Biomedical subjects

Masaru Hirohata

Publications and source records attributed to Masaru Hirohata.

9 recordsLinked to original sources

PubMed2005

[Ischemia of the sternocleidomastoid muscle following occipital artery embolization for dural arteriovenous fistula].

We report a case of localized ischemia of the sternocleidomastoid muscle (SCM) occurring after occipital artery embolization of a dural arteriovenous fistula (dAVF). A 45-year-old man presented intracerebral hemorrhage from a dAVF at the left transverse-sigmoid sinus. The dAVF had a high flow fistula from the left occipital artery (OA). Endovascular therapy was carried out one month later. Transarterial embolization of the OA was carried out prior to the transvenous approach to decrease the shunt flow. During obliteration of the proximal portion of the OA with fiber platinum coils and polyvinyl alcohol particles, the patient reported severe neck pain. The fistula was successfully embolized after transvenous packing of the left sigmoid sinus with detachable coils. The neck pain persisted for one week and disappeared after conservative treatment. T2-MR imaging 3 days after the embolization showed a hyperintensity in the left SCM. This ischemic lesion was probably induced by occlusion of the muscular branch of the OA. We discuss this common but rarely reported complication of OA embolization.

Carotid Artery, External↗

PubMed2005

[Case of meningioma with extracranial extension through the internal jugular vein].

We report a case of posterior fossa meningioma extending into the cervical jugular vein, which was successfully resected. A 57-year old male with ataxia and mild hypogeusia was admitted to our hospital. MRI demonstrated a well-circumscribed large posterior fossa mass with extracranial extension through the internal jugular vein. Two-staged surgical treatment was then performed. The mass in the posterior fossa was removed at the first operation. The tumor was invading into the sigmoid sinus which was filled with tumor. The second operation for extracranial mass was performed 1 month later. Transcervically, the internal jugular vein obstructed by tumor was successfully removed. The post-operative course was uneventful and histopathological examination revealed the fibrous meningioma in the posterior fossa, but the intravenous portion of the tumor showed more atypical findings. Such a case is quite uncommon and the mechanism of tumor extension with different histological features is discussed.

Humans↗

PubMed2004

[Angiography].

The clinical usefulness of three dimensional images was widely recognized. The three dimensional digital subtraction angiography (3D-DSA) well demonstrated anatomical structures of cerebral arteries with high special resolution. This 3D observation allowed high quality planning for aneurysmal coil packing and neck clipping. Because of the bony structure and curvy arterial anatomy in the skull base region, 3D-CTA and MRA was sometimes distureved the demonstration of the anatomical relationship adjacent to the aneurysm. However, 3D-DSA not only demonstrated arterial anatomy, but also analyzed of vascular structure, quantifiably. And it was useful in radiation dose reduction by reduction of DSA exposure number. We believe that 3D-DSA should provided useful information for planning of surgical and endovascular treatment in the field of cerebro-vascular disease.

Angiography, Digital Subtraction↗

PubMed2004

[A successfully treated case of a ruptured anterior wall aneurysm of the internal carotid artery (C2) which changed in form from blister-like to saccular type].

We successfully treated a case of ruptured anterior wall aneurysm of the ICA (C2) which changed in form from blister-like to saccular type. A 46-year-old woman developed subarachnoid hemorrhage on July 12, 2002. Cerebral angiogram demonstrated a blister-like aneurysm located in the left C2 portion of the internal carotid artery, but which didn't affect the arterial branches. Because of the risk of premature rupture during early surgery, delayed surgery was scheduled and the patient underwent serial study of the aneurysm. During 2 weeks of follow-up, the shape and size of the aneurysm changed in form blister-like to an enlarged saccular type aneurysm. On the day 18th, a left episubcombined approach, after insertion of a balloon catheter into the cervical ICA, was attempted and the aneurysm projecting antero-medially under the left carotid artery was exposed. The aneurysm had a distinct neck and its wall was not fragile. There was no macroscopic evidence of dissection of the ICA and the aneurysm was successfully clipped by conventional manipulation. Because of the difficulty in determining by angiographic evidence alone, whether an anterior wall aneurysm is a blister type or saccular type, careful follow-up is needed and if the shape or size changes, immediate appropriate treatment becomes mandatory. Intraoperative observation will determine the final diagnosis, as in this uncommon case.

Aneurysm, Ruptured↗

PubMed2003

Bilateral anomalous posterior inferior cerebellar artery-anterior inferior cerebellar artery anastomotic arteries associated with a ruptured cerebral aneurysm--case report.

A 50-year-old man presented with subarachnoid hemorrhage from a ruptured cerebral aneurysm arising from a left posterior inferior cerebellar artery (PICA)-anterior inferior cerebellar artery anastomotic artery manifesting as severe headache, obtundation, and quadriplegia. Conventional and three-dimensional digital subtraction angiography showed that the anastomotic complex was present bilaterally and both vertebral arteries terminated at the origin of the PICA. The identification of this anomalous vascular network allowed coil embolization of the broad-based aneurysm with occlusion of the parent artery. The patient had residual moderate disturbance of consciousness and quadriplegia before transfer for rehabilitation.

Aneurysm, Ruptured↗

PubMed2002

Primary intracerebral malignant fibrous histiocytoma in a child.

We report herein a rare case of pediatric intracerebral malignant fibrous histiocytoma (MFH). A 2-year-old boy gradually developed mild left hemiparesis and became somnolent. Magnetic resonance imaging upon admission revealed a well-enhanced mass lesion in the right frontotemporal operculum. Subtotal removal of the tumor was successfully performed using a right transsulcal and transcortical approach. The tumor developed as an extraaxial mass with brain adhesion to the arterial wall of the branch of the middle cerebral artery rather than to cerebral tissue. Pathological examination confirmed the presence of inflammatory-type MFH. Pediatric cases of intracerebral MFH are rare, and the possible origin of the tumor is discussed based on clinicopathological findings.

Brain Neoplasms↗

PubMed2002

Clinical benefits of rotational 3D angiography in endovascular treatment of ruptured cerebral aneurysm.

BACKGROUND AND PURPOSE: Recent neurointerventional and neurosurgical technologies require an understanding of lesions and adjacent structures in three dimensions. To clarify the clinical benefits of rotational 3D digital subtraction angiography (DSA), we retrospectively analyzed its advantages and disadvantages at the time of interventional procedures for ruptured cerebral aneurysms. METHODS: From January 1998 through September 2000, 85 patients with a ruptured cerebral aneurysm were treated with Guglielmi detachable coils in the acute phase. Data for the patients treated before availability of 3D DSA (group A, 52 patients) were compared with data for patients treated after availability of 3D DSA (group B, 33 patients). Variables analyzed were age, sex, location of aneurysm, size of aneurysm, number of implanted coils, number of DSA exposures, and total amount of contrast medium used. RESULTS: No statistically significant differences between the groups were noted when we compared the age, sex, aneurysm location, aneurysm size, and number of implanted coils. The number of DSA exposures was decreased in total by using 3D DSA (P <.0001), not only to determine the working projection (P <.0001) but also during the procedure (P <.0002). However, no statistically significant difference was noted in the comparison of total amount of contrast medium. CONCLUSION: Three-dimensional DSA allows acquisition of high-quality 3D images of cerebral arteries and also allows observation and analysis from multiple directions to determine the appropriate working projection for embolization. Three-dimensional DSA is essential for optimal diagnosis and embolization of cerebral aneurysms and can reduce the number of exposures.

Adolescent↗

PubMedDate not supplied

Distal-tip shape-consistency testing of steam-shaped microcatheters suitable for cerebral aneurysm coil placement.

BACKGROUND AND PURPOSE: Although the selection of microcatheter for endovascular aneurysmal treatment is one important factor in patient outcome, the use of steam shaping for achieving safe entry and stability during coil placement has not, to our knowledge, been systematically evaluated. The goal of this study was to compare the durability of distal microcatheter steam shaping in five different catheters with typical intraprocedural stresses that are similar to those encountered during aneurysm coil placement. METHODS: Distal tips of microcatheters were shaped into a 90 degrees turn with distal straight-segment lengths of 3, 5, or 7 mm by using steam, performed according to the instructions for use included with each catheter. In a water bath kept at body temperature, the changes in catheter tip angle were recorded and measured following microcatheter insertion into a guiding catheter, microguidewire insertion through the microcatheter, and Guglielmi detachable coil (GDC) placement through the microcatheter. RESULTS: The degree of distal microcatheter straightening with typical intraprocedural manipulations was more pronounced on braided microcatheters and on microcatheters with 3- or 5-mm distal-shaped segments. The degree of spontaneous recovery of the initially steamed shape was more pronounced with nonbraided catheters. The most significant single variable contributing to straightening of a steam-shaped catheter tip was the effect of microguidewire insertion. The catheter-tip straightening effect encountered with inserting GDCs was less than that encountered with microguidewire insertion. We demonstrated that the decreased catheter-tip angle encountered with a large-magnitude straightening stress spontaneously recovered once the stress was removed or when it was reduced to a smaller magnitude stress. CONCLUSION: Our study shows that, although braided microcatheters are suitable for maintaining durable configurations when long distal-tip lengths are permissible, nonbraided microcatheters demonstrate the most durable distal-tip configurations when short distal-tip lengths are called for. This may be one of significant factors in catheter choice for endovascular treatment of aneurysm.

Catheterization↗

PubMedDate not supplied

Blood brain-barrier disruption of nonionic iodinated contrast medium following coil embolization of a ruptured intracerebral aneurysm.

Few reports of temporary disruption of the blood-brain barrier (BBB) following neurointerventional procedures, presumably caused by nonionic radiographic contrast medium (CM), exist in the literature. We described such a case in a 72-year-old man presenting with acute subarachnoid hemorrhage, who underwent coil embolization of a ruptured anterior communicating artery complex aneurysm. At the time of his follow-up CT examination, a large amount of iodine was found in the cerebrospinal fluid (CSF). Because of this experience, the iodine concentration in the CSF of five other patients who also underwent an intracranial endovascular procedure was measured. It was concluded that this increased iodine might have been caused by temporary leakage or breakdown of the BBB. Even if the total amount of CM may not be excessive, the disproportionately high concentration injected into a single vascular territory may pose a unique set of variables increasing the risk of BBB disruption.

Aged↗