Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The increasing prevalence of heated tobacco products (HTPs) has heightened concerns regarding their potential health risks. Previous studies have demonstrated the toxicity of cigarette smoke extract (CSE) from traditional tobacco's mainstream smoke, even after the removal of nicotine and tar. Our study aimed to investigate the cytotoxicity of CSE derived from HTPs and traditional tobacco, with a particular focus on the role of reactive oxygen species (ROS) and intracellular Ca2+. METHODS: A human oral squamous cell carcinoma (OSCC) cell line, HSC-3 was utilized. To prepare CSE, aerosols from HTPs (IQOS) and traditional tobacco products (1R6F reference cigarette) were collected into cell culture media. A cell viability assay, apoptosis assay, western blotting, and Fluo-4 assay were conducted. Changes in ROS levels were measured using electron spin resonance spectroscopy and the high-sensitivity 2',7'-dichlorofluorescein diacetate assay. We performed a knockdown of calcium/calmodulin-dependent protein kinase kinase 2 (CaMKK2) by shRNA lentivirus in OSCC cells. RESULTS: CSE from both HTPs and traditional tobacco exhibited cytotoxic effects in OSCC cells. Exposure to CSE from both sources led to an increase in intracellular Ca2+ concentration and induced p38 phosphorylation. Additionally, these extracts prompted cell apoptosis and heightened ROS levels. N-acetylcysteine (NAC) mitigated the cytotoxic effects and p38 phosphorylation. Furthermore, the knockdown of CaMKK2 in HSC-3 cells reduced cytotoxicity, ROS production, and p38 phosphorylation in response to CSE. CONCLUSION: Our findings suggest that the CSE from both HTPs and traditional tobacco induce cytotoxicity. This toxicity is mediated by ROS, which are regulated through Ca2+ signaling and CaMKK2 pathways.

DOI： 10.1186/s12576-024-00928-1

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Introduction Preoperative embolization can potentially facilitate surgical resection of challenging tumors in the intracranial and facial regions; however, its clinical efficacy remains controversial, mainly due to potential morbidity risks. We explored negative factors of the combined treatment of preoperative embolization and tumor resection that affect neurological prognosis. Method This retrospective study used clinical data from 132 consecutive tumors that underwent combined treatment at multiple facilities between January 2016 and May 2021. Basic patient information, tumor characteristics, and treatment details were assessed to identify predictors of deterioration as measured using the modified Rankin scale (mRS) score at three months post-treatment. Results Among the 126 eligible combined treatments, a deterioration in the postoperative mRS score was observed in 19/126 (15.1%). Complications related to embolization and tumor resection occurred in 8/126 (6.3%) and 19/125 (15.2%) of procedures, respectively. Multivariate analyses indicated significant associations between migration of embolic material (adjusted odds ratio 13.80; 95% confidence interval 1.25-152.52; p=0.03), elevated intraoperative blood loss (p=0.04), and deterioration of postoperative mRS score. Embolic material migration was identified as the primary prognostic factor for the deterioration of score. An analysis of 192 procedures, excluding those that exclusively used coils, identified embolization targeting the accessory meningeal artery (p=0.046) and the third segment of the internal maxillary artery (p=0.03) as a risk factor for embolic material migration. Conclusions Embolic material migration is the predominant factor associated with declining neurological outcome that persists into the chronic phase after combined treatment. Given that preoperative embolization is a supplementary treatment option, a thorough understanding of vascular anatomy and striving safe procedure are critical.

DOI： 10.7759/cureus.57315

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BACKGROUND: Vertebral artery (VA) stenosis can be caused by several factors, including arteriosclerosis, arterial dissection, and mechanical compression. Symptomatic vertebrobasilar insufficiency caused by VA stenosis due to mechanical compression associated with head rotation is well-known as Bow Hunter's syndrome. However, an accurate diagnosis of asymptomatic osteophyte compression-induced nonrotational VA stenosis is difficult. We report a case of left posterior inferior cerebellar artery aneurysm with severe left VA stenosis, treated with stent-assisted coil embolization following appropriate diagnosis. CASE DESCRIPTION: A 72-year-old female patient was found to have severe asymptomatic VA stenosis at the V2 segment (C4-5 level of the cervical spine) on cerebral angiography. Osteophyte compression-induced VA stenosis was suspected, which was confirmed by cone-beam computed tomography. The VA stenosis improved by flexing the neck and fixing the head position, following which the endovascular treatment was successfully completed. CONCLUSION: The site of the VA stenosis is critical in determining the etiology. Atherosclerotic VA stenosis often occurs at the origin of the artery or V4 segment, whereas bony compression-induced stenosis is more likely to occur at the V2 segment. Diagnosis and appropriate management of VA stenosis is based on determining the site.

DOI： 10.25259/SNI_772_2024

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OBJECTIVES: The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. METHODS: This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. RESULTS: A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). CONCLUSION: The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

DOI： 10.5797/jnet.oa.2023-0083

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BACKGROUND: Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous sinus (CS), are rare. Targeting embolization of an intraosseous clival AVF is challenging because of its complex venous and skull base anatomy; therefore, a therapeutic strategy based on detailed preoperative radiological findings is required to achieve a favorable outcome. Here, the authors report the successful targeted embolization of an intraosseous clival AVF using an ingenious access route. OBSERVATIONS: A 74-year-old woman presented with left-sided visual impairment, oculomotor nerve palsy, and right facial pain. A fusion image of three-dimensional rotational angiography and cone-beam computed tomography revealed a left CS dural AVF and a right intraosseous clival AVF. The shunt flow of the clival AVF drained extracranially from the posterior and anterior condylar veins via the intraosseous venous route. Transvenous embolization was performed by devising suboccipital, posterior condylar, and intraosseous access routes. The symptoms resolved after the bilateral AVFs were treated. LESSONS: Accurate diagnosis and proper transvenous access based on detailed intraosseous and craniocervical venous information obtained from advanced imaging modalities are key to resolving intraosseous clival AVF.

DOI： 10.3171/CASE23492

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OBJECTIVES: Carotid artery stenting is sometimes adapted for some at-risk cases; however, appropriate treatment timing with stroke onset is controversial. This study aims to identify factors that have an impact on complications and outcomes, especially in patients at high risk. MATERIALS AND METHODS: We examined the characteristics of 152 consecutive patients treated by carotid artery stenting between January 2018 and March 2022 and retrospectively analyzed the risk factors for complications and poor outcomes (modified-Rankin-Scale deterioration), such as patient background, carotid artery stenting risks (access route tortuosity, severe calcification, vulnerable plaque, estimated glomerular filtration rate <30 mL/min/1.73 m2, etc.), characteristics of the stenosis, details of treatment, and treatment timing. RESULTS: The average North American Symptomatic Carotid Endarterectomy Trial criteria score was 68.3% and the lesion length was 20.5±9.7mm. Among patients, 107 (70.4%) had a carotid artery stenting risk. In high-risk carotid artery stenting cases, symptomatic complications occurred in 32 (30.0%), and the 90-day modified Rankin scale score deteriorated in 15 cases (14.0%). Multivariate analysis showed that cases with triple antithrombotic therapy (p=0.003), stenting within 7 days (p=0.0032), and after 28+ days (p=0.0035) of stroke onset were independently associated factors for complications. CONCLUSIONS: This study showed that among risk factors, triple antithrombotic therapy in particular was a risk factor for perioperative complications. Carotid artery stenting for patients with stroke after 28 days of onset affects the prognosis. Therefore, although further study is warranted, waiting more than one month for treatment in patients requiring carotid artery stenting is a potential risk.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107329

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DOI： 10.1016/j.inat.2022.101678

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Meningiomas are often embolized preoperatively to reduce intraoperative blood loss and facilitate tumor resection. However, the procedure is controversial and its effects have not yet been reported. We evaluated preoperative embolization for meningiomas and its effect on postoperative outcome and recurrence. METHODS: We retrospectively reviewed the medical records of 186 patients with WHO grade I meningiomas who underwent surgical treatment at our hospital between January 2010 and December 2020. We used propensity score matching to generate embolization and no-embolization groups (42 patients each) to examine embolization effects. RESULTS: Preoperative embolization was performed in 71 patients (38.2%). In the propensity-matched analysis, the embolization group showed favorable recurrence-free survival (RFS) (mean 49.4 vs 24.1 months; Wilcoxon p=0.049). The embolization group had significantly less intraoperative blood loss (178±203 mL vs 221±165 mL; p=0.009) and shorter operation time (5.6±2.0 hours vs 6.8±2.8 hours; p=0.036). There were no significant differences in Simpson grade IV resection (33.3% vs 28.6%; p=0.637) or overall perioperative complications (21.4% vs 11.9%; p=0.241). Tumor embolization prolonged RFS in a subanalysis of cases who experienced recurrence (n=39) among the overall cases before variable control (mean RFS 33.2 vs 16.0 months; log-rank p=0.003). CONCLUSIONS: After controlling for variables, preoperative embolization for meningioma did not improve the Simpson grade or patient outcomes. However, it might have effects outside of surgical outcomes by prolonging RFS without increasing complications.

DOI： 10.1136/neurintsurg-2022-019080

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PURPOSE: Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data. METHODS: This retrospective multicenter cohort study aimed to identify the prognostic factors after CAS using real-world data from the stroke registry of Yokohama (STrOke Registry of Yokohama; STORY) from January 1, 2018 to May 31, 2021. Patient characteristics, procedural factors, complications, and prognoses were collected using medical records. RESULTS: Data from 107 patients were enrolled in this study after excluding those with insufficient data (2 cases). The mean participant age was 74.9±8.2 years, and 66 patients (61.7%) were symptomatic. Symptomatic lesions were a significant prognostic factor in the overall analysis (p=0.003). A multivariate analysis showed that the estimated glomerular filtration rate (eGFR) (odds ratio: 1.11, p=0.003) and staged CAS (odds ratio: 38.9, p=0.04) were independent prognostic factors. The odds ratio and relative risk of mRS deterioration when eGFR was under 49 mL/min/1.73 m2 compared with when eGFR was above 49 mL/min/1.73 m2 were 5.2 and 3.74, respectively. CONCLUSIONS: In this real-world multicenter study, we established independent prognostic factors for CAS using high totality data. For patients with symptomatic lesions and low eGFR (≤49 mL/min/1.73 m2), indication for treatment should be considered strictly.

DOI： 10.1016/j.jstrokecerebrovasdis.2021.106269

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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We herein report a case of developmental venous anomaly (DVA) with venous congestion caused by stenosis of the collecting vein that presented with intracerebral hemorrhage (ICH). A 74-year-old woman was referred to our hospital a few days after the onset of motor aphasia. Computed tomography (CT) and magnetic resonance imaging (MRI) showed ICH in the left frontal lobe. Angiography revealed DVA in the left frontal lobe in the late venous phase. Stenosis of the collecting vein of DVA at the entrance to the superior sagittal sinus was detected and accompanied by cavernous malformation (CM) beside DVA. Cone-beam CT revealed the absence of the left septal vein and hypoplastic transverse caudate veins. The patient was treated by blood pressure management and no additional neurological symptoms were detected. DVA develops to compensate for the absence of pial or deep venous systems, and generally benign and clinically asymptomatic. However, the outflow restriction of DVA causes chronic venous hypertension and the formation of CM. These abnormalities are considered to occur during post-natal life and may result in ICH. The risk of hemorrhage needs to be considered in cases of DVA with restricted venous outflow or CM.

DOI： 10.1080/02688697.2021.1940859

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We report a rare case of an aneurysm originating from the penetrating artery of the distal middle cerebral artery (MCA). A 76-year-old man without a notable past history presented with sudden-onset severe headache, left hemiparesis, and a decreased level of consciousness. Computed tomography (CT) revealed subarachnoid hemorrhage (SAH) with intracerebral hemorrhage (ICH) in the right temporal lobe extending into the ventricle. Contrast-enhanced CT (CE-CT) demonstrated a focus of contrast enhancement (CE) adjacent to the hematoma in the right frontal lobe. An aneurysm fed by a penetrating artery branching off from the right distal MCA was found on angiography. The patient underwent emergency resection of the aneurysm and hematoma evacuation. Histological analysis revealed that arterial dissection may be an associated factor in the pathogenesis of this peripheral aneurysm formation. A focus of CE within or adjacent to the hematoma may be useful for diagnosing this peripheral aneurysm. ICH can result in a life-threatening situation. Therefore, microsurgery may be the first treatment choice for aneurysms in this location.

DOI： 10.2176/nmccrj.cr.2020-0004

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BACKGROUND: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. CASE DESCRIPTION: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. CONCLUSION: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

DOI： 10.25259/SNI_564_2020

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BACKGROUND: A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intracranial aneurysm. Most aneurysms associated with duplicated middle cerebral artery are located at the origin of the duplicated middle cerebral artery. An aneurysm located at the distal middle cerebral artery is not common. CASE PRESENTATION: We encountered a 62-year-old Asian man with duplicated middle cerebral artery associated with aneurysms at the M1/M2 junction of the duplicated middle cerebral artery and top of the internal carotid artery. CONCLUSIONS: In cases of duplicated middle cerebral artery, association with a distal aneurysm on the duplicated middle cerebral artery is rare. However, the aneurysm may be formed on the thicker middle cerebral artery due to hemodynamic stress.

DOI： 10.1186/s13256-018-1824-7

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BACKGROUND: Bow hunter's syndrome (BHS) is rare and typically induced by mechanical compression of the dominant vertebral artery (VA) during head rotation. We report a case of BHS induced by nondominant VA compression in which contralateral VA patency was preserved. Definite diagnosis of BHS is not often feasible because of transient symptoms and nonspecific clinical features, such as vertigo or dizziness, especially in nondominant VA compression. We discuss the diagnostic clues of BHS and clinical features of BHS caused by nondominant VA compression through a literature review. CASE DESCRIPTION: A 65-year-old man suffered repeated bouts of dizziness whenever his head was rotated to the left. This dizziness was consistently accompanied by downbeat nystagmus (DBN). Radiography revealed left VA compression by a lateral osteophyte at the C3-C4 level only during left head rotation. In contrast, patency of the right VA, which was almost equivalent in size to the left VA, was preserved during head rotation. The distinctive clinical finding of head rotation-induced DBN, which is usually associated with lesions involving the caudal midline cerebellum, was observed. Symptoms disappeared immediately after left VA decompression with osteophytectomy and C3-C4 fusion. CONCLUSIONS: Despite excellent flow through the contralateral VA, occlusion of the nondominant VA occasionally induces BHS. According to a review of the literature, BHS cases do not always depend on the VA on one side for blood supply. Head rotation-induced DBN can be useful for diagnosis of BHS, even in cases of nondominant VA compression.

DOI： 10.1016/j.wneu.2017.12.167

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Background In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms. Patients and methods From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation. The aneurysms were located at the anterior communicating artery and basilar artery in two patients each, and on the internal carotid artery at the bifurcation of the anterior choroidal artery (AChoA) in one. In these patients, the clinical course, radiological findings, and management were retrospectively reviewed. Results Thrombus formation was observed in the posterior cerebral artery, anterior cerebral artery (A2), AChoA, and middle cerebral artery. The timing of thrombus formation was during coil delivery in four cases, and guiding catheter advancement in one. As for thrombus management, for all patients, administrations of heparin and antiplatelet agents were performed. For four patients, urokinase injection into the affected arteries was added after the completion of embolization. Cerebral infarction was postoperatively identified in two patients, but no hemorrhage was noted. Conclusion Administrations of heparin and antiplatelet drugs should be performed appropriately during procedures, and close observation of the arterial condition on angiography is necessary. Once thromboembolism occurs during the endovascular embolization of ruptured cerebral aneurysms, adequate heparinization, and antiplatelet therapy should first be performed.

DOI： 10.1177/1591019917739448

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A 28-year-old man without a significant medical history visited our hospital complaining of a headache. Computed tomography (CT) demonstrated thick, calcified vertebral artery (VA) and basilar artery (BA), despite the patient being young. Magnetic resonance angiography demonstrated the absence of the left internal carotid artery (ICA). The right ICA, the bilateral VA, and the BA were well developed and dolichoectatic. CT revealed the absence of the carotid canal on the left side. The condition was diagnosed as congenital agenesis of the left ICA with dolichoectatic changes in 3 other arteries. In a young patient with thick, calcified intracranial arteries, close examination is necessary, because vascular anomalies such as ICA agenesis may exist.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.021

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Background and Objective Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is a procedure to reconstruct cerebral blood flow in the MCA territory. In some cases, the STA wall is thickened and the size discrepancy between STA and MCA is apparent. In such a situation, STA-MCA bypass is challenging. We present two patients who underwent STA-MCA bypass using STA in which a thickened intima was removed. We discuss the usefulness of this rescue technique. Patients and Results A patient with an atherosclerotic MCA occlusion and another with an occluded internal carotid artery are included. Endarterectomy of STA was performed before or during anastomosis, and the intima-resected STA was anastomosed to MCA. In both cases, the STA was thick and hard, and it was difficult to anastomose the STA as it was to the MCA. Patency of the bypass was confirmed by postoperative angiography. Conclusion Endarterectomy of a thickened STA might be an effective rescue technique in cases with severely atherosclerotic STA in STA-MCA bypass.

DOI： 10.1055/s-0037-1598050

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We report the rare case of a right aortic arch associated with agenesis of the left internal carotid artery. A 75-year-old woman with a medical history of tetralogy of Fallot presented with dizziness. Magnetic resonance angiography revealed agenesis of the left internal carotid artery in addition to a previously diagnosed right aortic arch. The left common carotid artery was present, but it was thin. Computed tomography showed the absence of the left carotid canal. The left anterior cerebral artery was fed via the anterior communicating artery. The left middle cerebral artery was fed via a thickened posterior communicating artery originating from the left posterior cerebral artery. Although a right aortic arch and agenesis of the internal carotid artery are both very rare, association of the two conditions may occur. Both anomalies depend on the abnormal regression of the dorsal aorta during embryonic development. In such a situation, the presence of other anomalies in the cardiac or central nervous system should be taken into consideration.

DOI： 10.2176/nmccrj.cr.2016-0240

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Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.

DOI： 10.1177/1971400916684667

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We report a patient with a traumatic middle cerebral artery dissection, which showed hyperperfusion in the territory supplied by the left middle cerebral artery. A 45-year-old man experienced speech disturbance and motor weakness in his right hemibody on the day following mild head trauma. His symptoms worsened on the fourth day. Magnetic resonance imaging showed narrowing in the left M1 portion of the middle cerebral artery. Angiography showed narrowing and dilatation in the left middle cerebral artery trunk. The lesion was diagnosed as a dissection of the middle cerebral artery. Arterial spin labelling of magnetic resonance imaging and single photon emission computed tomography showed increased cerebral blood flow in the left temporal region compared with the right. The patient was treated conservatively and the symptoms gradually improved. The hyperperfusion observed on arterial spin labelling and single photon emission computed tomography gradually improved and disappeared on the 25th day. This is the first reported case of traumatic middle cerebral artery dissection, which showed post-ischaemic hyperperfusion in the territory of the affected artery. To detect hyperperfusion in the brain, arterial spin labelling is a useful technique.

DOI： 10.1177/1971400916665370

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Intraorbital schwannoma is a rare tumor which accounts for about 1-2% of all neoplasms of the orbit. Orbital schwannomas most commonly arise from the sensory branches of the trigeminal nerve. On the other hand, intraorbital abducens nerve schwannomas are extremely rare, with a search of the English literature identifying only four cases of intraorbital abducens nerve schwannoma. This is the 5th reported case of an orbital schwannoma arising from the terminal branch of the abducens nerve to the lateral rectus muscle. We report a case of an intraorbital abducens nerve schwannoma in a 51-year-old man with no signs of neurofibromatosis. The tumor was totally excised with functional preservation of the nerve by a zygomatic approach with lateral orbitotomy. With knowledge of these anatomic features, total removal of the tumor with preservation of the abducens nerve function might be possible.

DOI： 10.2176/nmccrj.cr.2015-0259

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Cavernous sinus (CS) dural arteriovenous fistula (dAVF) patients presenting with only headache as an initial symptom are not common. Patients with CS-dAVF commonly present with symptoms related to their eyes. In all three patients, headache was the initial symptom. Other symptoms related to the eyes developed 1 - 7 months after headache. In one patient, headache was controlled by sumatriptan succinate, but not diclofenac sodium or loxoprofen sodium. In another patient, headache was controlled by loxoprofen sodium. In the third patient, headache was improved by stellate ganglion block. In all patients, magnetic resonance angiography (MRA) in the early stage of the clinical course showed abnormal blood flow in the CS. However, reflux to the superior ophthalmic vein (SOV) was not detected. As treatment, transarterial and transvenous embolizations were necessary for one patient, and transvenous embolization was performed for another patient with significant blood flow to the SOV and cortical veins. On the other hand, manual compression of the bilateral carotid arteries at the neck resulted in disappearance of the fistula in the third patient. In all patients, the symptoms improved after the disappearance of blood reflux to the CS. The refluxed blood to the CS might cause elevation of the CS pressure and stimulate the trigeminal nerve in the dural membrane, resulting in headache before developing reflux in an anterior direction. CS-dAVF could induce both migraine and common headache. In cases with blood reflux to the CS on magnetic resonance imaging and/or MRA even without eye symptoms, a differential diagnosis of CS-dAVF should be taken into consideration.

DOI： 10.14740/jocmr2489w

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BACKGROUND: An aneurysm originating from the junction of the A1 segment of the anterior cerebral artery and accessory middle cerebral artery (Acc-MCA) is markedly rare. We report a rare case of an Acc-MCA aneurysm, and discuss the clinical course and management of this rare condition. CASE DESCRIPTION: A 64-year-old man with a past history of cerebral infarction was revealed to have a left Acc-MCA and an aneurysm at its origin. The aneurysm was clipped via a transsylvian approach. Due to its location and projectile direction, the neck of the aneurysm was left partially unclipped. CONCLUSION: Although an Acc-MCA aneurysm is very rare, it has a potential risk of rupture. Therefore, radical treatment is necessary for such aneurysms.

DOI： 10.4103/2152-7806.166179

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BACKGROUND: A duplicated middle cerebral artery (DMCA) is a rare vessel anomaly. Aneurysms at the origin of DMCA have been reported. CASE DESCRIPTION: We report 2 cases of aneurysms at the origin of DMCA accompanied by aneurysms at different sites. Each case of ruptured and unruptured aneurysm at the DMCA origin was associated with an unruptured aneurysm at the ipsilateral internal carotid artery and a ruptured one at the ipsilateral MCA, respectively. The aneurysms were clipped successfully in both patients. CONCLUSION: In cases of DMCA aneurysm associated with an aneurysm at another site, either aneurysm has a high risk of rupture. In such a case, radical treatment is necessary.

DOI： 10.4103/2152-7806.168069

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：国家公務員共済組合連合会  

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