記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND IMPORTANCE: In cardiogenic cerebral embolism, early recanalization is the most important factor for good prognosis. However, endovascular thrombectomy often fails to achieve recanalization. We present an open surgical embolectomy technique and discuss its advantages. CLINICAL PRESENTATION: A 79-year-old woman developed right hemiparesis and severe aphasia. Magnetic resonance imaging revealed an acute cerebral infarction caused by left middle cerebral artery (MCA) occlusion. We attempted endovascular thrombectomy but failed because it was impossible to guide the catheter to the occlusion site. Hence, we converted to open surgical embolectomy. Sylvian fissure was widely opened. After confirming the range of thrombosis using indocyanine green videoangiography (ICGVAG), the proximal and distal arteries were secured, and a temporary clip was placed on the distal M2 to prevent distal thrombosis migration. MCA was cut approximately 3 mm from the bifurcation, and thrombosis was removed using micro-forceps. The proximal clip was simultaneously inserted but was not clamped because the thrombus was extruded by proximal vascular flow. Immediately after removing the thrombus, intense bleeding occurred from the proximal flow. An assistant clamped the proximal artery using the prepared clip, and the incised area of MCA was sutured using 9-0 threads. We finally confirmed blood flow after recanalization using ICGVAG. The time from skin incision to recanalization was 27 min. After the procedure, the patient developed slight aphasia but had no hemiparesis and was later transferred to a rehabilitation hospital. CONCLUSION: Open surgical embolectomy may be a secondary rescue treatment option in the case of endovascular thrombectomy failure.

DOI： 10.1016/j.jocn.2021.05.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We aimed to identify the risk factors for surgical treatment of unruptured intracranial aneurysms (UIAs) in individuals aged >60 years, particularly focusing on white matter lesions (WMLs). MATERIAL AND METHODS: We investigated a total of 214 patients with UIAs. The patient group comprised 53 males and 151 females with an average age of 68.2 years. UIA size ranged from 2.7 to 26 (mean: 7.3) mm. The primary endpoint of the study was patient prognosis evaluated at the time of discharge using the modified Rankin Scale. We examined the risk factors for poor outcome and WMLs using magnetic resonance imaging. RESULTS: Poor outcome was observed in 23 (10.7%) patients. Significant correlations were observed between poor outcome and UIA size (P < 0.0001), UIAs located posteriorly (P = 0.0204), UIA thrombosis (P = 0.0002), and presence of WMLs (P < 0.0001) in univariate regression analysis. However, no significant correlations were noted between poor outcome and age (P = 0.1438). Multivariate logistic regression analyses showed significant correlations between poor outcome and UIA size (P < 0.0001), presence of WMLs (P = 0.001). Severe WMLs based on the Fazekas classification was correlated to age (P < 0.0001) and atherosclerosis (P = 0.0001). Severe WMLs were associated with ischemia (P < 0.001) and epilepsy (P = 0.0502) as well as length of hospitalization (P < 0.0001). CONCLUSION: Severe WMLs are risk factors for surgical treatment of UIAs in the elderly. Surgical indications must be considered and caution should be taken when managing patients with severe WMLs.

DOI： 10.1016/j.jstrokecerebrovasdis.2020.105121

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Carotid artery stenosis is elicited by atherosclerosis and is the main cause of cerebral thrombosis. Flow-mediated endothelial vasodilation (FMD) can be measured noninvasively to assess vascular endothelial function related to atherosclerosis. The pulse wave velocity (PWV) is used to evaluate the vascular media involved in atherosclerosis. We investigated the relationship between these measurements in 75 consecutive patients with atherosclerotic cerebral thrombosis. They were assigned to three equal groups based on the severity of carotid artery stenosis on ultrasonograms. Group 1 had no stenosis, group 2 manifested moderate stenosis (<60%), and group 3 presented with severe stenosis (≥60%). We compared the FMD and PWV among the three groups. The PWV was significantly lower in group 1 than the other two groups. The FMD was significantly lower in group 3; it was significantly lower in group 2 than group 1. There was an inverse correlation between the FMD and the severity of carotid artery stenosis. Our findings show that for assessing the severity of carotid artery stenosis, the FMD is more useful than the PWV.

DOI： 10.2176/nmc.oa.2019-0193

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記述言語：英語  

BACKGROUND: Aplastic or twiglike middle cerebral artery (MCA), a congenital anomaly related to the abnormal development of the MCA, is rare. It is usually unilateral; bilateral lesions are extremely rare. An aplastic or twiglike MCA may lead to cerebral ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage (SAH). In patients with ischemic stroke due to hemodynamic stress, extracranial-intracranial (EC-IC) bypass surgery is indicated. As hemodynamic stress may also elicit SAH, it is important to select the appropriate treatment. EC-IC bypass surgery was successful in a patient with bilateral aplastic or twiglike MCA who suffered SAH due to hemodynamic stress. CASE DESCRIPTION: A 64-year-old female with a history of surgery for tetralogy of Fallot experienced SAH in the left sylvian fissure. As angiography showed a bilateral aplastic or twiglike MCA and single photon emission computed tomography revealed a decrease in the cerebral blood flow in the left MCA territory, we attributed her SAH to hemodynamic stress due to the decreased blood flow in the MCA territory and to the vulnerability of abnormal vessels as are seen in moyamoya disease. We performed EC-IC bypass surgery to reduce hemodynamic stress. A cerebral angiogram obtained 2 weeks postoperatively revealed sufficient blood flow in the MCA territory from the superficial temporal artery used for bypass. In the course of 2-year follow-up she remained stroke free. CONCLUSIONS: The presence of aplastic or twiglike MCA may lead to stroke due to hemodynamic stress. EC-IC bypass surgery may help to prevent stroke recurrence and SAH.

DOI： 10.1016/j.wneu.2019.10.054

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Complete control of back bleeding during carotid endarterectomy (CEA) is important. We investigated the causes of back bleeding during CEA and techniques for the control of bleeding. METHODS: A retrospective review was performed of 214 CEA procedures. We assessed the results of routine preoperative examinations, instruments used for arterial clamping (vessel loop and crude or bulldog clamps), and severity of carotid artery stenosis and arterial wall calcification. The study end point was incomplete control of back bleeding before arteriotomy. Factors associated with back bleeding were identified by univariate analysis. The culprit artery and intraoperative technique used in patients with back bleeding were also determined. RESULTS: Transient back bleeding occurred in 19 CEA procedures (8.9%). Back bleeding was from the ascending pharyngeal artery in 9 cases, common carotid artery in 8 cases, and external carotid artery in 2 cases. Univariate analysis identified the following factors as being related to incomplete control of back bleeding: moderate carotid artery stenosis (20 mm thick) and use of bulldog clamps. CONCLUSIONS: Transient back bleeding during CEA was uncommon, with the risk factors being severe carotid calcification and moderate carotid stenosis. Transient back bleeding was managed by clamping an undetected ascending pharyngeal artery or by additional clamping of the common carotid or external carotid artery. The vessel loop and crude were superior to the bulldog clamp for clamping the carotid artery.

DOI： 10.1016/j.wneu.2019.07.114

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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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study was performed to identify risk factors for neck haematoma requiring re-exploration after carotid endarterectomy. Neck haematoma is a well-known complication after carotid endarterectomy, but there has been little discussion about intraoperative techniques for its prevention. We also investigated an intraoperative neck flexion technique for prevention of neck haematoma. METHODS: A retrospective study reviewed 384 carotid endarterectomies performed at our institution from 2003 to 2016. The endpoint was neck haematomas requiring re-exploration after carotid endarterectomy. Endpoint predictors (general factors, preoperative medication, and intraoperative factors) were identified by univariate analysis. Our intraoperative neck flexion technique involved changing the neck and head position from extension to flexion during carotid endarterectomy. In patients with neck haematoma, we assessed the interval from carotid endarterectomy to re-exploration, the source of bleeding, and the method of airway rescue. RESULTS: There was one major and three minor perioperative strokes (1.1%). Neck haematoma occurred in 9 patients (2.4%). Univariate analysis (odds ratio [95% confidence interval]) identified preoperative clopidogrel therapy (4.19 [1.03-17.06], P = .04) and not using protamine sulfate after heparin (4.13 [1.02-25.06], P = .04) as risk factors for haematoma. We used the intraoperative neck flexion technique in 87 patients and no neck haematomas occurred. There was no additional morbidity and no mortality in the patients who required re-exploration. The interval between carotid endarterectomy and re-exploration ranged from 0 to 30 hours. Intubation before re-exploration was often difficult. We recommend using a laryngeal mask and performing minor wound re-exploration under local anesthesia before tracheal intubation for general anesthesia. Haematomas were mainly caused by venous bleeding or capillary oozing. CONCLUSIONS: This study showed that neck haematoma is uncommon after carotid endarterectomy, but requires emergency airway rescue and re-exploration.

DOI： 10.1080/02688697.2018.1468018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

A lipoma is a slow-growing, benign tumor and is usually asymptomatic; hence, surgical intervention can often be avoided in patients with these tumors in the cervical and cranial area. Lipomas arise most commonly in the subcutaneous fat, but occasionally in muscle tissue. Intramuscular lipomas in the cervico-cranial area have rarely been reported. We describe here a patient with a large intramuscular lipoma in the deep cervical tissue. The patient experienced troublesome pain in the neck and occipital area, and surgical treatment was therefore suggested. Particularly in the cervical area, intramuscular lipomas sometimes invade the surrounding muscles and tissue layers and develop into an irregular mass, despite being benign. In addition, the cervical area has one of the most complex muscle structures. Nevertheless, surgical management of intramuscular lipoma in the cervical and cranial area is sometimes indicated, for example, in patients with clinical symptoms or masses with a tendency to grow large.

DOI： 10.1272/jnms.84.96

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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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  

頸動脈内膜摘出術(CEA)を施行した頸動脈狭窄症患者97名(男92、女5、CEA時平均年齢76歳)を対象に、癌との関連性を検討した。CEA後の追跡期間は6ヵ月〜11年(平均3.6年)で、この間、5名が死亡し、うち3名の死因が癌であった。CEAと癌の発症時期で、I群(CEA時に癌の既往あり)、II群(CEA時に癌の治療中)、III群(癌の手術直前に超音波検査で頸動脈狭窄が認められCEAを施行)、IV群(CEA後に癌を発症)に分類した。I群は10名で、うち5名は頸部放射線治療を受けていたが、CEAは安全に施行された。II群は2名で、うち1名は食道癌で死亡した。III群は2名の大腸癌患者で、CEA後、腹腔鏡下大腸癌摘出術が無事に施行された。IV群は8名で、うち2名が癌で死亡した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02079&link_issn=&doc_id=20150612260005&doc_link_id=%2Fcp4strok%2F2015%2F004303%2F005%2F0188-0192%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2015%2F004303%2F005%2F0188-0192%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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  

Anterior cervical fixation with autologous bone transplantation without the need for harvesting bone from other sites, such as the ilium was developed by Williams and modified by Isu et al. In recent intervertebral fusion procedures, after harvesting the cuboid bone from vertebral bodies, a hydroxyapatite block is placed between two harvested vertebral bones in the same way as in the sandwich method for intervertebral fixation. According to previous studies, this procedure has the following disadvantages: (i) as the corrective force for cervical kyphosis is insufficient, it could not be adapted for patients with preoperative kyphosis; (ii) special devices, including a microsurgical saw, are required for harvesting vertebral bones. In our modified method, we used a conventional high-speed drill instead of a microsurgical saw. Nevertheless, the results show that the operated spine can be stabilized to a greater extent by decreasing the height of the grafted bone, and this might help in reducing postoperative kyphosis.

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

Background: Anterior cervical discectomy and fusion (ACDF) has become a common procedure for cervical spine surgeries, since it is safe and effective in most patients. However, some patients develop life-threatening problems such as respiratory obstruction arising from rare postoperative hematoma and edema, although intraoperative bleeding caused by the connective tissue splitting procedure or bleeding caused by postoperative insertion of a suction tube has rarely been reported. Investigation of the requirement for indwelling drains in patients who undergo cervical spine surgery is necessary because of the pain, anxiety, and discomfort caused despite the use of high-quality materials. Methods: Enrolled in the study were 43 patients who underwent one-level anterior cervical fixation surgery, including 23 (randomly selected) who received an indwelling drain (group A, mean age: 57.78±14.46 years, range: 39-82 years, male/female: 13/10), and 20 who received no indwelling drain (group B, mean age: 57.00±13.99 years, range: 29-81 years, male/female: 12/8). Intraoperative bleeding amounts, lateral views of plain cervical spine radiographs, prevertebral space (PVS) changes on plain radiographs and computed tomography (CT) images, wound inspections, and pain assessments on the Numeric Rating Scale (NRS) were compared between groups. In addition, a history of risk factors for bleeding, such as hypertension, diabetes, and cerebrovascular diseases which require antiplatelet therapy, was determined. Hepatic failure was observed in none of the patients. Results: Postoperative CT images obtained the day following surgery showed no densities indicating the presence of postoperative hematoma in any of the 43 patients. The maximum amount of intraoperative bleeding was 10 mL, with no significant difference between groups. No patients reported an obvious pain level on NRS, but the pain was significantly milder in group B (A: 1.326±0.911, B: 0.555±0.556, p=0.0037). The postoperative PVS increment on plain radiographs was comparable between groups (A: 1.778±0.992, B: 1.730±0.966, p=0.8728). Discussion: Given the negligible intraoperative and postoperative bleeding observed in both groups, and the lack of difference in PVS increments between the groups, our results suggested that indwelling drains are not required for patients undergoing typical anterior cervical fixation surgery. However, it is important to take care of major vessels such as the superior and inferior thyroid arteries and the external jugular vein as well as the prevertebral venous plexus during surgery.

DOI： 10.1272/jnms.82.124

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その他リンク： http://search.jamas.or.jp/link/ui/2016091117

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Unilateral paresis of cranial nerves IX to XI is defined as Vernet's syndrome. We retrospectively assessed cranial nerve symptoms from the clinical records of 143 carotid endarterectomy patients. A flexible nasolaryngoscope was used to examine vocal fold movements in 73 patients. If vocal fold paresis (VFP) was confirmed, the patient also underwent magnifying laryngoscopy (for correct diagnosis of injury to the glossopharyngeal and vagus nerves). It was found from clinical records that 8 patients (6%) were confirmed to have cranial nerve symptoms corresponding to Vernet's syndrome; 7 patients (9 %) had VFP on nasolaryngoscopy. In 2 patients, magnifying laryngoscopy confirmed ipsilateral VFP, pharyngeal paresis, pharyngeal wall hypesthesia, and ipsilateral pharyngeal wall swelling. These 2 patients also had symptoms of injury to the accessory nerve. Damage to cranial nerves IX to XI probably occurred in the parapharyngeal space, based on the existence of posterior pharyngeal wall edema or swelling after carotid endarterectomy.

DOI： 10.1177/1531003514525476

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Injury to the vagus nerve or one of its branches during carotid endarterectomy (CEA) can result in vocal fold paralysis (VFP), but the exact mechanisms and site of injury responsible for VFP after CEA are unclear. The aim of this study was to identify the site of nerve injury in patients with VFP after CEA using magnifying laryngoscopy. METHODS: We performed 96 consecutive CEA procedures in 87 patients over 5 years. After 56 CEA procedures, we examined vocal fold movements with a flexible nasolaryngoscope and detected VFP in 5 of 40 cases (9 %). At 6-8 weeks after CEA, these five patients also underwent magnifying laryngoscopy at another institution by a specialist in vocalization. RESULTS: We confirmed ipsilateral VFP and pharyngeal paralysis in three patients. The other two patients recovered from their nerve injuries spontaneously before the magnifying examination. CONCLUSIONS: VFP and pharyngeal paralysis were caused by damage to the recurrent laryngeal and pharyngeal nerves. Therefore, the probable site of nerve injury during CEA was near the inferior vagal ganglion of the vagus nerve trunk in our three patients.

DOI： 10.1007/s00268-013-1920-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To determine the causes and site(s) of nerve injury and to identify potential predictors of vocal fold paralysis (VFP) after carotid endarterectomy (CEA) by application of intraoperative neuromonitoring (IONM). A total of 68 CEA patients were enrolled in this study. A 3-step IONM procedure was designed to obtain vocal fold EMG data at V1 (just after identification of the vagus nerve [VN]), V2 (just before arteriotomy), and V3 (just before wound closure). We also performed IONM before/after hemostasis near the VN using bipolar forceps and before/after dissection of the VN. All patients underwent laryngoscopy to assess postoperative VFP. One patient showed loss of EMG signals between V2 and V3 and developed VFP that persisted for 11 months. The other 62 patients had no loss of EMG signals, but 2 patients had confirmed VFP for 1 month after CEA. There were no changes of EMG signal before and after VN dissection or hemostasis with bipolar forceps near the VN.

DOI： 10.1177/1531003512472239

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記述言語：英語  

We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels arising from the right opthalamic artery. Kimura's disease is a chronic disease characterized by the clinical triad of slowly enlarging subcutaneous masses with lymphoid hyperplasia in the head and neck. It often occurs in young Asian men. In our patient, the pathogenesis of internal carotid artery occlusion was unknown. There have only been a few case reports in which occlusion of the internal carotid artery was associated with autoimmune disease, and no previous cases of internal carotid occlusion associated with Kimura's disease have been reported. We suspected that occlusion of this patient's internal carotid artery may be caused by the autoimmune mechanism that underlies Kimura's disease.

DOI： 10.1155/2010/407538

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記述言語：英語  

The technical factors and surgical methods employed in carotid endarterectomy are controversial. In particular, whether or not to use an indwelling arterial shunt during carotid endarterectomy remains a source of conflict. We describe a rare case in which uncomplicated carotid endarterectomy was followed by distal internal carotid artery dissection and suggest that this devastating complication was due to intimal damage produced by the use of an indwelling arterial shunt.

DOI： 10.1155/2010/816937

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 62-year-old woman presented with a symptomatic arachnoid cyst of the right occipital convexity manifesting as visual disturbances and headache. She underwent craniotomy with membranectomy and fenestration to the subarachnoid space. Postoperatively, her complaints disappeared and brain magnetic resonance (MR) imaging showed cyst shrinkage. During the first 1 year after surgery, she made a good recovery without clinical symptoms or cyst enlargement. However, she complained of visual disturbances after 6 years. Brain MR imaging revealed cyst enlargement and Goldmann perimetry detected left lower quadrantanopia. The diagnosis was recurrent arachnoid cyst. A second surgical procedure was performed including membranectomy for histological examination of the cyst membrane, and an Ommaya reservoir was inserted into the cyst cavity to prevent further cyst enlargement. The histological findings were compatible with arachnoid cyst, similar to the results seen at the first surgery. She was discharged 3 weeks after the second operation with no complications, and follow up continues as an outpatient. Patients with symptomatic arachnoid cysts typically have good progress after surgery, but the present case shows that follow up should continue for at least 6 years after surgery, even if cyst volume reduction was initially favorable.

PubMed

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記述言語：日本語   出版者・発行元：The Japanese Society on Surgery for Cerebral Stroke  

Patch angioplasty with carotid endarterectomy has been advocated to decrease the incidence of recurrent stenosis and postoperative acute occlusion. In this article, we describe our experience with 35 carotid endarterectomies using the Hemashield patch graft. The technique is simple and does not require any special preparation of the patch material. The Hemashield is placed over the arteriotomy and cut to the exact length of the opening. Each end of the patch is then anchored to the arteriotomy with double-armed 6-0 prolene or pronova. The other steps of carotid endarterectomy are unchanged, and the same suture can be used for patch placement. The 30-day major mortality/morbidity rate was 2.8% (1 patient died of postoperative cerebral infarction). There was no postoperative occlusion. We also introduce 3 representative cases treated with a Hemashield patch graft. This patch graft is useful for safer carotid endarterectomy.<br>

DOI： 10.2335/scs.37.416

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study was to investigate the physiologic changes of ketone bodies in patients with aneurysmal subarachnoid hemorrhage. We tested the hypothesis that the plasma ketone bodies are associated with the vasoconstrictor and lipolysis effect of circulating catecholamine. METHODS: Twenty-four patients with mild aneurysmal subarachnoid hemorrhage and 18 healthy volunteers were enrolled in this study. We collected arterial blood samples immediately after admission and 30 days later to measure the levels of 3-hydroxybutyrate, acetoacetate, epinephrine and norepinephrine. RESULT: At the onset of aneurysmal subarachnoid hemorrhage, the plasma ketone body (3-hydroxybutyrate + acetoacetate) level and the epinephrine and norepinephrine concentrations were significantly elevated, but the arterial ketone body ratio (acetoacetate/3-hydroxybutyrate) was significantly decreased compared with that of the control group. There was a negative correlation between the plasma ketone body level and the arterial ketone body ratio. There was a positive correlation between the plasma ketone body level and epinephrine level. Thirty days after admission, the ketone body, epinephrine and norepinephrine levels, as well as the arterial ketone body ratio, showed no significant differences between the patients and controls. CONCLUSION: At the onset of mild aneurysmal subarachnoid hemorrhage, the plasma ketone body level was significantly increased, while the arterial ketone body ratio was significantly decreased.

DOI： 10.1179/016164108X323708

PubMed

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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：英語   掲載種別：研究論文（学術雑誌）  

Blunt traumatic occlusion or stenosis of the internal carotid artery is a rare complication of whiplash injury and may not be recognized until the onset of neurological symptoms. The clinical course can vary considerably, with regard to both the symptoms and the interval between injury and manifestation. A dissecting aneurysm and intimal tear are usually observed after blunt internal carotid artery injury. Atherosclerotic plaque is often observed in the cervical internal carotid artery and carotid bifurcation, but involvement of plaque has been confirmed in relatively few cases of blunt traumatic internal carotid injury. We describe a 58-year-old man who developed cerebral embolism due to intraplaque thrombus after a minor whiplash injury and was successfully treated with carotid endarterectomy. Because thrombosis occurred within the atherosclerotic plaque, we named the mechanism of this case "plaque injury".

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study was to clarify the mechanism of hemodynamic changes leading to intraoperative hypotension during evacuation of acute subdural hematoma. To our knowledge, little data is available about the mechanism of hemodynamic changes during surgical interventions to decrease intracranial pressure after severe head injury. The influence of preoperative hypotension on intraoperative hypotension was examined. Hemodynamic studies (pulmonary artery catheterization) were carried out in 15 patients before and after acute subdural hematoma evacuation. All patients were assessed for hemodynamic parameters, evacuated hematoma volume, and intracranial pressure measurements. Comparison between just before and after evacuation of the hematoma showed that the mean arterial pressure, pulmonary arterial pressure, systemic vascular resistance, pulmonary vascular resistance, central venous pressure, and pulmonary capillary wedge pressure all decreased after hematoma evacuation. However, the cardiac index was unchanged after hematoma evacuation. Mean arterial blood pressure is dependent on the cardiac index and vascular resistance, so the decrease in arterial blood pressure during hematoma evacuation was the result of a decline in vascular resistance. The influence of preoperative blood pressure on intraoperative hemodynamic changes was analyzed by dividing the patients into two groups, the preoperative hypotension group and preoperative nonhypotension group. The decrease in mean arterial blood pressure was more marked in the preoperative hypotension group than in the preoperative nonhypotension group. Intraoperative hypotension during evacuation of acute subdural hematoma is caused by a decrease in vascular resistance. Preoperative hypotension is a also risk factor for intraoperative hypotension.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Stiffening and thickening of the arterial walls are two important components of atherosclerosis. A better understanding of the relationship between stiffening and thickening of the large arteries might lead to optimal strategies for the prevention of cerebrovascular disease. However, there have been few investigations of the correlation between carotid artery wall thickening and arterial stiffness. In this study, we investigated the relationship between arterial stiffness (assessed by the ankle-brachial pulse wave velocity) and carotid plaque (detected by high-resolution real-time B-mode ultrasonography) in patients with cerebral thrombosis. The subjects were 109 patients with cerebral thrombosis aged 40-80 years. Fifty-six subjects had carotid plaque (27 had low-grade plaques (plaque score<7.0) and 29 had high-grade plaques (plaque score >or=7.0)) and 53 subjects did not have plaques. High pulse wave velocity was found to be significantly associated with existence of carotid plaque (p<0.001), but was not associated with the severity of the plaque (p=0.14) in multivariate logistic regression models. This study shows that the pulse wave velocity is associated with the existence of carotid atherosclerosis, but not with the severity of carotid atherosclerosis, in patients with cerebral thrombosis.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with spontaneous cerebellar hemorrhage are usually treated by large suboccipital craniectomy for hematoma evacuation or by computed tomography-guided stereotactic aspiration of the hematoma. The present study evaluated the outcome and complications in 25 patients with spontaneous cerebellar hemorrhage treated by paramedian suboccipital mini-craniectomy and 21 patients treated by large suboccipital craniectomy. There were no significant differences between the two groups with respect to age, clinical grade, hematoma volume, hematoma location, hydrocephalus, and mean interval from admission to operation. There was also no significant difference in postoperative outcome between the two groups. However, patients treated by paramedian suboccipital mini-craniectomy were less likely to require blood transfusion, had a shorter operating time, and had less postoperative liquorrhea compared with those undergoing extensive suboccipital craniectomy. Paramedian suboccipital mini-craniectomy is a simple and effective method for hematoma evacuation that causes fewer complications.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 74-year-old man was diagnosed with cerebellar glioblastoma multiforme (GBM). He initially presented with headache, nausea, vomiting, and truncal ataxia. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a round mass with ring enhancement in the vermis of the cerebellum. Subtotal removal of tumour was performed, and the pathological diagnosis was cerebellar glioblastoma multiforme. Subsequently, radiochemotherapy was performed. GBM of the cerebellum is rare and only accounts for a small fraction of all GBM. To our knowledge, there have only been 7 cases of senile cerebellar GBM reported. Our patient is one of the oldest cases recorded in the Asian literature.

PubMed

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記述言語：日本語   出版者・発行元：(株)医学書院  

MR画像で責任病巣がテント上に同定された脳血栓患者66例(脳血栓群)および,高血圧症,糖尿病または高コレステロール血症の既往を有した29例(危険因子群)の計95例(男62例・女33例,46〜89歳)を対象に頸動脈粥状動脈硬化を低侵襲に評価できる超音波断層法を使用し,粥状動脈硬化と側脳室周囲高信号域(PVH)の関連を検討した.脳血栓群と危険因子群の平均年齢に統計学的有意差は認めなかった.また,PVHが広範であるほど,頸部動脈における隆起性病変の検出率,最大狭窄率は高値であった

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2003&ichushi_jid=J01228&link_issn=&doc_id=20030401130003&doc_link_id=10.11477%2Fmf.1436902372&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436902372&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We have evaluated the relationship between carotid atherosclerotic change and periventricular hyper intensity (PVH). PVH was studied in 66 cases with cerebral thrombosis, comparing them with another group of age-matched controls, which consisted of 29 cases with hypertension, diabetes, and hypercholesteremia. MRI (fluid attenuated inversion recovery) and B-mode carotid ultrasonography of each lesion were analyzed. Thrombosis lesions, compatible with neurological manifestation were divided into two types, cerebral cortical type (including centrum semiovale type) and small infarction in the deep subcortical type. PVH was classified into 4 grades, none, rims/caps, patchy and diffuse. Smooth PVH was, adjoining the anterior/posterior angles and the margins of the lateral ventricles, were defined as caps and rims. Irregular PVH areas, confluent with each other, were defined as patchy, while diffuse PVH areas extending below the cortex beyond the level of the corpus callosum were defined as diffuse. Carotid atherosclerosis was evaluated using B-mode carotid ultrasonography. The severity of carotid atherosclerosis was assessed by using two indicators; incidence of carotid atherosclerosis and maximum percentage diameter of the stenosis areas. Patchy and diffuse type PVH was frequent in the thrombosis group. On B-mode carotid ultrasonography, diffuse PVH was prominent in patients with stenotic change and high maximum percentage of stenosis, but none/rims/caps PVH was accompanied by variable B-mode carotid ultrasonographical findings. Six patients had ulcerated plaques and they suffered more frequently with diffuse PVH. Diffuse PVH was more frequent in cases with severe carotid stenosis than in other PVH types. These findings suggested that large vessel atherosclerosis could result in diffuse PVH.

PubMed

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記述言語：英語   出版者・発行元：日本脳神経外科学会  

A 50-year-old male with acromegalic features presented with a pituitary stone in a growth hormone-secreting adenoma. Endocrinological examination showed "low growth hormone acromegaly." The serum growth hormone level responded to the thyrotropin-releasing hormone test and was not suppressed by oral glucose loading. Neuroimaging revealed an adenoma including a large calcification (pituitary stone) located in the right lateral wing. The adenoma with stone was totally removed by transsphenoidal surgery. The patient regained almost normal response of serum growth hormone. Histological examination showed the stone was composed of thick calcification surrounded by necrotic adenoma tissue and chronic hemorrhage. Large intratumoral pituitary stone is very rare, although calcification is sometimes observed in the adenoma capsule. The long history of this disease and previous apoplexy within the tumor may have caused the pituitary stone in this patient.

DOI： 10.2176/nmc.40.383

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2000261388

記述言語：日本語   出版者・発行元：(株)医学書院  

初発症候性脳血栓例を対照群とした.1)ICHで頸部動脈における隆起性病変の検出率,最大狭窄率は高値であり,粥状動脈硬化の合併が多いことを示唆させた.2)隆起性病変内のエコー輝度による分類を行うと,脳血栓群と病態が異なっており,ICHでは隆起性病変内の出血を示唆するsoft typeの隆起性病変,及びに潰瘍病変は少なかった.3)L群,重症群では頸部粥状動脈硬化病変が進展していた

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2000&ichushi_jid=J01228&link_issn=&doc_id=20000124300004&doc_link_id=10.11477%2Fmf.1436901847&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436901847&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We have evaluated the relationship between carotid atherosclerotic change and intracerebral hemorrhage patients. Forty-eight patients with intracerebral hemorrhage treated at our institution were included in this study. Their ages ranged from 38 to 86 years old (average: 61.5 years). There were 28 cases of putaminal hemorrhage and 20 cases of thalamic hemorrhage. Evacuation of hematoma or ventricle drainage was performed in 18 cases within 3 days after the onset of symptoms. The outcome in these cases was that 40 patients survived and 8 patiented died. Carotid atherosclerosis was evaluated by B mode-ultrasonography. The severity of carotid atherosclerosis was assessed by using two indicators
incidence of carotid atherosclerosis and maximum percentage diameter of the stenosis. Carotid atherosclerosis on B mode-ultrasonography was detected more frequently in patients with thalamic hemorrhage (84.2%) than in those with putaminal hemorrhage (51.7%). Maximum percentage stenosis of thalamic hemorrhage (17.2 ± 15.2%) was higher than maximum percentage stenosis of putaminal hemorrhage (6.4 ± 9.7%). In conclusion, carotid atherosclerosis was an effective indicator of not only ischemical cerebrovascular disease but also of intracerebral hemorrhage.

Scopus

PubMed

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記述言語：日本語   出版者・発行元：Japanese Association for Acute Medicine  

急性硬膜下血腫(ASDH)の外減圧術中に著明な脳腫脹を来した13症例をもとに,致死的ASDHの治療限界について考察した。術前のGCSは3-4点7例,5-8点6例,瞳孔は散大4例,不同8例だった。CTで10例が脳挫傷や外傷性クモ膜下出血(T-SAH)を伴い,10例は脚間槽が描出されていなかった。手術は受傷後平均2時間41分で開始された。術後は適宜,低体温療法やバルビツレート療法を導入した。12例は平均5.2日目に死亡した。2歳女児の1例は神経脱落症状を残すことなく退院した。CTで脚間槽が描出されない,またT-SAHで脳底槽が充満しているASDHはきわめて救命困難であるが,小児例は積極的治療の対象とすべきである。

DOI： 10.3893/jjaam.8.369

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記述言語：日本語   出版者・発行元：日本脳ドック学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2017258639

J-GLOBAL

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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  

脳室内出血を伴う視床出血14例に対し前頭部小切開頭血腫除去術(小開頭群)を行い、治療成績を脳室ドレナージのみ施行した16例(脳室ドレナージ群)と比較検討した。その結果、小開頭群は脳室ドレナージ群と比べ、血腫除去率が有意に高く、脳室ドレナージ期間が有意に短かった。更に急性期病棟入院期間が有意に短く、髄膜炎合併率は有意に低かった。発症から手術開始時間および手術時間は脳室ドレナージ群で短かった。また、転帰に関しては全例mRSにて4以上と劇的な改善が得られた症例はなく、2群間で有意差は認めなかったが、死亡例は小切開群が2例、脳室ドレナージ群が4例と小開頭群で救命率が高かった。

J-GLOBAL

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J02079&link_issn=&doc_id=20100617260009&doc_link_id=%2Fcp4strok%2F2010%2F003803%2F009%2F0181-0185%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2010%2F003803%2F009%2F0181-0185%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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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J-GLOBAL

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J-GLOBAL

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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：特定非営利活動法人日本臨床細胞学会  

CiNii Books

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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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J-GLOBAL

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記述言語：日本語   出版者・発行元：日総研出版  

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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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J-GLOBAL

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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  

CiNii Books

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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  

J-GLOBAL

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J-GLOBAL

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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  

救急医療体制の下, 高度救命救急センターにおける最近のクモ膜下出血(SAH)の症例を分析し, SAH急性期における患者管理について検討した.対象は最近2年間に当センターに搬入された連続200例のSAHである.搬入時心肺停止を含めたpoor grade症例が半数以上を占め, 積極的な神経集中管理の下, 脳保護を図る重要性が指摘された.急性期管理をprehospital phase, hospital phaseの各phaseに分けた対応と工夫が必要であり, 特にprehospital phaseにおける搬送時の降圧, 鎮静化の徹底化, さらに3次元CTアンギオをSAH周術期の管理(術前, 術後, 脳血管攣縮の評価)に使用し, 診断の低侵襲化を図ることも重要と考えられた.

CiNii Books

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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  

今回われわれは,高血圧の既往を有する51歳男性で,きわめて短期間(26日間)で右被殻に脳内出血を繰り返した症例を経験した.初回出血,再出血とも右被殻部に限局した出血であり,神経症状も軽症であった.また,脳血管撮影上血管奇形などを認めず,血液生化学的所見にも異常を認めなかった.われわれが文献を検索したかきりでは,同一部位に脳内出血を繰り返した症例は本邦では7例を認めるのみであり,比較的稀な現象であると思われた.症例をまとめたところ特徴として,(1)初回出血,再出血とも小出血が多く,神経症状も軽いこと,(2)出血部位は被殻が多いこと,があげられた.また,今回初回出血から再出血にかけて経時的CT, MRIにて興味ある所見を得たので,再出血の経過について考察を加えた.

CiNii Books

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