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Biomedical subjects

Masaki Komiyama

Publications and source records attributed to Masaki Komiyama.

15 recordsLinked to original sources
PubMed2005

A brainstem cavernoma demonstrating a dramatic, spontaneous decrease in size during follow-up: case report and review of the literature.

BACKGROUND: Many reports have demonstrated a worse prognosis for patients whose cavernomas were subtotally removed than for those whose cavernomas were not surgically treated. Therefore, it is better not to touch the cavernoma if a surgeon is not prepared to totally remove it. This report describes a large brainstem cavernoma showing a spontaneous, dramatic reduction in size after removal of only the biopsy specimen of the lesion. CASE DESCRIPTION: A 42-year-old woman experienced facial numbness, diplopia, and ataxia. A magnetic resonance (MR) study revealed a pontine cavernoma with hemorrhage. Two weeks later, recurrence of the patient's symptoms and consciousness disturbance were noted. An MR study revealed massive hemorrhage from the cavernoma with a ventricle dilatation. An operation on the lesion was conducted 3 months after the initial hemorrhage. However, the operation was aborted when an exploration of the lesion showed a tight adhesion between the lesion and the pons. Removal of only a biopsy specimen and evacuation of the suckable hematoma were done. No neurologic recovery and no decrease in the size of the cavernoma were detected postoperatively. Her family did not wish for further treatments. She was in a bedridden state with severe brainstem dysfunction when she was transferred to a local hospital. Sixteen months after the surgery, her consciousness was clear, and MR imaging confirmed a marked reduction in the size of the cavernoma. CONCLUSION: A dramatic, spontaneous decrease in size does occur even in the case of a large brainstem cavernoma showing hemorrhages. Conservative therapy may be one of the treatment options for the symptomatic brainstem cavernoma.

Adult↗
PubMed2005

[The usefulness of adjuvant therapy using gamma knife radiosurgery for the recurrent or residual nonfunctioning pituitary adenomas].

We evaluated the treatment results of nonfunctioning pituitary adenomas in the era of radiosurgery. Between January 1994 and December 2003, we operated on 44 patients with nonfunctioning pituitary adenomas. 43 patients were operated on by transsphenoidal surgery and one patient was operated on by the transcranial approach. Total removal was able to be achieved in 13 patients (30%). Gamma knife radiosurgery was performed for residual tumor in 26 patients and for recurrence in 2 patients. The mean tumor diameter at the gamma knife radiosurgery was 18.2 mm (7.9 to 26.3 mm). The treatment dose was a mean of 12.3 Gy (8 to 16 Gy) to the tumor margin. The mean follow-up period after radiosurgery was 36.4 months. Tumor growth control was able to be achieved in 26 patients (93%). Two patients (7%) required adrenal and thyroid hormonal replacement during the follow-up period after radiosurgery due to radiation-induced endocrinopathy. None of the patients suffered from new cranial nerve deficits. This included optic neuropathy. Surgical resection using transsphenoidal surgery and subsequent gamma knife radiosurgery for residual and recurrent tumor proved to have a highly effective tumor growth control rate, and maintained the quality of life in patients with nonfunctioning pituitary adenomas.

Adenoma↗
PubMed2004

Regrowth and fatal rerupture despite proximal occlusion after coil embolization of a ruptured large basilar bifurcation aneurysm--case report.

A 40-year-old man suffered chronic progressive symptoms of brainstem compression after undergoing endosaccular coil placement in a ruptured large basilar bifurcation aneurysm. Radiographical examinations showed coil compaction and regrowth of the aneurysmal mass with perifocal mesencephalic edema. The symptoms did not resolve even after additional clip occlusion of the upper basilar artery and the patient died of rerupture. At present, direct surgical clipping using a skull base technique with or without hypothermic circulatory arrest or upper basilar artery occlusion with or without bypass surgery may be a better choice as an initial treatment for giant or large basilar bifurcation aneurysm with a wide neck.

Adult↗
PubMed2004

Endovascular treatment of dural sinus malformation with arteriovenous shunt in a low birth weight neonate--case report.

A boy was born at 36 weeks gestation weighing 2,135 g, with a prenatal diagnosis of dural sinus malformation with arteriovenous shunts. Congestive heart failure and anuria at birth prompted emergency intervention. Transfemoral-transvenous coil embolization was performed on day 1, resulting in partial occlusion of the huge venous pouch with a total length of 2,355 cm of detachable coils. Transarterial glue embolization on days 7, 23, and 42 was required due to persistent heart failure. Transarterial embolization was performed by common carotid puncture because the transfemoral route could not be used due to the small size and compromised blood flow of the femoral artery. Transarterial embolization reduced the arteriovenous shunts markedly and resulted in clinical improvement. Early treatment of a high flow dural arteriovenous fistula in a low birth weight neonate can achieve an excellent result with an acceptable neurological outcome.

Arteriovenous Shunt, Surgical↗
PubMed2004

Serial antenatal sonographic observation of cerebral dural sinus malformation.

Dural sinus malformation is an extremely rare congenital cerebrovascular malformation. We report serial antenatal sonographic findings in two patients with dural sinus malformation. Sonography can reveal dural sinus malformation at 24 weeks' gestation. Correct and early diagnosis may help determine the appropriate place, timing, and mode of delivery, which may result in a better therapeutic course and patient outcome.

Adult↗
PubMed2003

Acute angle-closure glaucoma after successful embolization of traumatic carotid-cavernous sinus fistula--case report.

A 69-year-old woman developed acute angle-closure glaucoma 2 weeks after successful transvenous coil embolization of a traumatic carotid-cavernous sinus fistula. The angle-closure glaucoma was precipitated by oculomotor palsy caused by transvenous coil packing of the cavernous sinus. Emergency iridotomy resulted in normalization of the intraocular pressure and restoration of vision. Acute angle-closure glaucoma may develop in association with an oculomotor palsy caused by any etiology, including neurointervention.

Aged↗
PubMed2003

[Surgical stress in patients with asymptomatic unruptured intracranial aneurysms].

BACKGROUND: Surgical stress elicits a characteristic response involving induction of synthesis and release of acute-phase proteins such as C-reactive protein (CRP). To objectively evaluate the surgical stress in patients with asymptomatic unruptured intracranial aneurysms, serum levels of CRP after direct clipping via the pterional approach were measured. METHODS: 42 patients who experienced an uneventful postoperative course, were evaluated according to age (less or more than 65 years old [adult or elderly]), aneurysmal location (middle cerebral artery territory [MC], anterior communicating artery [Acom] or internal carotid artery territory [IC]) and intraoperative trauma (positive or negative). We defined intraoperative trauma as intentional vein cutting, perforator vessel injury or suction of the gyrus rectus. All patients received standardized general anesthesia and were treated after the operations according to our standard protocols. Serum levels of CRP on postoperative day 2 were compared in each category. RESULTS: Serum levels of CRP showed no significant difference between the adult group and the elderly group, but were greater in Acom patients than in MC and IC patients (p < 0.01, p < 0.05). As to intraoperative traumas, the positive group (almost all were intentional vein cutting) showed greater CRP levels than the negative group in MC and IC patients (p < 0.05). Operation time and volume of blood loss were almost the same in each category. CONCLUSION: Our study shows that as far as serum levels of CRP are concerned, Acom location and vein cutting are the main factors of surgical stress in cases of unruptured aneurysms.

Aged↗
PubMed2003

[The surgical treatment strategy and results of parasellar meningiomas in the era of radiosurgery].

We evaluated the surgical treatment results of parasellar meningiomas in the era of radiosurgery. We treated 24 patients of parasellar meningiomas surgically. The median age was 60 yrs (ranging from 29 to 82 yrs). The most common tumor location was the sphenoid ridge in 12 patients and the tuberculum sellae in 7 patients. The pterional approach using fronto-temporal craniotomy was performed for all patients. The residual or recurrent tumors were treated by gamma knife radiosurgery (GKS). We are able to follow up these cases for a median of 3.8 yrs (ranging from 1 to 8 yrs) after the operations. The radicality of tumor resection was Simpson grade II in 13 patients (54%), grade III in 3 patients (13%) and grade IV in 7 patients (33%). Clinical improvement was achieved in 81% of the patients. Of the patients who had visual disturbance preoperatively, 8 patients (73%) showed improvement, but 3 patients suffered deterioration postoperatively. None of the patients died. One patient suffered transient memory disturbance and one patient suffered mild facial numbness postoperatively. Boost radiosurgery for the residual tumors was performed for six patients and tumor growth control was able to be achieved in all patients, with a median of 3.1 years follow-up period (ranging from 0.5 to 6 yrs). Five patients with tumor regrowth or recurrence were treated by GKS. We recommend fronto-temporal craniotomy with nonradical resection for parasellar meningiomas and radiosurgery for residual and recurrent tumors. This strategy will achieve good functional outcome with long-term tumor growth control.

Adult↗
PubMed2003

[The treatment for asymptomatic meningiomas in the era of radiosurgery].

We evaluated the treatment results in asymptomatic meningiomas in the era of radiosurgery. We encountered 56 patients with asymptomatic meningiomas from January, 1994 to December, 2001. There were 16 male patients and 40 female patients. The most common location was the cerebral convexity. We performed gamma knife radiosurgery for three patients after diagnosis of cavernous sinus meningiomas. The other patients were followed-up after diagnosis for a mean follow-up period of 30.8 months (5 months to 8 years). Tumor growth was verified in 25 patients (43%) and two patients (3.7%) suffered neurological deficits. Among the tumor growth patients, operative resection was performed in six patients (11%) and gamma knife radiosurgery was performed in four patients (7.5%). The other patients were placed under observation. We decided the treatment strategy paying attention to the tumor location, tumor growth speed, tumor size and operative difficulty. The tumor growth rate was 0.1 cm/year among the patients with tumor growth. It was 0.72 cm/year (0.02 to 1.54 cm/year) in the operative group, 0.3 cm/year (0.04 to 0.76 cm/year) in the gamma knife radiosurgery group and 0.08 cm/year (0.01 to 0.76 cm/year) in the observed group. One patient suffered procedure-related deterioration of paresis after operation. The treatment of asymptomatic meningiomas must be decided depending on their natural history and locations. We recommend early radiosurgery for cavernous sinus meningiomas.

Aged↗
PubMed2002

Constructive interference in steady state imaging of moyamoya disease.

The diagnostic accuracy of three-dimensional constructive interference in steady state (CISS) magnetic resonance (MR) imaging was evaluated for the assessment of idiopathic moyamoya disease. Six consecutive patients underwent MR angiography, CISS imaging, and digital subtraction angiography. MR angiography and CISS imaging visualization of the steno-occlusive changes in the distal internal carotid arteries and the development of moyamoya vessels in the basal cistern were compared to the results obtained by digital subtraction angiography. MR angiography revealed the steno-occlusive changes correctly in nine and overestimated the changes in three of 12 hemispheres examined. CISS imaging showed the steno-occlusive changes defined as decreased caliber of the internal carotid artery correctly in two, underestimated the changes in nine, and overestimated the changes in one of the 12 hemispheres. MR angiography detected moyamoya vessels correctly in five and underestimated the vessels in seven of the 12 hemispheres. CISS imaging revealed the moyamoya vessels correctly in 10, underestimated the vessels in one, and overestimated the vessels in one of the 12 hemispheres. CISS imaging can supplement MR angiography in the non-invasive diagnosis of moyamoya disease, especially for the evaluation of moyamoya vessels.

Adolescent↗
PubMed2002

Dural arteriovenous fistula involving the superior sagittal sinus following sinus thrombosis--case report.

A 57-year-old woman presented with a dural arteriovenous fistula (AVF) involving the superior sagittal sinus (SSS) based upon serial radiological examinations. Her chief complaints were headache and vomiting. Cerebral angiography and magnetic resonance (MR) venography revealed the sinus thrombosis involving the SSS, the bilateral transverse sinuses (TSs), and the right sigmoid sinus. Her symptoms disappeared after anticoagulant therapy. Follow-up MR venography revealed almost complete recanalization of the occluded sinuses, followed by restenosis of the SSS and the left TS and occlusion of the right TS without symptoms. She developed transient right hemiparesis 13 months after the initial onset. Cerebral angiography revealed a dural AVF involving the SSS with cortical reflux into the left frontoparietal region. The dural AVF was occluded by transarterial and transvenous embolization. Her symptom disappeared during the follow-up period.

Anticoagulants↗
PubMed2002

[Dejerine-Roussy syndrome following endovascular parent artery occlusion for an unruptured posterior cerebral artery aneurysm (P2 segment): case report].

A right posterior cerebral artery (PCA) fusiform aneurysm was incidentally discovered in a 53-year-old man. Although the aneurysm was asymptomatic, treatment of the aneurysm was indicated to avoid possible hemorrhage and/or mass effect. Since the patient tolerated temporary balloon occlusion of the right PCA at P1-P2 segments and sufficient collateral flow to the right temporo-occipital region was observed during such occlusion, parent artery occlusion as well as intraluminal occlusion of the aneurysm was performed with Guglielmi detachable coils. The patient did not develop neurological deficit immediately after embolization. However, he subsequently developed Dejerine-Roussy syndrome due to an infarction in the territory of the thalamogeniculate artery. Parent artery occlusion together with intraluminal aneurysmal obliteration is an useful treatment for a fusiform aneurysm of the PCA. However, ischemic complication in the territory of the perforating artery can not be predicted.

Balloon Occlusion↗
PubMed2002

[Results of treatment for male prolactinomas].

We evaluated the results of medical treatment for male prolactinomas. We encountered eight patients with male prolactinomas. The age was 25 to 54 years old (mean 43 years) and the chief clinical symptoms were visual acuity/field defect in three patients, pituitary apoplexy in one patient, disturbance of ejection in one patient, generalized convulsion in one patient, headache in one patient and general fatigue in one patient. The serum prolactin level was 279 to 7,360 ng/ml (mean 2,832 ng/ml). The tumors in all patients were large with a mean diameter of 34.9 mm (range, 21 to 43 mm). In only one patient, the operation was performed due to pituitary apoplexy. All the patients were treated by medication, with bromocriptine being used in seven patients and terguride in one. The follow-up period was 0.8 to 13 years (mean 5.9 years) and, in all patients, the medical treatment was continued. The tumor decreased in size in all patients and the serum prolactin level at the last follow-up observation was 0.5 to 70.5 ng/ml (mean 26.9 ng/ml). All the neurological symptoms disappeared in the early stage of treatment. As for the complications of medical treatment; in one patient, orthostatic hypotension occurred during the initial administration of bromocriptine and one patient suffered CSF leakage two months after the administration of bromocriptine, so the repair of the sella floor by transsphenoidal surgery was necessary. The medical treatment for male prolactinomas is effective for a long term and should be the primary treatment for the male prolactinomas. In conclusion, patients can maintain a good quality of life for a long time by using dopamine agonists.

Adult↗