A report of two cases

http://n-acetylaspartate.com/PDF%20files/NAA%20Review.pdf

N-Acetylaspartate in the CNS: From neurodiagnostics to neurobiology

The characteristics of moyamoya disease (spontaneous occlusion of the circle of Willis, cerebrovascular ``moyamoya'' disease) on cerebral angiography were reported for the first time in 1957,8) and the concept of moyamoya disease as a separate disease entity was established in the 1960s.1–3,6,7) Pathologically, moyamoya disease is characterized by chronic progressive stenosis of the terminal portion of the bilateral internal carotid arteries, which leads to the formation of an abnormal vascular network composed of collateral pathways at the base of the brain (moyamoya vessels at the base of the brain) (`moyamoya' is the Japanese term for a ``puff of smoke,'' which has been used to describe the appearance of these collateral vessels on cerebral angiograms6)). Eventually, with bilateral internal carotid artery occlusion, the moyamoya vessels at the base of the brain derived from the internal carotid arteries disappear, and the entire brain is perfused by the external carotid artery system and the vertebrobasilar artery system.1–3,5–7) This disease is included in the list of diseases for Research on Measures for Intractable Diseases and the Specified Disease Treatment Research Program specified by the Ministry of Health, Labour and Welfare. Currently, the diagnostic criteria for moyamoya disease (spontaneous occlusion of the circle of Willis) laid down by the research committee are as follows.4)

Moyamoya Disease (Spontaneous Occlusion of the Circle of Willis)

Transient ischemic attack

Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to...

/pdf/complications-of-cranioplasty-following-decompressive-3r96jw3ofw.pdf

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases.

https://ir.lib.hiroshima-u.ac.jp/files/public/1/17054/20141016130214393000/CNN_148_77.pdf

CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty

BACKGROUND AND PURPOSE: 3D computed tomographic angiography (3DCTA) has been used recently for the evaluation of intracerebral aneurysms, but it is difficult to use this technique to visualize aneurysms near the base of the skull because of the presence of bone. Subtracted 3DCTA could replace digital subtraction angiography (DSA) for evaluation of aneurysms near the base of the skull if the 2 methods were to give similar results. The aim of this study was to compare the evaluation of aneurysms of the internal carotid artery (ICA) near the base of the skull by subtracted 3DCTA and DSA. METHODS: CTA and DSA were obtained in 25 patients with unruptured aneurysms of the ICA. To create subtracted 3DCTA images, we used a volume subtraction (VS) method, wherein nonenhanced volume data are subtracted from enhanced volume data. CTA and DSA were reviewed by 2 neuroradiologists who performed the detection and characterization of aneurysms of the ICA by using 2D multiplanar reformatted (MPR) and VS- and nonsubtracted (NS)-3DCTA images with volume rendering techniques. RESULTS: DSA detected 29 aneurysms in the 25 patients. VS-3DCTA detected all 29 aneurysms in the 25 patients and was equivalent to DSA for evaluating their characteristics (location, size, and direction). NS-3DCTA detected 19 (1 cavernous, 4 ophthalmic, 1 superior hypophyseal, 7 posterior communicating, and 6 anterior choroidal artery) of these 29 aneurysms, but it could not characterize ophthalmic and superior hypophyseal artery aneurysms because they were only partly visible on NS-3DCTA because of bony structures. 2D-MPR images detected all but the small aneurysms (24 of 29 detected). VS-3DCTA and 2D-MPR could visualize all branching arteries (ophthalmic, posterior communicating, and anterior choroidal) detected by DSA, but NS-3DCTA could not visualize ophthalmic arteries because of the presence of bony structures. CONCLUSION: VS-3DCTA can be used as an alternative to DSA for preoperative examination of aneurysms near the skull base, where it provides equivalent identification and characterization.

http://www.ajnr.org/content/ajnr/27/6/1332.full.pdf

Subtracted 3D CT Angiography for Evaluation of Internal Carotid Artery Aneurysms: Comparison with Conventional Digital Subtraction Angiography

Epileptic seizures induced by N-acetyl-L-aspartate in rats: in vivo and in vitro studies.

Vascular endothelial growth factor (VEGF) has been found to be involved in vasculogenesis in different intracranial lesions. We investigated meningeal cellularity and VEGF expression in dura mater of patients with and without moyamoya disease. Nine dural specimens from nine cerebral hemispheres of seven patients with moyamoya disease and four control dural specimens from four non-moyamoya patients were collected during surgery and investigated. Dural specimens were immunohistochemically stained with VEGF antibody, and then meningeal cellularity and VEGF expression in dural tissue were analyzed. The mean ± standard error (SE) of total number of meningeal cells (meningeal cellularity) in dural tissue was 21.5 ± 3.0 in the moyamoya disease patients, whereas it was 2.7 ± 0.7 in control patients. The mean ± SE of VEGF expression was 51.1 ± 4.9% in the moyamoya disease patients, whereas it was 13.8 ± 5.9% in control patients. The meningeal cellularity and VEGF expression were statistically significantly higher in the moyamoya group in comparison to control group (p < 0.0001). Meningeal cellularity and VEGF expression are significantly increased in dura mater of the patients with moyamoya disease.

Expression of vascular endothelial growth factor in dura mater of patients with moyamoya disease

The role of multi-detector-row computed tomographic angiography (MDCTA) in spinal vascular malformations has not yet been determined. We present a report on a short series of spinal arteriovenous fistulae (AVF) evaluated by MDCTA. With 4-row and 16-row MDCTA, three cases of spinal dural AVF and one case of perimedullary AVF were examined. Each case was also examined by magnetic resonance (MR) imaging and spinal catheter angiography. In two patients with spinal dural AVF, including one patient with angiographically occult AVF, MDCTA successfully located the site of the AVF in a multi-planar reformation image. MDCTA failed to locate the remaining case of spinal dural AVF, probably due to the small amount of shunting blood volume at the fistula. In a patient with perimedullary AVF, MDCTA visualized the broad range of the lesion, including the anterior spinal artery as a single feeder, the fistulous point, and the single perimedullary draining vein. In conclusion, although conventional spinal angiography might be still essential, MDCTA provides useful information for the surgeon in treatment of the spinal dural AVF. Further accumulation of clinical cases is required to determine the potential of MDCTA for perimedullary AVF. MDCTA should be considered as a choice of investigation in the evaluation of spinal AVFs.

Yoshihiro Kiura

Papers

CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty

Subtracted 3D CT Angiography for Evaluation of Internal Carotid Artery Aneurysms: Comparison with Conventional Digital Subtraction Angiography

Epileptic seizures induced by N-acetyl-L-aspartate in rats: in vivo and in vitro studies.

Expression of vascular endothelial growth factor in dura mater of patients with moyamoya disease

Multi-detector-row CT angiography as a preoperative evaluation for spinal arteriovenous fistulae