記述言語：英語   掲載種別：学位論文（その他）  

BACKGROUND: The hemodynamic changes that occur after high-flow (extracranial-intracranial) EC-IC bypass surgery with internal carotid artery (ICA) ligation are not well known. OBJECTIVE: To assess blood flow changes after high-flow EC-IC bypass with ICA ligation by time-resolved 3-dimensional phase-contrast (4D Flow) magnetic resonance imaging (MRI). METHODS: We enrolled 11 patients who underwent high-flow EC-IC bypass. 4D Flow MRI was performed before and after surgery to quantify the blood flow volume (BFV) of the ipsilateral ICA (BFViICA), bypass artery (BFVbypass), contralateral ICA (BFVcICA), and basilar artery (BFVBA). Subsequently, we calculated the total BFV (BFVtotal = BFViICA + BFVcICA + BFVBA [before surgery], BFVcICA + BFVBA + BFVbypass [after surgery]). The BFV changes after bypass was statistically analyzed. RESULTS: BFVbypass was slightly lower than BFViICA, but the difference was not statistically significant (3.84 ± 0.94 vs 4.42 ± 1.38 mL/s). The BFVcICA and BFVBA significantly increased after bypass surgery (BFVcICA 5.89 ± 1.44 vs 7.22 ± 1.37 mL/s [P = .0018], BFVBA 3.06 ± 0.41 vs 4.12 ± 0.38 mL/s [P < .001]). The BFVtotal significantly increased after surgery (13.37 ± 2.58 vs 15.18 ± 1.77 mL/s [P = .015]). There was no evidence of hyperperfusion syndrome in any cases. CONCLUSION: After high-flow EC-IC bypass with permanent ICA ligation, the bypass artery could partially compensate for the loss of BFV of the sacrificed ICA. The increased flow of the contralateral ICA and BA supply collateral blood flow. Clinically irrelevant hyperperfusion was observed.

DOI： 10.1093/neuros/nyy192

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography. METHODS: In a systematic review of OVID MEDLINE-with additional hand-searching of relevant studies' bibliographies- from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5-24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known. FINDINGS: Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56-76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36-0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46-11·60; p<0·0001), antiplatelet use (1·68, 1·06-2·66; p=0·026), and anticoagulant use (3·48, 1·96-6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75-0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95-6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03-0·07). INTERPRETATION: In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials. FUNDING: UK Medical Research Council and British Heart Foundation.

DOI： 10.1016/S1474-4422(18)30253-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND AND PURPOSE: Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign. METHODS: We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates. RESULTS: Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours (P<0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased (P=0.004), with positive predictive values decreasing from 53% to 33%. CONCLUSIONS: The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.

DOI： 10.1161/STROKEAHA.115.012012

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Transluminal balloon angioplasty (TBA) has come into wide use for management of symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH). The long-term effects of TBA in this clinical context on cerebral blood flow (CBF) and the functional properties of the arterial wall after aneurysmal SAH remain controversial. We therefore studied these effects. METHODS: All patients underwent unilateral TBA. Xenon-enhanced computed tomography was performed for an average of 18 days after TBA to measure CBF and cerebrovascular reactivity (CVR). Cerebral blood flow and CVR were compared between the side of TBA and the contralateral side. RESULTS: Nineteen vascular territories were treated successfully with TBA in 12 patients. Angiographic improvement of vasospasm was demonstrated in all 12 patients, and 9 (75%) patients showed neurological improvement. After balloon angioplasty, global CBF was 35.1 +/- 8.2 mL/100 g per minute, with CBF on the side with TBA (37.8 +/- 10.3 mL/100 g per minute) being essentially the same as that on the other side (P = .0671, paired Student t test). Likewise, reactivity to acetazolamide did not differ significantly between sides (P = .0817). CONCLUSION: Transluminal balloon angioplasty increased proximal vessel diameters but showed no significant influence on CBF or vascular reactivity 3 weeks later. Benefits presumably were short term, but the procedure was clinically safe.

DOI： 10.1016/j.surneu.2004.11.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The authors report a case in which a germinoma in the pineal body displayed spontaneous regression after placement of a ventriculoperitoneal (VP) shunt. Spontaneous regression of malignant tumors is extremely rare, occurring in only one of 60,000 to 100,000 patients. Although in rare cases spontaneous regression is known to occur in patients with testicular seminomas, only one case of spontaneous regression of a primary pineal germinoma has so far been reported. In the present case a 17-year-old man presented with headache. A tumor in the pineal body and acute hydrocephalus were revealed by head computerized tomography (CT) and magnetic resonance (MR) imaging, and VP shunt placement was performed. Computerized tomography scanning of the head was performed four times during a 2-week period following the operation, and the patient was temporarily discharged to return to school. At the time of discharge, CT scanning demonstrated no change in the size of the tumor. Two months later, the patient was readmitted to the hospital to undergo surgery. At that time, head MR imaging revealed regression of the tumor. The pathological diagnosis of the lesion was germinoma. The patient underwent three courses of chemotherapy, during which carboplatin and etoposide were administered, in addition to a 24-Gy dose of radiotherapy. No manifestations of nerve impairment were noticed, and the patient was observed on an outpatient basis. The authors think that the factors involved in tumor regression included the effects of the VP shunt, the effects of radiation absorbed during head CT scanning, and the role of the patient's own immune response. However, no conclusion has been reached concerning the actual cause.

DOI： 10.3171/jns.2000.93.5.0884

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Association of Neurological Surgeons  

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH). Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement. Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients
three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma. Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully. Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

DOI： 10.3171/jns.1999.91.3.0424

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Association of Neurological Surgeons  

Object. The aim of this study was to determine the usefulness of magnetic resonance (MR) imaging-documented extravasation as an indicator of continued hemorrhage in patients with acute hypertensive intracerebral hemorrhage (ICH). Methods. The authors studied 108 patients with acute hyperintensive ICH. Imaging modalities included noncontrast-enhanced computerized tomography (CT) scanning, gadolinium-enhanced MR imaging, and conventional cerebral angiography obtained within 6 hours after the onset of hemorrhage. A repeated CT scan was obtained within 48 hours to evaluate enlargement of the hematoma. Findings on MR imaging indicating extravasation, including any high-intensity signals on T1-weighted postcontrast images, were observed in 39 patients, and 17 of these also showed evidence of extravasation on cerebral angiography. The presence of extravasation on MR imaging was closely correlated with evidence of hematoma enlargement on follow-up CT scans (p &lt
0.001). Conclusions. Evidence of extravasation documented on MR imaging indicates persistent hemorrhage and correlates with enlargement of the hematoma.

DOI： 10.3171/jns.1998.88.4.0650

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

(1) Background Cerebral revascularization is necessary to treat intracranial arterial stenosis caused by moyamoya disease, atherosclerosis, or large complex aneurysms. Although various donor vascular harvesting methods have been reported safe, there are no reports on the histological evaluation of donor vessels for each disease, despite the variety of diseases wherein vascular anastomosis is required. (2) Methods Pathological findings of the superficial temporal artery (STA), radial artery (RA), occipital artery (OA), and saphenous vein (SV) harvested at the institution were analyzed. Patients classified according to aneurysm, atherosclerosis, and moyamoya disease were assessed for pathological abnormalities, medical history, age, sex, smoking, and postoperative anastomosis patency. (3) Results There were 38 cases of atherosclerosis, 15 cases of moyamoya disease, and 30 cases of aneurysm in 98 donor vessels (mean age 57.2) taken after 2006. Of the 84 STA, 11 RA, 2 OA, and 1 SV arteries that were harvested, 71.4% had atherosclerosis, 11.2% had dissection, and 10.2% had inflammation. There was no significant difference in the proportion of pathological findings according to the disease. A history of hypertension is associated with atherosclerosis in donor vessels. (4) Conclusions This is the first study to histologically evaluate the pathological findings of donor vessels according to disease. The proportion of dissection findings indicative of vascular damage due to surgical manipulation was not statistically different between the different conditions.

DOI： 10.3390/jcm13072125

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Low back pain (LBP) can be attributable to entrapment of the superior cluneal nerve (SCN) around the iliac crest. Surgical decompression is a useful treatment; however, finding all entrapped SCNs involved in patients with LBP can be difficult. We performed a retrospective study to help identify entrapped SCNs in the narrow surgical field. METHODS: We enrolled 20 LBP patient (22 sides) with SCN entrapment. They were 9 males and 11 females; their mean age was 72.5 years. We developed a 3-step procedure for successful SCN decompression surgery. In step 1, the thoracolumbar fascia is exposed and the SCN penetrating the fascia is released. In step 2, the fascia is opened and the SCN is released. In step 3, the fascia above the iliac crest is opened and the SCN is released. RESULTS: We successfully released 66 nerves; the average was 3.0 ± 0.8 (1-4) per patient. Step 1 detected 18 nerves (27.3%), step 2 identified 35 (53.0%), and in step 3, 13 (19.7%) were recognized. By tracing the thin nerves branching off the SCN, we found 7 nerves (10.6%). We performed 22 operations; step 1 identified 16 SCNs (72.7%), step 2 identified 21 (95.5%), and step 3 found 12 nerves (54.5%). CONCLUSIONS: The SCN is most readily identified upon opening of the thoracolumbar fascia. To identify as many SCN branches as possible, our 3-step method may be useful.

DOI： 10.1007/s00701-024-05960-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Collision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-year-old man who underwent tumor resection 36 and 18 years prior to presentation for bladder and colon cancer, respectively, without recurrence presented with bitemporal hemianopsia, ptosis, and diplopia of the right eye. Subsequent magnetic resonance imaging (MRI) revealed a tumor 3.2 cm in diameter that extended from the anterior pituitary gland to the suprasellar region. Gadolinium-enhanced MRI of the tumor showed heterogeneous contrast enhancement. Considering the relatively rapid progression of neurological symptoms, semi-emergency endoscopic endonasal transsphenoidal surgery was performed. Histopathological examination revealed a group of thyroid transcription factor-1- and napsin A-positive papillary proliferating cells intermingled with α-subunit- and steroidogenic factor-1-positive PitNET cells. Thus, the patient was diagnosed with lung adenocarcinoma metastasis within a gonadotroph PitNET. Genetic testing revealed the presence of an EGFR (Ex-19del) mutation, after which chemotherapy was initiated. Additional stereotactic radiotherapy was performed for the residual tumor in the sella turcica. With continued chemotherapy, good control of both the primary and metastatic tumors was noted after 24 months after surgery. Cases of malignant neoplasm metastasis within a PitNET are difficult to diagnose. In the case of a sella turcica tumor with relatively rapid progression of neurological symptoms, early surgical intervention is recommended given the possibility of a highly proliferative tumor and the need to obtain pathologic specimens.

DOI： 10.1507/endocrj.EJ23-0372

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Spinal cord untethering by sectioning the filum terminale is commonly performed in tethered cord syndrome patients with minor abnormalities such as filar lipoma, thickened filum terminale, and low conus medullaris. Our endoscopic surgical technique, using the interlaminar approach, allows for sectioning the filum terminale through a very small skin incision. To our knowledge, this procedure has not been previously reported. This is the first case report involving a 1 cm skin incision. CASE PRESENTATION: A 9-month-old male patient was referred to our neurosurgical department due to a coccygeal dimple. MRI revealed a thickened fatty filum. After considering the treatment options for this patient, the parents agreed to spinal cord untethering. A midline 1 cm skin incision was made at the L4/5 vertebral level. Untethering by sectioning the filum terminale was performed by full endoscopic surgery using the interlaminar approach. The procedure was uneventful and there were no postoperative complications. CONCLUSIONS: In terms of visibility and minimizing invasiveness, our surgical technique of using the interlaminar approach with endoscopy allows for untethering by sectioning the filum terminale through a very small skin incision.

DOI： 10.1186/s12887-023-04390-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00586-023-07944-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. Objective The objective of this study was to compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and the formation of microvascular thrombosis in anastomosis were compared. Methods We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink. Results The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4. Conclusion BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced using BV4.

DOI： 10.1055/a-2175-3295

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10143-023-02139-5

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その他リンク： https://link.springer.com/article/10.1007/s10143-023-02139-5/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effect of posterior cranial fossa stroke on changes in cerebral volume is not known. We assessed cerebral volume changes in patients with acute posterior fossa stroke using CT scans, and looked for risk factors for cerebral atrophy. METHODS: Patients with cerebellar or brainstem hemorrhage/infarction admitted to the ICU, and who underwent at least two subsequent inpatient head CT scans during hospitalization were included (n = 60). The cerebral volume was estimated using an automatic segmentation method. Patients with cerebral volume reduction > 0% from the first to the last scan were defined as the "cerebral atrophy group (n = 47)," and those with ≤ 0% were defined as the "no cerebral atrophy group (n = 13)." RESULTS: The cerebral atrophy group showed a significant decrease in cerebral volume (first CT scan: 0.974 ± 0.109 L vs. last CT scan: 0.927 ± 0.104 L, P < 0.001). The mean percentage change in cerebral volume between CT scans in the cerebral atrophy group was -4.7%, equivalent to a cerebral volume of 46.8 cm3, over a median of 17 days. The proportions of cases with a history of hypertension, diabetes mellitus, and median time on mechanical ventilation were significantly higher in the cerebral atrophy group than in the no cerebral atrophy group. CONCLUSIONS: Many ICU patients with posterior cranial fossa stroke showed signs of cerebral atrophy. Those with rapidly progressive cerebral atrophy were more likely to have a history of hypertension or diabetes mellitus and required prolonged ventilation.

DOI： 10.1007/s00701-023-05609-3

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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出版者・発行元：Research Square Platform LLC  

Abstract

Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection—five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, presence of an aneurysm, presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area (p=0.00) and were correlated with hemorrhage (p&lt;0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed-up, and antithrombotic treatment should be considered with particular care in older adults.

DOI： 10.21203/rs.3.rs-2711255/v1

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その他リンク： https://www.researchsquare.com/article/rs-2711255/v1.html

記述言語：日本語   出版者・発行元：(一社)日本医療安全学会  

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記述言語：英語  

Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.

DOI： 10.2176/jns-nmc.2023-0088

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Traumatic brain injury (TBI) is associated with coagulation/fibrinolysis disorders. We retrospectively evaluated 61 TBI cases transported to hospital within 1 h post-injury. Levels of thrombin-antithrombin III complex (TAT), D-dimer, and plasminogen activator inhibitor-1 (PAI-1) were measured on arrival and 3 h, 6 h, 12 h, 1 day, 3 days and 7 days after injury. Multivariate logistic regression analysis was performed to identify prognostic factors for coagulation and fibrinolysis. Plasma TAT levels peaked at admission and decreased until 1 day after injury. Plasma D-dimer levels increased, peaking up to 3 h after injury, and decreasing up to 3 days after injury. Plasma PAI-1 levels increased up to 3 h after injury, the upward trend continuing until 6 h after injury, followed by a decrease until 3 days after injury. TAT, D-dimer, and PAI-1 were elevated in the acute phase of TBI in cases with poor outcome. Multivariate logistic regression analysis showed that D-dimer elevation from admission to 3 h after injury and PAI-1 elevation from 6 h to 1 day after injury were significant negative prognostic indicators. Post-TBI hypercoagulation, fibrinolysis, and fibrinolysis shutdown were activated consecutively. Hyperfibrinolysis immediately after injury and subsequent fibrinolysis shutdown were associated with poor outcome.

DOI： 10.1038/s41598-022-23912-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Coagulopathy, a common complication of traumatic brain injury (TBI), is characterized by a hypercoagulable state developing immediately after injury, with hyperfibrinolysis and bleeding tendency peaking 3 h after injury, followed by fibrinolysis shutdown. Reflecting this timeframe, the coagulation factor fibrinogen is first consumed and then degraded after TBI, its concentration rapidly decreasing by 3 h post-TBI. The fibrinolytic marker D-dimer reaches its maximum concentration at the same time. Hyperfibrinolysis in the acute phase of TBI is associated with poor prognosis via hematoma expansion. In the acute phase, the coagulation and fibrinolysis parameters must be monitored to determine the treatment strategy. The combination of D-dimer plasma level at admission and the level of consciousness upon arrival at the hospital can be used to predict the patients who will "talk and deteriorate." Fibrinogen and D-dimer levels should determine case selection and the amount of fresh frozen plasma required for transfusion. Surgery around 3 h after injury, when fibrinolysis and bleeding diathesis peak, should be avoided if possible. In recent years, attempts have been made to estimate the time of injury from the time course of coagulation and fibrinolysis parameter levels, which has been particularly useful in some cases of pediatric abusive head trauma patients.

DOI： 10.2176/jns-nmc.2022-0226

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Crystal violet (CV) ink has been used as a skin marker worldwide. It has been reported to be useful for vessel wall visualization of microvascular anastomoses. Contrastingly, it has been found to be carcinogenic and inhibit migration and proliferation of venous cells. In some countries, its use in the medical field has been restricted. Therefore, it is necessary to consider alternatives to CV. In this present study, we compared the time required for the anastomosis of a 0.8-1 mm diameter vessel in the chicken wrist artery using CV and a CV-free dye (ethyl violet; EV). The surgeon, microscope, and anastomosis microsurgical tools were standardized for comparison. CV and EV were changed for each anastomosis. The same surgeon performed 30 anastomoses using each dye. No visually obvious differences were noted in the vascular transections with CV and EV. As per the results, no statistically significant difference was observed in the time required for anastomosis using CV and EV. EV conforming to California Proposition 65 may be an effective alternative to CV for vascular visualization of microvascular anastomoses. However, further studies on the effectiveness of the EV in clinical cases are needed.

DOI： 10.2176/jns-nmc.2022-0188

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)中外医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Coagulopathy is a common sequela of traumatic brain injury. Consumptive coagulopathy and secondary hyperfibrinolysis are associated with hypercoagulability. In addition, fibrinolytic pathways are hyperactivated as a result of vascular endothelial cell damage in the injured brain. Coagulation and fibrinolytic parameters change dynamically to reflect these pathologies. Fibrinogen is consumed and degraded after injury, with fibrinogen concentrations at their lowest 3-6 h after injury. Hypercoagulability causes increased fibrinolytic activity, and plasma levels of D-dimer increase immediately after traumatic brain injury, reaching a maximum at 3 h. Owing to disseminated intravascular coagulation in the presence of fibrinolysis, the bleeding tendency is highest within the first 3 h after injury, and often a condition called "talk and deteriorate" occurs. In neurointensive care, it is necessary to measure coagulation and fibrinolytic parameters such as fibrinogen and D-dimer routinely to predict and prevent the development of coagulopathy and its negative outcomes. Currently, the only evidence-based treatment for traumatic brain injury with coagulopathy is tranexamic acid in the subset of patients with mild-to-moderate traumatic brain injury. Coagulation and fibrinolytic parameters should be closely monitored, and treatment should be considered on a patient-by-patient basis.

DOI： 10.2176/jns-nmc.2022-0018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The use of an endoscope in exoscopic transcranial neurosurgery for skull-base lesions has not yet been investigated. Thus, this study aimed to investigate the advantages, disadvantages, and safety of "simultaneous temporary use of an endoscope during exoscopic surgery" (exo-endoscopic surgery (EES)). Consecutive exo-endoscopic surgeries performed by experienced neurosurgeons and assistants were analyzed. Surgical complications and time were compared with previous consecutive microsurgeries performed by the same surgeon. A questionnaire survey was conducted on 16 neurosurgeons with experience in both "temporary simultaneous use of endoscope during microscopic surgery" (micro-endoscopic surgery (MES)) and EES. EES was performed in 18 of 76 exoscopic surgeries, including tumor removal (n = 10), aneurysm clipping (n = 5), and others (n = 3). There were no significant differences in operative time, anesthesia time, or complications from microsurgery by the same operator. According to the questionnaire survey results, compared with MES, EES had a wider field of view due to its lack of an eyepiece, was easier when loading and unloading instruments into and out of the surgical field, and was more suitable for the simultaneous observation of two fields of view. Overall, 79.2% of surgeons indicated that EES may be better suited than MES to simultaneously observe two fields of view.

DOI： 10.3390/jcm11071753

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記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞4D flow MRIはMRIの位相情報を活用する撮影手法で,様々な血流解析を可能とする。4D flow MRIの撮影原理は20年以上前に考案されており,その有用性は当初から認知されていたものの,当初は撮影時間が長く,臨床での普及には至らなかった。しかし,近年,高速化撮像手法の組み合わせにより,同撮像の撮影時間の大幅な短縮が実現している。このような背景の下,4D flow MRIは臨床現場で撮影される機会が着実に増加しており,昨今あらためて注目が集まっている。本稿では4D flow MRIの基礎および中枢神経領域における臨床研究について概説する。

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記述言語：日本語   出版者・発行元：日本脳神経CI学会  

これまでに進められた研究プロジェクトのコンセプトと現況、課題をまとめた。プロジェクトIの脳神経外科領域robotic system(Smart Arm)の開発では、1)深部狭小術野操作を可能とするシステムと、2)浅術野の超微細手術を可能とするシステムを構築した。今回、1)において特に経鼻内視鏡手術支援用robotic systemの構築を企画した。プロジェクトIIでは外科技術のデジタル評価、プロジェクトIIIでは自動化手術を試みた。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Considering the lack of studies on the long-term evaluation of improvements in microsurgical techniques using simulation models, we determined whether technical improvements in surgical techniques could be assessed based on an increase in the score of contest-style continuous and objective evaluation systems involving the same microsurgical task. METHODS: Since 2014, neurosurgeons with 1-10 years of experience participated in a biannual competition-style test. The task involved suturing as many times as possible within 5 min after arteriotomy of 1-mm artificial vessels. A modified version of the Objective Structured Assessment of Technical Skills examination was created and used. Changes and differences in scoring results over time were examined for each evaluator. RESULTS: Overall, 103 neurosurgeons participated in the study at least once, and those who participated more than once were divided into two groups: those who obtained the highest score in each contest and those who obtained the lowest score. The linear regression equations for the highest and lowest scorer groups were y=7.62x+81.56 (R2=0.628) and y=1.94x+67.93 (R2=0.0433), respectively. The high-scoring group had high scores from the first time they participated, and their scores tended to increase further, while the low-scoring group did not show any tendency of score increases after gaining experience. No significant differences were found in scores according to four evaluators. CONCLUSIONS: Our study showed the possibility of assessing technical improvements in surgery through long-term and continuous microsurgical technique evaluation. A surgical technique evaluation system was established, and its potential to contribute to surgical safety was demonstrated.

DOI： 10.1272/jnms.JNMS.2022_89-407

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記述言語：英語  

Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.

DOI： 10.3390/diagnostics12010120

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記述言語：英語  

Background: Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known. Case Presentation: A 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful. Conclusion: We believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.

DOI： 10.3389/fsurg.2022.895233

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掲載種別：研究論文（学術雑誌）  

Robotic surgery, which has been introduced to the field of neurosurgery, has the potential to improve the safety, accuracy, and dexterity of surgery compared to conventional methods. Currently, accuracy‒ enhancing robotic systems for stereotactic and spinal neurosurgery are used. In particular, stereotactic depth electrode placement using a robotic system has shown clinical benefits over conventional frame‒ based placements. Several microsurgery systems for dexterity‒enhancing systems are available. Our trials aimed to develop the following two systems：1）a deep endonasal robotic system that supports endonasal procedures, including dural suturing at the anterior cranial base and complicated vascular procedures and 2）a super‒microsurgery system that enables anastomosis of 0.3 mm diameter vessels. Our systems showed a rapid learning curve for surgical beginners and enhanced the accuracy of left‒hand procedures. In future, we aim to improve the user‒friendly control and durability of these systems. At the same time, robotics engineering can enhance surgical science by digitalizing all dimensions of surgical procedures and introducing artificial intelligence for sensor‒ and image‒guided automated surgical developments. In the near future, robotic surgery will be routinely applied in complex and daily surgical procedures to improve surgical outcomes without significant variance between occasions and surgical or hospital experiences.

DOI： 10.7887/jcns.31.500

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A mutation in RNF213 (c.14576G>A), a gene associated with moyamoya disease (>80%), plays a role in terminal internal carotid artery (ICA) stenosis (>15%) (ICS). Studies on RNF213 and cerebral aneurysms (AN), which did not focus on the site of origin or morphology, could not elucidate the relationship between the two. However, a report suggested a relationship between RNF213 and AN in French-Canadians. Here, we investigated the relationship between ICA saccular aneurysm (ICA-AN) and RNF213. We analyzed RNF213 expression in subjects with ICA-AN and atherosclerotic ICS. Cases with a family history of moyamoya disease were excluded. AN smaller than 4 mm were confirmed as AN only by surgical or angiographic findings. RNF213 was detected in 12.2% of patients with ICA-AN and 13.6% of patients with ICS; patients with ICA-AN and ICS had a similar risk of RNF213 mutation expression (odds ratio, 0.884; 95% confidence interval, 0.199–3.91; p = 0.871). The relationship between ICA-AN and RNF213 (c.14576G>A) was not correlated with the location of the ICA and bifurcation, presence of rupture, or multiplicity. When the etiology and location of AN were more restricted, the incidence of RNF213 mutations in ICA-AN was higher than that reported in previous studies. Our results suggest that strict maternal vessel selection and pathological selection of AN morphology may reveal an association between genetic mutations and ICA-AN development. The results of this study may form a basis for further research on systemic vascular diseases, in which the RNF213 (c.14576G>A) mutation has been implicated.

DOI： 10.3390/genes12101468

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: It was reported that the XYZ/2 technique (using length, width and height of hematoma) is a simple and reliable method of estimation of chronic subdural hematoma volume. Two subtypes of techniques enable to adequately estimate, it is unclear which is more accurate. Computer-assisted volumetric analysis is widely considered the gold standard for CSDH volumetric analysis. It is important to consider the stability of analyses between examiners, because individual, decision-making differences may be relevant to the analysis, as hematoma margin and length are hand-operated. In this study, we investigated potential measurement biases of three neurosurgeons and analyzed the validity of the XYZ/2 technique by comparing it to the gold standard method. METHOD: We retrospectively analyzed CT scans that indicated the need for an operation in 50 patients with CSDH in our department. Three neurosurgeons measured and calculated CSDH volumes independent of one another. We investigated potential measurement biases of three neurosurgeons and analyzed the validity of the XYZ/2 technique by comparing it to the gold standard method. The XYZ/2 technique includes the "maximal method" that uses the maximum length and maximum width of a slice to determine volume, and the "central method" that uses only the central slice to measure length and width. RESULTS: ICCs for the gold standard, central method, and maximal method were 0.945, 0.916, and 0.844, respectively, all of which indicated excellent reliability. For all examiners, the differences in calculation from gold standard and central method were not statistically significant (P>0.05). The estimations of CSDH volume calculated by the maximal method were significantly greater than the estimates calculated by the gold standard (P<0.05). CONCLUSIONS: This study proves that the XYZ/2 technique is a simple and reliable method of estimating CSDH volume. The "central method" in particular yielded similar results to that of the gold standard method.

DOI： 10.1016/j.neuchi.2021.04.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives: Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures. Design: Narrative literature review with analysis of IDEAL stage of each field of study. Setting: All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery. Main outcome measures: The IDEAL stage of research evidence was determined for each specialty field using a previously described approach. Results: 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported. Conclusions: Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.

DOI： 10.1136/bmjsit-2021-000088

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記述言語：英語  

To the best of our knowledge, we report a case of MEN2A complicated by moyamoya syndrome. A 52-year-old woman presented with vertigo. Magnetic resonance angiography (MRA) revealed bilateral supraclinoid stenosis of the internal carotid artery and abnormal moyamoya-like vessels around the basal ganglia. She had a heterozygous variant of RNF213, which is the susceptibility gene for moyamoya disease. She had also previously received diagnoses of medullary thyroid carcinoma (MTC) at age 23 and left-sided pheochromocytoma (PHEO) at age 41. Genetic testing revealed heterozygosity for a mutation at codon 634 in exon 11 (TGC-TTC mutation; p.Cys634Phe) of the Ret gene. Intracranial vascular stenosis may have been caused by a genetic mutation of RNF213 and hypersecretion of catecholamines by MEN2A. Physicians should recognize that MEN2A can be present with moyamoya syndrome.

DOI： 10.3389/fendo.2021.703410

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/NRL.0000000000000256

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical clipping of an internal carotid artery (ICA)-posterior communicating artery (ICPC) aneurysm is often difficult in cases involving limited space to insert a clip at the proximal aneurysm neck hidden by the tent. In such cases, we perform incision of the anterior petroclinoidal fold to secure the proximal space for clip insertion. Between April 2013 and March 2018, we treated 89 ICPC aneurysm cases by clipping. Incision of the anterior petroclinoidal fold was performed in 15 of the 89 cases (16.8%). Fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) can indicate the locations of the aneurysm and tent and can help assess the need for tent incision. We widely dissected the distal sylvian fissure and sufficiently exposed around the aneurysmal space. We coagulated and cut the anterior petroclinoidal fold supra between the ICA and proximal neck of the aneurysm using a low-power bipolar system and needles or micro-scissors with care to avoid injury around structures such as the ICA, aneurysm, and oculomotor nerve. When using this strategy, we often select the Yasargil FT717 clip that has a curve along the skull base because of easy insertion. All cases showed complete aneurysm exclusion on three-dimensional computed tomography angiography, and there was no cerebral infarction, neurological deficit (such as hemiparesis), or oculomotor nerve palsy. Therefore, our strategy of incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an ICA aneurysm is effective and safe.

DOI： 10.1007/s10143-019-01121-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Cerebral vasospasm is associated with poor prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH), and biomarkers for predicting poor prognosis have not yet been established. We attempted to clarify the relationship between serum glucose/potassium ratio and cerebral vasospasm in patients with aneurysmal SAH. METHODS: We studied 333 of 535 aneurysmal SAH patients treated between 2006 and 2016 (123 males, 210 females; mean age 59.7 years; range 24-93). We retrospectively analyzed the relationship between cerebral vasospasm grade and clinical risk factors, including serum glucose/potassium ratio. RESULTS: Postoperative angiography revealed cerebral vasospasm in 112 patients (33.6%). Significant correlations existed between the ischemic complication due to cerebral vasospasm and glucose/potassium ratio (P < .0001), glucose (P = .016), and potassium (P = .0017). Serum glucose/potassium ratio was elevated in the cerebral vasospasm grade dependent manner (Spearman's r = 0.1207, P = .0279). According to the Glasgow Outcome Scale (GOS) score at discharge, 185 patients (55.5%) had a poor outcome (GOS scores 1-3). Serum glucose/potassium ratio was significantly correlated between poor outcome (GOS scores 1-3) and age (P < .0001), serum glucose/potassium ratio (P < .0001), glucose (P < .0001), potassium (P = .0004), white blood cell count (P = .0012), and cerebral infarction due to cerebral vasospasm (P < .0001). Multivariate logistic regression analyzes showed significant correlations between cerebral infarction due to cerebral vasospasm and serum glucose/potassium ratio (P = .018), glucose (P = .027), and potassium (P = .052). CONCLUSIONS: Serum glucose/potassium ratio in cases of aneurysmal SAH was significantly associated with cerebral infarction due to cerebral vasospasm and GOS at discharge. Therefore, this factor was useful to predict prognosis in patients with cerebral vasospasm and aneurysmal SAH.

DOI： 10.1016/j.jstrokecerebrovasdis.2019.03.041

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The exoscope has been reported as a novel neurosurgical instrumentation in clinical practice. OBJECTIVE: To investigate the possibility that ORBEYE (OE), a novel instrument that excludes eyepiece lenses and allows for microsurgery by observation of the 4K3D monitor, could replace microscopes. METHODS: We report 22 clinical cases by 5 experienced neurosurgeons and the comparative results of training 10 residents. An observation study with questionnaire survey was conducted on usability. Twelve items including image quality, eyestrain, and function of the arm were evaluated. RESULTS: The following 22 clinical procedures were conducted: surgery for intracranial hemorrhage (n = 2) and brain tumor (n = 8), laminectomy (n = 3), aneurysm clipping (n = 3), vascular anastomosis (n = 2), carotid endarterectomy (n = 2), and nerve decompression (n = 1). No complications were observed. The fluorescent study, including indocyanine-green and 5-aminolevunic acid, allowed for clear depiction on the 4K monitor. The surgeon could operate in a comfortable posture. Similar to the microscope, it was possible to change the optical and viewing axes with the OE, but the OE was switched to the microscope or endoscope in hematoma removal and pituitary surgery. Residents judged that eyestrain was strong (P = .0096). Experienced neurosurgeons acting as assistants judged that the scope arm's range of movement was narrow (P = .0204). Sixty percent of residents judged that the OE was superior to the microscope. CONCLUSION: Although based on limited experience, it was not possible to substitute the microscope with the OE in all operations; however, the OE surpasses the microscope in terms of ergonomic features.

DOI： 10.1093/ons/opy277

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記述言語：英語   掲載種別：学位論文（その他）  

OBJECTIVE: The efficacy of thyrotropin-releasing hormone tartrate (TRH-T) for treating prolonged disturbance of consciousness due to aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of the present study was to determine whether TRH-T was really effective, and what was the recovery factor when it was valid. This was a retrospective study of a single facility. METHODS: We treated 208 patients with aneurysmal SAH at our hospital between 2011 and 2017. Among them, we investigated 97 cases in which TRH-T was administered to prolonged disturbance of consciousness. Thirty one patients with Hasegawa dementia rating scale-revised (HDS-R) score less than 20 were included. Patients' HDS-R scores were evaluated 7 days after clipping the aneurysm and 2 days after completing a course of TRH-T treatment. HDS-R score increases of greater than or over equal to 8 and less than 8 were defined as good and poor outcomes, respectively. Outcomes were compared to 11 patients who did not receive TRH-T treatment. RESULTS: Average initial and post-treatment HDS-R scores were 9 ± 6.6 and 19 ± 9.5, respectively. The good outcome group included 19 patients. Statistically significant differences in HDS-R score changes were observed between the group with initial HDS-R scores of 0-4 and the other groups. Poor outcomes were significantly correlated with age of greater than 60 years and initial HDS-R scores less than oroverequal to 4 points. The improvement in HDS-R score was significantly greater in the TRH-T administration group than the control group. CONCLUSIONS: TRH-T was effective for treating prolonged disturbance of consciousness due to aneurysmal SAH, especially in young patients with HDS-R scores between 5 and 20.

DOI： 10.1016/j.jstrokecerebrovasdis.2018.12.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Moyamoya disease is an idiopathic progressive cerebrovascular steno-occlusive disorder characterized by the formation of numerous collaterals called Moyamoya vessels. Accurate evaluation of vascular status and cerebral blood flow (CBF) is needed for prompt treatment to prevent ischemic and/or hemorrhagic events. The pathogenesis of the ivy sign on fluid attenuated inversion recovery (FLAIR) images of Moyamoya disease patients is unclear. We report a Moyamoya disease case wherein the ivy sign changed in relation to single-photon emission computed tomography (SPECT)-measured CBF during progression and following treatment. A 49-year-old female presented with slight aphasia and right hemiparesis. Magnetic resonance imaging (MRI) diffusionweighted image revealed cerebral infarction in the left frontal lobe. Cerebral angiography images showed bilateral distal internal carotid artery stenosis and Moyamoya vessels. FLAIR images exhibited the ivy sign. We performed superficial temporal arteryâ€" middle cerebral artery (STA-MCA) bypass surgery with encephalogaleosynangiosis (EGS) and encephalomyosynangiosis (EMS) on the left side 6 months after first presentation. After operation, left-side resting CBF gradually improved on SPECT and the ivy sign decreased. On the other hand, right-side CBF gradually deteriorated at rest, and the ivy sign increased. Therefore, we performed STAâˆ'MCA bypass with EGS and EMS on the right side 4 years after first presentation. After the operation, the resting CBF increased and the ivy sign decreased. The FLAIR ivy sign may be a useful indicator of both deterioration and improvement of CBF status without the need for CBF imaging using contrast material.

DOI： 10.5137/1019-5149.JTN.19271-16.1

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.

DOI： 10.1272/jnms.JNMS.2019_86-406

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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DOI： 10.3171/2018.3.JNS18510

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (SAH) can result in poor outcomes, and biomarkers for predicting poor prognosis have not yet been established. The aim of this study was to clarify the significance of the serum glucose/potassium ratio for predicting the prognosis of aneurysmal SAH. METHODS: The authors retrospectively reviewed the records of 565 patients with aneurysmal SAH between 2006 and 2016. The patient group comprised 208 men and 357 women (mean age 61.5 years, range 10-95 years). A statistical analysis was conducted of the clinical and laboratory risk factors of poor outcome, including the serum glucose/potassium ratio. RESULTS: On estimation of the initial assessment using Hunt and Kosnik (H-K) grading, 233 patients (41.2%) were classified as the severe SAH group (H-K Grade IV or V). There were significant correlations between the severe SAH group and serum glucose/potassium ratio (p < 0.0001). Serum glucose/potassium ratio was elevated in an H-K grade-dependent manner (Spearman's r = 0.5374, p < 0.0001). With the estimation of the Glasgow Outcome Scale (GOS) score at discharge, 355 patients (62.8%) were classified as poor outcome (GOS score 1-3). The serum glucose/potassium ratio was elevated in a GOS score at discharge-dependent manner (Spearman's r = 0.4006, p < 0.0001), and was significantly elevated in the poor outcome group compared with the good outcome group (GOS score 4 or 5; p = 0.0245). There were significant correlations between poor outcome and serum glucose/potassium ratio (p < 0.0001), age (p < 0.0001), brain natriuretic peptide levels (p = 0.011), cerebral infarction due to vasospasm (p < 0.0001), and H-K grade (p < 0.0001). Multivariate logistic regression analyses showed significant correlations between poor outcome and serum glucose/potassium ratio (p = 0.009). CONCLUSIONS: In this study, the serum glucose/potassium ratio of patients with aneurysmal SAH at admission was significantly correlated with H-K grade and GOS score at discharge. Therefore, this ratio was useful for predicting prognosis of aneurysmal SAH, especially in severe cases.

DOI： 10.3171/2017.5.JNS162799

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担当区分：責任著者   記述言語：英語   掲載種別：学位論文（その他）   出版者・発行元：Wiley-VCH Verlag  

Various reports have been published regarding quantitative evaluations of intraoperative fluorescent intensity studies using indocyanine green (ICG) with videoangiography (VAG). The effects of scattering and point-spread functions (PSF) on quantitative ICG-VAG evaluations have not been investigated. Clinically, when ICG is administered through the peripheral vein, it reaches the tissue intra-arterially. To achieve more reliable intraoperative quantitative intensity evaluations, we examined the impact of high-intensity structures on close areas. The study was conducted using a phantom model and surgical fluorescent microscope. A region of interest (ROI) was created for the vessel model and another ROI was created within 3 cm of that. With an ROI of 6.8 mm in the vessel phantom model, 10% intensity was confirmed, even though there was no fluorescent structure. Intensity decreased gradually as the ROI moved further from the vessel model. Our study results suggest that the presence of a high-intensity structure and the size of the ROI may affect quantitative intensity evaluations using ICG-VAG. Results of linear regression analysis indicate that the relationship of intensity (Y) and distance (X) is as follows: Y(real/A) = 29 Exp(-0.062X) + 164.3 Exp(-1.81X). The optical effect should be considered when performing an intraoperative intensity study with a surgical microscope.

DOI： 10.1002/jbio.201700254

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Inc.  

BACKGROUND: In vascular reconstructive surgery, intraoperative confirmation of patency is performed by angiography, Doppler, or indocyanine videoangiography, but it is sometimes insufficient. OBJECTIVE: Using the FLOW 800 system (Carl Zeiss, Oberkochen, Germany), we confirmed patency in a quantitative relative evaluation of the timing of the luminance change of the regions of interest (ROIs) on the donor and recipient. METHODS: Thirty-seven patients (58 anastomoses) were divided into 2 groups: those with arteriosclerotic ischemic disease (CI group; n = 23) and those with cerebral aneurysm (AN group; n = 14). Four ROIs were set: the donor, proximal, and distal sides of the recipient middle cerebral artery (MCA) and cortical MCA (control MCA). The half-life for fluorescence intensity was calculated by using the FLOW 800 system. A delay map analysis was also performed. RESULTS: In the CI group, there were statistically significant differences (P < 0.05) between the donor vessel and control MCA, proximal MCA and MCA control, and distal MCA and control MCA. The investigation with the delay map showed red tones in 20/22 patients in the CI group and in 2/17 patients in the AN group. CONCLUSIONS: In the CI group, the transit time of the donor vessel was shown relatively early as red T. When good patency has been achieved, the FLOW 800 system can be used to confirm patency more reliably, especially in ischemic regions. The unique point of this research is that the patency of anastomotic vessels was evaluated as a quantitative value of its rendering time rather than as a change in fluorescence intensity.

DOI： 10.1016/j.wneu.2017.11.072

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: To assess the clinical feasibility of time-resolved 3D phase contrast (4D Flow) MRI assessment of the ophthalmic artery (OphA) flow in patients with internal carotid artery stenosis (ICS). MATERIALS AND METHODS: Twenty-one consecutive patients with unilateral ICS were recruited. 4D Flow MRI and acetazolamide-stress brain perfusion single photon emission computed tomography (SPECT) were performed. The flow direction on the affected-side OphA was categorized into native flow (anterograde or unclear) and non-native flow (retrograde flow) based on 4D Flow MRI. In the affected-side middle cerebral artery (MCA) territory, the ratio of rest cerebral blood flow to normal control (RCBFMCA) and cerebral vascular reserve (CVRMCA) were calculated from SPECT dataset. High-risk patients were defined based on the previous large cohort study (RCBFMCA < 80% and CVRMCA < 10%). RESULTS: Eleven patients had native OphA flow (4 anterograde, 7 unclear) and the remaining 10 had non-native OphA flow. RCBFMCA and CVRMCA each were significantly lower in non-native flow group (84.9 ± 18.9% vs. 69.8 ± 7.3%, P < 0.05; 36.4 ± 20.6% vs. 17.0 ± 15.0%, P < 0.05). Four patients in the non-native flow group and none in the native flow group were confirmed as high-risk (Sensitivity/Specificity, 1.00/0.65). CONCLUSION: The 6 min standard 4D Flow MRI assessment of OphA in patients with ICS can predict intracranial hemodynamic impairment.

DOI： 10.2463/mrms.mp.2016-0074

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Inc.  

BACKGROUND: Arachnoid cysts and intracranial aneurysms are not rare, but it is unusual for an aneurysm to be associated with an arachnoid cyst. The objective of this study was to reveal the association between arachnoid cysts and intracranial aneurysms. METHODS: Methods included to report 3 cases with these 2 pathologies and to perform a systematic review of the English and Japanese literature using PubMed, Scopus, and Ichushi Web. RESULTS: The first case was of a 46-year-old man with a subarachnoid hemorrhage on the basal cistern and bilateral arachnoid cysts in the middle fossa, the second was that of a 29-year-old woman with a subarachnoid hemorrhage at the basal cistern and an arachnoid cyst in the left middle fossa, and the third was that of a 60-year-old man with a right putaminal hemorrhage and contralateral unruptured aneurysm and arachnoid cyst. A literature search for similar cases found 27 patients. CONCLUSIONS: It was difficult to diagnose a ruptured aneurysm in some cases with an arachnoid cyst because computed tomography scan showed atypical findings, such as no hemorrhage, intracystic localized hemorrhage, or subdural hematoma. This review revealed that aneurysms and arachnoid cysts were significantly located ipsilaterally and that they occurred together in relatively young patients.

DOI： 10.1016/j.wneu.2017.09.139

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

In penetrating injuries, woods are known to be difficult to detect with radiological imaging studies, because the wood density are known to be extremely close to the value of air on CT. Adjustment of CT window and reconstruction of a 3D image from CT images allowed us to more accurately distinguish wood from air and to find the fragment of the wooden chopstick. It is particularly useful in transorbital penetrating injury.

DOI： 10.1007/s00381-017-3510-2

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Giant thrombosed aneurysms of the vertebral artery (VA) are difficult to treat. Moreover, marked tortuosity of the parent VA complicates determination of the surgical approach. We report the case of a 71-year-old male patient who presented with gait disturbance. Magnetic resonance imaging revealed a giant thrombosed aneurysm of approximately 4cm in diameter located in the ventral region and to the right of the medulla oblongata. Computed tomography angiography showed that the right VA had extreme tortuosity, and that the VA union was in contact with the left 7th and 8th cranial nerves. Given that the aneurysm was thrombosed and causing a mass effect, we sought to trap it. In this case, because of the tortuous VA, intravascular team considered intravascular therapy to be too difficult. We made a question mark-shaped skin incision and used a wide bilateral suboccipital approach. The VA proximal to the aneurysm was occluded with an aneurysm clip using an approach from the right of the brainstem, while the VA distal to the aneurysm was occluded using a lateral suboccipital approach. When the VA and basilar artery are atherosclerotic and extremely tortuous, the distal and proximal aspects of the aneurysm can exist on both sides of the midline. In difficult cases such as that reported here, in which a giant VA aneurysm exceeded the midline of the anterior surface of the medulla, we believe that it is useful to employ a bilateral approach from both sides of the brainstem.

DOI： 10.1016/j.jocn.2017.08.019

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Bilateral vertebral artery dissection (VAD) may result in subarachnoid hemorrhage (SAH). However, a variety of factors contribute to the difficulties with treating SAH. We report a case of bilateral VAD with SAH, as well as a literature review. CASE DESCRIPTION: A 32-year-old woman developed headache. Computed tomography demonstrated diffuse SAH, and 3-dimensional computed tomography indicated bilateral VAD. Her left vertebral artery was severely stenosed, and the basilar artery retrogradely flowed via the posterior communicating artery. Her bilateral VAD was trapped with the use of staged craniotomy. The postoperative course was uneventful for 13 days; however, severe neurologic deterioration remained in the area of the cerebral infarction, due to vasospasm of the internal carotid artery. This is the first report of hemorrhagic bilateral VAD treated with bilateral trapping and aggressive spasm treatment in the acute phase. However, the treatment was not successful. CONCLUSIONS: Because of the increasing use of stent therapy, there has been a shift toward this treatment choice. For cases in which stents cannot be used, treatment methods based on prestenting protocols are helpful. A literature review indicated that conservative treatment for 2 weeks, in which vasospasm and rebleeding are controlled, may be considered compared with acute-stage stent treatment. Following our literature review, in situations in which stents cannot be used, only the ruptured side should be trapped with strict blood pressure control and detailed radiological images should be observed for 2 weeks. In conclusion, patient selection is essential to subject the patient to open surgery in such cases.

DOI： 10.1016/j.wneu.2017.06.167

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Teflon has been commonly used as a surgical material. In particular, Teflon has been considered suitable for microvascular decompression of cranial nerves, as it is a stable, inert substance that does not resorb or migrate. Giant cell foreign body reactions after microvascular decompression (MVD) have been reported, but this rare complication has not been well recognized. Here, we report one case of Teflon granuloma that occurred 4 years after MVD for hemifacial spasm. We discuss the cause, histopathological analysis, particular MVD surgical methods, and management of Teflon granuloma.

DOI： 10.1007/s10143-017-0865-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Few reports of delirium-related risk factors have focused on environmental risk factors and clinical risk factors, such as white matter signal abnormalities on magnetic resonance imaging fluid attenuated inversion recovery images. METHODS: We prospectively enrolled 253 patients admitted to our neurosurgical center between December 2014 and June 2015 and analyzed 220 patients (100 male patients; mean age, 64.1 years; age range, 17-92 years). An Intensive Care Delirium Screening Checklist score ≥4 points indicated delirium. We evaluated patient factors consisting of baseline characteristics and related factors, such as white matter lesions (WMLs), as well as the surrounding environment. RESULTS: Delirium occurred in 29/220 cases (13.2%). Regarding baseline characteristics, there were significant statistical correlations between delirium and age (P = 0.0187), Hasegawa Dementia Scale-Revised score (P = 0.0022) on admission, and WMLs (P < 0.0001). WMLs were related to age (P < 0.0001) and atherosclerotic disease (P = 0.004). Regarding related factors, there were significant statistical correlations between delirium and stay in a neurosurgical care unit (P = 0.0245). Multivariate logistic regression analyses showed statistically significant correlations of delirium with WMLs (P < 0.0001) and surrounding patients with delirium (P = 0.026). CONCLUSIONS: WMLs in patients and the surrounding environment are risk factors for delirium in a neurosurgical center. To prevent delirium, clinicians must recognize risk factors, such as high-grade WMLs, and manage environmental factors.

DOI： 10.1016/j.wneu.2017.03.139

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

BACKGROUND: It can be difficult to make complete burr holes using a perforator with automatic releasing systems in cases of a soft diploe or thick calvarial bone. OBJECTIVE: To demonstrate the utility of a flipped "bone pad" (BP) in recovery of penetration failure when using an automatic releasing perforator. METHODS: For craniotomy or ventricular drainage, the first step is to make 1 or more burr holes using a craniotome. Neurosurgeons sometimes incompletely penetrate the skull using the latest tools. As a countermeasure for such cases, we have developed a simple and practical method. When making a perforation using a high-speed perforator, a round bone piece we call the BP is formed just above the dura. We pulled the BP from a completed burr hole, and placed the reversed BP in position at the bottom of the incompletely perforated burr hole. The BP acted as a new hard surface, preventing the automatic releasing system from activating, and allowed the burr hole to be completed by the craniotome without the need for additional tools. RESULTS: With this technique, we have successfully completed 6 out of 7 imperfectly perforated burr holes using a perforator with an automatic releasing system. There were no technique-related complications, such as plunging or dural laceration. CONCLUSIONS: The method has the advantage that the BP can be obtained without drilling an additional burr hole, and can be completed without the need for increasing cost, time, or instrument usage.

DOI： 10.1093/ons/opw043

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

BACKGROUND: A quantitative analysis comparing indocyanine green videoangiography (ICG-VAG) and fluorescein videoangiography (FL-VAG) in cerebrovascular surgery has not been reported so far. OBJECTIVE: To clear the differences of characteristics of ICG-VAG and FL-VAG by quantitative assessment. METHODS: We prospectively analyzed results from 23 patients (3 males; mean age at surgery: 60.9 years, range: 14-75 years) at our hospital from August 2014 to July 2015. Eighteen patients had cerebral aneurysms for clipping, and 5 had intracranial arterial stenosis for superficial temporal artery (STA)-middle cerebral artery bypass. We imported data from the operative image data, converted by Audio Video Interleave to Aquacosmos as picture fluorescence intensity-analyzing software. Regions of interest were set at the parent artery, dome of aneurysms, and perforating artery in cases of clipping of aneurysms, and setting at 3 points in STA, in case of bypass. The transition of fluorescence intensity at each region of interest was calculated and plotted using Aquacosmos. RESULTS: Thick-walled artery, such as parent artery ( P = .0017) and STA ( P = .0182), was more significantly visualized by ICG-VAG than FL-VAG, whereas the perforating artery, especially in deep surgical fields, such as anterior communicating artery, internal carotid artery, and basilar artery, was better visualized by FL-VAG than ICG-VAG ( P < .0001). CONCLUSION: In this quantitative analysis of fluorescence study, ICG-VAG showed greater efficacy than FL-VAG in visualizing relatively thick arteries, such as parent artery and STA. However, FL-VAG has greater efficacy than ICG-VAG in visualizing perforating artery, especially in deep surgical fields with characteristic vessel walls.

DOI： 10.1093/ons/opw020

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CAMBRIDGE UNIV PRESS  

We experienced two cases in which aneurysm clips sprang from the applier. In case 1, a subdural haematoma from a ruptured anterior cerebral artery aneurysm was detected. When the clip was opened for final positioning, it suddenly sprang from the applier and ruptured the aneurysm. In case 2, the clip suddenly sprang from the applier as the surgeon opened the applier to clip an unruptured anterior cerebral aneurysm. These accidental phenomena are rare but dangerous. We present these cases to help prevent similar occurrences in the future. Video recordings of actual procedures can point to potential mechanisms and help reduce the incidence of this complication.

DOI： 10.1017/cjn.2016.434

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

It is difficult to treat large internal carotid aneurysms with simple surgical clipping. Here, we present a retrograde suction decompression (RSD) procedure for large internal carotid aneurysms using a balloon guide catheter combined with a blood-returning circuit and a superficial temporal artery to middle cerebral artery (STA-MCA) bypass.All patients underwent an STA-MCA bypass before the temporary occlusion of the internal carotid artery (ICA). A 6-French sheath was inserted into the common carotid artery (CCA), and a 6-French Patrive balloon catheter was placed into the ICA 5 cm past the bifurcation. Aneurysm exposure was obtained; temporary clips were placed on the proximal M1, A1, and posterior communicating (Pcom) segments; and an extension tube was then connected to the balloon catheter. A three-way stopcock was placed, and aspiration was performed through the device to collapse the aneurysm. The aspirated blood was returned to a venous line with an added heparin to prevent anemia after aspiration. During the decompression, the blood flow to the cortical area was supplied through the STA-MCA bypass. After the aneurysm collapse, the surgeon carefully dissected the perforating artery from the aneurysm dome or neck, and permanent clips were then placed on the aneurysm neck. Our procedure has several advantages, such as STA-MCA bypass without external carotid artery occlusion for preventing ischemic complications of the cortical area, anemia may be avoided because of the return of the aspirated blood, and a hybrid operation room is not required to perform this method.

DOI： 10.1007/s10143-016-0808-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Large or giant internal carotid artery (ICA) aneurysms often cause visual deficits and cranial nerve palsy. The aim of this study was to investigate the efficacy of ligation of the ICA with high-flow bypass. METHODS: We retrospectively analyzed the findings from patients with visual deficit and ophthalmologic symptoms due to ICA aneurysms. In addition, we analyzed the recovery factors associated with the visual deficit and ophthalmologic symptoms postoperatively, focusing on the type of cranial nerve palsy, aneurysm size, location, and the time to treatment from first symptoms. RESULTS: We identified 38 patients (35 women, 3 men) with a mean age at surgery of 63.6 years (range, 24-81 years) with visual and ophthalmologic symptoms due to large or giant internal carotid aneurysm. Aneurysms ranged in size from 15-50 mm (mean, 25.2 mm). Visual disturbance (7 cases, 18%) and ophthalmoplegia (31 cases, 82%) were the only preoperative cranial nerve palsies. Aneurysms were completely thrombosed in 94.7% of cases (36/38). Visual disturbance improved in 28.5% of cases (2/7), and ophthalmoplegia improved in 87.1% of cases (27/31). Time to therapy from developing a visual disturbance was longer than time to therapy from developing ophthalmoplegia (P = 0.001). Time to therapy was significantly associated with recovery from cranial nerve palsy (P < 0.0001). The recovery of visual disturbance was worse than that of ophthalmoplegia (P = 0.001). CONCLUSION: Early treatment is recommended when the visual and ophthalmologic symptoms are present because treatment delay is a risk factor for nonimprovement of symptoms.

DOI： 10.1016/j.wneu.2016.10.082

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記述言語：英語  

Few papers have reported detailed accounts of intracerebral hemorrhage caused by cerebral hyperperfusion after superficial temporal artery to middle cerebral artery bypass (STA-MCA) bypass for atherosclerotic occlusive cerebrovascular disease. We report a case of vasogenic edema and subsequent intracerebral hemorrhage caused by the cerebral hyperperfusion syndrome (CHS) after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease disease without intense postoperative blood pressure control. A 63-year-old man with repeating left hemiparesis underwent magnetic resonance angiography (MRA), which revealed right internal carotid artery (ICA) occlusion. We performed a double bypass superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery for the M2 and M3 branches. While the patient's postoperative course was relatively uneventful, he suffered generalized convulsions, and computed tomography revealed a low area in the right frontal lobe on Day 4 after surgery. We considered this lesion to be pure vasogenic edema caused by cerebral hyperperfusion after revascularization. Intravenous drip infusion of a free radical scavenger (edaravone) and efforts to reduce systolic blood pressure to <120 mmHg were continued. The patient experienced severe left hemiparesis and disturbance of consciousness on Day 8 after surgery, due to intracerebral hemorrhage in the right frontal lobe at the site of the earlier vasogenic edema. Brain edema associated with cerebral hyperperfusion after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease should be recognized as a risk factor for intracerebral hemorrhage. The development of brain edema associated with CHS after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease requires not only intensive control of blood pressure, but also consideration of sedation therapy with propofol.

DOI： 10.2176/nmccrj.cr.2016-0043

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担当区分：筆頭著者,　責任著者   記述言語：日本語  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

脳血行再建術には様々な術式がある。我々は、1995年より上山博康先生に脳血行再建術と脳神経外科手術の基本をご指導いただき、その実際と我々の応用を報告してきた。この20年間にJET Study、JAM trialも行われ、STA-MCA吻合術における虚血性合併症防止の重要性が指摘されている。実際、COSSでは虚血性合併症の多さが指摘された。STA-MCA吻合術を中心に、我々が励行している血管吻合術における様々な虚血性合併症を予防するため手技を提示する。当院で行われた動脈硬化性虚血性病変に対するSTA-MCA吻合術における虚血性合併症を予防するための手術手技の要点を提示し、実際の虚血性合併症を検討する。その要点として、*血管、脳溝の剥離操作におけるlayerの可視化の重要性、*Donorの捻じれとSpasmの防止を目的としたliquid angioplastyによる、temporary clipとヘパリン加生食での血管拡張維持、*血管内血栓形成予防のための血流を残した血管遮断法、*吻合血管のpatency確認法の実際などについてのべる。また、ICGとFLOW 800を用いてdonorの早期描出とrecipientの両方向への血流を繰り返し確認することの重要性と実際の方法を提示する。当院で行われたSTA-MCA吻合術では症候性虚血性合併症は見られなかった。最新式の上山式とは異なるかもしれないが、基本概念に大きな変化はないと考えている。上山先生から学んだ、&quot;神の手&quot;でなく、&quot;人の手&quot;で安全な手術を行うための手技を提示する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

OBJECTIVE No previous study has monitored middle cerebral artery (MCA) pressure during the superficial temporal artery (STA)-MCA bypass procedure for cerebral atherosclerotic disease. In this paper, the authors describe their method of monitoring MCA pressure and report their initial data on intraoperative MCA pressure and its relationship with hemodynamics prior to and after the bypass procedures. METHODS The results from a total of 39 revascularization procedures performed between 2004 and 2014 were analyzed. The patient group included 27 men and 12 women, and their mean age at surgery was 67.6 years (range 39-83 years). The authors investigated the MCA pressure via the STA during STA-MCA bypass procedures. After one branch of the STA was anastomosed to the MCA, the other branch was connected to an arterial line, and a clip was placed temporally on the main STA trunk to monitor the pre-anastomosis MCA pressure. Simultaneously, the radial artery (RA) pressure was determined before removing the temporal clip to measure the post-anastomosis MCA pressure. The relationship between MCA pressures and single photon emission computed tomography findings and the risk factors for hyperperfusion after STA-MCA bypass were analyzed. RESULTS The MCA/RA (%) pressure was significantly correlated with that of the resting stenotic/normal side cerebral blood flow (CBF) ratio (%) in the linear regression analysis (slope 1.200, r2 = 0.3564, F = 20.49, p < 0.0001). The intraoperative MCA pressure was 39.3% of RA pressure in patients with Powers' Stage 2 cerebral atherosclerotic disease. After 1 branch of the STA was anastomosed, the intraoperative MCA pressure increased to 75.3% of the RA pressure. The rate of increase in pressure was significantly correlated with the increase in the STA diameter in the linear regression analysis (slope 2.59, r2 = 0.205, F = 9.549, p = 0.0038). Hyperperfusion occurred in 2 cases. When mean values for these 2 patients were compared with those for the 37 patients without hyperperfusion, significant differences were found in the stenotic/normal side CBF ratio (p = 0.0001), pre-anastomosis MCA pressure (p = 0.02), rate of increase in pressure (p = 0.02), pre-anastomotic MCA/RA pressure ratio (p = 0.01), vascular reserve (p = 0.0489), and STA diameter (p = 0.0002). CONCLUSIONS The measurement of intraoperative MCA pressure may be a useful technique to assess cerebral perfusion and for predicting the risk of hyperperfusion. Monitoring MCA pressure is recommended during STA-MCA bypass procedures for atherosclerotic disease.

DOI： 10.3171/2015.10.JNS151305

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p < 0.0001), location of anastomosis (p = 0.075), and preoperative cerebral blood flow (p = 0.0399). In our retrospective study, hyperperfusion and smoking after surgery may be risk factors for decreased bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.

DOI： 10.1007/s10143-016-0736-5

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The intraoperative confirmation of blood flow direction is necessary in cerebral vascular surgery. Using indocyanine green video angiography (ICG-VAG) with the FLOW 800 system, we examined the transit time of the blood vessel of interest and semiquantitatively evaluated the delay time (T1/2max) from indocyanine green (ICG) injection into the donor artery in reconstructive surgery and the middle cerebral artery (MCA) in aneurysmal surgery. The direction of cerebral blood flow (CBF), which can often be confirmed by ICG-VAG, may be more difficult to determine with faster blood flow. Here, we report our findings regarding the feasibility of detecting CBF direction using the FLOW 800 system. Twenty patients undergoing superficial temporal artery (STA) to MCA anastomosis for carotid occlusive disease and 13 patients with a small MCA aneurysm clipping were evaluated using the T1/2max, semiquantitative method with the FLOW 800 system. In STA-MCA anastomosis cases, the regions of interest (ROIs) included: the proximal donor STA and a region more than 10 mm on the distal side of the donor STA near the anastomosis site. In MCA aneurysms, the ROIs included the proximal M1 and distal M2 sides of the MCA aneurysm. T1/2max was significantly shorter for the proximal sites compared to the distal sites for all subjects (ps < 0.01). T1/2max was shorter for all subjects in the proximal sites. The direction of CBF can be determined using the FLOW 800 system.

DOI： 10.1007/s10143-016-0726-7

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1161/STROKEAHA.116.013575

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

In neurosurgical procedures, avoiding damage of surrounding tissues such as muscle and periosteum during a craniotomy is important for esthetic and other reasons. We devised a protection tool by using an amputated syringe barrel to cover the perforating drill and protect temporal muscle damage. This device made it possible to prevent damage to surrounding tissues, such as the muscle and periosteum, during cranial perforation. This method could be useful as it is cost-effective, simple, and versatile.

DOI： 10.1016/j.wneu.2016.01.001

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

OBJECTIVE: In neurosurgical operations, such as clipping of ruptured cerebral aneurysms, irrigation of the operative field is a basic and extremely important surgical technique. Various irrigation-suction (IS) systems have been marketed for irrigation of operative fields in neurosurgery. However, with these devices, we often must increase the cuff pressure to maintain fluid power and change the fluid bag relatively frequently. We report the usefulness of pressurized irrigation fluid with the Niagara high-flow irrigation system (NI). METHOD: Using both the NI system and an IS, we altered pressure and duration to investigate differences in flow rate. RESULTS: There was no change in flow rate 80 minutes after pressurization of the NI system, and flow rates decreased slightly. Additionally, flow rates using NI were sensitive to changes in pressure. CONCLUSION: This system has reduced the workload of assisting nurses and surgeons during surgery. Thus we consider the technique to be very useful for neurosurgical operations that require delicate procedures.

DOI： 10.1055/s-0034-1376188

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

INTRODUCTION: Our aim was to assess the feasibility of using time-resolved 3D phase-contrast (4D flow) MRI to characterize extracranial-intracranial (EC-IC) bypass. METHODS: We enrolled 32 patients who underwent EC-IC bypass (15 men, 17 women; mean age 66.4 years). In all, 16 underwent radial artery graft (RAG) bypass and 16 underwent superficial temporal artery (STA) bypass. 4D flow MRI, time-of-flight (TOF) magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were performed. Bypass patency, flow direction, and blood flow volume (BFV) of each artery were determined by 4D flow MRI. Arterial diameters were measured by TOF-MRA and CTA. We compared RAG and STA bypasses by evaluating the flow direction and BFV of each artery. We evaluated the correlation between arterial diameters (measured by CTA or MRA) and the BFV and the detectability of flow direction (measured by 4D flow MRI) of each artery. RESULTS: 4D flow MRI confirmed the patency of each bypass artery. Flow direction of the M1 segment of the middle cerebral artery and BFV in the bypass artery differed between RAG and STA groups (p < 0.01). BFV in the bypass slightly correlated with the diameters on CTA (p < 0.05, R (2) = 0.287). Of the 29 arteries in the circle of Willis, nine were not depicted on 4D flow MRI. Cutoff values for arterial diameters on CTA and TOF-MRA for detecting the artery on 4D flow MRI were 2.4 and 1.8 mm, respectively. CONCLUSION: 4D flow MRI provided unique information for characterizing EC-IC bypasses, although this detectability is limited when addressing small arteries with slow flow.

DOI： 10.1007/s00234-015-1626-1

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Anosmia is not a rare complication of surgeries that employ the anterior interhemispheric approach. Here, we present a fibrin-gelatin fixation method that provides reinforcement and moisture to help preserve the olfactory nerve when using the anterior interhemispheric approach and describe the results and outcomes of this technique. We analyze the outcomes with this technique in 45 patients who undergo surgery for aneurysms, brain tumors, or other pathologies via the anterior interhemispheric approach. Anosmia occurred in 4 patients (8.8%); it was transient in 2 (4.4%) and permanent in the remaining 2 (4.4%). Brain tumors clearly attached to the olfactory nerve were resected in the patients with permanent anosmia. We found a significant difference in the presence of anosmia between patients with or without lesions that were attaching the olfactory nerve (p = 0.011). Our results suggested that fibrin-gelatin fixation method can reduce the reported risk of anosmia. However, the possibility of olfactory nerve damage is relatively high when operating on brain tumors attaching olfactory nerve.

DOI： 10.1007/s10143-015-0647-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass. MATERIAL AND METHODS: We retrospectively analyzed findings from 127 consecutive patients (19 males, mean age at surgery: 56.8 years, range: 19-81 years) at our hospital. The size of aneurysms ranged from 2.7-43.2 mm (mean: 6.9 mm). Extradural anterior clinoidectomy was used to clip small aneurysms. As large or giant aneurysms required a longer temporal occlusion period and often could not undergo simple clipping, high-flow bypass with anterior clinoidectomy or cervical internal carotid ligation was performed to reduce aneurysm blood flow and induce thrombosis. We reviewed a postoperative modified Rankin Scale (mRS), radiographic outcomes, cerebral infarction, and visual disturbance. In addition, we analyzed factors relating to the outcomes and complications, with focus on the aneurysm size, location, and type of surgical treatment. RESULTS: Good outcomes were achieved in all patients, as follows: mRS 0:100, mRS 1:16, mRS 2:11, and mRS 3-6:0. Among the 127 patients, complete exclusion of aneurysm was achieved in 119 cases (93.7%). Postoperative morbidity included ischemic lesions in 11 (8.6%) and visual disturbance in 24 (18.8%). Significant statistical differences were observed between ischemic complication and aneurysm size and location (P = 0.0001) and surgical treatment (P < 0.0001). CONCLUSION: Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.

DOI： 10.1016/j.wneu.2015.08.068

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Infundibular dilatation (ID) is a funnel-shaped enlargement of the origin of cerebral arteries. The coexistence of an aneurysm and ID is relatively rare. Patients with IDs are rarely followed up. However, some IDs have been reported to develop into aneurysms with subsequent rupture. Here we report on a case of an aneurysm that coexisted with ID of the posterior communicating artery. CASE PRESENTATION: A 51-year-old woman underwent magnetic resonance imaging (MRI) to check for aneurysms and other problems. MRI revealed an unruptured aneurysm of the right internal carotid artery, for which the patient was admitted to our hospital. Three-dimensional computed tomographic angiography revealed an aneurysm, which protruded outward, and ID of the posterior communicating artery, which protruded inward. A right pterional craniotomy was performed with aneurysm clipping. The postoperative course was uneventful. In this report, we demonstrate operative views of the aneurysm and ID with the use of neuroendoscopy. CONCLUSION: ID can develop into a true arterial aneurysm and potentially rupture. Therefore, we need to observe the patients with IDs carefully, particularly in young women.

DOI： 10.1272/jnms.83.268

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: We report a case of an internal carotid artery (ICA) aneurysm anomalously originating from the posterior communicating artery (PComA). CASE DESCRIPTION: Preoperative radiologic findings revealed a paraclinoid carotid artery aneurysm at the level of the distal dural ring. Because of the low rupture risk, there are no treatment indications for small paraclinoid or ICA-superior hypophyseal artery unruptured aneurysms. In this case, because of the patient's age and the irregular shape of the aneurysm, treatment was considered necessary. Intraoperative findings using microscopic and endoscopic angiography showed that the aneurysm originated from the proximal branched PComA. The PComA originated from the same level as the ophthalmic artery, and the superior hypophyseal artery originated from the distal side of the PComA. CONCLUSIONS: According to numerous reports, small incidental paraclinoid aneurysms have a lower risk of rupture and growth than PComA aneurysms. Preoperative radiologic examination of unruptured small aneurysms was performed using magnetic resonance angiography and three-dimensional computed tomography angiography. Because the ability of magnetic resonance angiography and three-dimensional computed tomography angiography to detect small branches of the ICA is inferior to digital subtraction angiography, the location of an unruptured ICA aneurysm should be evaluated with other diagnostic modalities besides magnetic resonance angiography and three-dimensional computed tomography angiography.

DOI： 10.1016/j.wneu.2015.08.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ Publishing Group  

Inadequate information is available about the cerebral blood flow and surgical strategies of a direct aneurysmal carotid cavernous fistula (daCCF). We report a quantitative analysis of flow velocity and volume using preoperative time-resolved phase-contrast MRI (four-dimensional (4D) flow MRI) in a daCCF. This is the first report of 4D flow findings with a daCCF. A 55-year-old woman developed a sudden headache and bruit of the right orbit, and MRI suggested the presence of a daCCF. Quantitative analysis using preoperative 4D flow MRI revealed the flow volume of the right internal carotid artery. The daCCF was successfully treated by high-flow bypass using a radial artery graft and internal carotid artery trapping. Postoperative angiography showed a complete obliteration of the daCCF. Studies to collect data from additional cases are required so that 4D flow findings can be further used in the management of daCCFs.

DOI： 10.1136/bcr-2014-206084

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Confirming the patency of the proximal parent and distal artery is necessary in cerebral aneurysm surgery. To understand the relationship between the parent and distal arteries of the aneurysm, the blood vessels running through the subarachnoid space should be extensively dissected, which is time consuming. To examine the efficacy of a temporary clip with indocyanine green (ICG) technique, in which the parent artery is temporarily occluded using a temporary clip, an ICG videoangiography (ICGVAG) is performed to clarify the relationship between the distal artery and the proximal parent artery. Three patients with a distal aneurysm. This technique was used to confirm the connection of the parent and the distal artery in distal aneurysms. With regard to middle cerebral artery (MCA), the procedure is conducted as follows. First, the M2 within the Sylvian fissure is investigated to ensure the absence of atherosclerosis and perforators and that this vessel could undergo occlusion by temporary clipping. The subarachnoid space surrounding the distal artery of the lesion site suspected of an existent aneurysm is dissected. The image range of the ICGVAG is set sufficiently wide to accommodate the possibility that the distal artery is not the artery that was anticipated. Subsequently, after the temporary clip occlusion is completed, the ICGVAG is recorded. In the three distal aneurysms, the relationship between the aneurysm, the distal artery, and the parent artery was confirmed. This method was useful, suggesting that unnecessary dissection in the subarachnoid space might be reduced.

DOI： 10.2176/nmc.tn.2013-0249

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TURKISH NEUROSURGICAL SOC  

Angiographically occult arteriovenous malformations (AOAVMs) are poorly understood. AOAVMs include spontaneous regression of cerebral AVMs. Here we discuss spontaneous angiographical regression of cerebral arteriovenous malformations (SRAVM). We present the case of a 34-year-old male patient with SRAVM in whom an arteriovenous (AV) shunt remnant was revealed by intraoperative indocyanine green videoangiography (ICG-VAG). Preoperative angiography indicated spontaneous regression of AVM. We reviewed the literature for articles having specific citations or case histories of SRAVMs. On the basis of our ICG-VAG findings, we confirmed the possibility of an AV shunt remnant being present in patients with SRAVMs. In addition to our own case, we reviewed previously reported cases and analyzed the data from 132 patients with SRAVMs. Ninety-five (72%) such patients received conservative therapy without surgical removal, and 37 (28%) were treated surgically. Only three patients in whom an SRAVM recanalized after 39, 31, and 16 months have been reported. The rate of recanalization in SRAVM including 3 previously reported cases and the present case, is 3.0% (4/132). Intraoperative ICG-VAG can reveal more SRAVMs that recanalize within a short period even if AV shunts are not depicted by angiography. Therefore, surgical removal of the AOAVM should be considered in cases with low surgical risk.

DOI： 10.5137/1019-5149.JTN.9579-13.4

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CANADIAN JOURNAL NEUROLOGICAL SCIENCES INC  

DOI： 10.1017/cjn.2014.6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

We report the case of a 61-year-old man with supratentorial extraventricular anaplastic ependymoma who presented with repeated intratumoral hemorrhage. The patient was admitted with headache. Computed tomography and magnetic resonance imaging showed an enhancing mass with intratumoral hemorrhage in the right temporal lobe. Gross total resection was performed. The tumor was well demarcated from the brain tissue, and showed no continuity with the ventricular system. Histopathological examination revealed the features of anaplastic ependymoma. Therefore, additional radiation therapy and adjuvant chemotherapy were administered. Ten months later, the tumor recurred with hemorrhage in the spinal canal. This case showed rapid malignant progression and repeated intratumoral hemorrhage within a short period of time, both of which are characteristics of anaplastic ependymomas. Close observation of the central nervous system and adjuvant radiotherapy are mandatory, even if the ependymoma presents with repeated intratumoral hemorrhage.

DOI： 10.1007/s10014-013-0146-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Cases of moyamoya disease or intracranial arterial stenosis around the circle of Willis (M/IAS) associated with hyperthyroidism have been reported. However, most of these previous reports were of the ischemic form of M/IAS and primary hyperthyroidism. To the best of our knowledge, no studies have documented therapy for M/IAS associated with hyperthyroidism. We discuss four previously unreported cases, including those involving the intracerebral hemorrhage form and thyroid-stimulating hormone (TSH) secretion from a pituitary adenoma (secondary hyperthyroidism). We analyzed data from 52 previously reported cases, including the 4 cases presented here, and discuss M/IAS associated with hyperthyroidism, treatment options, pathophysiology, the ischemic and hemorrhagic forms, secondary hyperthyroidism, and the relevant literature. Hyperthyroidism results in thyrotoxicosis and the stimulation of the superior cervical ganglion by TSH antibodies and f-T3/f-T4. Consequently, hypercoagulability and stenosis of the cerebral artery can occur. There are many reports of ischemic M/IAS associated with hyperthyroidism. A conservative approach to treatment is important in such cases; for example, antithyroid therapy should be the first choice to treat ischemic M/IAS. There have been only a limited number of reports on hemorrhagic M/IAS. We presume that hemorrhagic M/IAS tears the weakened vasculature in a manner similar to that of normal M/IAS (with no complicating hyperthyroidism). The authors also reported M/IAS associated with secondary hyperthyroidism due to pituitary thyroid secreting hormone secreting adenoma.

DOI： 10.1007/s10143-013-0511-9

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

OBJECT: To understand the relationship between the parent artery and its distal arteries, blood vessels running through the subarachnoid space need to be extensively dissected, which is time-consuming. We examined the efficacy of temporary clipping with the indocyanine green (ICG) technique (target-controlled infusion (TCI) technique), in which the parent artery is occluded using a temporary clip, and ICGV (videoangiography) is performed to clarify the relationship between the distal M4 and proximal M2. METHODS: Thirteen radial artery grafts (RAGs) for internal carotid aneurysm underwent TCI to confirm the relationship between M2 and cortical M4. To monitor the perfusion pressure of the cortical middle cerebral artery, superficial temporal artery (STA) to M4 anastomosis was performed before RA-M2 anastomosis. We performed anastomosis of the recipient of STA- M4 that was distal and downstream of the M2 segment that is the recipient of RA-M2 anastomosis. To select the proper recipient M4 of the STA-M4 anastomosis, the ICGV image range was set sufficiently wide to accommodate the possibility that the distal artery was not the one anticipated. ICGV followed complete occlusion by temporary clipping of the recipient M2. RESULTS: In 2 of the 13 cases, the relationship between the M2 and M4 could not be clarified. CONCLUSIONS: In cases with developed collateral circulation or small perfusion area of the occluded M2, it was difficult to ascertain the relationship by TCI. Nevertheless, TCI was useful in 11 of the 13 cases, suggesting that unnecessary dissection in the subarachnoid space may be reduced using this technique.

DOI： 10.1016/j.clineuro.2014.01.015

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Cerebrospinal fluid leakage and meningitis caused by frontal sinus (FS) exposure are characteristic complications of bifrontal craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. We describe in detail our procedure for sealing exposed FSs during bifrontal craniotomy and present the results and outcomes of the procedure. METHODS: A total of 51 consecutive patients who had undergone bifrontal craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed FSs is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas Gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the FSs were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal base dura mater. RESULTS: Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients. CONCLUSION: Our results indicate the effectiveness of our technique in the prevention of FS-related postoperative complications.

DOI： 10.1016/j.wneu.2013.01.032

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Acute intracerebral hemorrhage (ICH) associated with mild anemia is commonly observed on radiological examination, and there are several reports of ruptured aneurysms occurring with ICH but without accompanying subarachnoid hemorrhage. However, the relationship among computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia has been rarely reported and is poorly understood. Here, we report atypical radiological and intraoperative findings of acute ICH caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. A 64-year-old man with anemia was admitted to our hospital after he experienced left hemiparesis and a disturbance of consciousness. At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104×10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6×10(4)/μL). Both CT and MRI showed a right frontal ICH. The outer ring of the hematoma appeared as low-density area on CT, a low-intensity area on T1-weighted MRI, and a high-intensity area on T2-weighted MRI with a serous component. The patient received a blood transfusion and underwent surgical removal of the hematoma the following day. The white serous effusion visualized with CT and MRI was identified as a blood clot in the hematoma cavity. The blood that leaks from blood vessels appears as a high-intensity area on CT because it undergoes plasma absorption in a solidification shrinkage process, and is, therefore, concentrated. Although we did not examine the white effusion to determine if serous components were present, we speculated that the effusion may have contained serous components. Therefore, we removed the part of the effusion that appeared as a low-density area on CT. The presence of ICH without subarachnoid hemorrhage suggested the possible adhesion and rupture of a previous aneurysm. Therefore, ICH appeared as a mixed density area on CT because bleeding may have occurred several times. Because radiological findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia are similar to those of ICH and cerebral edema, we suggest that the atypical radiological findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia should be carefully evaluated, especially when surgery is indicated.

DOI： 10.1272/jnms.81.264

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JPN SOC MAGNETIC RESONANCE IN MEDICINE  

PURPOSE: A drawback of time-resolved 3-dimensional phase contrast magnetic resonance (4D Flow MR) imaging is its lengthy scan time for clinical application in the brain. We assessed the feasibility for flow measurement and visualization of 4D Flow MR imaging using Cartesian y-z radial sampling and that using k-t sensitivity encoding (k-t SENSE) by comparison with the standard scan using SENSE. MATERIALS AND METHODS: Sixteen volunteers underwent 3 types of 4D Flow MR imaging of the brain using a 3.0-tesla scanner. As the standard scan, 4D Flow MR imaging with SENSE was performed first and then followed by 2 types of acceleration scan-with Cartesian y-z radial sampling and with k-t SENSE. We measured peak systolic velocity (PSV) and blood flow volume (BFV) in 9 arteries, and the percentage of particles arriving from the emitter plane at the target plane in 3 arteries, visually graded image quality in 9 arteries, and compared these quantitative and visual data between the standard scan and each acceleration scan. RESULTS: 4D Flow MR imaging examinations were completed in all but one volunteer, who did not undergo the last examination because of headache. Each acceleration scan reduced scan time by 50% compared with the standard scan. The k-t SENSE imaging underestimated PSV and BFV (P < 0.05). There were significant correlations for PSV and BFV between the standard scan and each acceleration scan (P < 0.01). The percentage of particles reaching the target plane did not differ between the standard scan and each acceleration scan. For visual assessment, y-z radial sampling deteriorated the image quality of the 3 arteries. CONCLUSION: Cartesian y-z radial sampling is feasible for measuring flow, and k-t SENSE offers sufficient flow visualization; both allow acquisition of 4D Flow MR imaging with shorter scan time.

DOI： 10.2463/mrms.2013-0008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TURKISH NEUROSURGICAL SOC  

AIM: In surgeries involving clamping, opening and repairing the carotid artery such as carotid endarterectomy (CEA) and proximal anastomosis at radial artery (RA) grafting, back-bleeding, often due to insufficient occlusion of the ascending pharyngeal artery (APA), must be avoided. In 96% of cases the APA originates at the dorsal side of the external carotid artery, while in 2% each it arises at the carotid bifurcation or the internal carotid artery. We developed a method to prevent back-bleeding from the APA irrespective of its origin. MATERIAL AND METHODS: For CEA we dissect the internal carotid artery and clamp the APA and the external carotid artery together. For RA grafting we dissect the external carotid artery and if the APA branches directly from this vessel, the APA is clamped directly. RESULTS: We used our new surgical technique in 54 cases (22 CEA and 32 RA grafts) and encountered no major back-bleeding. CONCLUSION: We consider this method to be simple and useful for improving the safety and success of carotid artery surgeries.

DOI： 10.5137/1019-5149.JTN.9527-13.0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Microcystic meningiomas are rare but benign brain tumors. Previous reports have shown that Thallium-201 single-photon emission computed tomography ((201)Tl SPECT) demonstrated a higher late-phase accumulation of (201)Tl in malignant or recurrent meningiomas than in nonaggressive meningiomas. No study has reported (201)Tl SPECT findings in microcystic meningiomas. We here describe a case of a microcystic meningioma with a high (201)Tl SPECT retention rate in a 62-year-old woman who complained of headache. Computed tomography revealed an intracranial tumor in the right frontal lobe. Moreover, (201)Tl SPECT revealed a high uptake of (201)Tl in the tumor, which was particularly prominent in the delayed phase. The uptake index on an early image was 1.46 and that on a delayed image was 1.35. Therefore, the retention index was 0.92. After 2 years of tumor growth, we performed successful radical resection, and histological examination revealed the presence of a microcystic meningioma. Therefore, we concluded that (201)Tl SPECT may be useful for the preoperative diagnosis of microcystic meningiomas and that late-phase accumulation of (201)Tl is not a specific finding of malignant brain tumors. Therefore, we need to be careful in the evaluation and judgment of high retention in a delayed image of (201)Tl SPECT.

DOI： 10.2176/nmc.cr.2013-0220

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.clineuro.2013.05.022

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

BACKGROUND: Cerebral revascularization surgery (CRS) is increasingly recognized as an important component in the treatment of complex cerebral vascular disease and tumors. CRS requires that the incidence of perioperative neurological complications should be minimized, because CRS for ischemic disease is often not the goal of treatment, but rather a prophylactic surgery. CRS carries the risk of focal postoperative neurological deficits. Little has been established concerning mechanisms of post-CRS ischemia. We used 3.0-T diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance angiography (MRA) to analyze the incidence and mechanism of ischemic lesions. METHODS: We studied the anterior circulation territory after 20 CRS procedures involving 33 vascular anastomosis procedures (13 double anastomoses and 7 single anastomoses) in 12 men and 8 women between June 2007 and October 2011. The operations included single or double superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to treat internal carotid artery/MCA occlusions or severe MCA stenosis. A combined STA-MCA anastomosis and indirect bypass were performed for moyamoya disease. Postoperative DWI and MRA were obtained in all patients between 24 and 96 h after surgery to detect thromboembolism, hypoperfusion, or procedural ischemic complications and vasospasms of the donor STA. RESULTS: Follow-up DWI and MRA were carried out 1.8±0.6 days after CRS (range, 1-4 days). Temporary occlusion time for anastomoses averaged 18.9 min (range, 16-32 min). Asymptomatic new hyperintensities occurred in the ipsilateral hemisphere of 2 patients on postoperative DWI (10% patients/6.0% anastomoses), and 1 moyamoya patient (5.0% patients/3.0% anastomoses) developed a symptomatic hyperintensity in the ipsilateral occipital lobe in response to the operation. Two abnormal small (<5 mm) cortical DWI lesions were caused by sacrifices of a small branch of the recipient MCA. CONCLUSION: This study is the first postoperative 3.0-T DWI study of CRS and related clinical events. The incidence of symptomatic postoperative DWI abnormalities was restricted to 1 moyamoya patient representing 5.0% of total patients and 3.0% anastomoses. Although some postoperative DWI abnormalities occurred, CRS was found to be safe with a low risk of symptomatic ischemia.

DOI： 10.1016/j.clineuro.2012.10.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECT: Only a few studies have reported the risk of ischemic complications occurring when superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is performed during surgery for complex MCA aneurysms. SUBJECTS AND METHODS: This is a retrospective study of 10 patients (age 52-73) with MCA aneurysms treated with revascularization surgery. The aneurysms were 10-50mm in size (mean: 21mm). We studied the causes and frequency of ischemic complications by analyzing postoperative magnetic resonance imaging. RESULTS: Postoperative diffusion-imaging confirmed ischemic complications in six of the 10 patients (in two of the five ruptured aneurysms and in four of the five unruptured). The ischemic complications that observed were infarction of the lenticulostriate artery territory in three cases, cortical infarction in two cases, and cerebral infarction that was likely to be due to cerebral vasospasm in one case. In one case, both cortical infarction and infarction of the lenticulostriate artery territory were observed. The Glasgow Outcome Scale (GOS) scores at the time of discharge indicated good recovery (GR) and moderate disability (MD) in seven cases, severe disability (SD) in two cases, and death (D) in one case. CONCLUSIONS: The present study suggests the possibility that STA-MCA anastamosis in surgeries for MCA aneurysms can be performed with comparatively better safety. However, the temporary occlusion time with this surgery is longer than that with a temporary clipping for aneurysmal surgery; thus, we believe that adequate countermeasures are required to prevent ischemic complications.

DOI： 10.1016/j.clineuro.2012.08.007

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記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：Springer Netherlands  

The aim of the present study was to assess the usefulness of a new technique for surgical microscope-based indocyanine green videoangiography (ICGVAG) in the removal of cerebellar haemangioblastomas (HBs). Cerebellar HB was detected in five patients presenting with symptoms of vertigo and/or headaches and diagnosed on the basis of preoperative magnetic resonance imaging (MRI) and cerebral angiographic findings. None of the patients underwent any procedure prior to ICGVAG that would affect the ICG findings, such as perilesional haemostatic coagulation or ablation. In each patient, it was possible to judge the approximate location of the tumour in relation to the brain surface and to differentiate between the feeding and draining vessels. Following resection of the tumour, ICGVAG images confirmed that the mural nodule had been eliminated. None of the patients required blood transfusion, either during or after the surgery. For each patient, the lesion was pathologically confirmed as HB, postoperative contrast-enhanced MRI confirmed the absence of a residual tumour and diffusion-weighted MRI revealed no ischaemic changes. Differentiation between the feeding and draining vessels in the region of the lesion is particularly important for successful surgical removal of HBs. ICGVAG findings enabled easy vascular differentiation and were also useful for confirming that there was no residual tumour. Thus, ICGVAG is useful for the safe resection of HBs.

DOI： 10.1007/978-94-007-5645-8_27

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TURKISH NEUROSURGICAL SOC  

AIM: Replacement of aneurysm clips or temporary parent artery occlusion during aneurysm clipping (AC) carries the risk of inducing postoperative neurologic deficits. When studying the risk of surgical complications associated with cerebral aneurysms, patients with similar conditions should be compared to eliminate the influence of rupture and location of aneurysm. MATERIAL AND METHODS: We used 3.0-Tesla (3.0T) magnetic resonance diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) to analyze surgical complications after AC. A total of 42 AC procedures for 40 unruptured and 2 delayed-phase ruptured MCA aneurysms were evaluated. RESULTS: In six patients, temporary parent artery occlusion was performed. Asymptomatic hyperintensities were observed on DWI of three patients. In one patient, an asymptomatic lesion was most likely caused by a small contusion that occurred during dissection of an aneurysm attached to the brain surface. In two patients, asymptomatic cortical lesions were caused by brain surface contusions due to lacerations of the open dura. No symptomatic hyperintensities on DWI were observed after surgery. No fixed ischaemic neurologic deficits resulted from AC. CONCLUSION: Although some postoperative abnormalities were observed with 3.0T DWI, we found clipping of MCA aneurysms to be a safe procedure with a low risk of ischaemic complications.

DOI： 10.5137/1019-5149.JTN.7886-13.1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

DOI： 10.1272/jnms.80.2

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND AND PURPOSE: Primary brain damage, caused by acute ischemic changes during initial hemorrhage, is an important cause of death and disability following subarachnoid hemorrhage (SAH). However, the mechanism underlying the reduction in cerebral circulation in patients in the acute stage of SAH remains unclear. The goal of this study was to clarify this mechanism with the aid of perfusion computed tomography (CT). METHODS: We prospectively evaluated 21 patients who had been undergone perfusion CT within 3 hours of SAH onset. Mean transit time (MTT) was estimated. Forty circular regions of interest 5 mm in diameter were delineated in the cortical region of the bilateral hemispheres on perfusion CT images. Neurological condition was graded with the Hunt and Hess scale, and initial CT findings were graded with the Fisher scale. We defined a good outcome as a modified Rankin scale (mRs) score of ≤2 at 3 months after SAH onset. RESULTS: Global MTT was an independent predictor of outcome. The global MTT of patients with poor outcomes was longer than that of patients with good outcome. Furthermore, global MTT correlated significantly with Hunt & Hess grades, and disturbances in higher cerebral function. CONCLUSION: Hemodynamic disturbances frequently occur after SAH. These abnormalities probably reflect the primary brain damage caused by initial hemorrhage. Perfusion CT is valuable for detecting hemodynamic changes in the acute stages of SAH.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

INTRODUCTION: We aim to present and discuss clinical outcomes of preoperative liquid embolization of hemangioblastomas (HB) using N-butyl cyanoacrylate (NBCA). METHODS: From 1999 through 2010, 19 patients presenting with symptoms of vertigo and/or headaches were diagnosed with HB based on preoperative magnetic resonance imaging and cerebral angiographic findings at our institution. Preoperative embolization with NBCA was performed on tumors in 10 of 21 operations for 19 patients. For each of these patients, the lesion was pathologically confirmed as HB. RESULTS: Embolization had a favorable outcome in all patients. No permanent neurological complications were observed after preoperative embolization using NBCA. However, thalamic infarction and minor hemorrhage were observed in two patients with cerebellar HB. CONCLUSION: The authors recommend NBCA as an embolization material for large cerebellar HB.

DOI： 10.1007/s00234-011-0985-5

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Treatment of ruptured internal carotid artery anterior wall (ICAW) aneurysms presents a surgical challenge because limitations and difficulties are encountered with either clipping or endovascular treatment. The present study examined clinical outcomes after aneurysmal trapping followed by radial artery grafting for management of these difficult lesions. METHODS: Radial artery grafting was followed immediately by parent artery occlusion in five sides of five patients with acute ruptured ICAW aneurysm (3 men, 2 women; mean age 55.2 years). All patients underwent postoperative angiography and computerized tomography to assess graft patency and ischemic complications including vasospasm. RESULTS: Of the five patients, only one had a poor outcome. However, temporary ischemic complications due to vasospasm developed in four (80%) of the five patients. Long-term results of radial artery grafting and internal carotid trapping for acute stage ruptured ICAW were satisfactory, but detailed analysis indicated a high risk of ischemic complications. CONCLUSIONS: The long-term result was satisfactory, but there was a high rate of acute stage ischemic complications due to delayed vasospasm and low perfusion from the radial artery graft. Based on these results, the investigators recommend that, in addition to intraoperative anticoagulation therapy, in cases where the cerebral blood flow study in the early postoperative period indicates low cerebral perfusion or in cases with World Federation of Neurological Societies grade III-V, the patients should be placed under the highest level of intensive care to detect ischemic complications.

DOI： 10.1016/j.wneu.2011.05.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

The etiology of autism remains unclear, but relationships to cerebellar factors have been reported. We report 2 cases of infantile cerebellar pilocytic astrocytoma in children with autism spectrum disorder. Cerebellar tumors may be related to the pathogenesis of autism.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

BACKGROUND: Only 8% to 22% of cases of subarachnoid hemorrhage (SAH) are of nonaneurysmal origin. Among these, perimesencephalic nonaneurysmal SAH is a distinct clinical and radiologic entity with normal angiographic findings and a good prognosis. In contrast, SAH of nonaneurysmal origin occurring along the cortical convexity is rare and poorly understood. We report 2 cases of subarachnoid hemorrhage along the cortical convexity and discuss their possible etiologies. METHODS: In a retrospective analysis of 234 patients with SAH, we identified 2 patients with a typical computed tomographic pattern of convexity SAH that was associated with no known etiology. RESULTS: In these 2 cases, the source of hemorrhage could not be identified with computed tomography, magnetic resonance imaging, or digital subtraction angiography, although neurovascular outcomes were good. The patients reported such incidents as coughing or exertion immediately before headache developed. These incidents may have caused increased intracranial pressure. CONCLUSION: We suggest the possible involvement of a brief increase in intracranial pressure, such as that accompanying coughing or exertion, in the occurrence of SAH along the cortical convexity.

DOI： 10.1272/jnms.79.301

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

OBJECT: A simple method for preventing and correcting graft kinking for vascular reconstructive surgery through a subcutaneous tunnel is described. PATIENTS AND METHODS: Using a chest tube, 1-0 silk suture and cerebral aneurysmal clips, the problem of postoperative ischemic complications due to kinking can be solved. CONCLUSION: The main advantages of this method are its simplicity and low cost. Using this method does not require any special equipment and the problem of postoperative ischemic complications due to vascular injury, kinking and vasospasms can be addressed.

DOI： 10.1016/j.clineuro.2011.05.016

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: The aim of the present study was to assess a new technique of surgical microscope-based indocyanine green (ICG) videoangiography (VAG) to confirm the patency of the anterior communicating artery (AcomA) after clipping AcomA aneurysms. METHODS: Aneurysmal clipping of five cases of unruptured, broad-neck AcomA aneurysm was performed using the Carl Zeiss Surgical Microscope OPMI Pentero INFRARED 800. RESULTS: In all five patients, after clipping AcomA aneurysms, the patency of AcomA was confirmed using ICGVAG findings and temporary unilateral occlusion of the A1 segment of the anterior cerebral artery using temporary clips. Images were excellent and enabled a real-time surgical assessment because the structures of interest, including vessels, perforating arteries, or residual aneurysm neck, were visible to the surgeon's eye under the microscope in all five patients. CONCLUSIONS: ICGVAG and temporary unilateral occlusion with clips provides a simple, reliable, real-time, and rapid intraoperative assessment of the patency of AcomA. This technique may help to improve the quality of neurosurgical procedures.

DOI： 10.1016/j.wneu.2011.03.044

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDKNOW PUBLICATIONS & MEDIA PVT LTD  

Background: Radial artery grafts (RAG) have been used in the treatment of complex vascular lesions, but not for symptomatic cavernous carotid aneurysms in elderly patients. Aim: To investigate the safety, usefulness, and perioperative complications of RAGs for symptomatic cavernous carotid aneurysms in elderly patients. Material and Methods: Of the 74 consecutive patients, in whom RAGs were used, we retrospectively investigated the postoperative outcomes and complications in eight elderly patients aged over 70years with symptomatic internal carotid artery aneurysms in cavernous sinus. Results: Postoperative complications included one case of cerebral infarction, one case of symptomatic seizures, and one case of delayed cranial nerve palsy. Outcome: Seven patients had an mRS score of 0, and one patient had a score of 2. Postoperatively there was improvement in cranial nerve palsy in seven patients and the patients who had symptoms for one year and eight months had residual deficits. Although it cannot be stated that the frequency of perioperative complications was low, the final outcomes were favorable. Conclusion: Even in carotid disease that is difficult to treat among the elderly, RAG would appear to be a useful and safe treatment.

DOI： 10.4103/0028-3886.84333

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CANADIAN JOURNAL NEUROLOGICAL SCIENCES INC  

OBJECTIVE: We present herein the intraoperative indocyanin green videoangiography (ICGVAG) findings for three cases of cerebellar hemangioblastoma (HB). CASES: Cerebellar HB was detected in three patients presenting with symptoms of vertigo and/or headaches and diagnosed on the basis of preoperative magnetic resonance imaging (MRI) and cerebral angiographic findings. Preoperative embolization of the tumor feeding artery was not performed in any of the patients. None of the patients underwent any procedure prior to ICGVAG that would affect the ICG findings, such as perilesional hemostatic coagulation or ablation. In each patient, it was possible to judge the approximate location of the tumor in relation to the brain surface and to distinguish the feeding and draining vessels. Following resection of the tumor, ICGVAG images confirmed that the mural nodule had been eliminated. None of the patients required blood transfusion, either during or after the surgery. For each patient, the lesion was pathologically confirmed as HB, postoperative contrast-enhanced MRI confirmed the absence of residual tumor, and diffusion-weighted MRI revealed no ischemic changes. RESULTS: Differentiation of feeding and draining vessels in the region of the lesion is particularly important for successful surgical removal of HB. In the present three patients, ICGVAG findings enabled easy vascular differentiation and were also useful for confirming that there was no residual tumor. Indocyanin green videoangiography was concluded to be useful for safe resection of HB.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Because multiple intracranial aneurysms are not rare, accurate preoperative detection of asymptomatic aneurysms is important. In this paper, we report a ruptured distal anterior cerebral artery (DACA) aneurysm associated with an unruptured mirror-image aneurysm in a 62-year-old man presenting with headache. Although delayed vasospasm after subarachnoid hemorrhage has been reported to persist for 2 to 3 weeks, angiographic parent artery narrowing was far more prolonged in our case. Computed tomography revealed a subarachnoid hemorrhage in the interhemispheric and right sylvian fissures and a right frontal lobe hematoma. Digital subtraction angiography demonstrated bilateral symmetric saccular aneurysms of DACAs. On the day of admission, both aneurysms were clipped using an interhemispheric approach in a one-stage procedure, and the hematoma was aspirated. Angiography performed 8 days after the surgery demonstrated a residual aneurysm neck on the left side. Follow-up digital subtraction angiography performed on day 42 from onset showed resolution of the residual aneurysm neck along with narrowing of the left A2. However, at 7 months, the A2 narrowing had lessened. The location of the bilateral aneurysms near the midline facilitated a single approach but necessitated the application of juxtaposed clips. Regarding the pathogenesis of the bilateral aneurysms, previous reports have suggested symmetry of congenital anatomic defects and hemodynamic stress as potential causes. The persistent narrowing that was observed could have resulted from proliferative vasculopathy or from fibrosis possibly induced by the clips.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

The intraoperative findings of an indocyanine green videoangiography (ICG-VAG) study of a cavernous angioma located in the optic chiasm are reported. A 23-year-old Japanese man suddenly developed visual field loss, and magnetic resonance imaging suggested the presence of a suprasellar tumor in contact with the optic chiasm. Preoperative angiography did not clearly show any tumor shadow. Right fronto-temporal craniotomy was performed, and an aggregation of blood vessels was seen on the right surface of the optic chiasm. Cavernous angioma was suspected. ICG-VAG was begun 22 seconds after the beginning of contrast agent infusion via a peripheral blood vessel. The lesion remained unstained, although the brain surface, an artery superior to the optic nerve, and veins were visualized. The cavernous angioma was resected following surface coagulation. ICG-VAG is currently being evaluated for future application in the differential diagnosis based on imaging findings, and the present case provides an important example of intraoperative ICG-VAG imaging of an unoperated cavernous angioma.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

OBJECTIVE: To investigate the importance of sufficient dissection of the interhemispheric and sylvian fissures, an orbitocranial approach was used for clipping of ruptured anterior communicating artery aneurysms. PATIENTS AND METHODS: From January 1998 through March 2009, 41 patients underwent surgery for subarachnoid hemorrhage caused by rupture of an anterior communicating artery aneurysm. Their mean age was 58.4 years, with a range of 37 to 84 years. The preoperative World Federation of Neurosurgical Societies grade was I to III in 32 patients and IV to V in 9 patients. The direction of the aneurysm was upward in 23 patients, forward in 14 patients, and backward in 4 patients. Seven patients had a large aneurysm. RESULTS: All patients underwent surgery during the acute stage following the subarachnoid hemorrhage (day 0-2). A right orbitocranial approach was used for most patients, but a left orbitocranial approach was used for 9 patients because of the presence of a complicated aneurysm and the positional relationship of the left-right A2 segment. In 12 patients, external decompression was performed. The outcome, using the Glasgow Outcome Scale, was good recovery in 24 patients, moderately disabled in 8 patients, and severely disabled in 4 patients, and 5 patients died. Temporary eye movement disorders developed after surgery in 5 patients but resolved in all patients within 2 months. No patients had olfactory disturbance. DISCUSSION: Using the orbitocranial approach and sufficient dissection of the interhemispheric and sylvian fissures, we could secure a broad field of vision and surgical field, which contributed to a safe operation. The only postoperative complication caused by the surgical approach was temporary eye movement disorder. Thus, for some patients with aneurysms of the anterior communicating artery, the orbitocranial approach contributes to improved outcomes.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although percutaneous transluminal angioplasty (PTA) is a widely used less invasive method to treat coronary artery stenosis, 10% of treated patients experience restenosis. Restenosis also occurs in approximately 5% of patients subjected to carotid artery stenting. Animal and human data suggested that restenosis is a response to injury incurred during PTA. As PTA has come into wide use to manage symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH) we studied the incidence of restenosis after PTA for cerebral vasospasm. METHODS: Our study population consisted of 32 patients who had undergone PTA. They were followed by cerebral or 3DCT angiography or MRA for 6 126 months post-PTA (mean 48.65 months) to diagnose restenosis of the cerebral artery. We compared the size of the cerebral artery on the PTA and the contralateral side. RESULTS: All 32 patients underwent successful PTA of 38 vascular territories and all manifested angiographic improvement of vasospasm. None suffered restenosis during the follow up period. CONCLUSION: PTA resulted in a significant improvement in the vessel diameter in patients with vasospasm after SAH and they did not suffer restenosis in the course of prolonged follow-up.

DOI： 10.4103/2152-7806.79758

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Two patients presented with post-traumatic carotid-cavernous sinus fistulae (CCFs) that were successfully treated by high-flow bypass using a radial artery graft after initial unsuccessful attempts at obliteration by intravascular embolization. Case 1 was a 20-year-old man with a CCF detected by magnetic resonance imaging and angiography following an accident. Although the CCF appeared partially occluded by intravascular embolization, serial angiography revealed CCF recurrence. The CCF was trapped by placing a high-flow bypass. Case 2 was a 21-year-old man who presented with bilateral CCFs after sustaining face trauma. The bilateral CCFs were directly treated because of recurrence after balloon occlusion. At present, intravascular surgery is the first treatment choice, but placing a high-flow bypass with trapping of the CCF gained time to treat the CCF and may be useful for treating post-traumatic CCF that cannot be effectively eliminated by intravascular techniques.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KOREAN NEUROSURGICAL SOC  

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

DOI： 10.3340/jkns.2010.48.1.88

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

J-GLOBAL

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

Complex internal carotid artery disease presents a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict occurrence of ischemic complications after internal carotid artery ligation. The present study concerns long-term clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions.<br> Between September 1997 and October 2007, we performed radial artery grafting followed immediately by parent artery occlusion in 20 sides of 19 patients with complex internal carotid arteries disease with follow-up for more than 36 months (5 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative MRI and MRA every year to assess graft patency, ischemic complications, and de novo aneurysm. Another 20 carotid aneurysms with visual disturbance were assessed concerning outcome.<br> Among 13 patients with cranial nerve (III & VI) disturbances, all dysfunctions were improved in cases treated within 8 months of onset to operation. On the other hand, patients with second cranial nerve disturbances were not improved in cases treated after 4 months of onset. No long-term complications were discovered with MRI and MRA.<br> With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Long-term safety is satisfactory, with no delayed complications such as graft stenosis, ischemic complications or de novo aneurysm formations in follow-up periods of more than 3 years. Good clinical outcome of cranial nerve palsy was achieved in patients treated within 8 months of onset for CN III and VI, and 4 of CN II palsy.<br>

DOI： 10.2335/scs.37.369

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

1997〜2005年10月にradial arteryを用いてhigh flow bypass(HFB)を行った大型、巨大内頸動脈瘤17例(男2例、女15例、平均年齢59.6歳)を対象に、周術期合併症の予後、原因を検討した。術後血管撮影で全例にHFBのpatencyを確認し、術後に前腕部の虚血をきたした症例は認めなかった。術前症状の一過性悪化を2例、新たな一過性症状の出現は4例(動眼神経麻痺、外転神経麻痺、brain retractionによると思われる失語、硬膜外血腫による不全片麻痺)認めたが、動眼神経麻痺を除き2ヵ月以内に軽快した。最も高頻度の合併症であった脳神経麻痺は、内頸動脈から海綿静脈洞内の脳神経への血流不全によるものと考えられた。

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

A 72-year-old man presented with a cerebellar vermian tumor manifesting as headaches and vertigo. Angiography disclosed a vascular tumor fed by the superior cerebellar artery and an aneurysm of a primitive trigeminal artery. The patient underwent right occipital craniotomy to remove the highly vascular tumor via an occipital transtentorial approach. Association of a cerebral aneurysm with a hemangioblastoma has been reported previously in only five cases. Only three aneurysms were located on the feeding artery. The aneurysm in this case was not on the feeding artery. Simple coincidence might account for this case.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00701-005-0685-1

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CANADIAN J NEUROL SCI INC  

BACKGROUND: Many anomalies and variants in vascular anatomy have been reported in relation to the anterior cerebral artery (ACA). PATIENTS AND METHODS: We encountered an apparently novel anomaly in a 30-year-old man admitted for disturbance of consciousness following a traffic accident. Computed tomography revealed an acute subdural hematoma and subarachnoid hemorrhage. RESULTS AND CONCLUSIONS: No vascular abnormalities related to the hemorrhage were detected by conventional angiography, so we concluded that the bleeding was of traumatic origin. Anomalous origin of the ACA was disclosed incidentally, with both A1 segments arising from the right internal carotid artery; no normal A1 segment of the left ACA was visualized. We discuss possible bases for this anomalous origin.

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Only 3 such reported intrasellar aneurysms have arisen from the anterior communicating artery. CASE DESCRIPTION: A neurologically normal 38-year-old man complaining of headache underwent cranial magnetic resonance imaging, which showed a heterogeneously enhancing, partially calcified intrasellar mass. The normal pituitary gland was identified at the bottom of the sella, and the optic chiasm was located superior to the aneurysm. Digital subtraction angiography and three-dimensional computed tomography angiography demonstrated the mass to be a partially thrombosed anterior communicating artery aneurysm. Frontotemporal craniotomy was performed, but initial attempts to occlude the neck of the aneurysm were unsuccessful. We could not expose the dome of the aneurysm or confirm the anatomic relationship of the pituitary to the aneurysm. The patient declined further intervention, and close follow-up has been maintained. CONCLUSION: Our case suggested that unlike intrasellar aneurysms arising from the internal carotid artery, intrasellar aneurysms originating from the anterior communicating artery are likely to present difficulty in dissecting the neck of the aneurysm from the bilateral optic nerves and pituitary stalk, impeding direct aneurysm clipping. When we operated upon a patient with a large unruptured intrasellar aneurysm originating from the anterior communicating artery via the prechiasmatic space, we encountered considerable technical difficulty.

DOI： 10.1016/j.surneu.2003.08.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A new forceps for grasping and cutting tumour in a narrow surgical field is described. The working length is 12 cm and the grasping element at the tip is 1 mm in diameter. To avoid damage to surrounding structures caused by pulling out the tumour, the grasping portion consists of two hollow cylinders with sharp edges that divides, rather than tears tissue.

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記述言語：日本語  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

There have been several reports describing the cases of acromegaly, which show reduction in size of tumor in due to pituitary apoplexy or lymphocytic hypophysitis. We have encountered a patient of acromegaly, who developed panhypopituitarism after suffering from meningitis and showed the reduction of tumor in size. The results of imaging examination suggested the presence of pituitary apoplexy and lymphocytic hypophysitis. The patient was a 27-year-old woman, who visited a local physician with complains of headache and fever. After performing lumbar puncture, she was diagnosed as viral meningitis, and conservative therapy was initiated. The results of biochemical test of blood revealed hyponatremia. Because facial appearance of the patient was similar to that of acromegaly, endocrine dysfunction was suspected. The result of pituitary hormone tests showed high levels of growth hormone (GH) and somatomedin C (IGF-1) and low levels of the other hormones. At the same time, sign of diabetes insipidus was noted, and the patient was referred to our hospital. In the examination at the admission, GH and IGF-1 showed the trends to decrease, and the reduction in size of tumor was also detected. From the results of imaging examination, pituitary apoplexy and lymphocytic hypophysitis were suspected. Operation was performed, and pathological examination revealed inflammation of pituitary adenoma.

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(株)メディカ出版  

軽症脳動脈瘤破裂によるくも膜下出血(SAH)に対する脳神経外科手術を行った28例を,来院時に交互に,代替髄液として生理食塩水を用いたS群18例,ラクトリンゲルを用いたL群10例の2群に分類し,術後の頭痛,症候性脳血管撃縮の発生頻度,発熱の程度,髄液中の電解質所見を検討した.その結果,術後に頭痛の悪化を訴えた症例はL群で1例,S群で5例存在した.症候性血管攣縮はL群において0例,S群において6例存在したが有意差は認めなかった.術後の体温は,2時間毎の計測値の平均及び体温の最高値に関しては術後24時間,48時間両者とも有意差を認めなかった.しかし,38度,38.5度以上の高体温を示した症例はS群で多い傾向を示した.髄液中のNa,K,Clは,S群とL群で有意差を認めず,血液中と髄液中の電解質の比においても有意差は認めなかった.以上より,ラクトリンゲルを洗浄システムに用いたSAH症例の手術の場合,有意差は認めなかったものの術後の頭痛,発熱の程度を軽減できる可能性が示唆された

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Acute subdural hematoma (ASDH) without subarachnoid or intracerebral hemorrhage following rupture of an intracranial aneurysm is rare. Only 34 cases of pure ASDH resulting from rupture of an intracranial aneurysm, and 5 cases of pure ASDH secondary to rupture of an anterior cerebral artery (ACA) aneurysm, have been reported in the literature. We report a case of a patient with a ruptured distal ACA aneurysm who presented pure ASDH on CT. A 63-year-old woman was admitted with the acute onset of severe headache, nausea, and dizziness. CT showed a right convexity and interhemispheric ASDH in the absence of subarachnoid or intracerebral hemorrhage. Cerebrospinal fluid was clear by lumbar puncture. However, we still suspected a ruptured intracranial aneurysm as the diagnosis. Angiography was performed and demonstrated a right distal ACA aneurysm with a daughter aneurysm. Evacuation of the subdural hematoma, with the clipping of the aneurysm was performed. Intraoperatively, adhesion between the dome of aneurysm and the falx cerebri was observed. The patient was discharged from the hospital without neurological deficits.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)へるす出版  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

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総ページ数：viii, 287p   記述言語：日本語  

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総ページ数：2 v.   記述言語：英語  

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総ページ数：193p   記述言語：日本語  

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総ページ数：167p   記述言語：日本語  

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記述言語：日本語   出版者・発行元：日本シミュレーション医療教育学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

DOI： 10.7887/jcns.23.812

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(株)メヂカルフレンド社  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一財)博慈会老人病研究所  

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記述言語：日本語   出版者・発行元：(株)へるす出版事業部  

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記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

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記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(株)にゅーろん社  

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記述言語：日本語   出版者・発行元：医学書院  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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掲載種別：速報，短報，研究ノート等（学術雑誌）  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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Introduction: Abnormalities in the coagulation and fibrinolytic system can be developed in patients with severe head injuries. The brain tissue contains high concentration of tissue factor, which activates extrinsic coagulation pathway after head injuries, subsequently produces hypercoagulable state followed by fibrinolytic activation. It has been reported that the degree of abnormalities in the coagulation and fibrinolysis can be an independent predictor of outcome. Based on these observations, we evaluated the importance of fibrinolytic activities in the pathogenesis of severe head injury, especially focused on α2-plasmin inhibitor (α2-PI). Materials and Methods: Thirteen consecutive patients admitted with isolated head injury to our department within 2 hrs after injury were studied. Patients with clinical and laboratory evidence for hepatic impairment were excluded. A Glasgow Coma Scale of ≤8 points was 8 cases, ≥9 was 5. Seven of 13 patients died. Blood samples were collected on admission and serially, coagulation and fibrinolytic parameters were measured. Results: In all patients, abnormalities of coagulation and fibrinolysis were evident on admission. All patients showed markedly elevated concentration of thrombin-antithrombin III complex, which were ≥100 μg/L. Although plasma levels of FDP, D-dimer, and plasmin-α2-PI complex were increased in non-survivors as compared to survivors (248.4 ± 264.3 vs 68.0 ± 58.7 μg/mL, p &lt;0.05 ;143.8 ± 156.3 vs 43.8 ± 31.3 μg/mL, ns ;22.7 ± 23.4 vs 12.8 ± 10.1 μg/mL, ns. respectively), the levels of these parameters showed large deviations. Plasma α2-PI levels of non-survivors were 55% or less on admission, while more than 60% in survivors (46.3 ± 13.2 vs 78.0 ± 10.2%, p &lt;0.001). In non-survivors, delayed intracerebral hemorrhage or marked bleeding tendency during surgery were shown. Conclusion: α2-PI is the most important inhibitor of fibrinolysis, and it has been reported that excessive fibrinolysis and plasmin-induced endothelial injury occur in its deficiency. The results suggest that excessive fibrinolysis induced by secondary α2-PI deficiency may contribute to the pathophysiology of severe head injury.

DOI： 10.1097/00003246-199901001-00180

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(株)エムイー振興協会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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開催年月日： 2000年

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開催年月日： 1998年

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開催年月日： 1998年

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