded except for the pterygoid plexus. Therefore, the authors chose the dilated pterygoid plexus to approach the shunted pouch at the cavernous sinus and achieve shunt obliteration by selective embolization with coils and n-butyl cyanoacrylate.<h4>Lessons</h4>Careful study of the three-dimensional rotational images in the preoperative examination is important when considering the various approaches to surgery. The pterygoid plexus can be an effective venous approach route to reach the cavernous sinus area.

DOI： 10.3171/case22558

DOI： 10.3171/CASE22558

Angioarchitecture of the Normal Lateral Spinal Artery and Craniocervical Junction Arteriovenous Fistula Using Contrast-enhanced Cone-beam CT 査読

Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Jun Haruma, Kazuhiko Nishi, Yoko Yamaoka, Yuki Ebisudani, Hisanori Edaki, Ryu Kimura, Isao Date

CLINICAL NEURORADIOLOGY 2022年10月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SPRINGER HEIDELBERG

Background and Purpose The lateral spinal artery (LSA) perfuses the dorsolateral part of the spinal cord at the craniocervical junction (CCJ). We analyzed the angioarchitecture of the normal LSA and CCJ arteriovenous fistula (AVF). Methods The first study included 26 patients with a cerebral aneurysm of the posterior circulation. Using slab maximum intensity projection (MIP) images from three-dimensional rotational angiography (3D-RA) and contrast-enhanced cone-beam CT (CE-CBCT), we analyzed the origin of the LSA, its anastomosis with the posterior inferior cerebellar artery (PICA), the point where it reaches the spinal cord, and the visualized range. In the second study, we analyzed the angioarchitecture and treatment results of 7 CCJAVF lesions treated in our department between 2016 and 2021. Results We visualized the normal LSA for all patients. In 23 patients with an intradural origin PICA, all LSAs originated from the C1 or C2 radicular artery, and 8 patients had an anastomosis with the PICA. In three patients with a C1 level origin PICA, all LSAs originated from the PICA. All LSAs reached the dorsolateral part of the spinal cord. The mean visualized range of the LSA was 27.4 mm. The LSA was involved in five of seven CCJAVF lesions (71%). There was one lesion with a spinal infarction after LSA embolization. Other lesions were treated by direct interruption of the AVF, and the ASA and LSA were preserved. Conclusion This is the first report that visualized the LSA's normal anatomy using slab MIP images from 3D-RA and CE-CBCT. Knowledge of LSA anatomy is critical to avoid complications during the treatment of CCJAVF.

DOI： 10.1007/s00062-022-01218-2

Incidence and clinical characteristics of spinal arteriovenous shunts: Hospital-based surveillance in Okayama, Japan 査読国際誌

Hiramatsu M, Ishibashi R, Suzuki E, Miyazaki Y, Murai S, Takai H, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I, Okayama Cranial and Spinal A-V Shunts (OCSS) Study Group

Journal of Neurosurgery: Spine 36 ( 4 ) 1 - 8 2021年10月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs.
METHODS The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed.
RESULTS The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advanc- ing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001).
CONCLUSIONS The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

DOI： 10.3171/2021.7.SPINE21233

Trends in Incidence of Intracranial and Spinal Arteriovenous Shunts: Hospital-Based Surveillance in Okayama, Japan. 査読国際誌

Murai S, Hiramatsu M, Suzuki E, Ishibashi R, Takai H, Miyazaki Y, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I, Okayama Cranial and Spinal A-V Shunts (OCSS) Study Group

Stroke 52 ( 4 ) 1455 - 1459 2021年2月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

<h4>Background and purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

DOI： 10.1161/strokeaha.120.032052

DOI： 10.1161/STROKEAHA.120.032052

Osseous arteriovenous fistulas in the dorsum sellae, clivus, and condyle 査読

Masafumi Hiramatsu, Kenji Sugiu, Jun Haruma, Tomohito Hishikawa, Yu Takahashi, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Neuroradiology 63 ( 1 ) 133 - 140 2021年1月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

DOI： 10.1007/s00234-020-02506-9

その他リンク： https://link.springer.com/article/10.1007/s00234-020-02506-9/fulltext.html

Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery 査読国際誌

M. Hiramatsu, K. Sugiu, T. Hishikawa, J. Haruma, Y. Takahashi, S. Murai, K. Nishi, Y. Yamaoka, Y. Shimazu, K. Fujii, M. Kameda, K. Kurozumi, I. Date

American Journal of Neuroradiology 41 ( 11 ) 2082 - 2087 2020年11月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Society of Neuroradiology (ASNR)

BACKGROUND AND PURPOSE: Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS: This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS: We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS: Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.

DOI： 10.3174/ajnr.a6790

Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image 査読国際誌

Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Jun Haruma, Yu Takahashi, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Neuroradiology 62 ( 10 ) 1285 - 1292 2020年10月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

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.

DOI： 10.1007/s00234-020-02466-0

その他リンク： http://link.springer.com/article/10.1007/s00234-020-02466-0/fulltext.html

Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3) 査読国際誌

Masafumi Hiramatsu, Kenji Sugiu, Tomohito Hishikawa, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai, Isao Date, Naoya Kuwayama, Tetsu Satow, Koji Iihara, Nobuyuki Sakai

Journal of Neurosurgery 133 ( 1 ) 166 - 173 2020年7月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery Publishing Group (JNSPG)

<sec><title>OBJECTIVE</title>Embolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization.

</sec><sec><title>METHODS</title>Patient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization.

</sec><sec><title>RESULTS</title>Transarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non–sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications.

</sec><sec><title>CONCLUSIONS</title>Complication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.

</sec>

DOI： 10.3171/2019.4.jns183458

その他リンク： https://thejns.org/downloadpdf/journals/j-neurosurg/133/1/article-p166.xml

Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus 招待査読

Masafumi Hiramatsu, Kenji Sugiu, Jun Haruma, Tomohito Hishikawa, Yu Takahashi, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Journal of Neuroendovascular Therapy 14 ( 12 ) 593 - 604 2020年

Comparison between Spinal Dural Arteriovenous Fistula and Spinal Epidural Arteriovenous Fistula 査読

Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai, Isao Date

Journal of Neuroendovascular Therapy 13 ( 3 ) 114 - 119 2019年

Angioarchitecture of arteriovenous fistulas at the craniocervical junction: a multicenter cohort study of 54 patients 査読

Masafumi Hiramatsu, Kenji Sugiu, Tomoya Ishiguro, Hiro Kiyosue, Kenichi Sato, Keisuke Takai, Yasunari Niimi, Yuji Matsumaru

Journal of Neurosurgery 128 ( 6 ) 1839 - 1849 2018年6月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS

OBJECTIVE The aim of this retrospective multicenter cohort study was to assess the details of the angioarchitecture of arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) and to determine the associations between the angiographic characteristics and the clinical presentations and outcomes.METHODS The authors analyzed angiographic and clinical data for patients with CCJ AVFs from 20 participating centers that are members of the Japanese Society for Neuroendovascular Therapy (JSNET). Angiographic findings (feeding artery, location of AV shunt, draining vein) and patient data (age, sex, presentation, treatment modality, outcome) were tabulated and stratified based on the angiographic types of the lesions, as diagnosed by a member of the CCJ AVF study group, which consisted of a panel of 6 neurointerventionalists and 1 spine neurosurgeon.RESULTS The study included 54 patients (median age 65 years, interquartile range 61-75 years) with a total of 59 lesions. Five angiographic types were found among the 59 lesions: Type 1, dural AVF (22 [37%] of 59); Type 2, radicular AVF (17 [29%] of 59); Type 3, epidural AVF (EDAVF) with pial feeders (8 [14%] of 59); Type 4, EDAVF (6 [10%] of 59); and Type 5, perimedullary AVF (6 [10%] of 59). In almost all lesions (98%), AV shunts were fed by radiculomeningeal arteries from the vertebral artery that drained into intradural or epidural veins through AV shunts on the dura mater, on the spinal nerves, in the epidural space, or on the spinal cord. In more than half of the lesions (63%), the AV shunts were also fed by a spinal pial artery from the anterior spinal artery (ASA) and/or the lateral spinal artery. The data also showed that the angiographic characteristics associated with hemorrhagic presentations-the most common presentation of the lesions (73%)-were the inclusion of the ASA as a feeder, the presence of aneurysmal dilatation on the feeder, and CCJ AVF Type 2 (radicular AVF). Treatment outcomes differed among the angiographic types of the lesions.CONCLUSIONS Craniocervical junction AVFs commonly present with hemorrhage and are frequently fed by both radiculomeningeal and spinal pial arteries. The AV shunt develops along the C-1 or C-2 nerve roots and can be located on the spinal cord, on the spinal nerves, and/or on the inner or outer surface of the dura mater.

DOI： 10.3171/2017.3.JNS163048

Angiographic and Clinical Characteristics of Thoracolumbar Spinal Epidural and Dural Arteriovenous Fistulas 査読

Hiro Kiyosue, Yuji Matsumaru, Yasunari Niimi, Keisuke Takai, Tomoya Ishiguro, Masafumi Hiramatsu, Kotaro Tatebayashi, Toshinori Takagi, Shinichi Yoshimura

Stroke 48 ( 12 ) 3215 - 3222 2017年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Background and Purpose-The purpose of this study is to compare the angiographic and clinical characteristics of spinal epidural arteriovenous fistulas (SEAVFs) and spinal dural arteriovenous fistulas (SDAVFs) of the thoracolumbar spine.Methods-A total of 168 cases diagnosed as spinal dural or extradural arteriovenous fistulas of the thoracolumbar spine were collected from 31 centers. Angiography and clinical findings, including symptoms, sex, and history of spinal surgery/trauma, were retrospectively reviewed. Angiographic images were evaluated, with a special interest in spinal levels, feeders, shunt points, a shunted epidural pouch and its location, and drainage pattern, by 6 readers to reach a consensus.Results-The consensus diagnoses by the 6 readers were SDAVFs in 108 cases, SEAVFs in 59 cases, and paravertebral arteriovenous fistulas in 1 case. Twenty-nine of 59 cases (49%) of SEAVFs were incorrectly diagnosed as SDAVFs at the individual centers. The thoracic spine was involved in SDAVFs (87%) more often than SEAVFs (17%). Both types of arteriovenous fistulas were predominant in men (82% and 73%) and frequently showed progressive myelopathy (97% and 92%). A history of spinal injury/surgery was more frequently found in SEAVFs (36%) than in SDAVFs (12%; P=0.001). The shunt points of SDAVFs were medial to the medial interpedicle line in 77%, suggesting that SDAVFs commonly shunt to the bridging vein. All SEAVFs formed an epidural shunted pouch, which was frequently located in the ventral epidural space (88%) and drained into the perimedullary vein (75%), the paravertebral veins (10%), or both (15%).Conclusions-SDAVFs and SEAVFs showed similar symptoms and male predominance. SDAVFs frequently involve the thoracic spine and shunt into the bridging vein. SEAVFs frequently involve the lumbar spine and form a shunted pouch in the ventral epidural space draining into the perimedullary vein.

DOI： 10.1161/STROKEAHA.117.019131

Epidemiology of Dural Arteriovenous Fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2) 査読

Masafumi Hiramatsu, Kenji Sugiu, Tomohito Hishikawa, Jun Haruma, Koji Tokunaga, Isao Date, Naoya Kuwayama, Nobuyuki Sakai

Neurologia Medico-Chirurgica 54 ( 1 ) 63 - 71 2014年1月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：JAPAN NEUROSURGICAL SOC

We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65 +/- 13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.

DOI： 10.2176/nmc.st.2013-0172

Cranial and spinal computed tomography (CT) angiography with photon-counting detector CT: comparison with angiographic and operative findings. 招待査読

Fumiyo Higaki, Masafumi Hiramatsu, Takao Yasuhara, Susumu Sasada, Yoshihiro Otani, Jun Haruma, Tomohiro Inoue, Yusuke Morimitsu, Noriaki Akagi, Yusuke Matsui, Toshihiro Iguchi, Takao Hiraki

Japanese journal of radiology 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

The clinical imaging features of photon-counting detector (PCD) computed tomography (CT) are mainly known as dose reduction, improvement of spatial resolution, and reduction of artifacts compared to energy-integrating detector CT (EID-CT). The utility of cranial and spinal PCD-CT and PCD-CT angiography (CTA) has been previously reported. CTA is a widely used technique for noninvasive evaluation. Cranial CTA is important in brain tumors, especially glioblastoma; it evaluates whether the tumor is highly vascularized prior to an operation and helps in the diagnosis and assessment of bleeding risk. Spinal CTA has an important role in the estimation of feeders and drainers prior to selective angiography in the cases of spinal epidural arteriovenous fistulas and spinal tumors, especially in hemangioblastoma. So far, EID-CTA is commonly performed in an adjunctive role prior to selective angiography; PCD-CTA with high spatial resolution can be an alternative to selective angiography. In the cases of cerebral aneurysms, flow diverters are important tools for the treatment of intracranial aneurysms, and postoperative evaluation with cone beam CT with angiography using diluted contrast media is performed to evaluate stent adhesion and in-stent thrombosis. If CTA can replace selective angiography, it will be less invasive for the patient. In this review, we present representative cases with PCD-CT. We also show how well the cranial and spinal PCD-CTA approaches the accuracy of angiographic and intraoperative findings.

DOI： 10.1007/s11604-024-01661-w

Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case. 査読国際誌

Toru Satoh, Kenji Sugiu, Masafumi Hiramatsu, Jun Haruma, Isao Date

Journal of neurosurgery. Case lessons 7 ( 16 ) 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS: The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS: Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.

DOI： 10.3171/CASE24141

Power suppression in EEG after the onset of SAH is a significant marker of early brain injury in rat models. 査読国際誌

Yuji Takasugi, Tomohito Hishikawa, Tomohisa Shimizu, Satoshi Murai, Jun Haruma, Masafumi Hiramatsu, Koji Tokunaga, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific reports 14 ( 1 ) 2277 - 2277 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

We analyzed the correlation between the duration of electroencephalogram (EEG) recovery and histological outcome in rats in the acute stage of subarachnoid hemorrhage (SAH) to find a new predictor of the subsequent outcome. SAH was induced in eight rats by cisternal blood injection, and the duration of cortical depolarization was measured. EEG power spectrums were given by time frequency analysis, and histology was evaluated. The appropriate frequency band and recovery percentage of EEG (defined as EEG recovery time) to predict the neuronal damage were determined from 25 patterns (5 bands × 5 recovery rates) of receiver operating characteristic (ROC) curves. Probit regression curves were depicted to evaluate the relationships between neuronal injury and duration of depolarization and EEG recovery. The optimal values of the EEG band and the EEG recovery time to predict neuronal damage were 10-15 Hz and 40%, respectively (area under the curve [AUC]: 0.97). There was a close relationship between the percentage of damaged neurons and the duration of depolarization or EEG recovery time. These results suggest that EEG recovery time, under the above frequency band and recovery rate, may be a novel marker to predict the outcome after SAH.

DOI： 10.1038/s41598-024-52527-0

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