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Endovascular Treatment for Intracranial Artery Dissections in Posterior Circulation. 招待査読

Jun Haruma, Kenji Sugiu, Yuki Ebisudani, Ryu Kimura, Hisanori Edaki, Yoko Yamaoka, Masato Kawakami, Yuta Soutome, Masafumi Hiramatsu

Journal of neuroendovascular therapy 18 ( 3 ) 92 - 102 2024年

記述言語：英語掲載種別：研究論文（学術雑誌）

Intracranial artery dissections (IADs), although uncommon, are an important cause of cerebral infarction and subarachnoid hemorrhage (SAH). Some IADs can heal spontaneously after reconstitution of the vessel lumen with excellent prognosis. Meanwhile, others can progress to stroke that requires treatment. The incidence of IAD in the posterior circulation is higher than that in the anterior circulation. Anterior circulation dissections are more likely to develop into ischemia and posterior circulation lesions into hemorrhage. The mortality rate after IAD among patients with SAH is 19%-83%. Further, the mortality rate of IAD without SAH is 0%-3%. Patients with SAH commonly undergo surgery or receive neuroendovascular treatment (EVT) to prevent rebleeding. However, the treatment of IADs is empirical in the absence of data from randomized controlled trials. Recently, EVT has emerged and is considered for IADs because of its less invasiveness and perceived low rates of procedure-related morbidity with good efficacy. EVT strategies can be classified into deconstructive (involving sacrifice of the parent artery) and reconstructive (preserving blood flow via the parent vessel) techniques. In particular, the number of reports on reconstructive techniques is increasing. However, a reconstructive technique for ruptured IADs has not yet been established. This review aimed to provide an overview of IADs in the posterior circulation managed with EVT by performing a literature search.

DOI： 10.5797/jnet.ra.2023-0068

Characteristics and outcomes of subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies. 査読国際誌

Shu Oshita, Tetsuya Yumoto, Shunta Jinno, Ippei Matsuo, Takashi Hongo, Hiromichi Naito, Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka, Atsunori Nakao

Acute medicine & surgery 11 ( 1 ) e70031 2024年

記述言語：英語掲載種別：研究論文（学術雑誌）

AIM: Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture. METHODS: This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into "VAD rupture" and "other etiologies" groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3-6. RESULTS: A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, p = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, p = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, p < 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, p = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months. CONCLUSIONS: VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.

DOI： 10.1002/ams2.70031

Questionnaire Survey of Neurointerventional Simulation Training in the Japanese Society for Neuroendovascular Therapy. 査読

Yuki Ebisudani, Kenji Sugiu, Satoshi Murai, Jun Haruma, Masafumi Hiramatsu, Tomohito Hishikawa, Isao Date

Journal of neuroendovascular therapy 17 ( 9 ) 181 - 187 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Simulation training has focused on education and practical training. However, the adoption rate of neurointerventional simulation training in Japan is unknown. Therefore, we sent a questionnaire survey form to consulting specialists from the Japanese Society for Neuroendovascular Therapy (JSNET) to clarify the actual simulation training situation and compare the differences between university hospitals and general hospitals in Japan. METHODS: The questionnaire survey was conducted in 243 neurosurgical training facilities that had JSNET consulting specialists between May 31, 2021 and July 31, 2021. The questionnaire survey forms were distributed by Google Forms. RESULTS: A total of 162 facilities responded to the survey (response rate: 66.7%; 35.2% from university hospitals and 64.8% from general hospitals). The adoption rate for simulation training was 53.7%, and it was significantly higher in the university hospitals than in the general hospitals (64.9% vs. 47.6%, p = 0.035). On the simulation effectiveness survey, more than 80% of respondents answered that the simulation training was a useful tool for upskill training. The open-ended question on interventional simulation training showed that there are limiting factors such as financial constraints. Additionally, respondents expressed a desire for a standard neurointerventional simulation training and education program. CONCLUSION: The adoption rate for simulation training was 53.7% in the training facilities of JSNET, and it was higher in the university hospitals than in the general hospitals. Most of the respondents answered that simulation training is an effective tool to improve neurointerventional skills. They also requested the establishment of simulation training programs and simulation tools.

DOI： 10.5797/jnet.ra.2022-0062

Depolarization time and extracellular glutamate levels aggravate ultraearly brain injury after subarachnoid hemorrhage 査読

Satoshi Murai, Tomohito Hishikawa, Yoshimasa Takeda, Yasuko Okura, Miki Fushimi, Hirokazu Kawase, Yu Takahashi, Naoya Kidani, Jun Haruma, Masafumi Hiramatsu, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific Reports 12 ( 1 ) 2022年12月

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

Abstract

Early brain injury after aneurysmal subarachnoid hemorrhage (SAH) worsens the neurological outcome. We hypothesize that a longer duration of depolarization and excessive release of glutamate aggravate neurological outcomes after SAH, and that brain hypothermia can accelerate repolarization and inhibit the excessive release of extracellular glutamate and subsequent neuronal damage. So, we investigated the influence of depolarization time and extracellular glutamate levels on the neurological outcome in the ultra-early phase of SAH using a rat injection model as Experiment 1 and then evaluated the efficacy of brain hypothermia targeting ultra-early brain injury as Experiment 2. Dynamic changes in membrane potentials, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and extracellular glutamate levels were observed within 30 min after SAH. A prolonged duration of depolarization correlated with peak extracellular glutamate levels, and these two factors worsened the neuronal injury. Under brain hypothermia using pharyngeal cooling after SAH, cerebral perfusion pressure in the hypothermia group recovered earlier than that in the normothermia group. Extracellular glutamate levels in the hypothermia group were significantly lower than those in the normothermia group. The early induction of brain hypothermia could facilitate faster recovery of cerebral perfusion pressure, repolarization, and the inhibition of excessive glutamate release, which would prevent ultra-early brain injury following SAH.

DOI： 10.1038/s41598-022-14360-1

その他リンク： https://www.nature.com/articles/s41598-022-14360-1

Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience. 査読国際誌

Satoshi Murai, Yuki Ebisudani, Ryu Kimura, Hisanori Edaki, Yu Sato, Yoko Yamaoka, Kazuhiko Nishi, Jun Haruma, Masafumi Hiramatsu, Tomohito Hishikawa, Kenji Sugiu, Isao Date

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 31 ( 12 ) 106811 - 106811 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: In recent years, endovascular treatment has become the treatment of choice for distal anterior cerebral artery (DACA) aneurysms. In this study, we report the outcomes of coil embolization for DACA aneurysms. METHODS: Eighteen DACA aneurysms in 16 patients treated with endovascular treatment between January 2010 and December 2020 were included in this study. We retrospectively analyzed patient characteristics, data on aneurysms, the reason for the selection of endovascular treatment, treatment technique, and treatment outcomes. RESULTS: There were 18 procedures in 16 patients. The average age was 65.7 years and 56% of patients were male. The average diameter of the dome was 5.5 mm, and the location of aneurysm was A3 in 83% and A4 in 17%. We mainly selected endovascular treatment for patients with a past history of craniotomy and head trauma, or with systemic comorbidities. The technical success rate was 94%, and adequate obliteration immediately after treatment was achieved in 72%. There were no symptomatic periprocedural complications. The retreatment rate was 11.1%. CONCLUSION: Coil embolization for DACA aneurysms yielded good treatment outcomes. Endovascular treatment for DACA aneurysms will become more common with advances in endovascular devices and the establishment of stable perioperative antiplatelet therapy.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106811

A case of delayed foreshortening and disconnection of pipeline embolization device detected by chronological cone-beam computed tomography fusion image. 査読国際誌

Yuki Ebisudani, Kenji Sugiu, Jun Haruma, Satoshi Murai, Tomohito Hishikawa, Masafumi Hiramatsu, Yu Takahashi, Kazuhiko Nishi, Yoko Yamaoka, Yu Sato, Ryu Kimura, Hisanori Edaki, Isao Date

Acta neurochirurgica 164 ( 8 ) 2203 - 2206 2022年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: The morphological changes of the pipeline embolization device (PED; Medtronic, Minneapolis, MN, USA), such as delayed migration or foreshortening, can relate to the incomplete occlusion of aneurysms. CASE PRESENTATION: A 30-year-old man with a giant cavernous carotid artery aneurysm was treated with two PEDs using the overlapping technique. Six months after treatment, follow-up angiography showed morphological changes of the PEDs and residual flow into the aneurysm. Chronological cone-beam computed tomography fusion imaging clearly revealed the dynamic foreshortening of the first PED and the disconnection of both PEDs, so we decided to implant an additional PED. CONCLUSION: This case illustrates that a three-dimensional understanding can be useful for assessing the cause of treatment failure or recurrence.

DOI： 10.1007/s00701-022-05245-3

Hemifacial spasm due to vertebral artery dissecting aneurysm treated with stent-in-stent placement; Pre- and post-treatment evaluation by 3D multifusion imaging using silent MR angiography. 査読国際誌

Toru Satoh, Yu Sato, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Jun Haruma, Isao Date

Surgical neurology international 13 232 - 232 2022年

記述言語：英語

BACKGROUND: Hemifacial spasm (HFS) due to vertebral artery (VA) dissecting aneurysm (VADA) is rare and endovascular treatment has been performed in selected cases. CASE DESCRIPTION: We encountered a case of HFS caused by VADA that was managed with endovascular stent placement and additional stent-in-stent placement. Therapeutic strategies and benefits based on pre- and post-treatment evaluation by 3D multifusion imaging using silent MRA were discussed. CONCLUSION: This is the first case report of stent-in-stent placement in successful treatment of HFS caused by VADA, in which relief of neurovascular contact was demonstrated by multifusion imaging.

DOI： 10.25259/SNI_253_2022

A new method of intracranial aneurysm modeling for stereolithography apparatus 3D printer: the "Wall-carving technique" using digital imaging and communications in medicine data. 査読国際誌

Jun Haruma, Kenji Sugiu, Minori Hoshika, Masafumi Hiramatsu, Tomohito Hishikawa, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Yu Sato, Yuki Ebisudani, Hisanori Edaki, Ryu Kimura, Isao Date

World neurosurgery 159 e113-e119 2021年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: To assess the ability of the "wall-carving (WC) image technique," which uses vascular images from three-dimensional digital subtraction angiograms (3DDSAs). Also, to verify the accuracy of the resulting 3D-printed hollow models of intracranial aneurysms. METHODS: The 3DDSA data from nine aneurysms were processed to obtain volumetric models suitable for the stereolithography apparatus. The resulting models were filled with iodinated contrast media. 3D rotational angiography of the models was carried out, and the aneurysm geometry was compared with the original patient data. The accuracy of the 3D-printed hollow models' sizes and shapes was evaluated using the nonparametric Wilcoxon signed-rank test and the Dice coefficient index. RESULTS: The aneurysm volumes ranged from 34.1 to 4609.8 mm3 (maximum diameters 5.1-30.1 mm), and no statistically significant differences were noted between the patient data and the 3D-printed models (p = 0.4). Shape analysis of the aneurysms and related arteries indicated a high level of accuracy (Dice coefficient index value, 88.7-97.3%; mean [± standard deviation (SD)], 93.6% ± 2.5%). The vessel wall thickness of the 3D-printed hollow models was 0.4 mm for the parent and 0.2 mm for small branches and aneurysms, almost the same as the patient data. CONCLUSION: The WC technique, which involves volume rendering of 3DDSAs, can provide a detailed description of the contrast enhancement of intracranial vessels and aneurysms at arbitrary depths. These models can provide precise anatomic information and be used for simulations of endovascular treatment.

DOI： 10.1016/j.wneu.2021.12.018

Risk factors for medullary infarction after endovascular trapping of vertebral artery dissecting aneurysms 査読国際誌

Hidenori Endo, Shuichi Tanoue, Masafumi Hiramatsu, Yasushi Matsumoto, Kenichi Sato, Masayuki Sato, Yuji Matsumaru, Wataro Tsuruta, Hiro Kiyosue

Neurosurgical Review 44 ( 4 ) 2283 - 2290 2021年8月

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

Internal trapping (IT) is a treatment option for intracranial vertebral artery dissecting aneurysms (VADAs). Medullary infarction (MI) is a complication linked to this treatment. This study aims to clarify the outcomes of IT for VADAs and the risk factors for MIs. We retrospectively reviewed the databases from 2010 to 2017 to identify patients with VADAs treated by IT at seven collaborating institutions. Radiological findings, clinical courses, and outcomes were analyzed. Perforating arteries were classified into terminal or longitudinal types using preoperative angiography. IT was completed in 90 patients (74 ruptured and 16 unruptured VADA). Postoperative rebleeding did not occur in any ruptured VADA patients. Postoperative MRI detected MIs in 26 patients (28.9%). The incidence of MIs in the ruptured VADA (32%) was higher compared with that in the unruptured VADA (13%), though it was not significant. In the MI group, the occlusion or blind alley of the terminal-type and longitudinal-type perforator was confirmed in 23 patients (88%) and 11 patients (42%), respectively. The occlusion or blind alley of the terminal-type perforator was an independent risk factor for MIs in the logistic regression analysis (OR 5.81; 95% CI 1.34-25.11; p = 0.018). In ruptured VADA, postoperative MI (OR 12.2; 95% CI 3.19-64.55; p = 0.0001) and high-grade SAH (OR 8.02; 95% CI 2.32-37.70; p = 0.0006) were independent risk factors of an unfavorable clinical outcome. In conclusion, MIs were an independent risk factor for unfavorable outcomes after IT, especially for a ruptured VADA. The occlusion or blind alley of the terminal-type perforator caused by the IT was associated with postoperative MIs.

DOI： 10.1007/s10143-020-01424-x

その他リンク： https://link.springer.com/article/10.1007/s10143-020-01424-x/fulltext.html

An Evaluation of the Safety and Feasibility of Adenosine-assisted Clipping Surgery for Unruptured Cerebral Aneurysms: Study Protocol 査読

Tomohito Hishikawa, Satoshi Murai, Masafumi Hiramatsu, Jun Haruma, Kazuhiko Nishi, Yuki Ebisudani, Yu Sato, Takao Yasuhara, Kenji Sugiu, Kazuyoshi Shimizu, Motomu Kobayashi, Koji Nakagawa, Aya Kimura-Ono, Katsuyuki Hotta, Hiroshi Morimatsu, Isao Date

Neurologia Medico-Chirurgica 61 ( 7 ) 393 - 396 2021年7月

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

The effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.

DOI： 10.2176/nmc.st.2021-0018

Mobile endovascular therapy for acute treatment of ruptured vertebral artery dissecting aneurysm in multiple hospitals 査読国際誌

Naoya Kidani, Kenji Sugiu, Kaoru Terasaka, Hiroyuki Nakashima, Koji Tokunaga, Kazuki Kobayashi, Hirokazu Kambara, Tomohito Hishikawa, Masafumi Hiramatsu, Isao Date

Acta Neurochirurgica 2021年6月

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

BACKGROUND: The patients with ruptured vertebral artery dissecting aneurysm (rVADA) should be treated as early as possible because VADA carries extremely high risk of rebleeding in the acute phase. We have established a mobile endovascular strategy for the patients with rVADA between our flagship center and its affiliated local hospitals. We introduced and reviewed our mobile endovascular therapy in this study. METHODS: We retrospectively evaluated 98 consecutive patients who underwent endovascular surgery for rVADA from 2000 to 2018 at our institution or five affiliated hospitals. When each patient was initially transported to the local affiliated hospitals, neuroendovascular surgeons traveled directly to the affiliated hospital from the flagship center in order to treat the patient there. Clinical outcomes using modified Rankin Scale at 6 months after treatment, radiological results, and procedure-related complications were reviewed to justify our mobile endovascular strategy. RESULTS: All aneurysms were cured successfully by internal trapping. Favorable outcome was achieved in 61 patients (62.2%) even though 53 patients (54.1%) had presented with severe subarachnoid hemorrhage. Overall mortality rate, treatment-related mortality rate, and treatment related complication rate were 18.4% (18/98), 0%, and 16% (16/98), respectively. There were no differences in clinical and radiological outcomes between the patients treated in the flagship center and those who treated in the affiliated hospitals. Treatment in the affiliated hospital was not a predictive factor of unfavorable outcome in our multivariate analysis, and elderly age (≥ 60) was negatively associated with favorable outcome. CONCLUSIONS: Our results prove the efficacy and safety of mobile endovascular therapy for the treatment of rVADA in the ultra-acute stage. Mobile endovascular therapy may work well in the acute treatment of rVADAs in the certain circumstance.

DOI： 10.1007/s00701-021-04885-1

その他リンク： https://link.springer.com/article/10.1007/s00701-021-04885-1/fulltext.html

Arteriovenous Fistula at the Craniocervical Junction Found After Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament. 査読国際誌

Susumu Sasada, Masafumi Hiramatsu, Akira Kusumegi, Haruto Fujimura, Shogo Oshikata, Yuichi Takahashi, Kenki Nishida, Takao Yasuhara, Isao Date

Neurospine 17 ( 4 ) 947 - 953 2020年12月

記述言語：英語

Ossification of the posterior longitudinal ligament (OPLL) is common in East Asia. Arteriovenous fistula at the craniocervical junction (CCJ-AVF), in contrast, is rare. As OPLL occurs most often in the cervical region, these 2 conditions can coexist in the cervical spinal canal of a single patient. We report a case of CCJ-AVF found after cervical laminoplasty (CLP) for OPLL. A 68-year-old man experienced progressive myelopathy due to cervical OPLL. Magnetic resonance imaging (MRI) revealed a high-intensity area inside the spinal cord. CLP was performed and his symptoms immediately improved. Three months after CLP, however, myelopathy recurred. MRI revealed an exacerbated and enlarged high-intensity area inside the cord from the medulla oblongata to the C4/5 level with a flow void around the cord. Left vertebral artery angiography revealed CCJ-AVF with ascending and descending draining veins. Direct surgery was performed to interrupt shunt flow into the draining veins. The patient's symptoms improved to a limited degree. In this case, increased pressure inside the spinal canal due to OPLL might have decreased the shunt flow of the CCJ-AVF. Thus, the venous congestion induced by CCJ-AVF might have been exacerbated after the pressure was removed by CLP. Magnetic resonance angiography screening could help detect concurrent CCJ-AVF and OPLL.

DOI： 10.14245/ns.2040200.100

Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients. 査読国際誌

Keisuke Takai, Toshiki Endo, Takao Yasuhara, Toshitaka Seki, Kei Watanabe, Yuki Tanaka, Ryu Kurokawa, Hideaki Kanaya, Fumiaki Honda, Takashi Itabashi, Osamu Ishikawa, Hidetoshi Murata, Takahiro Tanaka, Yusuke Nishimura, Kaoru Eguchi, Toshihiro Takami, Yusuke Watanabe, Takeo Nishida, Masafumi Hiramatsu, Tatsuya Ohtonari, Satoshi Yamaguchi, Takafumi Mitsuhara, Seishi Matsui, Hisaaki Uchikado, Gohsuke Hattori, Hitoshi Yamahata, Makoto Taniguchi

Journal of Neurosurgery: Spine 1 - 8 2020年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: The purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs). METHODS: Data from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed. RESULTS: Spinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7-546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of ≥ 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02). CONCLUSIONS: Based on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.

DOI： 10.3171/2020.6.SPINE20309

Posterior Condylar Canal硬膜動静脈瘻に対して経静脈的塞栓術を行った1例査読

河内哲, 平松匡文, 杉生憲志, 山岡陽子, 西和彦, 村井智, 高橋悠, 春間純, 菱川朋人, 伊達勲

脳血管内治療 5 ( 4 ) 155 - 160 2020年11月

担当区分：責任著者記述言語：日本語出版者・発行元：(NPO)日本脳神経血管内治療学会

【目的】経静脈的塞栓術にて治療したposterior condylar canal(PCC)近傍の硬膜動静脈瘻を経験したので報告する.【症例】60代男性.持続的な拍動性耳鳴を主訴に受診.脳血管撮影にて上行咽頭動脈,後頭動脈からのfeederがPCC前方の骨内shunted pouchに流入し,左posterior condylar vein(PCV)に流出していた.局所麻酔下にshunted pouchからPCV内を経静脈的に塞栓し,術後に合併症は認めなかった.【結語】PCC近傍の硬膜動静脈瘻は稀であるが,その診断および治療には解剖学的理解および3次元回転撮影の再構成が非常に有用であった.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J06751&link_issn=&doc_id=20201127220001&doc_link_id=%2Fcf5nokec%2F2020%2F000504%2F001%2F0155-0160%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2020%2F000504%2F001%2F0155-0160%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Microsurgical versus endovascular treatment of spinal epidural arteriovenous fistulas with intradural venous drainage: a multicenter study of 81 patients 査読

Keisuke Takai, Toshiki Endo, Takao Yasuhara, Toshitaka Seki, Kei Watanabe, Yuki Tanaka, Ryu Kurokawa, Hideaki Kanaya, Fumiaki Honda, Takashi Itabashi, Osamu Ishikawa, Hidetoshi Murata, Yusuke Nishimura, Kaoru Eguchi, Toshihiro Takami, Yusuke Watanabe, Takeo Nishida, Masafumi Hiramatsu, Tatsuya Ohtonari, Satoshi Yamaguchi, Takafumi Mitsuhara, Seishi Matsui, Hisaaki Uchikado, Gohsuke Hattori, Nobutaka Horie, Hitoshi Yamahata, Makoto Taniguchi

Journal of Neurosurgery: Spine 33 ( 3 ) 381 - 391 2020年9月

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

OBJECTIVE Spinal arteriovenous shunts are rare vascular lesions and are classified into 4 types (types I-IV). Due to rapid advances in neuroimaging, spinal epidural AVFs (edAVFs), which are similar to type I spinal dural AVFs (dAVFs), have recently been increasingly reported. These 2 entities have several important differences that influence the treatment strategy selected. The purposes of the present study were to compare angiographic and clinical differences between edAVFs and dAVFs and to provide treatment strategies for edAVFs based on a multicenter cohort.METHODS A total of 280 consecutive patients with thoracic and lumbosacral spinal dural arteriovenous fistulas (dAVFs) and edAVFs with intradural venous drainage were collected from 19 centers. After angiographic and clinical comparisons, the treatment failure rate by procedure, risk factors for treatment failure, and neurological outcomes were statistically analyzed in edAVF cases.RESULTS Final diagnoses after an angiographic review included 199 dAVFs and 81 edAVFs. At individual centers, 29 patients (36%) with edAVFs were misdiagnosed with dAVFs. Spinal edAVFs were commonly fed by multiple feeding arteries (54%) shunted into a single or multiple intradural vein(s) (91% and 9%) through a dilated epidural venous plexus. Preoperative modified Rankin Scale (mRS) and Aminoff Logue gait and micturition grades were worse in patients with edAVFs than in those with dAVFs. Among the microsurgical (n = 42), endovascular (n = 36), and combined (n = 3) treat- ment groups of edAVFs, the treatment failure rate was significantly higher in the index endovascular treatment group (7.5%, 31%, and 0%, respectively). Endovascular treatment was found to be associated with significantly higher odds of initial treatment failure (OR 5.72, 95% CI 1.45-22.6). In edAVFs, the independent risk factor for treatment failure after microsurgery was the number of intradural draining veins (OR 17.9, 95% C11.56-207), while that for treatment failure after the endovascular treatment was the number of feeders (OR 4.11, 95% CI 1.23-13.8). Postoperatively, mRS score and Aminoff-Logue gait and micturition grades significantly improved in edAVFs with a median follow-up of 31 months.CONCLUSIONS Spinal epidural AVFs with intradural venous drainage are a distinct entity and may be classified as type V spinal vascular malformations. Based on the largest multicenter cohort, this study showed that primary microsurgery was superior to endovascular treatment for initial treatment success in patients with spinal edAVFs.

DOI： 10.3171/2020.2.SPINE191432

Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for endovascular treatment of dissecting aneurysms 査読

Shuichi Tanoue, Hidenori Endo, Masafumi Hiramatsu, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Sato, Wataro Tsuruta, Masayuki Sato, Masaru Hirohata, Toshi Abe, Hiro Kiyosue

Neuroradiology 63 ( 4 ) 609 - 617 2020年9月

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

Background and Purpose Endovascular trapping of the vertebral artery dissecting aneurysms (VADAs) carries a risk of medullary infarction due to the occlusion of the perforating arteries. We evaluated the detectability and anatomical variations of perforating arteries arising from the vertebral artery (VA) using three-dimensional DSA. Methods In 120 patients without VA lesions who underwent rotational vertebral arteriography, the anatomical configurations of perforating arteries from the VA were retrospectively evaluated on the bi-plane DSA and reconstructed images to reach the consensus between two experienced reviewers. The images were interpreted by focusing on the numbers and types of perforating arteries, the relationships between the number of perforators and the anatomy of the VA and its branches. Results Zero, 1, 2, 3, 4, and 6 perforators were detected in 2, 51, 56, 9, 1, and 1 patient, respectively (median of 2 perforators per VA). The 200 perforators were classified into 146 terminal and 54 longitudinal course types and into 32 ventral, 151 lateral, and 17 dorsolateral distribution types. All ventral type perforators were also terminal type. In contrast, the longitudinal type was seen in 28.5% of lateral types and in 65% of dorsolateral types. Regarding the difference in the origin of the posterior inferior cerebellar artery (PICA), non-PICA type VAs gave off larger number of perforators than the other types of VAs. Conclusions Non-PICA type VAs give off a significantly larger number of perforators than other types, indicating that the trapping of non-PICA type VAs is associated with a risk of ischemic complications.

DOI： 10.1007/s00234-020-02549-y

Cerebellar Blood Flow and Gene Expression in Crossed Cerebellar Diaschisis after Transient Middle Cerebral Artery Occlusion in Rats 査読

Naoya Kidani, Tomohito Hishikawa, Masafumi Hiramatsu, Shingo Nishihiro, Kyohei Kin, Yu Takahashi, Satoshi Murai, Kenji Sugiu, Takao Yasuhara, Ikuko Miyazaki, Masato Asanuma, Isao Date

International Journal of Molecular Sciences 21 ( 11 ) 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI

Crossed cerebellar diaschisis (CCD) is a state of hypoperfusion and hypometabolism in the contralesional cerebellar hemisphere caused by a supratentorial lesion, but its pathophysiology is not fully understood. We evaluated chronological changes in cerebellar blood flow (CbBF) and gene expressions in the cerebellum using a rat model of transient middle cerebral artery occlusion (MCAO). CbBF was analyzed at two and seven days after MCAO using single photon emission computed tomography (SPECT). DNA microarray analysis and western blotting of the cerebellar cortex were performed and apoptotic cells in the cerebellar cortex were stained. CbBF in the contralesional hemisphere was significantly decreased and this lateral imbalance recovered over one week. Gene set enrichment analysis revealed that a gene set for "oxidative phosphorylation" was significantly upregulated while fourteen other gene sets including "apoptosis", "hypoxia" and "reactive oxygen species" showed a tendency toward upregulation in the contralesional cerebellum. MCAO upregulated the expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) in the contralesional cerebellar cortex. The number of apoptotic cells increased in the molecular layer of the contralesional cerebellum. Focal cerebral ischemia in our rat MCAO model caused CCD along with enhanced expression of genes related to oxidative stress and apoptosis.

DOI： 10.3390/ijms21114137

Correction to: High‑Mobility Group Box‑1‑Induced Angiogenesis After Indirect Bypass Surgery in a Chronic Cerebral Hypoperfusion Model. 国際誌

Shingo Nishihiro, Tomohito Hishikawa, Masafumi Hiramatsu, Naoya Kidani, Yu Takahashi, Satoshi Murai, Kenji Sugiu, Yusuke Higaki, Takao Yasuhara, Cesario V Borlongan, Isao Date

Neuromolecular Medicine 22 ( 2 ) 332 - 333 2020年6月

Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study 査読

Satoshi Murai, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Neuroradiology 62 ( 4 ) 503 - 510 2020年4月

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

Purpose Intracranial hemorrhage following hyperperfusion syndrome (HPS) is a rare but potentially fatal complication after carotid artery stenting (CAS). Staged angioplasty (SAP) is a two-stage form of CAS that can prevent the abrupt increase of cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. Methods One hundred thirty-four patients who underwent CAS for high-grade carotid artery stenosis between January 2010 and December 2018 were enrolled. Patients who showed severe impairment of hemodynamic reserve in I-123-IMP SPECT with acetazolamide received SAP (SAP group), while the others received regular CAS (RS group). Results Twenty-six (19.4%) patients at risk for HPS received SAP. HPS was not observed in either group. Diffusion-weighted image (DWI)-positive lesions on postoperative MRI were observed in 56 (52.3%) cases in the RS group and 16 (64.0%) cases in the SAP group. Symptomatic procedure-related complications occurred in 5 (4.6%) cases in the RS group and 1 (3.8%) case in the SAP group. These differences were not statistically significant. Modified Rankin Scale score had declined 30 days after discharge in 4 (3.0%) cases. Distal filter protection was significantly correlated to the occurrence of new DWI-positive lesions. Conclusions For patients at high risk of HPS, SAP was a reasonable treatment strategy to prevent HPS. SAP did not increase the rate of DWI-positive lesions or procedure-related complications compared with regular CAS.

DOI： 10.1007/s00234-019-02343-5

Precise MEP monitoring with a reduced interval is safe and useful for detecting permissive duration for temporary clipping 査読

Masahiro Kameda, Tomohito Hishikawa, Masafumi Hiramatsu, Takao Yasuhara, Kazuhiko Kurozumi, Isao Date

Scientific Reports 10 ( 1 ) 2020年2月

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

Although temporary clipping of the parent artery is an indispensable technique in clipping surgery for intracranial aneurysms, the permissive duration of temporary clipping is still not well known. The aim of this study is to confirm the safety of precise motor evoked potential (MEP) monitoring and to estimate the permissive duration of temporary clipping for middle cerebral artery (MCA) aneurysm based on precise MEP monitoring results. Under precise MEP monitoring via direct cortical stimulation every 30 seconds to 1 minute, surgeons released a temporary clip and waited for MEP amplitude to recover following severe (>50%) reduction of MEP amplitude during temporary clipping. Precise MEP monitoring was safely performed. Twenty-eight instances of temporary clipping were performed in 42 MCA aneurysm clipping surgeries. Because precise MEP monitoring could be used to determine when to release a temporary clip even with a severe reduction in MEP amplitude due to lengthy temporary clipping, no patients experienced permanent postoperative hemiparesis. Based on logistic regression analysis, if a temporary clip is applied for 312 seconds or more, there is a higher probability of a severe reduction in MEP amplitude. We should therefore release temporary clips after 5 minutes in order to avoid permanent postoperative hemiparesis.

DOI： 10.1038/s41598-020-60377-9

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