記述言語：日本語   出版者・発行元：(一社)日本脳ドック学会  

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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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その他リンク： http://orcid.org/0000-0003-3378-051X

記述言語：日本語   出版者・発行元：(一社)日本鼻科学会  

DOI： 10.7248/jjrhi.54.479

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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  

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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その他リンク： http://orcid.org/0000-0003-3378-051X

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 (fourdimensional (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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その他リンク： http://orcid.org/0000-0003-3378-051X

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. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.clineuro.2014.01.015

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その他リンク： http://orcid.org/0000-0003-3378-051X

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 10-50 mm in size (mean: 21 mm). 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. © 2012 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.clineuro.2012.08.007

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その他リンク： http://orcid.org/0000-0003-3378-051X

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 <= 2at 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. (J Nippon Med Sch 2013; 80: 110-118)

DOI： 10.1272/jnms.80.110

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その他リンク： http://orcid.org/0000-0003-3378-051X

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  

当院でradial artery graft(RAG)を行った頭頸部内頸動脈瘤病変81例のうち、合併症またはその対策を講じた3例について報告した。ケース1は視野障害で発症した大型部分血栓化頸動脈瘤の症例で、手術翌日のCTで硬膜外血腫を認め、術後5日目に軽度の不全麻痺をきたした。画像上血腫の拡大がなく、不全麻痺が軽度であったため、経過観察したところ、約2週間で症状は軽快した。ケース2は眼瞼下垂を主体とした動眼神経麻痺で発症した海綿静脈内頸動脈瘤の症例で、RAGと頸部頸動脈の結紮術を行ったが、術後5日目より軽度の外転神経麻痺による複視が出現した。ビタミンB12製剤投与にて経過観察したところ、約3週間で症状は軽快した。ケース3は内頸動脈後交通動脈分岐部部分血栓化大型動脈瘤の症例で、橈骨動脈採取のため前腕の創部を<ギザギザ>な形とし、切開線と垂直な方向の張力を減じるようにした。また、真皮縫合は行わず、derma bondとテープ固定とし、術後2週から2ヵ月はシリコンジェルシートを創部に用いた結果、ケロイド形成を予防することができた。

DOI： 10.2335/scs.41.33

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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: 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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その他リンク： http://orcid.org/0000-0003-3378-051X

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. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.clineuro.2011.05.016

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その他リンク： http://orcid.org/0000-0003-3378-051X

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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その他リンク： http://orcid.org/0000-0003-3378-051X

DOI： 10.4103/0028-3886.84333

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その他リンク： http://orcid.org/0000-0003-3378-051X

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  

1995〜2007年に頸動脈内膜剥離術(CEA)を施行した95症例(男性81例、女性14例、平均74歳)97病変を対象に、著者等は積極的にCEAにヘマシールドパッチグラフトを使用しており、血管形成術に併用した成績について検討した。その結果、CEA施行97例中術後1ヵ月後の転帰は死亡1例(内膜損傷が原因と考えられる解離性動脈瘤による脳梗塞)で、一次縫合群62例とヘマシールド群35例との比較では、平均年齢・性別・嗄声出現・創部出血および手術時期には有意差は認めず、術後1ヵ月以内の死亡はヘマシールド群で1例、脳梗塞は一次縫合群で1例であった。再狭窄をきたした症例は各群とも1例で、精査目的の3D-CTAまたは脳血管撮影での狭窄率はいずれも50%未満であり、かつ無症候性で経過しており外科的処置は必要としなかった。以上より、ヘマシールドパッチグラフトは術後急性期内頸動脈閉塞に対して有用であり、CEAを安全に施行する備えとして意味があると考えられた。

DOI： 10.2335/scs.37.416

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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  

1997年〜2007年10月にradial artery graftを併用した治療困難な内頸動脈病変41症例46側中、3年以上経過観察が可能であった19症例20側(A群)の長期成績と、視機能障害で発症し1年以上経過観察が可能であった大型内頸動脈瘤20例(B群)の予後について検討した。その結果、A群の経過観察(39〜105ヵ月・平均62.8ヵ月)では新生動脈瘤の出現、graft血管の狭窄はみられず、視機能は全例GRであった。B群の視機能は発症から8ヵ月未満に治療したものは80%が軽快したが、8ヵ月以上経過した症例では視機能を改善し得た症例は1例もなかった。特に視神経に関して4ヵ月以上経過してから手術したものに症状が軽快したものはなく、動眼神経・外転神経に関しては8ヵ月を超えて手術を行った症状が軽快したものはなかった。

DOI： 10.2335/scs.37.369

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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  

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.

DOI： 10.2176/nmc.46.143

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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   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：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)日本脳卒中学会  

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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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