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Teiji Tominaga - One of the best experts on this subject based on the ideXlab platform.
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incidence and risk factors of the watershed shift phenomenon after superficial temporal Artery middle cerebral Artery Anastomosis for adult moyamoya disease
Cerebrovascular Diseases, 2019Co-Authors: Ryosuke Tashiro, Miki Fujimura, Shunji Mugikura, Kuniyasu Niizuma, Hidenori Endo, Masayuki Kameyama, Yohei Takeuchi, Yasutake Tomata, Teiji TominagaAbstract:Objective Superficial temporal Artery-middle cerebral Artery (STA-MCA) Anastomosis is the standard surgical management for adult moyamoya disease (MMD) patients, but local cerebral hyperperfusion (CHP) and cerebral ischemia are potential complications of this procedure. Recent hemodynamic analysis of the acute stage after revascularization surgery for MMD revealed a more complex and unique pathophysiological condition, the so-called "watershed shift (WS) phenomenon," which is defined as a paradoxical decrease in the cerebral blood flow (CBF) at the adjacent cortex near the site of local CHP. The objective of this study was to clarify the exact incidence, clinical presentation, and risk factors of the WS phenomenon after direct revascularization surgery for adult MMD. Patients and methods Among 74 patients with MMD undergoing STA-MCA Anastomosis for 78 affected hemispheres, 60 adult patients comprising 64 hemispheres underwent serial quantitative CBF analysis by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography after revascularization surgery. The local CBF was quantitatively measured at the site of Anastomosis and the adjacent cortex before surgery, as well as on 1 and 7 days after surgery. Then, we investigated the incidence, clinical presentation, and risk factors of the WS phenomenon. Results The WS phenomenon was evident in 7 patients (7/64 hemispheres; 10.9%) after STA-MCA Anastomosis for adult MMD. None of the patients developed neurological deterioration due to the WS phenomenon, but 1 patient developed reversible ischemic change on diffusion-weighted imaging at the site of the WS phenomenon. Multivariate analysis revealed that a lower preoperative CBF value was significantly associated with the occurrence of the WS phenomenon (20.3 ± 7.70 mL/100 g/min in WS-positive group vs. 31.7 ± 8.81 mL/100 g/min in WS-negative group, p= 1.1 × 10-2). Conclusions The incidence of the WS phenomenon was as high as 10.9% after STA-MCA Anastomosis for adult MMD. The clinical outcome of the WS phenomenon is generally favorable, but there is a potential risk for perioperative cerebral infarction. Thus, we recommend routine CBF measurement in the acute stage after revascularization surgery for adult MMD to avoid surgical complications, such as local CHP and cerebral ischemia, caused by the WS phenomenon. Concomitant detection of the WS phenomenon with local CHP is clinically important because blood pressure reduction to counteract local CHP may have to be avoided in the presence of the WS phenomenon.
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local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease
Journal of Stroke & Cerebrovascular Diseases, 2015Co-Authors: Hiroyuki Sakata, Miki Fujimura, Shunji Mugikura, Kenichi Sato, Teiji TominagaAbstract:Superficial temporal Artery–middle cerebral Artery Anastomosis is generally used as the standard surgical treatment for moyamoya disease to prevent cerebral ischemic attacks. Although the main potential complications associated with this treatment are cerebral hyperperfusion and ischemia, the adverse impacts of revascularization surgery remain unclear. Of the 142 consecutive surgeries for moyamoya disease at our hospital from 2008, we herein presented 2 cases of adult-onset moyamoya disease that manifested local vasogenic edema at the site of Anastomosis without cerebral hyperperfusion; 1 in a 31-year-old woman presented with transient ischemic attack and the other in a 22-year-old man manifested as minor completed stroke. Both patients underwent superficial temporal Artery–middle cerebral Artery Anastomosis, resulting in the formation of a reversible high-signal-intensity lesion at the site of Anastomosis on T2-weighted images along with an increase in apparent diffusion coefficient values, whereas diffusion-weighted images showed no changes. Neither hyperperfusion nor hypoperfusion, as assessed by single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine, was observed postoperatively. In light of the increased risk of the further progression of vasogenic edema to intracerebral hemorrhage, these patients were treated with prophylactic blood pressure lowering and the intravenous infusion of a free radical scavenger. They did not have any further cerebrovascular events during the follow-up period. Regional vasogenic edema without cerebral hyperperfusion, possibly due to cerebral ischemia/reperfusion injury, may be another novel entity that needs to be considered as a potential complication after extracranial–intracranial bypass for moyamoya disease. Strict postoperative management should be used to avoid hemorrhagic transformation.
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quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease
Neurological Research, 2015Co-Authors: Miki Fujimura, Hiroaki Shimizu, Kenichi Sato, Kuniyasu Niizuma, Hidenori Endo, Takashi Inoue, Teiji TominagaAbstract:AbstractObjective:Cerebral hyperperfusion syndrome (HPS) is a potential complication of extracranial–intracranial (EC–IC) bypass for moyamoya disease; however, the pathological threshold of the early cerebral blood flow (CBF) increases after EC–IC bypass has yet to be determined. The purpose of this study is to evaluate the predictive and diagnostic values of early quantitative CBF analysis for the detection of HPS after EC–IC bypass for moyamoya disease.Methods:We quantitatively evaluated regional CBF at the site of the Anastomosis in 23 patients with moyamoya disease aged between 18 and 66 years (mean, 39·6) before and 1 day after superficial temporal Artery-middle cerebral Artery Anastomosis by an auto-radiographic method using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography.Results:Regional CBF 1 day after surgery was significantly higher in patients with HPS (n = 5; mean, 54·6 ml/100 g/minutes) than in patients without HPS (n = 18; mean, 40·5 ml/100 g/minutes) (P =...
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development of moyamoya disease in pregnancy and puerperium case report
Neurologia Medico-chirurgica, 2014Co-Authors: Yosuke Akamatsu, Miki Fujimura, Hiroaki Shimizu, Hiroshi Uenohara, Teiji TominagaAbstract:Progressive moyamoya disease in pregnancy and puerperium has not been reported previously. Here, we present a 39-year-old woman who had been found to have moderate stenosis of right middle cerebral Artery (MCA) 4 years prior to her pregnancy, finally suffering minor completed stroke due to progressive moyamoya disease at the early postpartum period. Three days after cesarean section without any complication, she developed cerebral infraction at right hemisphere, when magnetic resonance angiography indicated apparent progression of the proximal MCA stenosis. Catheter angiography demonstrated nearly occlusion of the right terminal internal carotid Artery (ICA) and the development of an abnormal vascular network at the base of the brain as well as MCA stenosis, indicating a definitive diagnosis of moyamoya disease with unilateral involvement. The patient underwent superficial temporal Artery-middle cerebral Artery Anastomosis 1 month after the onset of stroke, and she did not manifest as further neurological events during the follow-up period of 2 years. Moyamoya disease could newly develop in pregnancy and puerperium, which should be noted as a pitfall of the management of moyamoya disease with pregnancy.
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asymptomatic moyamoya disease subsequently manifesting as transient ischemic attack intracerebral hemorrhage and subarachnoid hemorrhage in a short period
Neurologia Medico-chirurgica, 2010Co-Authors: Miki Fujimura, Shunji Mugikura, Hiroaki Shimizu, Teiji TominagaAbstract:A 59-year-old man, who had incidentally been found to have asymptomatic moyamoya disease 4 months previously, suffered transient ischemic attack (TIA) in the left extremities. Three weeks later, he again suffered TIA, and neuroimaging examination revealed fresh subarachnoid hemorrhage in the interhemispheric cistern as well as an asymptomatic thalamic hemorrhage in the contralateral hemisphere, which was not evident at the first onset of TIA. Digital subtraction angiography confirmed the diagnosis of moyamoya disease, and single-photon emission computed tomography demonstrated significant hemodynamic compromise in the right hemisphere. He underwent superficial temporal Artery-middle cerebral Artery Anastomosis with indirect pial synangiosis without complication one month later. The TIA completely disappeared after surgery, and no further cerebrovascular event occurred during the follow-up period of 2 years. Asymptomatic moyamoya disease may manifest with a dynamic course, so careful follow up is necessary. Simultaneous manifestation of ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage in a short period in the present case may indicate the underlying mechanism of the cerebrovascular events in this rare entity.
Michael J Mack - One of the best experts on this subject based on the ideXlab platform.
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computer assisted telemanipulation an enabling technology for endoscopic coronary Artery bypass
The Annals of Thoracic Surgery, 1998Co-Authors: Hani Shennib, Amr Bastawisy, Michael J Mack, Frederic H MollAbstract:Abstract Background . The ultimate objective of minimally invasive coronary Artery bypass grafting is to perform the Anastomosis totally endoscopically. In this feasibility study, we examined the potential of performing coronary Artery bypass grafting with the use of computer-assisted telemanipulation technology. Methods . Intuitive Telemanipulation Technology (Intuitive Surgical, Mountain View, CA) was used to perform an arterial graft to left anterior descending coronary Artery Anastomosis in an ex vivo on-bench swine heart model. The degree of difficulty in performing the Anastomosis, intraoperative events, duration of the Anastomosis, and its quality were determined. Results . Anastomosis was performed with relative facility, in a range of 10.7 to 17.4 minutes (mean ± standard deviation, 14.6 ± 2.6 minutes). All anastomoses were patent and of good quality except one, which had 30% narrowing of its heel. Conclusions . We conclude that Intuitive Telemanipulation Technology may in the future permit the performance of quality totally endoscopic coronary Artery Anastomosis with facility and acceptable time.
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minimally invasive coronary Artery bypass grafting
The Annals of Thoracic Surgery, 1996Co-Authors: Michael J Mack, Tea E Acuff, Rodney J Landreneau, Bartley P GriffithAbstract:Background. Standard options for the invasive management of proximal disease of the left anterior descending coronary Artery include coronary Artery bypass grafting with a left internal mammary Artery and percutaneous transluminal coronary angioplasty. Methods. We describe a surgical technique for bypass of the left anterior descending coronary Artery with a left internal mammary Artery without median sternotomy and without cardiopulmonary bypass. Thoracoscopy is used to harvest the internal mammary Artery, whereas the mammary-coronary Artery Anastomosis is performed under direct vision through a limited anterior thoracotomy. Results. We have performed this procedure successfully in 3 patients with minimal morbidity and shortened hospital stay. Average operative time was 3 hours and postoperative hospital stay averaged less than 48 hours. Conclusions. Although experience is limited and follow-up is very short, with further experience, this less invasive surgical technique may become a viable option for the management of proximal left anterior descending disease.
Miguel Valderrabano - One of the best experts on this subject based on the ideXlab platform.
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robot assisted stenting of a high grade anastomotic pulmonary Artery stenosis following single lung transplantation
Journal of Endovascular Therapy, 2010Co-Authors: Alan B Lumsden, Javier E Anayaayala, Matthias Loebe, Mark G Davies, Itamar Birnbaum, Jean Bismuth, Zulfiqar F Cheema, Hossam El F Sayed, Harish Seethamraju, Miguel ValderrabanoAbstract:Purpose To report robot-assisted stenting of a stenosis at the pulmonary Artery Anastomosis following lung transplantation, a rare complication that conveys poor prognosis even after surgical correction. Technique The technique is illustrated in a 72-year-old man with end-stage lung disease who received a left single lung transplant. On postoperative day 54, he was evaluated for recurrent dyspnea on exertion that was due to a severe stenosis at the site of the pulmonary Artery Anastomosis. Balloon angioplasty was performed, and a 10-mm stent was deployed, with marked clinical improvement. Fourteen months later, he presented with recurrent symptoms due to in-stent restenosis. Multiple attempts at catheterization and balloon angioplasty of the stent failed. Due to the technical difficulty involved in maneuvering the balloon while maintaining stability, it was decided to repeat the angioplasty with the assistance of a Hansen Sensei remote robotic navigation system. The robotic arm markedly enhanced stability and facilitated successful navigation of the stented site. A 16-mm-diameter Wallstent was placed through the previously placed balloon-expandable stent and postdilated. Conclusion A remote robotic catheter navigation system was able to assist stenting of an anastomotic pulmonary Artery stenosis following failure of conventional interventional techniques.
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robot assisted stenting of a high grade anastomotic pulmonary Artery stenosis following single lung transplantation
Journal of Endovascular Therapy, 2010Co-Authors: Alan B Lumsden, Javier E Anayaayala, Matthias Loebe, Mark G Davies, Itamar Birnbaum, Jean Bismuth, Zulfiqar F Cheema, Hossam El F Sayed, Harish Seethamraju, Miguel ValderrabanoAbstract:Purpose:To report robot-assisted stenting of a stenosis at the pulmonary Artery Anastomosis following lung transplantation, a rare complication that conveys poor prognosis even after surgical correction.Technique:The technique is illustrated in a 72-year-old man with end-stage lung disease who received a left single lung transplant. On postoperative day 54, he was evaluated for recurrent dyspnea on exertion that was due to a severe stenosis at the site of the pulmonary Artery Anastomosis. Balloon angioplasty was performed, and a 10-mm stent was deployed, with marked clinical improvement. Fourteen months later, he presented with recurrent symptoms due to in-stent restenosis. Multiple attempts at catheterization and balloon angioplasty of the stent failed. Due to the technical difficulty involved in maneuvering the balloon while maintaining stability, it was decided to repeat the angioplasty with the assistance of a Hansen Sensei remote robotic navigation system. The robotic arm markedly enhanced stability ...
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robot assisted stenting of a high grade anastomotic pulmonary Artery stenosis following single lung transplantation
Journal of Endovascular Therapy, 2010Co-Authors: Alan B Lumsden, Javier E Anayaayala, Matthias Loebe, Mark G Davies, Itamar Birnbaum, Jean Bismuth, Zulfiqar F Cheema, Hossam El F Sayed, Harish Seethamraju, Miguel ValderrabanoAbstract:Purpose:To report robot-assisted stenting of a stenosis at the pulmonary Artery Anastomosis following lung transplantation, a rare complication that conveys poor prognosis even after surgical corre...
Akira Uchino - One of the best experts on this subject based on the ideXlab platform.
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Ascending pharyngeal Artery-posterior inferior cerebellar Artery Anastomosis via the jugular foramen: a case report and literature review.
Surgical and radiologic anatomy : SRA, 2021Co-Authors: Akira Uchino, Hitoshi Ohno, Ryushi Kondo, Shoichiro IshiharaAbstract:The posterior inferior cerebellar Artery (PICA) rarely arises from the cavernous segment of the internal carotid Artery (ICA) and is called persistent trigeminal Artery variant. The PICA also can arise from the cervical segment of the ICA, and it enters the posterior fossa via the hypoglossal canal, where it is called persistent hypoglossal Artery variant. Using magnetic resonance angiography (MRA), we diagnosed a 79-year-old man with a PICA arising from the ascending pharyngeal Artery and passing through the medial side of the jugular foremen pars vascularis. Only six cases of this variation have been reported previously in the English language literature. To identify this variation on MRA, the careful observation of source images is useful. Recognizing this variation is important in order to avoid ischemic cerebellar complications during neck surgery and endovascular therapy.
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congenital external carotid internal carotid Artery Anastomosis diagnosed by mr angiography
Journal of Neuroimaging, 2013Co-Authors: Akira Uchino, Naoko Saito, Takeyuki WatadaniAbstract:We present what we believe is the first report of external carotid-internal carotid Artery Anastomosis, which forms a large arterial ring at the proximal cervical internal carotid Artery (ICA). If the small channel of the proximal cervical ICA is occluded, the remaining large channel of the external carotid Artery may be diagnosed as a nonbifurcating cervical carotid Artery.
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congenital external carotid internal carotid Artery Anastomosis associated with contralateral non bifurcating cervical carotid Artery
Neuroradiology, 2012Co-Authors: Kanji Nakai, Akira Uchino, Tatsumi Kaji, Toshio Kawauchi, Chiharu Tamura, Naoki Otani, Hiroshi NawashiroAbstract:Dear Sir, Non-bifurcating cervical carotid Artery is a rare anatomical variation of the carotid Artery in which the branches of the external carotid Artery (ECA) directly arise from the common carotid Artery without forming a bifurcation [1, 2]. In addition, cases of congenital EC–internal carotid Artery (ICA) Anastomosis at the cervical segment forming a large arterial ring have been reported, and it seems to be a variant of the non-bifurcating cervical carotid Artery [3]. We wish to bring to your attention a patient showing not only a non-bifurcating cervical carotid Artery on one side but also EC–IC Anastomosis on the contralateral side. This case suggests that there is a relationship between a nonbifurcating cervical carotid Artery and ring formation of the cervical carotid Artery. A 71-year-old man underwent CT angiography (CTA) of the extracranial neck vessels, because anomalies of bilateral cervical carotid arteries were discovered at a medical checkup. CTA showed that the right distal common carotid Artery changed in caliber at the level of the C6 vertebral body. The major branches of the proximal ECA arose separately from the terminal segment of the common carotid Artery or proximal ICA without a proximal main trunk of the ECA (Fig. 1). Thereafter, the Artery continued as a normal ICA in the cranial portion. The left carotid bifurcation was located at the level of the C6 vertebral body. The ICA and ECA anastomosed at midcervical level to form a large arterial ring at the proximal cervical segment (Fig. 1). Morimoto et al. [2] first used the term "non-bifurcating cervical carotid Artery" as variations/anomalies at the cervical carotid Artery in 1990. A non-bifurcating cervical carotid Artery is rare, and the overall incidence of the anomaly detected by magnetic resonance angiography was 0.21% [4]. Two hypotheses have been proposed for the development of a non-bifurcating carotid Artery [5–7]. The first is agenesis of the common stem of the ECA with regression failure of the hyoid Artery. The second is segmental agenesis of the ICA. Embryologically, the cervical carotid arteries develop by complicated processes of regression, and the communication within the vascular network consists of the ventral aorta, dorsal aorta, aortic arches, and intersegmental arteries. The ventral aorta and dorsal aorta communicate via aortic arches. Among them, the first aortic arch (mandibular Artery) further regresses, while the second aortic arch (hyoid Artery) continues to the stapedial Artery. It is generally thought that the ECA develops from both the ventral pharyngeal Artery system and the hyoid Artery system. According to Lasjaunias et al. [8], the occipital Artery (OA) is formed from the proatlantal Artery and arises from the primitive ICA, ECA, and vertebral Artery at points determined by the sites of regression. In our case, the OAs arose from the right IC and left EC, respectively. When the K. Nakai (*) : T. Kaji : T. Kawauchi :C. Tamura Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan e-mail: nakai@ndmc.ac.jp
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carotid anterior cerebral Artery Anastomosis on mr angiography a university hospital based study
Neuroradiology, 2012Co-Authors: Akira Uchino, Naoko Saito, Yoshitaka Okada, Kaiji InoueAbstract:Rarely in the anterior circulation, an Anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid Artery and anastomoses with the A1–A2 junction of the anterior communicating Artery. Right-side predominance is known. To our knowledge, the incidence of carotid–anterior cerebral Artery Anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid–anterior cerebral Artery Anastomosis (two men, one woman), representing an incidence of 0.086%. The Anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral Artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid–anterior cerebral Artery Anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system.
Miki Fujimura - One of the best experts on this subject based on the ideXlab platform.
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incidence and risk factors of the watershed shift phenomenon after superficial temporal Artery middle cerebral Artery Anastomosis for adult moyamoya disease
Cerebrovascular Diseases, 2019Co-Authors: Ryosuke Tashiro, Miki Fujimura, Shunji Mugikura, Kuniyasu Niizuma, Hidenori Endo, Masayuki Kameyama, Yohei Takeuchi, Yasutake Tomata, Teiji TominagaAbstract:Objective Superficial temporal Artery-middle cerebral Artery (STA-MCA) Anastomosis is the standard surgical management for adult moyamoya disease (MMD) patients, but local cerebral hyperperfusion (CHP) and cerebral ischemia are potential complications of this procedure. Recent hemodynamic analysis of the acute stage after revascularization surgery for MMD revealed a more complex and unique pathophysiological condition, the so-called "watershed shift (WS) phenomenon," which is defined as a paradoxical decrease in the cerebral blood flow (CBF) at the adjacent cortex near the site of local CHP. The objective of this study was to clarify the exact incidence, clinical presentation, and risk factors of the WS phenomenon after direct revascularization surgery for adult MMD. Patients and methods Among 74 patients with MMD undergoing STA-MCA Anastomosis for 78 affected hemispheres, 60 adult patients comprising 64 hemispheres underwent serial quantitative CBF analysis by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography after revascularization surgery. The local CBF was quantitatively measured at the site of Anastomosis and the adjacent cortex before surgery, as well as on 1 and 7 days after surgery. Then, we investigated the incidence, clinical presentation, and risk factors of the WS phenomenon. Results The WS phenomenon was evident in 7 patients (7/64 hemispheres; 10.9%) after STA-MCA Anastomosis for adult MMD. None of the patients developed neurological deterioration due to the WS phenomenon, but 1 patient developed reversible ischemic change on diffusion-weighted imaging at the site of the WS phenomenon. Multivariate analysis revealed that a lower preoperative CBF value was significantly associated with the occurrence of the WS phenomenon (20.3 ± 7.70 mL/100 g/min in WS-positive group vs. 31.7 ± 8.81 mL/100 g/min in WS-negative group, p= 1.1 × 10-2). Conclusions The incidence of the WS phenomenon was as high as 10.9% after STA-MCA Anastomosis for adult MMD. The clinical outcome of the WS phenomenon is generally favorable, but there is a potential risk for perioperative cerebral infarction. Thus, we recommend routine CBF measurement in the acute stage after revascularization surgery for adult MMD to avoid surgical complications, such as local CHP and cerebral ischemia, caused by the WS phenomenon. Concomitant detection of the WS phenomenon with local CHP is clinically important because blood pressure reduction to counteract local CHP may have to be avoided in the presence of the WS phenomenon.
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local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease
Journal of Stroke & Cerebrovascular Diseases, 2015Co-Authors: Hiroyuki Sakata, Miki Fujimura, Shunji Mugikura, Kenichi Sato, Teiji TominagaAbstract:Superficial temporal Artery–middle cerebral Artery Anastomosis is generally used as the standard surgical treatment for moyamoya disease to prevent cerebral ischemic attacks. Although the main potential complications associated with this treatment are cerebral hyperperfusion and ischemia, the adverse impacts of revascularization surgery remain unclear. Of the 142 consecutive surgeries for moyamoya disease at our hospital from 2008, we herein presented 2 cases of adult-onset moyamoya disease that manifested local vasogenic edema at the site of Anastomosis without cerebral hyperperfusion; 1 in a 31-year-old woman presented with transient ischemic attack and the other in a 22-year-old man manifested as minor completed stroke. Both patients underwent superficial temporal Artery–middle cerebral Artery Anastomosis, resulting in the formation of a reversible high-signal-intensity lesion at the site of Anastomosis on T2-weighted images along with an increase in apparent diffusion coefficient values, whereas diffusion-weighted images showed no changes. Neither hyperperfusion nor hypoperfusion, as assessed by single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine, was observed postoperatively. In light of the increased risk of the further progression of vasogenic edema to intracerebral hemorrhage, these patients were treated with prophylactic blood pressure lowering and the intravenous infusion of a free radical scavenger. They did not have any further cerebrovascular events during the follow-up period. Regional vasogenic edema without cerebral hyperperfusion, possibly due to cerebral ischemia/reperfusion injury, may be another novel entity that needs to be considered as a potential complication after extracranial–intracranial bypass for moyamoya disease. Strict postoperative management should be used to avoid hemorrhagic transformation.
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quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease
Neurological Research, 2015Co-Authors: Miki Fujimura, Hiroaki Shimizu, Kenichi Sato, Kuniyasu Niizuma, Hidenori Endo, Takashi Inoue, Teiji TominagaAbstract:AbstractObjective:Cerebral hyperperfusion syndrome (HPS) is a potential complication of extracranial–intracranial (EC–IC) bypass for moyamoya disease; however, the pathological threshold of the early cerebral blood flow (CBF) increases after EC–IC bypass has yet to be determined. The purpose of this study is to evaluate the predictive and diagnostic values of early quantitative CBF analysis for the detection of HPS after EC–IC bypass for moyamoya disease.Methods:We quantitatively evaluated regional CBF at the site of the Anastomosis in 23 patients with moyamoya disease aged between 18 and 66 years (mean, 39·6) before and 1 day after superficial temporal Artery-middle cerebral Artery Anastomosis by an auto-radiographic method using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography.Results:Regional CBF 1 day after surgery was significantly higher in patients with HPS (n = 5; mean, 54·6 ml/100 g/minutes) than in patients without HPS (n = 18; mean, 40·5 ml/100 g/minutes) (P =...
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development of moyamoya disease in pregnancy and puerperium case report
Neurologia Medico-chirurgica, 2014Co-Authors: Yosuke Akamatsu, Miki Fujimura, Hiroaki Shimizu, Hiroshi Uenohara, Teiji TominagaAbstract:Progressive moyamoya disease in pregnancy and puerperium has not been reported previously. Here, we present a 39-year-old woman who had been found to have moderate stenosis of right middle cerebral Artery (MCA) 4 years prior to her pregnancy, finally suffering minor completed stroke due to progressive moyamoya disease at the early postpartum period. Three days after cesarean section without any complication, she developed cerebral infraction at right hemisphere, when magnetic resonance angiography indicated apparent progression of the proximal MCA stenosis. Catheter angiography demonstrated nearly occlusion of the right terminal internal carotid Artery (ICA) and the development of an abnormal vascular network at the base of the brain as well as MCA stenosis, indicating a definitive diagnosis of moyamoya disease with unilateral involvement. The patient underwent superficial temporal Artery-middle cerebral Artery Anastomosis 1 month after the onset of stroke, and she did not manifest as further neurological events during the follow-up period of 2 years. Moyamoya disease could newly develop in pregnancy and puerperium, which should be noted as a pitfall of the management of moyamoya disease with pregnancy.
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asymptomatic moyamoya disease subsequently manifesting as transient ischemic attack intracerebral hemorrhage and subarachnoid hemorrhage in a short period
Neurologia Medico-chirurgica, 2010Co-Authors: Miki Fujimura, Shunji Mugikura, Hiroaki Shimizu, Teiji TominagaAbstract:A 59-year-old man, who had incidentally been found to have asymptomatic moyamoya disease 4 months previously, suffered transient ischemic attack (TIA) in the left extremities. Three weeks later, he again suffered TIA, and neuroimaging examination revealed fresh subarachnoid hemorrhage in the interhemispheric cistern as well as an asymptomatic thalamic hemorrhage in the contralateral hemisphere, which was not evident at the first onset of TIA. Digital subtraction angiography confirmed the diagnosis of moyamoya disease, and single-photon emission computed tomography demonstrated significant hemodynamic compromise in the right hemisphere. He underwent superficial temporal Artery-middle cerebral Artery Anastomosis with indirect pial synangiosis without complication one month later. The TIA completely disappeared after surgery, and no further cerebrovascular event occurred during the follow-up period of 2 years. Asymptomatic moyamoya disease may manifest with a dynamic course, so careful follow up is necessary. Simultaneous manifestation of ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage in a short period in the present case may indicate the underlying mechanism of the cerebrovascular events in this rare entity.