Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

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

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Superior/middle cluneal nerve entrapment (CN-E) is an elicitor of low back pain (LBP). The painDETECT questionnaire is used to characterize CN-E symptoms. METHODS: Nineteen consecutive patients with LBP caused by CN-E (superior CN-E = 7; middle CN-E = 12) participated in a Japanese language painDETECT questionnaire survey before surgery. A score of 12 or lower was recorded as 'neuropathic component unlikely', a score of 19 or higher as 'neuropathic pain likely', and scores between 13 and 18 as 'neuropathic pain possible'. LBP severity was recorded on a numerical rating scale, the Roland-Morris Disability Questionnaire, and the EuroQol-5 dimension-5 level. RESULTS: The mean painDETECT score was 11.8 and did not significantly differ between the superior CN-E and middle CN-E groups. We classified low back pain as unlikely to have a neuropathic component in 13 patients, as likely to have a neuropathic component in 2 patients, and as possibly neuropathic in 4 patients. There was no significant difference in the pain level of patients with scores of ≤12 and ≥13 on painDETECT. All patients reported trigger pain; the positive rate was high for electric shock pain, radiating pain, and pain attacks and low for a burning or tingling sensation, pain elicited by a light touch, and pain caused by cold or hot stimulation. CONCLUSION: The painDETECT questionnaire may not reliably identify LBP caused by superior/middle CN-E as neuropathic pain. A diagnosis of LBP due to CN-E must be made carefully because symptoms resemble nociceptive pain.

DOI： 10.1272/jnms.JNMS.2024_91-312

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy of the posterior tibial nerve. Surgery can be performed less invasively under local anesthesia. We adopted zig-zag skin incision to prevent postoperative wound complications. METHODS: Between July 2022 and June 2023, we operated on 19 legs of 14 consecutive TTS patients (5 males, 11 females; average age 73.3 years). We made a 2- to 3-cm zig-zag skin incision on the tarsal tunnel. After posterior tibial nerve decompression by posterior tibial artery (PTA) transposition, the subcutaneous layer was tightly sutured with 4-0 PDS and the skin was closed with Dermabond Advanced. We investigated adverse events that developed during the first 30 postoperative days and recorded surgical outcomes at the final visit. RESULTS: In all patients the nerves were successfully decompressed with PTA transposition. There were no intraoperative complications. During the 30 postoperative days there were no adverse events, including wound complications, and patients' symptoms improved significantly. CONCLUSION: Zig-zag skin incision was easy and convenient for surgical TTS treatment and may be useful for preventing postoperative wound complications.

DOI： 10.1272/jnms.JNMS.2024_91-404

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Persistent primitive olfactory arteries (PPOAs) are a rare variant of the anterior cerebral artery (ACA). Cerebral aneurysms may arise in the PPOA; most are saccular and on the unilateral PPOA. We report a 66-year-old male with bilateral PPOAs and a fusiform aneurysm on the left side detected at a health check-up. A brain magnetic resonance imaging (MRI) scan revealed a fusiform dilation in the proximal portion of the left ACA on a brain MRI. Good surgical results were obtained by combining trapping-and bonnet bypass surgery. Brain MRI and cerebral angiograms showed bilateral PPOAs and a fusiform aneurysm with the pearl-and-string sign in the proximal portion of the left PPOA. The aneurysm was trapped and a bonnet bypass using a radial artery (RA) graft was placed between the left superficial temporal artery and the distal portion of the left PPOA. The postoperative course was uneventful and 30 months after surgery he had no neurological symptoms; MRA showed no recurrence. In this patient, aneurysmal trapping and an A3-A3 bypass were an option, however, it would have placed an additional load on the right PPOA. Our decision to trap the aneurysm and perform bonnet bypass surgery using an RA graft led to success.

DOI： 10.2176/jns-nmc.2024-0156

PubMed

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Language：Japanese   Publisher：(株)メディカ出版  

症例は48歳女性で、前日からの頭痛を主訴とした。頭部CTでくも膜下出血を脳底槽からシルビウス裂に認め、やや左優位であった。脳血管撮影では右内頸動脈・左内頸動脈・左中大脳動脈・左前大脳動脈に多発脳動脈瘤を認めた。造影MRIによるvessel wall imagingで破裂瘤は右内頸動脈前壁動脈瘤の可能性が高いと判断し、同日開頭クリッピング術を行ったが、術中破裂所見は認めず動脈瘤を切除した。翌日に左側開頭クリッピング術を行い、左前大脳動脈瘤を破裂瘤と判断し、中内脳動脈瘤と左内頸動脈瘤もクリッピングした。初回手術7日後に脳血管撮影にて各動脈瘤の消失を確認し、遺残した高次脳機能障害のリハビリテーション目的に第76病日に転院した。切除した右内頸動脈瘤の病理所見では脳動脈瘤壁に炎症細胞の浸潤および毛細血管の増生を認め、造影された原因と考えられた。

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Internal carotid artery (ICA) ligation for placing a high-flow extracranial-intracranial (EC-IC) bypass is used in patients with aneurysms on the cavernous portion of the ICA. Recanalization and rupture after proximal ICA ligation can occur. We present four patients who underwent endovascular distal ICA occlusion and report our surgical technique and treatment results. We ligated the ICA to place an EC-IC bypass using a radial artery (RA) graft. Failure to obtain spontaneous occlusion in the distal region required endovascular treatment an average of 219 days later. A guide catheter was placed in the common carotid artery, a guide or distal access catheter was introduced in the RA graft from the external carotid artery, and a microcatheter was navigated into the cavernous aneurysm through the RA graft. Using detachable coils, endovascular ICA occlusion was from just distal to the aneurysmal neck to a site proximal to the origin of the ophthalmic artery. Aneurysmal occlusion was completed by endovascular occlusion of the distal ICA. Complications were RA graft stenosis and transient consciousness disturbance due to local subarachnoid hemorrhage. Outpatient follow-up for a mean of 109.5 months revealed no recurrences. Distal occlusion of the ICA through the implanted RA graft is simple and presents a low risk for cerebral infarction due to thrombus formation during the procedure. To treat cavernous carotid aneurysms that do not disappear after placing the EC-IC bypass after ICA ligation at the aneurysmal neck, we offer our procedure as a treatment option.

DOI： 10.2176/jns-nmc.2022-0303

PubMed

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Language：Japanese   Publisher：(一社)日本医療安全学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Mechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes of Health Stroke Scale score was 20.0 (range, 9-30), and the mean diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score on magnetic resonance images was 8.7 (range, 7-10). In six patients, MT of the CCA occlusion was successful, and the mean puncture-to-reperfusion time was 84 minutes (range, 39-211 minutes). In five patients, successful reperfusion was obtained. The mean total pass number was 4.1 (range, 2-7). Due to large thrombi, we performed balloon guide catheter (BGC) occlusion in three patients. Sheath occlusion occurred in two, and thrombus migration into the femoral artery around the sheath was observed in two patients. The mean modified Rankin Scale score 3 months post-stroke was 3.6 (range, 2-5). When the removal of a large CCA thrombus is attempted in a single step, catheter and sheath occlusion may occur, and this increases the risk for critical systemic artery occlusion. Therefore, we suggest that MT be combined with the BGC technique and propose the use of a large aspiration catheter to decrease the volume of the thrombus.

DOI： 10.2176/jns-nmc.2022-0183

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

The morphology of vertebral artery (VA) dissections can change in the clinical course. A 58-year-old female with a 2-week headache was diagnosed with left VA dissection. Hemodynamic stress on the right VA detected on 4D flow MRI scans resulted in increased wall shear stress but the vessel was morphologically unchanged. Subsequent MRA revealed right VA dissection. Her bilateral dissections were treated conservatively and no neurological abnormality developed. Serial 4D flow MRI may be useful for observing morphological changes in VA dissections and help to clarify the mechanism(s) underlying VA dissections.

DOI： 10.1007/s00701-022-05333-4

PubMed

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Placing an extracranial-intracranial (EC-IC) high-flow bypass using a radial artery (RA) graft plus internal carotid artery (ICA) trapping or ligation is an option for treating patients expected to be at high risk for complications by direct surgical treatment of the ICA. We focused on the anastomosis between the external carotid artery (ECA) and the RA graft in the cervical region and present adverse events and salvage procedures. METHODS: EC-IC high-flow bypass procedures using an RA graft were performed to treat 87 consecutive patients. The ECA diameter at the midpoint of the planned ECA-RA anastomosis and the non-branched length of the ECA were measured on preoperative angiograms. To study adverse events related to ECA-RA anastomoses, we reviewed the patients' surgical records and intraoperative videos. RESULTS: In 11 patients (12.6%) we encountered adverse events during anastomosis between the ECA and RA. The rate of ECA dissection was significantly higher in male patients (4 of 17; 23.5%) than female patients (3 of 70; 4.3%) (P = 0.012). Logistic regression analysis revealed that male sex, individuals with diabetes mellitus, and patients whose non-branching length of the ECA was short (16.1 ± 6.7 mm) were at high risk of ECA problems. We set the cutoff point at 17.5 mm (the area under the receiver operator characteristic curve was 0.72). CONCLUSIONS: Our findings indicate that patients, especially male patients, treated by EC-IC high-flow bypass using an RA graft are at increased risk for adverse events when the ECA length at the site of the planned anastomosis is shorter than 17.5 mm.

DOI： 10.1016/j.wneu.2022.04.061

PubMed

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Language：Japanese   Publisher：(公社)日本放射線技術学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English  

Background: Extracranial carotid artery aneurysms are rare. Surgery may be difficult when vessels are tortuous and on a high cervical level. We report two patients whose tortuous extracranial internal carotid artery (ICA) aneurysm located on a high cervical level was successfully treated by ICA ligation and a high-flow bypass using a radial artery (RA) graft between the external carotid- and the middle cerebral artery. Case Description: (Case 1) A 47-year-old man suffered a recurrent cerebral infarct despite medical treatment. His right extracranial ICA aneurysm measured 33 mm; it was tortuous and located at a high cervical level. We ligated the ICA after placing a high-flow bypass using an RA graft. The aneurysm was not repaired. (Case 2) A 59-year-old woman noticed pulsatile swelling on her left neck. It was due to an extracranial ICA aneurysm that was large (36 mm), tortuous, and located at a high cervical level. We performed ICA ligation after placing a high-flow bypass using an RA graft without direct aneurysmal repair. Six months after the operation she noted a pulsatile bulge on the left oropharynx. We confirmed recurrence of an aneurysm from retrograde blood flow and performed internal trapping by occluding the distal portion of the ICA aneurysm using an intravascular procedure. Conclusion: ICA ligation after placing a high-flow bypass with an RA-graft is a technically demanding, but safe procedure to address extracranial ICA aneurysms that are tortuous and located at a high cervical level.

DOI： 10.25259/SNI_408_2021

PubMed

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Background Exact identification of feeding arteries, shunt points, and draining veins is essential in treating cavernous sinus dural arteriovenous fistula (CS dAVF). In addition to digital subtraction angiography (DSA) and 3-dimensional rotational angiography (3DRA), high-resolution cone beam computed tomography (CBCT
especially 80-kv high-resolution cone beam computed tomography) have been performed in recent years. We evaluated the efficacy of CBCT in treating CS dAVF. Methods Eight CS dAVFs were treated with endovascular embolization between January 2013 and December 2016. We retrospectively examined these cases regarding information from DSA, 3DRA, and CBCT with contrast medium. Results Although all procedures can evaluate feeding arteries, shunt points, and draining veins, CBCT can provide the best definition of feeders and their course through the bony structures and the compartment of CS. Therefore, CBCT with placed microcatheter in the CS can reveal whether the microcatheter is set at the appropriate compartment to be embolized. Conclusions The efficacy of CBCT in treating dAVF is illustrating the relationships among the bony structures and feeders, compartment of CS, and the position of the microcatheter. Detailed information obtained with CBCT can lead to fewer complications and more effective treatment.

DOI： 10.1016/j.wneu.2017.10.026

Scopus

PubMed

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER WIEN  

Published results for carotid endarterectomy (CEA) in symptomatic and asymptomatic severe carotid stenosis with diabetes mellitus (DM) are contradictory. To evaluate perioperative and long-term results of CEA in patients with DM, we retrospectively analyzed data of patients with or without DM who underwent CEA in our institute.
Between January 2005 and December 2010, 281 consecutive CEAs were performed in 268 patients under general anesthesia. All patients were subject to cardiac work-ups before surgery, and coronary revascularization was performed prior to CEA if patients were diagnosed with significant coronary artery stenosis. Lesion characteristics were assessed by a duplex ultrasound scan, computed tomography angiography (CTA), and plaque imaging on magnetic resonance imaging (MRI) before surgery, and patients were followed-up by a duplex ultrasound scan at three, six, and 12 months, then yearly, after surgery.
Of 281 cases, 136 had DM (48 %). Diabetic patients more frequently had a history of coronary artery disease than non-diabetic patients (48.5 % vs. 36.6 %, P = 0.042). Coronary intervention prior to CEA was more frequently performed in diabetic patients than in non-diabetic patients (22.1 % vs. 11.0 %, P = 0.013). The incidence of perioperative (30 day) stroke (P = 1.000), death (P = 1.000), and cardiac complications (P = 0.484) did not differ among groups. Follow-up was available in 77.2 % of patients, with a median duration of 50 months (interquartile range, 32.1-67.2 months). The incidence of ipsilateral stroke (P = 0.720), death (P = 0.351), and severe restenosis (peak systolic velocity > 230 cm/sec) (P = 0.905) were not different between groups.
DM does not increase the risk of perioperative complications and does not influence long-term outcomes after CEA if preexisting vascular risk factors and cardiac diseases are appropriately evaluated and treated before surgery.

DOI： 10.1007/s00701-014-2040-x

Web of Science

PubMed

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Language：Japanese   Publisher：(一社)日本脳神経超音波学会  

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J-GLOBAL

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Language：Japanese   Publisher：The Japanese Society on Surgery for Cerebral Stroke  

Distal middle cerebral artery (MCA) aneurysms are relatively rare, and only few reports deal with treatment strategies. The present study retrospectively investigated the characteristics of and surgical approaches to distal MCA aneurysms. The subjects were 10 patients with distal MCA aneurysms selected from among 452 patients with cerebral aneurysms treated with neck clipping between September 2006 and August 2016. Sixteen distal MCA aneurysms were identified, with 13 (81.3%) located on the M2 segment. All the patients showed multiple cerebral aneurysms, and the total number of cerebral aneurysms was 37, representing a mean of 3.7 aneurysms per patient. The multiplicity of the aneurysms appeared markedly higher than the previous study findings in patients with distal MCA aneurysms. Evaluation with preoperative neuroimaging therefore appears important from this perspective. Of the 3 patients with ruptured distal MCA aneurysm, all the aneurysms were embedded in surrounding parenchyma with cerebral hemorrhage. This finding suggests the necessity to expose aneurysms from the surrounding parenchyma to obtain a wide surgical field for neck clipping. As for surgical approaches, anatomically, the M3 segment begins at the circular sulcus after turning 180° from the M2 segment and courses over a narrow space between the frontoparietal and temporal opercula. We therefore recommend the following: aneurysms located on M2 or M2-M3 segments above the limen insulae are accessible by using a distal sylvian approach, whereas aneurysms located from the M3 segment within the narrow and complicated structure of the opercular space need to be approached from sulci beyond the aneurysms.

DOI： 10.2335/scs.45.183

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：The Japanese Society for Neuroendovascular Therapy  

<b>Objective</b>: Navigation of the guiding catheter (GC) is important in performing neuroendovascular therapy, as the GC may often disturb blood flow of the parent artery. In the present study, we aimed to examine the risk factors of mechanical vasospasm (mVS) of the parent artery during neuroendovascular therapy.<br/><b>Methods</b>: We assessed a total of 64 consecutive cases who underwent coil embolization for unruptured intracranial aneurysms. mVS was defined as a stenotic change of the parent artery of > 25% after navigating GC.<br/><b>Results</b>: mVS was observed in 24 cases (38%), and in 5 cases the GCs were changed to smaller sizes. The vasospastic changes in all the cases improved after changing the position of GC or the GC itself. Young age, female gender, and absence of hypertensive history were significantly associated with mVS. However, body mass index, adjunctive technique of coil embolization, and presence of hyper-intense lesions on diffusion weighted images were not associated with mVS.<br/><b>Conclusions</b>: We suggest that care should be taken when navigating the GCs in patients with young age, female gender, and the absence of a history of hypertension in terms of the occurrence of mVS.

DOI： 10.5797/jnet.oa.2015-0039

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：KARGER  

Web of Science

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Language：Japanese   Publisher：The Japan Stroke Society  

Intravascular large B-cell lymphoma (IVLBCL) is a rare fatal neoplasm characterized by intravascular proliferation of lymphoma cells that commonly affects the central nervous system and skin. A 66-year-old woman, with a prior history of sudden onset of right hearing loss, developed transient monoplegia in the left arm in November 2008. Warfarin was started because of the patent foramen oval and stagnation in the deep vein of her legs. Since then, she developed various neurological episodes including brain stem, cranial nerves, and myelopathic abnormalities as well as skin rash, fever and hematologic abnormalities with a high serum LDH, monocytosis, anemia, thrombocytopenia, and splenomegaly. A skin biopsy and bone marrow aspiration revealed no atypical cells. Because she presented with high fever and body weight loss, low-dose prednisolone was started and warfarin was stopped. But even with steroid initiation, she became confused. Then, diffusion and FLAIR MR images showed multiple small hyperintense lesions in the cortical and subcortical regions. A stereotactic open brain biopsy of the left frontal cortex revealed large atypical intravascular tumor cells occluding the lumen of small cortical and meningeal vessels, and immunohistochemical staining demonstrated tumor cells as B cell-origin. She received R-CHOP chemotherapy and achieved a partial remission. IVL should be considered as an important differential diagnosis for patients presenting with a variety of neurological disorders and skin lesions accompanied by a high serum LDH. While brain biopsy is a rather invasive measure, in some cases, it can be only a diagnostic clue.

DOI： 10.3995/jstroke.32.406

CiNii Books

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