1
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Bucak B, Essibayi MA, Holmes CR, Casanegra AI, Lanzino G, Keser Z. Cervical radiculopathy secondary to vertebral artery dissection: clinical features and outcomes. Neurol Res 2024; 46:339-345. [PMID: 38402908 DOI: 10.1080/01616412.2024.2321013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Cervical radiculopathy due to various mechanical causes is commonly seen, however, cervical vertebral artery dissection (cVAD)-related radiculopathy is very rare with poorly characterized clinical outcomes. Thus, we conducted a systematic review of published literature and reported an institutional case to provide a better illustration of this rare entity. METHODS We systematically reviewed the PubMed literature and queried the clinical database at our center for cVAD-related radiculopathy. We described the baseline characteristics of patients with cVAD-related radiculopathy, the involved segment, diagnostic approach and treatment options. RESULT 14 previously published studies met the inclusion criteria and along with the case we identified in our center, our study included 17 patients total (median age: 35 years, 9 females). C5 was the most commonly affected root and ipsilateral shoulder/arm pain along with shoulder abduction weakness was most common presentation. Antiplatelet or anticoagulant therapy was the treatment of choice. Most cases managed conservatively (82%). Majority of the cases (92%) had either complete or partial resolution of their symptoms. CONCLUSION Despite its limitations, this study show that cVAD related radiculopathy is a relatively benign entity with excellent clinical outcomes when managed medically.
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Affiliation(s)
- Bilal Bucak
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Muhammed A Essibayi
- Department of Neurosurgery, Albert Einstein Medical School, New York City, NY, USA
| | | | - Ana I Casanegra
- Departments of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Zafer Keser
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
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2
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Akinnusotu O, Bhatti AUR, Ghaith AK, Nieves AB, Jarrah R, Wahood W, Bydon M, Bendok BR. Outcomes following surgical and endovascular treatment of extracranial vertebral artery aneurysms (VAA): a systematic evaluation of the literature. Neurosurg Rev 2023; 46:260. [PMID: 37779135 DOI: 10.1007/s10143-023-02171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Extracranial vertebral artery aneurysms are rare complications resulting from trauma and multiple different diseases. However, the difference between clinical and surgical profiles is well understood. To investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms (VAA) treatment through a systematic review of the literature to date, an electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAAs. These results included patient-specific risk factors, indications, and techniques. Our literature search resulted in 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (ranging from 13.0 to 76.0 years), and the majority of patients were males (71%, n =39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%, n = 19). The majority of aneurysms (60%) were dissected in nature. The most common form of treatment for extracranial VAAs was the use of a flow diverter (24%, n=13). Overall, five (9%) patients had long-term adverse neurological complications following intervention with 5% (n=3) mortality, 2% (n=1) resulting in unilateral vocal cord paralysis, and 2% (n=1) resulted in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality. The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This is in contrast to the surgical approach which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAAs is essential for the future improvement of patient outcomes.
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Affiliation(s)
| | - Atiq Ur Rehman Bhatti
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Abdul Karim Ghaith
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Antonio Bon Nieves
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waseem Wahood
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33328, USA
| | - Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
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Uzuka T, Umeta R, Uchiyama H, Arihara A, Hashiguchi H, Sasaki A. Iliofemoral Aneurysm in Patients with Type 1 Neurofibromatosis: A Case Report and a Literature Review. Ann Vasc Dis 2023; 16:139-141. [PMID: 37359093 PMCID: PMC10288123 DOI: 10.3400/avd.cr.23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023] Open
Abstract
Vascular involvement, especially in the iliofemoral segment, is rare in type 1 neurofibromatosis. We herein report a case involving a 49-year-old male diagnosed with type 1 neurofibromatosis who presented with right inguinal pain and swelling. CT angiography revealed a 50-mm aneurysm extending from the right external artery to the common femoral artery. Although surgical reconstruction was performed successfully, the patient required an additional operation 6 years later for aneurysm enlargement in the deep femoral artery. Histopathological examination confirmed the proliferation of neurofibromatosis cells in the aneurysm wall.
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Affiliation(s)
- Takeshi Uzuka
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Riko Umeta
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Hiroki Uchiyama
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Ayaka Arihara
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Hitoki Hashiguchi
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
| | - Akihiko Sasaki
- Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan
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4
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Kulubya ES, Yu N, Castillo JA, Duong H. External carotid artery-radial artery-vertebral artery bypass for surgical treatment of radiculopathy caused by an extracranial vertebral artery aneurysm: A case report and review of the literature. Surg Neurol Int 2023; 14:29. [PMID: 36895229 PMCID: PMC9990782 DOI: 10.25259/sni_1099_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
Background Vertebral artery (VA) aneurysm is a rare etiology of cervical radiculopathy and there is a paucity of case reports described in the literature. Case Description We describe a case of a patient with no history of trauma presenting with a large right VA aneurysm at the C5-C6 level compressing the C6 nerve root and causing a painful radiculopathy. The patient underwent successful external carotid artery-radial artery-VA bypass followed by trapping of the aneurysm and decompression of the C6 nerve root. Conclusion VA bypass is an effective tool for treatment of symptomatic large extracranial VA aneurysms and a rare cause of radiculopathy.
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Affiliation(s)
- Edwin Samuel Kulubya
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Nina Yu
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Jose Antonio Castillo
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Huy Duong
- Department of Neurosurgery, Kaiser Permanente Medical Center, Sacramento, California, United States
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5
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Fuga M, Tanaka T, Tachi R, Nogami R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Successful Endovascular Trapping for Symptomatic Thrombosed Giant Unruptured Aneurysms of the V1 and V2 Segments of the Vertebral Artery: Case Report and Literature Review. NMC Case Rep J 2022; 8:681-690. [PMID: 35079534 PMCID: PMC8769453 DOI: 10.2176/nmccrj.cr.2021-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022] Open
Abstract
A thrombosed giant aneurysm of the V1 and V2 segments of the vertebral artery (VA) is rare. Therefore, there is controversy regarding its optimal treatment. A case of a symptomatic giant VA aneurysm located in the V1 to V2 segments on the left treated successfully by endovascular trapping of the VA is reported. A 68-year-old woman presented with swelling in the left anterior neck. Computed tomography angiography (CTA) showed a giant aneurysm measuring 47 × 58 × 47 mm3 in the left neck. Ten days after her first visit, she presented with sudden onset of left anterior neck pain. Repeated CTA showed a partial thrombus in the aneurysm. Angiography showed two thrombosed giant aneurysms located in the V1 to V2 segments of the left VA. After endovascular trapping for the aneurysms, the anterior neck pain resolved and the aneurysm gradually shrank. This case demonstrates that endovascular surgery is better than open surgery because it is less invasive. When performing endovascular treatment, trapping will be an alternative strategy for a symptomatic giant thrombotic aneurysm of the V1 and V2 segments of the VA if the patient can tolerate ischemia.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ryo Nogami
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Evans K, Lindert RB, Dyde R, Tse GH. Chronic fusiform extracranial vertebral artery aneurysm with recurrent posterior circulation emboli: Case report and review of the literature. Interv Neuroradiol 2021; 28:9-15. [PMID: 34000865 PMCID: PMC8902263 DOI: 10.1177/15910199211018581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 64-year-old man with a fusiform right extracranial vertebral artery aneurysm, spanning over half the extra-cranial V2 (foraminal) segment, presenting with recurrent multi-focal posterior circulation embolic ischaemic stroke. The patient was treated with endovascular embolisation of the right vertebral artery to prevent further thrombo-embolic events. Distal and proximal occlusion of the aneurysmal vertebral artery was performed with a micro-vascular plug with partial aneurysm sack embolisation to aid thrombosis and reduce the risk of recanalisation. Two months post procedure MR angiography confirmed successful aneurysm occlusion with no post-procedural complication. The patient returned to his normal independent life. Endovascular treatment with vessel sacrifice is an effective treatment with low morbidity and we believe the MVP device to be a efficacious option in the vertebral artery.
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Affiliation(s)
- Katherine Evans
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ralf-Björn Lindert
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Richard Dyde
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - George H Tse
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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7
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Abdulrazeq HF, Goldstein IM, Elsamna ST, Pletcher BA. Vertebral artery aneurysm rupture and hemothorax in a patient with neurofibromatosis Type-1: A case report and review of the literature. Heliyon 2019; 5:e02201. [PMID: 31406942 PMCID: PMC6684516 DOI: 10.1016/j.heliyon.2019.e02201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hael F Abdulrazeq
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, MI, USA
| | - Ira M Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Samer T Elsamna
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Beth A Pletcher
- Division of Clinical Genetics, Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, USA
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8
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Bargiela D, Verkerk MM, Wee I, Welman K, Ng E, Choong AMTL. The endovascular management of neurofibromatosis-associated aneurysms: A systematic review. Eur J Radiol 2017; 100:66-75. [PMID: 29496081 DOI: 10.1016/j.ejrad.2017.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurofibroblastoma (NF) or Von Recklinghausen disease, is an autosomal dominant disorder affecting one in 3000 individuals. Cardinal features of NF include multiple café-au-lait macules, benign neurofibromas, and iris hamartomas. Albeit less common, vascular lesions of medium and large-sized arteries and veins are a well-recognized complication, which can lead to fatal consequences such as rupture. METHOD A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines utilizing PubMed, EMBASE, and Cochrane databases. RESULTS There were 59 articles identified involving 66 patients (mean age 44.3 ± 30 years), of which 89% had neurofibromatosis type 1. There were 63.6% of patients who presented with aneurysm rupture, 33.3% presented with intact symptomatic aneurysms, and 3.1% presented with intact asymptomatic aneurysms. Anatomically, 4.5% of patients suffered from intracranial aneurysms; 12.1% suffered from visceral artery aneurysms (including hepatic, superior mesenteric, gastroduodenal and renal arteries), and other patients suffered from aneurysms within the chest, abdomen, pelvis, upper limbs and neck. Amongst the various endovascular procedures, coiling was performed in 83.3% of cases. There were 12 covered stents employed in 10 patients (18.2%), of which 7 were balloon-expandable grafts; 2 were self-expandable graft; 3 were not mentioned. The rates of major and minor complications were 15% and 6% respectively, with 4 cases (6%) of perioperative death. On a mean follow-up of 15 months (range 1.5-72 months), two patients developed a distant vascular lesion from the treated lesion. CONCLUSION Endovascular management is safe and effective even in hemodynamically unstable neurofibroblastoma patients at all ages. Vascular tree screening should be conducted in clinically suspicious patients to prevent fatal aneurysmal complications. A formal meta-analysis could not be performed due to the lack of randomized controlled trials.
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Affiliation(s)
- David Bargiela
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - Misha M Verkerk
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Ear, Nose and Throat Department, St George's Hospital, London, UK
| | - Ian Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kiera Welman
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Hervey Bay Hospital, Pialba, Queensland, Australia
| | - Eugene Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Department of Vascular Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Division of Vascular Surgery, National University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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9
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Bissacco D, Domanin M, Romagnoli S, Martelli E, Civelli V, Gabrielli L. Spontaneous Rupture of Multiple Occipital Artery Aneurysms in a Patient With Neurofibromatosis Type 1. Vasc Endovascular Surg 2017; 52:86-88. [PMID: 29162026 DOI: 10.1177/1538574417742285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic disorder, mainly characterized by skin and peripheral nervous system abnormalities. Uncommonly, NF-1 may be associated with peripheral or supra-aortic trunks artery aneurysms. We report a case of symptomatic multiple occipital artery aneurysms detected in a 53-year-old woman affected by sporadic NF-1. An endovascular approach was performed to exclude aneurysms and to stop laterocervical spontaneous hematoma.
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Affiliation(s)
- Daniele Bissacco
- 1 School of Vascular Surgery, Università degli Studi di Milano, Italy
| | - Maurizio Domanin
- 2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,3 Operative Unit of Vascular Surgery, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- 3 Operative Unit of Vascular Surgery, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Martelli
- 3 Operative Unit of Vascular Surgery, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Civelli
- 4 Operative Unit of Neuroradiology, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Livio Gabrielli
- 2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,3 Operative Unit of Vascular Surgery, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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10
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Kiyohira M, Ishihara H, Oku T, Kawano A, Oka F, Suzuki M. Successful endovascular treatment for thrombosed giant aneurysm of the V1 segment of the vertebral artery: A case report. Interv Neuroradiol 2017; 23:628-631. [PMID: 28750562 DOI: 10.1177/1591019917722515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thrombosed giant aneurysm of the V1 segment of the vertebral artery is rare, and there is controversy regarding the optimal method of treatment in this portion. Here, we report a thrombosed giant aneurysm of the V1 segment of the vertebral artery with a good clinical course with endovascular proximal artery occlusion of the vertebral artery. A 59-year-old woman presented with a large mass in the left side of the neck. Echographic examination revealed a mass measuring 42 × 38 × 48 mm in the left neck. Angiography showed a thrombosed giant aneurysm of the V1 segment of the left vertebral artery. Endovascular proximal artery occlusion of the vertebral artery was performed, and the aneurysm lessened gradually. Although a number of procedures have been developed to treat extracranial vertebral artery aneurysms, endovascular proximal artery occlusion is a good option to treat aneurysms in this portion.
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Affiliation(s)
- Miwa Kiyohira
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Takayuki Oku
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Akiko Kawano
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Neurofibromatosis Type 1-Associated Extracranial Vertebral Artery Aneurysm Complicated by Vertebral Arteriovenous Fistula After Rupture: Case Report and Literature Review. World Neurosurg 2016; 96:609.e13-609.e18. [PMID: 27647034 DOI: 10.1016/j.wneu.2016.09.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extracranial vertebral artery aneurysm related to neurofibromatosis type 1 (NF1) is rare. Aneurysmal rupture typically induces such symptoms as cervical hematoma, hemothorax, and hypotension. Here we report a case of ruptured extracranial vertebral artery aneurysm in a patient with NF1 who, rather than cervical hematoma, hemothorax, or hypotension, developed a vertebral arteriovenous fistula (AVF) after aneurysm rupture. CASE DESCRIPTION A 35-year-old woman with a family history of NF1 presented with sudden-onset right neck and shoulder pain. Computed tomography angiography showed a right extracranial vertebral artery aneurysm. She had neither a cervical hematoma nor hypotension; however, angiography showed an AVF secondary to aneurysmal rupture. The patient was treated with endovascular coil embolization to prevent re-rupture. Postoperatively, her right neck and shoulder pain improved, and she was discharged without further neurologic deficits. CONCLUSIONS This patient's clinical course suggests that if there is minimal bleeding from an NF1-associated ruptured extracranial vertebral artery aneurysm, then typical symptoms, such as cervical hematoma, hemothorax, and hypotension, may be absent. Thus, ruptured extracranial vertebral artery aneurysm should be considered in the differential diagnosis of patients with NF1 with sudden-onset radiculopathy, even in the absence of typical symptoms. The detection of a vertebral AVF provides a useful clue to the diagnosis of aneurysm rupture in such cases.
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12
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Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: A review. Interv Neuroradiol 2016; 22:624-637. [PMID: 27511817 DOI: 10.1177/1591019916659262] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.
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13
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Kunert P, Prokopienko M, Czernicki T, Nowak A, Marchel A. Sensorimotor C5 and C6 radiculopathy caused by thrombosed vertebral artery dissection and successfully treated with limited oblique corpectomy - Case report. Neurol Neurochir Pol 2016; 50:48-51. [PMID: 26851690 DOI: 10.1016/j.pjnns.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
The authors report the case of an exceptional presentation of vertebral artery dissection. A 44-year-old man who presented with left shoulder weakness, radicular pain and numbness of the left forearm and thumb was admitted to our hospital with an initial diagnosis of cervical disc herniation. Due to the inconsistency between the levels of radiculopathy (C5 and C6) and discopathy (C6-C7), neuroimaging examinations were extended. Based on MRI, MRA, CTA and DSA, left vertebral artery dissection with intramural hematoma was diagnosed. The patient underwent surgical decompression of the affected nerve roots using the anterolateral approach described by Bernard George. The radicular pain resolved immediately and sensorimotor deficit completely disappeared within 4 months. MRI/MRA performed 6 months after surgery showed the normal image of the vertebral artery. There were no ischemic events within 2.5 years of follow-up.
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Affiliation(s)
- Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Marek Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Tomasz Czernicki
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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14
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Successful Hybrid Management of a Left Vertebral Artery Aneurysm Secondary to Type-1 Neurofibromatosis. Ann Vasc Surg 2014; 28:1936.e1-4. [DOI: 10.1016/j.avsg.2014.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/15/2022]
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15
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Pereira VM, Brina O, Gonzalez AM, Narata AP, Ouared R, Karl-Olof L. Biology and hemodynamics of aneurismal vasculopathies. Eur J Radiol 2013; 82:1606-17. [DOI: 10.1016/j.ejrad.2012.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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16
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Morasch MD, Phade SV, Naughton P, Garcia-Toca M, Escobar G, Berguer R. Primary Extracranial Vertebral Artery Aneurysms. Ann Vasc Surg 2013; 27:418-23. [DOI: 10.1016/j.avsg.2012.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/29/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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De Santis F, Negri G, Martini G, Mazzoleni G. Multiple aneurysms of the radial artery in a woman with neurofibromatosis type 1 presenting as aneurysm rupture. J Vasc Surg 2013; 58:1394-7. [PMID: 23561427 DOI: 10.1016/j.jvs.2013.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 11/15/2022]
Abstract
A 48-year-old woman with neurofibromatosis type 1 (NF1) experienced progressive forearm swelling coupled with impending compartment syndrome. Computed tomography angiography revealed a ruptured aneurysm of the proximal radial artery, multiple fusiform radial artery aneurysms, and a high independent ulnar artery origin. Compartment syndrome required prompt hematoma evacuation. Radial artery reconstruction, technically demanding due to vessel wall fragility, was deemed unnecessary because of satisfactory blood supply to the hand. Histologic findings indicated NF1-related vascular abnormalities also in the apparently normal radial artery as well as in a forearm vein, suggesting diffused vasculopathy. This case report is the first on ruptured radial artery aneurysm in NF1-related polianeurysmatic degeneration.
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Affiliation(s)
- Francesco De Santis
- Department of Vascular Surgery, Bressanone Hospital, Bressanone/Brixen, Italy.
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18
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Kim C, Lee SH, Park SS, Kim BJ, Ryu WS, Kim CK, Oh MY, Chung JW, Yoon BW. A Quantitative Comparison of the Vertebral Artery and Transverse Foramen Using CT Angiography. J Clin Neurol 2012; 8:259-64. [PMID: 23323133 PMCID: PMC3540284 DOI: 10.3988/jcn.2012.8.4.259] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/20/2012] [Accepted: 03/20/2012] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The vertebral artery (VA) is important for the development of the transverse foramen (TF). Most studies of these structures have focused on anatomical anomalies. Therefore, we investigated quantitatively the association between the relative sizes of the TF and VA. Methods We recruited a consecutive series of subjects who underwent CT angiography to estimate the relative sizes of the VA and TF in axial source images. Two neurologists independently reviewed the axial CT images of 208 patients who had no history of transient ischemic attack or stroke. Averaged areas of the VA and TF were defined by the sum of the areas at each level from C3 to C6, divided by 4. Correlation analyses were adjusted for age, sex, and vascular risk factors. Results The mean age of the subjects was 53 years. The interobserver and intraobserver reliabilities of TF size were good. There was a linear relationship between the sizes of the VA and TF on each side (right side: r2=0.58, p<0.001; left side: r2=0.62, p<0.001). The area of the VA was significantly associated with that of the TF after adjusting for vascular risk factors. Conclusions The size of the VA is strongly and linearly correlated with the size of the TF. These findings suggest that measurement of the TF and VA with CT angiography is a reliable method for evaluating VA diseases, and may provide new insight into the differentiation between VA hypoplasia and atherosclerosis of the VA.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Korea
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19
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Hughes DG, Alleyne CH. Rare giant traumatic cervical arteriovenous fistula in neurofibromatosis type 1 patient. BMJ Case Rep 2012; 2012:bcr.12.2011.5354. [PMID: 22744260 DOI: 10.1136/bcr.12.2011.5354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Arteriovenous fistulas can rarely occur in patients with neurofibromatosis type 1. These lesions typically result from traumatic insult to the dysplastic parent artery. The damaged artery forms abnormal connections with nearby paraspinal and epidural venous structures. Surgical treatment of these lesions can be extremely challenging given the proximity to the spinal cord and the ability of the fistula to recruit vessels from adjacent vascular structures. A 29-year-old woman with neurofibromatosis type 1 and a motor vehicle collision 2 years earlier presented with gait difficulty, lower extremity spasticity and neck and arm pain. Her investigation revealed a giant cervical vertebral arteriovenous fistula. The fistula was successfully treated in multiple stages using all endovascular techniques including detachable coils, stents and glue embolisation. Reduction in flow and improvement in symptoms are reasonable goals in this specific rare subgroup of complex cervical arteriovenous fistulae.
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Affiliation(s)
- Douglas G Hughes
- Neurosurgery Department, Medical College of Georgia, Georgia Health Sciences University, Augusta, Georgia, USA
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Hiramatsu H, Matsui S, Yamashita S, Kamiya M, Yamashita T, Akai K, Watanabe K, Namba H. Ruptured extracranial vertebral artery aneurysm associated with neurofibromatosis type 1. Case report. Neurol Med Chir (Tokyo) 2012; 52:446-9. [PMID: 22729080 DOI: 10.2176/nmc.52.446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass. Three-dimensional computed tomography angiography showed a large aneurysm involving the right extracranial vertebral artery associated with a pseudoaneurysm. The aneurysm was successfully treated by transarterial endovascular trapping with detachable coils. Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.
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Affiliation(s)
- Hisaya Hiramatsu
- Department of Neurosurgery, Hamamatsu University School of Medicine, Japan.
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21
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Uzuka T, Ito T, Koyanagi T, Maeda T, Tabuchi M, Kawaharada N, Higami T. Giant intercostal aneurysm complicated by Stanford type B acute aortic dissection in patients with type 1 neurofibromatosis. J Cardiothorac Surg 2012; 7:38. [PMID: 22531095 PMCID: PMC3423040 DOI: 10.1186/1749-8090-7-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
Vascular involvement is rare in neurofibromatosis type 1 (NF1). It is often missed because it is usually asymptomatic. We report a case of a 42 years old male with neurofibromatosis type 1 who presented with left back discomfort. CT angiography revealed a massive 42 mm aneurysm of left 11th intercostal artery. After a discussion between radiologists and cardiothoracic surgeons, endovascular coil embolization was chosen to treat this patient. Percutaneous aneurysm embolization was successfully performed. However, the procedure was complicated by Stanford type B acute aortic dissection. Stanford type B acute aortic dissection was medically managed and patient remained well after discharge. Fragile vascular nature was thought to be one of the causes of this unreported complication.
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Affiliation(s)
- Takeshi Uzuka
- Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan.
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22
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Morvan T, de Broucker F, de Broucker T. Subarachnoid hemorrhage in neurofibromatosis type 1: case report of extracranial cerebral aneurysm rupture into a meningocele. J Neuroradiol 2011; 38:125-8. [PMID: 21215453 DOI: 10.1016/j.neurad.2010.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 10/22/2010] [Accepted: 11/07/2010] [Indexed: 11/29/2022]
Abstract
Described here is a case of subarachnoid hemorrhage due to rupture of an extracranial vertebral artery (V3 segment) aneurysm in a patient with neurofibromatosis type 1 (NF-1). The pathophysiology of this never-before reported complication of NF-1 is examined in the light of a focused literature review and with illustrations characteristic of this unique case, involving complex malformations of the spine and meningeal spaces, as well as of the vertebral artery wall itself. All these abnormalities are directly related to the underlying NF-1 disease.
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Affiliation(s)
- T Morvan
- Service de neurologie et d'imagerie médicale, hôpital Delafontaine, 93200 Saint-Denis, France
| | - F de Broucker
- Service de neurologie, hôpital Delafontaine, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France
| | - T de Broucker
- Service de neurologie et d'imagerie médicale, hôpital Delafontaine, 93200 Saint-Denis, France.
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Higa G, Pacanowski JP, Jeck DT, Goshima KR, León LR. Vertebral artery aneurysms and cervical arteriovenous fistulae in patients with neurofibromatosis 1. Vascular 2010; 18:166-77. [PMID: 20470689 DOI: 10.2310/6670.2010.00032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular involvement in the setting of neurofibromatosis type 1(NF1) has been well described. However, the coexistence of NF1 with vertebral artery (VA) aneurysms and arteriovenous fistulae (AVFs) is a rare occurrence. A 60-year-old female with NF1 and other severe comorbidities presented with acute respiratory insufficiency caused by a ruptured large VA aneurysm and an associated AVF that required emergent intubation and eventual repair through endovascular techniques that resolved her symptoms. A detailed description of this case and a comprehensive review of the literature are also presented.
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Simulated surgery for a patient with neurofibromatosis type-1 who had severe cervicothoracic kyphoscoliosis and an anomalous vertebral artery. Spine (Phila Pa 1976) 2010; 35:E368-73. [PMID: 20375776 DOI: 10.1097/brs.0b013e3181c42559] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe the usefulness of simulated surgery for evaluation of a patient with neurofibromatosis type-1 (NF-1) who had severe cervicothoracic kyphoscoliosis and an anomalous vertebral artery (VA). SUMMARY OF BACKGROUND DATA Several surgical procedures have been used in the treatment of cervicothoracic kyphoscoliosis associated with myelopathy in patients with NF-1. However, to our knowledge, there has been no report that describes a surgical procedure for NF-1 patients with anomalous VA at the cervical spine. METHODS A 45-year-old man with NF-1 developed cervical myelopathy. Preoperative examinations revealed severe cervicothoracic kyphoscoliosis, dystrophic changes of the cervical vertebrae, and the anomalous course of a VA and VA aneurysms. To assist in the preoperative planning and intraoperative navigation, we created 3-dimensional (3D) full-scale models of the patient's spine. Using a model, we performed a simulation of the planned surgery for spinal cord decompression with spinal fusion through both anterior and posterior approaches. RESULTS Through the simulation, we could evaluate the risk of VA injury at the process of corpectomy, and altered the surgical procedure for the spinal cord decompression with spinal fusion from a posterior approach and a bone graft alone from an anterior approach. We accomplished the surgery successfully without any neurovascular complications. After surgery, the patient experienced relief from myelopathy. CONCLUSION Preoperative surgical simulation using a 3D full-scale model was useful for improving the accuracy and safety of the surgery for cervicothoracic kyphoscoliosis with NF-1.
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Aizawa K, Iwashita C, Saito T, Misawa Y. Spontaneous rupture of an intercostal artery in a patient with neurofibromatosis type 1. Interact Cardiovasc Thorac Surg 2010; 10:128-30. [PMID: 19833637 DOI: 10.1510/icvts.2009.222125] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kei Aizawa
- Division of Cardiovascular Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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