Moyamoya disease is an unusual form of chronic, occlusive
|
|
- Lesley Stafford
- 5 years ago
- Views:
Transcription
1 Angiographic Dilatation and Branch Extension of the Anterior Choroidal and Posterior Communicating Arteries Are Predictors of Hemorrhage in Adult Moyamoya Patients Motohiro Morioka, MD; Jun-Ichiro Hamada, MD; Takayuki Kawano, MD, PhD; Tatemi Todaka, MD; Shigetoshi Yano, MD; Yutaka Kai, MD; Yukitaka Ushio, MD Background and Purpose The cause of intracranial bleeding in moyamoya disease patients is still unknown. To identify factors that contribute to bleeding, we assessed the angiographic findings of moyamoya disease patients. Methods We examined angiograms obtained from 107 moyamoya patients; 70 manifested ischemic and 37 had hemorrhagic lesions. Patients with intracerebral aneurysms or both hemorrhagic and ischemic lesions in the same cerebral hemisphere were not included. Patients were divided into those 20 years of age (n 47) and those 20 years of age (n 60). The right and left hemispheres in each patient were individually classified as hemorrhagic, ischemic, or asymptomatic. Each hemisphere was assessed for dilatation and branch extension of the anterior choroidal artery (AChA) and posterior communicating artery (P-CoM) and for the degree of proliferation of basal moyamoya vessels. These data were then statistically analyzed for correlation with intracranial bleeding events. Results The degree of proliferation of basal moyamoya vessels was not statistically correlated with hemorrhagic events. On the other hand, there was a correlation between hemorrhage and dilatation and abnormal branching of the AChA. In 27 of 37 hemorrhagic hemispheres (73.0%), this artery was dilated, and its abnormal branches served as collateral supply vessels to other regions. This phenomenon was observed in 4 of 5 hemorrhagic hemispheres from young patients; it was noted in fewer than one third of ischemic and asymptomatic hemispheres from this age group. Similarly, 71.9% of hemorrhagic hemispheres from adult patients manifested AChA dilatation and branching, and the difference between hemorrhagic hemispheres and those that were ischemic or asymptomatic was statistically significant (P 0.01). Although the incidence of dilatation and abnormal branching of the P-CoM was relatively low in hemorrhagic hemispheres from adult patients (18.8%), it was significantly higher than in the ischemic and asymptomatic hemispheres from this age group. Using dilatation and abnormal branching of the AChA and/or P-CoM as assessment criteria, we obtained high specificity (86.4%) and sensitivity (84.4%) for hemorrhagic events in adult moyamoya patients. Conclusions In adult moyamoya patients, dilatation and abnormal branching of the AChA and/or P-CoM are strong predictors of hemorrhagic events. (Stroke. 2003;34:90-95.) Key Words: angiography hemorrhage moyamoya disease Moyamoya disease is an unusual form of chronic, occlusive cerebrovascular disease characterized by bilateral stenosis or occlusion at the terminal portion of the internal carotid artery (ICA) and an abnormal vascular network (the so-called moyamoya vessels) at the base of the brain. 1 4 Many patients with moyamoya disease experience cerebral ischemic or hemorrhagic events; pediatric patients suffer primarily ischemic attacks, whereas hemorrhage is prevalent among adults. 1,3 Although revascularization surgery can prevent ischemic attacks, 5 8 the cause of intracranial bleeding is unclear, and strategies to prevent its occurrence remain to be developed. Because the site of intracranial bleeding in many moyamoya patients is the basal ganglia, thalamus, and near lateral ventricle wall, 9 11 basal moyamoya vessels have been suspected as its origin. 1,12 15 However, in some patients with hemorrhage, few basal moyamoya vessels are found, and their location is away from the bleeding site (Figure 1). We noted that among hemorrhagic moyamoya patients, including some exhibiting this phenomenon, the anterior choroidal artery (AChA) was frequently dilated and exhibited abnormal extension of many branches (Figure 1B, 1D, and 1E) and that the bleeding site was within the AChA territory. Therefore, we examined the arteries that normally supply the central or Received March 6, 2002; final revision received August 8, 2002; accepted August 13, From the Department of Neurosurgery, Kumamoto University, School of Medicine, Kumamoto, Japan. Reprint requests to Motohiro Morioka, Department of Neurosurgery, Kumamoto University School of Medicine, 1-1-1, Honjo Kumamoto , Japan. morioka@kaiju.medic.kumamoto-u.ac.jp 2003 American Heart Association, Inc. Stroke is available at DOI: /01.STR D 90
2 Morioka et al Dilation and Branching of AChA/P-CoM in Moyamoya Disease 91 Figure 1. Demonstrative cases in which moyamoya vessels were not considered a bleeding vessel. A and B, A 33-year-old female. CT scan (A) shows right putaminal hematoma with intraventricular hemorrhage. Right internal carotid angiogram (B) showed fewer moyamoya vessels and dilated, abnormally branching AChA (arrowhead). C through E, A 52-year-old female. CT scan (C) shows massive right intraventricular hematoma and small intracerebral hemorrhage from posterior caudate nucleus to the near lateral ventricle wall. On right internal carotid angiogram (D and E), moyamoya vessels, far from the site of bleeding, are noted. AChA (arrowhead) was dilated and manifested abnormal branching. basal brain region in an effort to identify characteristic features of hemorrhagic moyamoya disease. Figure 2. Demonstrative angiograms. A, AChA appears normal; no proliferative vessels are apparent (grade 0). B, Note thickening of the AChA and staining of the proximal choroidal plexus. AChA is dilated, and distal vessels beyond the choroidal fissure are clearly visualized (grade 1). C and D, There is extension of other, not normally seen branches of AChA (grade 2). E and F, Moyamoya vessels classified as grades 1 (E) and 2 (F) are present. G, P-CoM, judged as positive, is dilated, and abnormal branches are clearly evident. Subjects and Methods A total of 170 patients with moyamoya disease underwent treatment at Kumamoto University Hospital and its affiliated hospitals beginning in Of these, 100 patients experienced ischemic events, including transient ischemic attacks or cerebral infarction; 47 presented with hemorrhage, including subarachnoid and intraventricular hemorrhage or intracerebral hematoma; and 23 had no or other Figure 3. Schematic illustrating the site of O/S of the ICA in patients with moyamoya disease. Right and left hemispheres were separately classified as ischemic (A), hemorrhagic (B), and asymptomatic (C), and the site of O/S of the ICA was identified. Circles represent the different age groups.
3 92 Stroke January 2003 symptoms. We focused only on patients with hemorrhagic or ischemic symptoms. Patients with intracerebral aneurysms and those with both hemorrhagic and ischemic lesions in the same hemisphere were excluded from this study. Finally, we could obtain 107 intra-arterial angiograms of 107 patients (ischemic, n 70; hemorrhagic, n 37) at the time of onset. We focused on vessels that supply the basal regions of the brain such as the basal ganglia, thalamus, and near lateral ventricle where intracranial bleeding frequently occurs in moyamoya patients. 1,4,9 11 Our focus was on the AChA, posterior communicating artery (P-CoM), and basal moyamoya vessels, except for the ethmoidal and vault moyamoya vessels because the territories they feed are not frequent bleeding sites. The right and left cerebral hemispheres (n 214) in each patient were separately identified as ischemic (including those with infarction and transient ischemic attacks, n 102), hemorrhagic (n 37), or asymptomatic (n 75). The AChA in each hemisphere was recorded as grade 0 (normal), 2 (dilated with distal branching), or 3 (dilated with abnormal branches serving as collateral supply vessels to other regions; Figure 2A through 2D). Basal moyamoya vessels were graded as absent (grade 0), few in number (grade 1), and densely proliferated (grade 2; Figure 2A, 2E, and 2F). Findings on the P-CoM were recorded as negative; normal, dilated, or positive; or dilated with abnormal branch extensions (Figure 2G). We also noted the site of occlusion or stenosis (O/S) of the ICA as following; site 1, ICA top or A1/M1; site 2, just distal to AChA; site 3, between the AChA and P-CoM; or site 4, proximal to P-CoM (Figure 3). The 107 patients were divided into a young ( 20 years of age; n 47) and an adult ( 20 years of age; n 60) group because childhood moyamoya patients tend to manifest ischemia and adults predominantly experience hemorrhage. We examined the correlation between angiographic findings and symptoms using the Mann- Whitney U and 2 tests. Differences of P 0.01 were considered statistically significant. Results We examined 107 angiograms (214 hemispheres) from 107 patients (ischemia, n 70; hemorrhage, n 37); the characteristics of these patients are shown in Table 1. The mean SD age of ischemic patients was years (range, 1.6 to 67.8 years); it was years (range, 5.3 to 66.8 years) for patients with hemorrhage. There were 102 ischemic, 37 hemorrhagic, and 75 asymptomatic hemispheres. The 37 hemorrhages were made up of 1 subarachnoid hemorrhage, 9 intraventricular hemorrhages, 14 intracerebral hematomas, and 13 lesions that were of both intracerebral hematoma and intraventricular hemorrhage origin. Among 47 young patients (94 hemispheres), only 5 patients (5 hemispheres) manifested hemorrhage; of 60 adult patients (120 hemispheres), 32 (32 hemispheres) had lesions of hemorrhagic origin. Angiographic Findings on Moyamoya Vessels and the AChA Compared with ischemic and asymptomatic hemispheres, those with hemorrhage tended to manifest a higher degree of moyamoya vessel proliferation, regardless of the age of the patient (Table 2). However, the difference was not statistically significant. Overall, in 33 of 37 hemorrhagic hemispheres (89.2%), the AChA was dilated and manifested branching (grades 1 and 2). More than 70% of the hemorrhagic hemispheres in both age groups had grade 2 AChA; the difference was statistically significant compared with ischemic and asymptomatic hemispheres (P 0.01). TABLE 1. Clinical Characteristics of 107 Moyamoya Disease Patients in This Study Ischemic Onset Cases (n 70) Hemorrhagic Onset Cases (n 37) Sex (male:female) All cases Young group (n 42) 1 4(n 5) Adult group (n 28) (n 32) Age at onset (mean SE) All cases* Young group (n 42) (n 5) Adult group (n 28) (n 32) Complications at onset Mental retardation 5 (7.1%) 1 (2.7%) Hypertension 5 (7.1%) 4 (10.8%) Diabetes mellitus 2 (2.9%) 1 (2.7%) Seizure 4 (5.7%) 1 (2.7%) Neurological-radiological characterizations at onset No. of Cases (hemispheres) No. of Cases (hemispheres) Ischemic onset TIA 19 (21) Infarction 33 (62) TIA and infarction 18 (19) No symptom 0 (38) (lesion) Hemorrhagic onset SAH 1 (1) IVH 9 (9) ICH 14 (14) ICH and IVH 13 (13) No symptom (lesion) 0 (37) Statistical significant difference *P 0.01, chi-square test. TIA indicates transient ischemic attack; SAH, subarachnoid hemorrhage; IVH, intraventricular hematoma; ICH, intracerebral hemorrhage. Angiographic Findings on the P-COM As shown in Table 2, approximately one fifth of the hemorrhagic hemispheres in both age groups showed P-CoM dilatation and branching. The difference between hemorrhagic and nonhemorrhagic hemispheres was statistically significant at P 0.01 ( 2 test) in both age groups. Site of O/S of the ICA Figure 3 demonstrates the distribution of the O/S site in the ICA. In 80.6% of adult hemorrhagic hemispheres, the lesion was just distal to the AChA (site 2); this site was involved in 45.9% and 20.8% of ischemic and asymptomatic hemispheres, respectively. The incidence of site 4 and 3 O/S was highest in ischemic hemispheres, and site 4 O/S was not found in hemorrhagic hemispheres.
4 Morioka et al Dilation and Branching of AChA/P-CoM in Moyamoya Disease 93 TABLE 2. Distribution of the Grades of Anterior Choroidal Artery and Moyamoya Vessels, and of Posterior Communicating Artery in Each Hemispheric Group Arterial Grading Symptom of Hemisphere Total Number Moyamoya vessels Hemorrhage 5 0 (0.0%) 1 (20.0%) 4 (80.0%) Ischemia (25.4%) 17 (27.0%) 30 (47.6%) No symptom 26 4 (15.4%) 11 (42.3%) 11 (42.3%) Hemorrhage 32 1 (3.1%) 15 (46.9%) 16 (50.0%) Ischemia (28.2%) 7 (17.9%) 21 (53.8%) No symptom (24.5%) 20 (40.8%) 17 (34.7%) Anterior choroidal artery Hemorrhage 5 1 (20.0%) 0 (0.0%) 4 (80.0%) Ischemia* (49.2%) 15 (23.8%) 17 (27.0%) No symptom* (50.0%) 5 (19.2%) 8 (30.8%) Hemorrhage 32 3 (9.4%) 6 (18.8%) 23 (71.9%) Ischemia* (56.4%) 10 (25.6%) 7 (17.9%) No symptom* (81.6%) 6 (12.2%) 3 (6.1%) Posterior communicating artery Dilatation and Branch Extension No Yes Hemorrhage 5 4 (80.0%) 1 (20.0%) Ischemia (92.1%) 5 (7.9%) No symptom (92.3%) 2 (7.7%) Hemorrhage (81.2%) 6 (18.8%) Ischemia (100.0%) 0 (0.0%) No symptom (98.0%) 1 (2.0%) Statistical significant difference compared to the hemorrhagic hemisphere group. *P 0.01, Mann-Whitney U test, P 0.01, chi-square test. Predictive Indicator(s) of a Hemorrhagic Event To determine the most important factor(s) for predicting a hemorrhagic event in adult moyamoya patients, we assessed different parameters for their positive or negative predictive value, specificity, and sensitivity for hemorrhagic events (Table 3). Although the findings of grade 1 or 2 AChA showed the highest sensitivity (90.6%), the specificity was not as high (70.5%). Finally, our findings suggest that the combination of a dilated AChA in which the branches provide collateral flow (grade 2) or dilated P-CoM with abnormal branch extensions represents an indicator with good sensitivity (84.4%) and specificity (86.4%) for predicting a hemorrhagic event. Discussion Our study shows a strong correlation between AChA dilatation and branching and hemorrhagic events in patients with moyamoya disease. Changes in the P-CoM were also correlated. In moyamoya patients without aneurysms, the main bleeding site has been thought to be the site of rupture of moyamoya vessels. 1,12 15 However, in some patients with hemorrhage, these vessels are few or are located away from the bleeding site (Figure 1). Bleeding was attributable to an intraventricular hematoma in 35% to 50% of patients reported by others 9 11 ; this was true in 22 (59.5%) of our 37 hemorrhagic moyamoya cases. However, because moyamoya vessels usually do not exist near the ventricle wall, it is difficult to accept that their rupture results in intraventricular hematoma. Suzuki and Kodama 3 suggested that there is a tendency for arteries near the ventricle wall to rupture. Under normal conditions, the AChA supplies areas such as the medial portion of the globus pallidus, anterior perforating substance, internal capsule, choroid plexus, tail of the caudate nucleus, and thalamus. The normal P-CoM gives off branches to the optic chiasm, oculomotor nerve, tuber cinereum, cerebral crura, ventral thalamus, and caudal portion of the
5 94 Stroke January 2003 TABLE 3. Positive/Negative Predictive Values, Sensitivity, and Specificity for Hemorrhagic Event Calculated With Various Conditions of Arterial Evaluation in the Adult Age Group Intracranial Bleeding Criteria of Arterial Evaluation* No. of Hemisphere No (%) Yes (%) Sensitivity, % Specificity, % AChA (grade 2) No (89.7) 9 (10.3) Yes (30.3) 23 (69.7) AChA (grades 1&2) No 65 62(95.4) 3 (4.6) Yes (47.3) 29 (52.7) P-COM ( ) No (77.0) 26 (23.0) Yes 7 1 (14.3) 6 (85.7) AChA (grade 2) or P-COM ( ) No (93.8) 5 (6.2) Yes (30.8) 27 (69.2) AChA (grades 1&2)orP-COM ( ) No (98.4) 1 (1.6) Yes (47.5) 31 (52.5) AChA indicates anterior choroidal artery; P-COM, posterior communicating artery; ( ), dilatation and branch extension of P-COM were found. Statistical significant difference *P 0.01, chi-square test. caudate nucleus. 16,17 Thus, the normal branches of the AChA and P-CoM provide blood to areas near the lateral ventricle, basal ganglia, and thalamus. In moyamoya patients, these normal branches sometimes extend to other regions, and their function as collateral vessels results in blood flow increases. Rupture of dilated branches of the AChA and/or P-CoM may produce intraventricular or thalamic hematomas, hematomas near the lateral ventricle, and hematomas of the basal ganglia that are frequently found in hemorrhagic moyamoya patients. It is considered that the postmortem data may support (or disprove) our hypothesis. Thus, we examined 3 autopsy cases with hemorrhagic moyamoya disease and tried to identify the bleeding vessels. However, we could not identify the branches of AChA and P-CoM. Although it is difficult to pinpoint the bleeding vessels, in our series, hemorrhagic events coincided with dilatation and branch extension of the AChA and/or P-CoM (Table 3), suggesting that these vessels may have been the origin of bleeding. According to the morphometric analysis of Yamashita et al, 15 most dilated arteries show fibrosis and marked attenuation of the media with occasional segmentation of the elastic lamina. As a result of hemodynamic stress or aging, dilated arteries with attenuated walls may acquire a predisposition for focal protrusion (microaneurysm formation) of the arterial wall. Subsequent rupture is thought to be a mechanism resulting in hemorrhage in patients with moyamoya disease. Such microscopic arterial changes may occur in the branches of the AChA and P-CoM. The normal AChA is 0.5 mm in diameter and 3.0 cm in length. On angiograms, the last visible portion of the AChA enters the plexus of the temporal horn, visualized as the angiographic brush of the plexus. Furthermore, the fine vessels of the normal P-CoM are scarcely visible angiographically. 16,17 Thus, the angiographically evident dilatation and branching of the AChA and P-CoM recorded in our study may signal increased blood flow and hemodynamic stress in these vessels. In 30% of nonhemorrhagic hemispheres from our young moyamoya patients, the dilated AChA had branches that served as collateral vessels; in adult ischemic and asymptomatic hemispheres, this phenomenon was more rare (Table 2). This suggests that in young patients the AChA may function as a major collateral route and that it may play the same role for moyamoya vessels. In nonhemorrhagic hemispheres, blood flow in the AChA decreases or disappears as the O/S site gets closer to the area proximal to the P-CoM (Figure 3). Furthermore, if the stenotic lesion is located just proximal to the P-CoM, neither the dilated AChA nor the basal moyamoya vessels are visible on angiograms. We posit this as the reason that no basal moyamoya vessels were discernible in about one fourth of the ischemic and asymptomatic hemispheres examined (Table 2). We also suspect that O/S just distal to the AChA induces the greatest change in this vessel and results in severe hemodynamic stress. In adults with hemorrhagic moyamoya, the site of O/S may have stopped progressing at a younger age, and the presence of prolonged hemodynamic stress and/or some factors related to aging 18 may eventually have led to bleeding. Intracranial bleeding is a major prognostic factor in moyamoya patients, 9,11 and currently we have no reliable indicator(s) for predicting a hemorrhagic event. In our series, angiograms were obtained within a few days of the initial hemorrhagic event, and the findings reflect the status before any rebleeding episodes. Of 32 adult patients who suffered hemorrhage, 17 who did not undergo bypass surgery experienced rebleeding during the follow-up period. Of these, 16 (94.1%) manifested a dilated AChA whose branches served as collateral vessels and/or a dilated P-CoM on angiograms obtained before the rebleeding episode. From these findings and the data shown in Table 3, we suggest that dilatation and branch extension of the AChA and P-CoM are sensitive and specific predictive indicators of rebleeding. Direct bypass surgery is thought to prevent recurrent intracranial bleeding in moyamoya patients A direct bypass may decrease the blood flow in the AChA and P-CoM, and the findings reported here may help to identify moyamoya patients at greatest risk for hemorrhage and thus make it possible to apply preventive surgical therapy before the occurrence of a potentially lethal repeated hemorrhage.
6 Morioka et al Dilation and Branching of AChA/P-CoM in Moyamoya Disease 95 However, because this study was retrospective, a large prospective study is needed to confirm our conclusions. Acknowledgments This work was supported by grants from the Research Committee on Spontaneous Occlusion of the Circle of Willis of the Ministry of Health and Welfare of Japan (1999). We wish to thank the members of Kumamoto Stroke Data Bank for the clinical data presentations. References 1. Masuda J, Ogata J, Yamaguchi T. Moyamoya disease. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM, eds. Stroke: Pathophysiology, Diagnosis, and Management. New York, NY: Churchill Livingston; 1998: Nishimoto A, Takeuchi S. Abnormal cerebrovascular network related to the internal carotid arteries. J Neurosurg. 1968;29: Suzuki J, Kodama N. Moyamoya disease: a review. Stroke. 1983;14: Suzuki J, Takaku A. Cerebrovascular moyamoya disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969; 20: Karasawa J, Kikuchi H, Furuse S, et al. Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg. 1978;49: Karasawa J, Touho H, Ohnishi H, et al. Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg. 1982;77: Kinugasa K, Mandai S, Kamata I, et al. Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results and angiograms. Neurosurg. 1993;32: Matsushima T, Inoue T, Suzuki SO, et al. Surgical treatment of moyamoya disease in pediatric patients: comparison between the results of indirect and direct revascularization procedures. Neurosurgery. 1992;31: Kobayashi E, Saeki N, Oishi H, et al. Long-term natural history of hemorrhagic moyamoya disease in 42 patients. J Neurosurg. 2000;93: Saeki N, Nakazaki S, Kubota M, et al. Hemorrhagic moyamoya disease. Clin Neurol Neurosurg. 1997;99(suppl 2): Yoshida Y, Yoshimoto T, Shirane R, et al. Clinical course, surgical management, and long-term outcome of moyamoya patients with rebleeding after an episode of intracranial hemorrhage: an extensive follow-up study. Stroke. 1999;30: Iwama T, Hashimoto N, Murai BN, et al. Intracranial rebleeding in moyamoya disease. J Clin Neurosci. 1997;1997:4: Morimoto M, Iwama T, Hashimoto N, et al. Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography. Acta Neurochir (Wien). 1999;141: Oka K, Yamashita M, Sadoshima S, et al. Cerebral haemorrhage in moyamoya disease at autopsy. Virchows Arch (Pathol Anat). 1981;392: Yamashita M, Oka K, Tanaka K. Histopathology of the brain vascular network in moyamoya disease. Stroke. 1983;14: Krayenbuhl H, Yasargil MG. Radiologic anatomy and topography of cerebral vessels. In: Huber P, ed. Cerebral Angiography. New York, NY: Georg Thieme Verlag; 1982: Taveras JM, Wood EH. Cerebral Angiography. In: Robbins LL, ed. Diagnostic Neuroradiology. Baltimore, Md: Williams & Wilkins Co; 1976: Mauro AJ, Johnson ES, Chikos PM, et al. Lipophyalinosis and miliary microaneurysms causing cerebral hemorrhage in a patient with moyamoya: a clinicopathological study. Stroke. 1980;11: Houkin K, Kamiyama H, Abe H, et al. Surgical therapy for adult moyamoya disease: can surgical revascularization prevent the recurrence of intracranial hemorrhage? Stroke. 1996;27: Kawaguchi S, Okuno S, Sakaki T. Effect of direct bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease. Stroke. 2000;93: Okada Y, Shima T, Nishida M, et al. Effectiveness of superficial temporal artery middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke. 1998;29:
Longitudinal anterior-to-posterior shift of collateral channels in patients with moyamoya disease: an implication for its hemorrhagic onset
CLINICAL ARTICLE Longitudinal anterior-to-posterior shift of collateral channels in patients with moyamoya disease: an implication for its hemorrhagic onset Shusuke Yamamoto, MD, Satoshi Hori, MD, PhD,
More informationMoyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature
Romanian Neurosurgery Volume XXXI Number 3 2017 July-September Article Moyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature Ashish Kumar Dwivedi, Pradeep Kumar,
More informationNeurosurg Focus 5 (5):Article 4, 1998
Neurosurg Focus 5 (5):Article 4, 1998 Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. A comparison with single indirect anastomosis with direct anastomosis
More informationAlthough moyamoya disease, a rare cerebrovascular occlusive
Renal Artery Lesions in Patients With Moyamoya Disease Angiographic Findings Ichiro Yamada, MD; Yoshiro Himeno, MD; Yoshiharu Matsushima, MD; Hitoshi Shibuya, MD Background and Purpose Renal artery lesions
More informationThirteen-year Experience of 44 Patients with Adult Hemorrhagic Moyamoya Disease from a Single Institution: Clinical Analysis by Management Modality
Journal of Cerebrovascular and Endovascular Neurosurgery ISSN 2234-8565, EISSN 2287-3139, http://dx.doi.org/10.7461/jcen.2013.15.3.191 Clinical Article Thirteen-year Experience of 44 Patients with Adult
More informationINSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU
CEREBRAL BYPASS An Innovative Treatment for Arteritis INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU CASE 1 q 1 year old girl -recurrent seizure, right side limb weakness, excessive cry and irritability.
More informationMoyamoya disease in the midwestern United States
Neurosurg Focus 5 (5):Article 1, 1998 Moyamoya disease in the midwestern United States Nicholas M. Wetjen, B.S., P. Charles Garell, M.D., Nicholas V. Stence, and Christopher M. Loftus, M.D. Division of
More informationMoyamoya disease (MMD) is a chronic, progressive cerebrovascular. Clinical and Angiographic Features and Stroke Types in Adult Moyamoya Disease
ORIGINAL RESEARCH BRAIN Clinical and Angiographic Features and Stroke Types in Adult Moyamoya Disease D.-K. Jang, K.-S. Lee, H.K. Rha, P.-W. Huh, J.-H. Yang, I.S. Park, J.-G. Ahn, J.H. Sung, and Y.-M.
More informationAngiographic features of hemorrhagic moyamoya disease with high recurrence risk: a supplementary analysis of the Japan Adult Moyamoya Trial
CLINICAL ARTICLE J Neurosurg 128:777 784, 2018 Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: a supplementary analysis of the Japan Adult Moyamoya Trial Takeshi Funaki,
More informationImaging of Moya Moya Disease
Abstract Imaging of Moya Moya Disease Pages with reference to book, From 181 To 185 Rashid Ahmed, Hurnera Ahsan ( Liaquat National Hospital, Karachi. ) Moya Moya disease is a rare disease causing occlusion
More informationMOYA Moya disease is a rare idiopathic
Research Papers Moya Moya Cases Treated with Encephaloduroarteriosynangiosis Parimal Tripathi, Varsha Tripathi, Ronak J. Naik and Jaimin M. Patel From Gujarat Cancer & Research Institute, Ahmedabad; Sterling
More informationRuptured Aneurysm of the Accessory Middle Cerebral Artery Associated with Moyamoya Disease A Case Report
Case Report 541 Ruptured Aneurysm of the Accessory Middle Cerebral Artery Associated with Moyamoya Disease A Case Report Cheng-Chi Lee, MD; Zhuo-Hao Liu, MD; Shih-Ming Jung 1, MD; Tao-Chieh Yang, MD The
More informationDiagnosis of Middle Cerebral Artery Occlusion with Transcranial Color-Coded Real-Time Sonography
Diagnosis of Middle Cerebral Artery Occlusion with Transcranial Color-Coded Real-Time Sonography Kazumi Kimura, Yoichiro Hashimoto, Teruyuki Hirano, Makoto Uchino, and Masayuki Ando PURPOSE: To determine
More information[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD]
2015 PHYSICIAN SIGN-OFF (1) STUDY NO (PHY-1) CASE, PER PHYSICIAN REVIEW 1=yes 2=no [strictly meets case definition] (PHY-1a) CASE, IN PHYSICIAN S OPINION 1=yes 2=no (PHY-2) (PHY-3) [based on all available
More informationYoung So, MD; Ho-Young Lee, MD; Seung-Ki Kim, MD; Jae Sung Lee, PhD; Kyu-Chang Wang, MD; Byung-Kyu Cho, MD; Eunjoo Kang, PhD; Dong Soo Lee, MD
Prediction of the Clinical Outcome of Pediatric Moyamoya Disease With Postoperative Basal/Acetazolamide Stress Brain Perfusion SPECT After Revascularization Surgery Young So, MD; Ho-Young Lee, MD; Seung-Ki
More informationTitle in Children. Issue Date Copyright 2011 S. Karger AG, Base.
NAOSITE: Nagasaki University's Ac Title Author(s) Clinical Features and Long-Term Fol in Children. Hayashi, Kentaro; Horie, Nobutaka; Citation Pediatric Neurosurgery, 47(1), pp.1 Issue Date 2011-09 URL
More informationNeuroscience. Journal. Moyamoya disease a review and case illustration. P A L M E T T O H E A L T H Vol. 2 Issue 3 Summer 2016
Neuroscience P A L M E T T O H E A L T H Vol. 2 Issue 3 Summer 2016 Journal Moyamoya disease a review and case illustration pg. 5 Choroid Plexus Papilloma in adults pg. 8 As physician co-leaders of Palmetto
More informationEssentials of Clinical MR, 2 nd edition. 14. Ischemia and Infarction II
14. Ischemia and Infarction II Lacunar infarcts are small deep parenchymal lesions involving the basal ganglia, internal capsule, thalamus, and brainstem. The vascular supply of these areas includes the
More informationHistory of revascularization
History of revascularization Author (year) Kredel, 1942 Woringer& Kunlin, 1963 Donaghy& Yasargil, 1968 Loughheed 1971 Kikuchini & Karasawa1973 Karasawa, 1977 Story, 1978 Sundt, 1982 EC/IC bypass study
More informationEmergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke
Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke Tetsuyoshi Horiuchi, Junpei Nitta, Shigetoshi Ishizaka, Kohei Kanaya, Takao Yanagawa, and Kazuhiro Hongo. Department of Neurosurgery,
More informationMoyamoya Disease A Vasculopathy and an Uncommon Cause of Recurrent Cerebrovascular Accidents
Moyamoya Disease A Vasculopathy and an Uncommon Cause of Recurrent Cerebrovascular Accidents Yasmin S. Hamirani, Md 1 *, Mohammad Valikhani, Md 2, Allison Sweney, Ms Iii 2, Hafsa Khan, Md 2, Mohammad Pathan,
More informationBlood Supply. Allen Chung, class of 2013
Blood Supply Allen Chung, class of 2013 Objectives Understand the importance of the cerebral circulation. Understand stroke and the types of vascular problems that cause it. Understand ischemic penumbra
More informationCerebral Hemodynamic Change in the Child and the Adult With Moyamoya Disease
272 Cerebral Hemodynamic Change in the Child and the Adult With Moyamoya Disease Yasuo Kuwabara, MD, Yuichi Ichiya, MD, Makoto Otsuka, MD, Takashi Tahara, MD, Ranjan Gunasekera, MD, Kanehiro Hasuo, MD,
More informationOverview Blood supply of the brain What is moyamoya disease? > 1
Moyamoya Disease Overview Moyamoya disease is caused by blocked arteries at the base of the brain. The name "moyamoya" means "puff of smoke" in Japanese and describes the appearance of tiny vessels that
More informationMoyamoya disease presenting as acute onset cortical blindness: a case report
Romanian Neurosurgery Volume XXX Number 1 2016 January-March Article Moyamoya disease presenting as acute onset cortical blindness: a case report Dudi Maniram, Bansal Rajeev, Srivastava Trilochan, Sardana
More informationSubject Review. Moyamoya Disease: The Disorder and Surgical Treatment
Subject Review Moyamoya Disease: The Disorder and Surgical Treatment KEISUKE UEKI, M.D.,* FREDRIC B. MEYER, M.D., AND JAMES F. MELLINGER, M.D. Objective: To discuss the clinical features of moyamoya disease,
More informationIn moyamoya disease, leptomeningeal vessels
1044 Histopathologic and Morphometric Studies of Leptomeningeal Vessels in Moyamoya Disease Shinji Kono, MD, Kazunari Oka, MD, and Katsuo Sueishi, MD To clarify the morphogenesis of vascular anastomoses
More informationCerebrovascular Disease
Neuropathology lecture series Cerebrovascular Disease Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output: 15-20% Percentage of O 2 consumption (resting):
More informationSummary of some of the landmark articles:
Summary of some of the landmark articles: The significance of unruptured intracranial saccular aneurysms: Weibers et al Mayo clinic. 1987 1. 131 patients with 161 aneurysms were followed up at until death,
More informationPTA 106 Unit 1 Lecture 3
PTA 106 Unit 1 Lecture 3 The Basics Arteries: Carry blood away from the heart toward tissues. They typically have thicker vessels walls to handle increased pressure. Contain internal and external elastic
More informationNeuropathology lecture series. III. Neuropathology of Cerebrovascular Disease. Physiology of cerebral blood flow
Neuropathology lecture series III. Neuropathology of Cerebrovascular Disease Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output: 15-20% Percentage of O
More informationMoyamoya Disease: Comparison of Assessment with 3.0T MR Angiography and MR Imaging versus Conventional
Moyamoya Disease: Comparison of Assessment with 3.0T MR Angiography and MR Imaging versus Conventional Angiography Poster No.: C-2771 Congress: ECR 2010 Type: Scientific Exhibit Topic: Neuro Authors: Q.
More informationMMD is a rare cerebrovascular disease first described by
ORIGINAL RESEARCH M.A. Mogensen P. Karzmark P.D. Zeifert J. Rosenberg M. Marks G.K. Steinberg L.J. Dorfman Neuroradiologic Correlates of Cognitive Impairment in Adult Moyamoya Disease BACKGROUND AND PURPOSE:
More informationAsymptomatic Moyamoya Disease: Literature Review and Ongoing AMORE Study
REVIEW ARTICLE Neurol Med Chir (Tokyo) 55, 194 198, 2015 doi: 10.2176/nmc.ra.2014-0305 Online February 20, 2015 Asymptomatic Moyamoya Disease: Literature Review and Ongoing AMORE Study Satoshi Kuroda;
More informationDouble STA-MCA Anatomosis for Bilateral Carotid Occlusion
Double STA-MCA Anatomosis for Bilateral Carotid Occlusion -Case Report and Literature Review- Sandra vuignier 1, Kenji Kanamaru 2, Tomohiro Araki 2 1 Department of Neurosurgery, Nagoya University School
More informationTitle. CitationWorld Neurosurgery, 80(5): Issue Date Doc URL. Rights. Rights(URL)
Title Effective Surgical Revascularization Improves Cerebr Moyamoya Disease Kawabori, Masahito; Kuroda, Satoshi; Nakayama, Naoki Author(s) Nagara CitationWorld Neurosurgery, 80(5): 612-619 Issue Date 2013-11
More informationMoyamoya syndrome associated with cocaine abuse Case report
Neurosurg Focus 5 (5):Article 7, 1998 Moyamoya syndrome associated with cocaine abuse Case report Marc S. Schwartz, M.D., and R. Michael Scott, M.D. Division of Neurosurgery, Albany Medical College, Albany,
More informationAcute stroke. Ischaemic stroke. Characteristics. Temporal classification. Clinical features. Interpretation of Emergency Head CT
Ischaemic stroke Characteristics Stroke is the third most common cause of death in the UK, and the leading cause of disability. 80% of strokes are ischaemic Large vessel occlusive atheromatous disease
More informationHemodynamics in the Anterior Part of the Circle of Willis in Patients with Intracranial Aneurysms : A Study by Cerebral Angiography
Tohoku J. exp. Med., 1980, 132, 69-73 Hemodynamics in the Anterior Part of the Circle of Willis in Patients with Intracranial Aneurysms : A Study by Cerebral Angiography RYUNGCHAN KWAK, HIROSHI NIIZUMA
More informationDirect Bypass Techniques for the Treatment of Pediatric Moyamoya Disease
Direct Bypass Techniques for the Treatment of Pediatric Moyamoya Disease Raphael Guzman, MD a, Gary K. Steinberg, MD, PhD b, * KEYWORDS Moyamoya disease Pediatric Direct bypass INDICATIONS Moyamoya disease
More informationVivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine
Vivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine Institute The Oregon Clinic Disclosure I declare that neither
More informationOriginal Contributions. Brain Damage After Open Heart Surgery in Patients With Acute Cardioembolic Stroke
305 Original Contributions Brain Damage After Open Heart Surgery in Patients With Acute Cardioembolic Stroke Michiyuki Maruyama, MD, Yoshihiro Kuriyama, MD, Tohru Sawada, MD, Takenori Yamaguchi, MD, Tsuyoshi
More informationTohoku J. Exp. Med., 2015, 236, Current Management of Moyamoya Disease 45
Tohoku J. Exp. Med., 2015, 236, 45-53 Current Management of Moyamoya Disease 45 Invited Review Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its Internal Carotid-External
More informationNeurosurgical Management of Stroke
Overview Hemorrhagic Stroke Ischemic Stroke Aneurysmal Subarachnoid hemorrhage Neurosurgical Management of Stroke Jesse Liu, MD Instructor, Neurological Surgery Initial management In hospital management
More informationCerebro-vascular stroke
Cerebro-vascular stroke CT Terminology Hypodense lesion = lesion of lower density than the normal brain tissue Hyperdense lesion = lesion of higher density than normal brain tissue Isodense lesion = lesion
More informationISCHEMIC STROKE IMAGING
ISCHEMIC STROKE IMAGING ผศ.พญ พญ.จ ร ร ตน ธรรมโรจน ภาคว ชาร งส ว ทยา คณะแพทยศาสตร มหาว ทยาล ยขอนแก น A case of acute hemiplegia Which side is the abnormality, right or left? Early Right MCA infarction
More informationEarly Angiographic and CT Findings in Patients with Hemorrhagic Infarction in the Distribution of the Middle Cerebral Artery
1115 Early Angiographic and CT Findings in Patients with Hemorrhagic Infarction in the Distribution of the Middle Cerebral Artery L. Bozzao 1 U. Angeloni S. Bastianello L. M. Fantozzi A. Pierallini C.
More informationMoyamoya disease (MMD) is a rare steno-occlusive
CLINICAL ARTICLE J Neurosurg 126:1573 1577, 2017 Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease *Hoyeon Cho, MD, 1 Kyung Il Jo, MD,
More informationClinical Symptoms in the Lateral Type of Hypertensive Intracerebral Hemorrhage
676 Correlation Between the Location of Hematoma and its Clinical Symptoms in the Lateral Type of Hypertensive Intracerebral Hemorrhage Observations on Pantopaque Radiography of the Hematoma Cavity in
More informationCLEAR III TRIAL : UPDATE ON SURGICAL MATTERS THAT MATTER
CLEAR III TRIAL : UPDATE ON SURGICAL MATTERS THAT MATTER CLEAR Surgical Center Team July 2011 Trial Enrollment Status Updates Insert latest enrollment update chart from most recent CLEAR newsletter Imaging
More informationCerebrovascular Disease
Neuropathology lecture series Cerebrovascular Disease Kurenai Tanji, M.D., Ph.D. December 11, 2007 Physiology of cerebral blood flow Brain makes up only 2% of body weight Percentage of cardiac output:
More informationCase Report 1. CTA head. (c) Tele3D Advantage, LLC
Case Report 1 CTA head 1 History 82 YEAR OLD woman with signs and symptoms of increased intra cranial pressure in setting of SAH. CT Brain was performed followed by CT Angiography of head. 2 CT brain Extensive
More informationBrain Arteriovenous Malformations Endovascular Therapy and Associated Therapeutic Protocols Jorge Guedes Cabral de Campos
Endovascular Therapy and Associated Therapeutic Protocols Jorge Guedes Cabral de Campos Neuroradiology Department Hospital de Santa Maria University of Lisbon CEREBRAL AVM CLINICAL / EPIDEMIOLOGY Brain
More informationComparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
More informationNEURO IMAGING 2. Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity
NEURO IMAGING 2 Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity I. EPIDURAL HEMATOMA (EDH) LOCATION Seventy to seventy-five percent occur in temporoparietal region. CAUSE Most likely caused
More informationCerebrovascular Disorders. Blood, Brain, and Energy. Blood Supply to the Brain 2/14/11
Cerebrovascular Disorders Blood, Brain, and Energy 20% of body s oxygen usage No oxygen/glucose reserves Hypoxia - reduced oxygen Anoxia - Absence of oxygen supply Cell death can occur in as little as
More informationBrain AVM with Accompanying Venous Aneurysm with Intracerebral and Intraventricular Hemorrhage
Cronicon OPEN ACCESS EC PAEDIATRICS Case Report Brain AVM with Accompanying Venous Aneurysm with Intracerebral and Intraventricular Hemorrhage Dimitrios Panagopoulos* Neurosurgical Department, University
More informationHow to interpret an unenhanced CT brain scan. Part 2: Clinical cases
How to interpret an unenhanced CT brain scan. Part 2: Clinical cases Thomas Osborne a, Christine Tang a, Kivraj Sabarwal b and Vineet Prakash c a Radiology Registrar; b Radiology Foundation Year 1 Doctor;
More informationMichael Horowitz, MD Pittsburgh, PA
Michael Horowitz, MD Pittsburgh, PA Introduction Cervical Artery Dissection occurs by a rupture within the arterial wall leading to an intra-mural Hematoma. A possible consequence is an acute occlusion
More informationCerebral Vascular Diseases. Nabila Hamdi MD, PhD
Cerebral Vascular Diseases Nabila Hamdi MD, PhD Outline I. Stroke statistics II. Cerebral circulation III. Clinical symptoms of stroke IV. Pathogenesis of cerebral infarcts (Stroke) 1. Ischemic - Thrombotic
More informationEffect of clot removal on cerebral vasospasm TETSUJI INAGAWA, M.D., MITSUO YAMAMOTO, M.D., AND KAZUKO KAMIYA, M.D.
J Neurosurg 72:224-230, 1990 Effect of clot removal on cerebral vasospasm TETSUJI INAGAWA, M.D., MITSUO YAMAMOTO, M.D., AND KAZUKO KAMIYA, M.D. Department of Neurosurgery, Shimane Prefectural Central Hospital,
More informationImpact of posterior cerebral artery Titleclinical and social outcome of pedi Dissertation_ 全文 ) Author(s) Funaki, Takeshi Citation Kyoto University ( 京都大学 ) Issue Date 2015-01-23 URL http://dx.doi.org/10.14989/doctor.r
More informationInterventions in the Management of Acute Stroke. Dr Md Shafiqul Islam Associate Professor Neurosurgery Dhaka Medical College Hospital
Interventions in the Management of Acute Stroke Dr Md Shafiqul Islam Associate Professor Neurosurgery Dhaka Medical College Hospital Acute stroke intervention Number of stroke patients increasing day by
More informationDepartment of Neurosurgery, Faculty of Medicine, Universitas Padjdajaran-Dr. Hasan Sadikin General Hospital 2
Case Rare Distal Anterior Choroidal Artery Aneurysm Muhammad Zafrullah Arifin, 1 Julius July, 2 Bilzardy Ferry, 1 Ahmad Faried 1 1 Department of Neurosurgery, Faculty of Medicine, Universitas Padjdajaran-Dr.
More informationA CASE OF RECURRENT ALTERNATING TRANSIENT HEMIPARESIS Dr. Shunmuga Arumugasamy.S DNB Resident Railway Hospital, Perambur.
A CASE OF RECURRENT ALTERNATING TRANSIENT HEMIPARESIS Dr. Shunmuga Arumugasamy.S DNB Resident Railway Hospital, Perambur. 6 year old school going child. Apparently normal till 3 yrs when she developed
More informationUPSTATE Comprehensive Stroke Center. Neurosurgical Interventions Satish Krishnamurthy MD, MCh
UPSTATE Comprehensive Stroke Center Neurosurgical Interventions Satish Krishnamurthy MD, MCh Regional cerebral blood flow is important Some essential facts Neurons are obligatory glucose users Under anerobic
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationIntracranial vascular anastomosis using the microanastomotic system
J Neurosurg 89:676 681, 1998 Intracranial vascular anastomosis using the microanastomotic system Technical note DAVID W. NEWELL, M.D., ANDREW T. DAILEY, M.D., AND STEPHEN L. SKIRBOLL, M.D. Department of
More informationEffect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms
J Neurosurg 57:622-628, 1982 Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms MAMORU TANEDA, M.D. Department of Neurosurgery, Hanwa Memorial Hospital, Osaka,
More informationNeurosurgical Treatment of Moyamoya Disease: Bypass Surgery for the Brain
Neurosurgical Treatment of Moyamoya Disease: Bypass Surgery for the Brain Christopher Payne Currently, no medical treatment exists to prevent the progression of moyamoya disease, and neurosurgical treatment
More informationPenetration of the Optic Nerve or Chiasm by Anterior Communicating Artery Aneurysms. - Three Case Reports-
Penetration of the Optic Nerve or Chiasm by Anterior Communicating Artery Aneurysms. - Three Case Reports- Tetsuyoshi Horiuchi 1, Toshiya Uchiyama 1, Yoshikazu Kusano 1, Maki Okada 1, Kazuhiro Hongo 1,
More informationI T IS well known that aneurysms occur at
The Lateral Perforating Branches of the Anterior and Middle Cerebral Arteries* HARRY A. KAPLAN, M.D. Division of Neurosurgery, Seton Hall College of Medicine, and Jersey City Medical Center, Jersey City,
More informationOcclusion of All Four Extracranial Vessels With Minimal Clinical Symptomatology. Case Report
Occlusion of All Four Extracranial Vessels With Minimal Clinical Symptomatology. Case Report BY JIRI J. VITEK, M.D., JAMES H. HALSEY, JR., M.D., AND HOLT A. McDOWELL, M.D. Abstract: Occlusion of All Four
More informationNeurosurgical decision making in structural lesions causing stroke. Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery)
Neurosurgical decision making in structural lesions causing stroke Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery) Subarachnoid Hemorrhage Every year, an estimated 30,000 people in the United States experience
More informationCT perfusion in Moyamoya disease
CT perfusion in Moyamoya disease Poster No.: C-1726 Congress: ECR 2015 Type: Scientific Exhibit Authors: K. C. Lam, C. P. Tsang, K. K. Wong, R. LEE ; HK, Hong Kong/HK Keywords: Hemodynamics / Flow dynamics,
More informationSpontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom
J Headache Pain (2012) 13:247 253 DOI 10.1007/s10194-012-0420-2 BRIEF REPORT Spontaneous cervicocephalic arterial dissection with headache and neck pain as the only symptom Hajime Maruyama Harumitsu Nagoya
More informationPostoperative Assessment of Extracranial Intracranial Bypass by Time- Resolved 3D Contrast-Enhanced MR Angiography Using Parallel Imaging
AJNR Am J Neuroradiol 26:2243 2247, October 2005 Postoperative Assessment of Extracranial Intracranial Bypass by Time- Resolved 3D Contrast-Enhanced MR Angiography Using Parallel Imaging Kazuhiro Tsuchiya,
More informationIntra-arterial nimodipine for the treatment of vasospasm due to aneurysmal subarachnoid hemorrhage
Romanian Neurosurgery (2016) XXX 4: 461 466 461 DOI: 10.1515/romneu-2016-0074 Intra-arterial nimodipine for the treatment of vasospasm due to aneurysmal subarachnoid hemorrhage A. Chiriac, Georgiana Ion*,
More informationDistal anterior cerebral artery (DACA) aneurysms are. Case Report
248 Formos J Surg 2010;43:248-252 Distal Anterior Cerebral Artery Aneurysm: an Infrequent Cause of Transient Ischemic Attack Followed by Diffuse Subarachnoid Hemorrhage: Report of a Case Che-Chuan Wang
More informationRefractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman
1 Refractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman Virginie Montiel a Cécile Grandin b Pierre Goffette b Edward Fomekong
More informationTitle Review of the Literature. Honda, Masaru; Ando, Takeo. Issue Date Right
NAOSITE: Nagasaki University's Ac Title Author(s) Proximal Anterior Cerebral Artery A Review of the Literature Honda, Masaru; Ando, Takeo Citation Acta medica Nagasakiensia, 57(3), p Issue Date 2013-02
More informationEffect of Chronic Middle Cerebral Artery Stenosis on the Local Cerebral Hemodynamics
24 Effect of Chronic Middle Cerebral Artery Stenosis on the Local Cerebral Hemodynamics HIROAKI NARITOMI, M.D.,* TOHRU SAWADA, M.D.,t YOSHIHIRO KURIYAMA, M.D.,t HIDEKAZU KINUGAWA, M.D.,t TAKAJI KANEKO,
More informationClinicoepidemiological Features of Asymptomatic Moyamoya Disease in Adult Patients
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, http://dx.doi.org/10.7461/jcen.2014.16.3.241 Original Article Clinicoepidemiological Features of Asymptomatic
More informationNicolas Bianchi M.D. May 15th, 2012
Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the
More informationTitle. Author(s) 黒田, 敏 ; 川堀, 真人 ; 宮本, 倫行 ; 笹森, 徹 ; 遠藤, 将吾 ; 中山, 若樹 ; 石川, 達哉. Citation 脳卒中の外科, 37(5): Issue Date Doc URL.
Title 側頭葉から後頭葉にかけて高度の虚血を有するもやもや病に対する脳血行再建術 Author(s) 黒田, 敏 ; 川堀, 真人 ; 宮本, 倫行 ; 笹森, 徹 ; 遠藤, 将吾 ; 中山, 若樹 ; 石川, 達哉 Citation 脳卒中の外科, 37(5): 345-349 Issue Date 2009 Doc URL http://hdl.handle.net/2115/70929
More informationSupratentorial cerebral arteriovenous malformations : a clinical analysis
Original article: Supratentorial cerebral arteriovenous malformations : a clinical analysis Dr. Rajneesh Gour 1, Dr. S. N. Ghosh 2, Dr. Sumit Deb 3 1Dept.Of Surgery,Chirayu Medical College & Research Centre,
More informationExtracranial-to-Intracranial Bypass Using Radial Artery Grafting for Complex Skull Base Tumors: Technical Note
Extracranial-to-Intracranial Bypass Using Radial Artery Grafting for Complex Skull Base Tumors: Technical Note Saleem I. Abdulrauf, M.D., F.A.C.S. 1 ABSTRACT The management of complex skull base tumors
More informationTransorbital blood flow sound recordings have the
397 Noninvasive Detection of Intracranial Vascular Lesions by Recording Blood Flow Sounds Yasushi Kurokawa, MD; Seisho Abiko, MD; Kohsaku Watanabe, MD Background and Purpose Transorbital blood flow sound
More informationCase Report. Fumihiro MATANO 1, Yasuo MURAI 2, Asami KUBOTA 1, Takayuki MIZUNARI 1, Shiro KOBAYASHI 1, Akio MORITA 2
DOI: 10.5137/1019-5149.JTN.19271-16.1 Received: 17.10.2016 / Accepted: 19.01.2017 Published Online: 07.02.2017 Case Report The Ivy Sign on Fluid Attenuated Inversion Recovery Images Related to Single-Photon
More informationTreatment of Unruptured Vertebral Artery Dissecting Aneurysms
33 Treatment of Unruptured Vertebral Artery Dissecting Aneurysms Isao NAITO, M.D., Shin TAKATAMA, M.D., Naoko MIYAMOTO, M.D., Hidetoshi SHIMAGUCHI, M.D., and Tomoyuki IWAI, M.D. Department of Neurosurgery,
More informationPosterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
Journal of Neuroendovascular Therapy 2017; 11: 371 375 Online March 3, 2017 DOI: 10.5797/jnet.cr.2016-0114 Posterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
More informationDivision of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine, Sendai 982
Tohoku J. exp. Med., 1978, 126, 125-132 Distribution of Intracranial Aneurysm TAKASHI YOSHIMOTO, TAKAMASA KAYAMA, NAMIO KODAMA and JIRO SUZUKI Division of Neurosurgery, Institute of Brain Diseases, Tohoku
More informationEndovascular Treatment of a Fusiform Aneurysm Involving a Premammillary Artery Originating from the Internal Carotid Artery: A Case Report
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, http://dx.doi.org/10.7461/jcen.2017.19.3.196 Case Report Endovascular Treatment of a Fusiform Aneurysm Involving
More informationMoyamoya disease is characterized by chronic progressive
clinical article J Neurosurg 124:1766 1772, 2016 Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography Takeshi Funaki, MD, PhD, 1 Jun C. Takahashi, MD,
More informationAlthough plaque morphology of patients with
1740 Short Communications Rupture of Atheromatous Plaque as a Cause of Thrombotic Occlusion of Stenotic Internal Carotid Artery Jun Ogata, MD, Junichi Masuda, MD, Chikao Yutani, MD, and Takenori Yamaguchi,
More informationThe Importance of Middle Cerebral Artery Stenosis In Patients With A Lacunar Infarction In The Carotid Artery Territory
The Importance of Middle Cerebral Artery Stenosis In Patients With A Lacunar Infarction In The Carotid Artery Territory Oh Young Bang, M.D., Jeong Hoon Cho, M.D., Ji Hoe Heo, M.D., Dong Ik Kim, M.D.* Department
More informationAnastomosis of the superficial temporal artery to the distal anterior cerebral artery with interposed cephalic vein graft
J Neurosurg 58~25-429, 1983 Anastomosis of the superficial temporal artery to the distal anterior cerebral artery with interposed cephalic vein graft Case report RYOJI ISHII, M.D., TETSUO KOIKE, M.D.,
More informationOcclusio Supra Occlusionem: Intracranial Occlusions Following Carotid Thrombosis as Diagnosed by Cerebral Angiography
Occlusio Supra Occlusionem: Intracranial Occlusions Following Carotid Thrombosis as Diagnosed by Cerebral Angiography BY B. ALBERT RING, M.D. Abstract: Occlusio Supra Occlusionem: Intracranial Occlusions
More informationSpontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke
Original Contribution Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke Abstract Introduction: Acute carotid artery occlusion carries
More informationMechanisms of cerebral artery thrombosis: a histopathological analysis on eight necropsy cases
J7ournal of Neurology, Neurosurgery, and Psychiatry 1994;57:17-21 17 PAPERS Research Institute, National Cardiovascular Center, Osaka, Japan J Ogata J Masuda Department of Pathology C Yutani Cerebrovascular
More information