研究者詳細 - 平松　匡文

論文 - 平松　匡文

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脳血管攣縮に対する薬物療法と髄液管理の治療成績

菱川朋人, 村井智, 高橋悠, 木谷尚哉, 平松匡文, 杉生憲志, 伊達勲

脳血管攣縮 35 16 - 19 2020年2月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：スパズム・シンポジウム事務局

2003年1月〜2018年9月に発症72時間以内に外科治療を行った脳動脈瘤破裂によるくも膜下出血115例(男48例、女67例、年齢中央値65歳)を対象とした。2003〜2009年の53例(前期)は動脈瘤の部位・重症度・年齢でクリップとコイルを選択していたが、2010〜2018年の62例(後期)はコイルファーストの治療を行った。症候性脳血管攣縮を27例(24%)に、脳血管攣縮による脳梗塞を14例(12%)に認めた。症候性脳血管攣縮のリスク評価を多変量解析した結果、75歳以上が有意なリスク因子であり、腰椎ドレナージは有意に症候性脳血管攣縮の発生を抑制した。症候性脳血管攣縮の頻度は前期38%、後期11%であり、後期で有意に少なかった。各期の多変量解析で前期では75歳以上が有意なリスクであり、後期は腰椎ドレナージが有意に症候性脳血管攣縮の発生を抑制していた。脳動脈瘤破裂によるくも膜下出血に対する外科治療の基本管理は腰椎ドレナージが推奨されることが示唆された。

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Metal artifact reduction algorithm for image quality improvement of cone-beam CT images of medium or large cerebral aneurysms treated with stent-assisted coil embolization 査読

Satoshi Murai, Masafumi Hiramatsu, Yuji Takasugi, Yu Takahashi, Naoya Kidani, Shingo Nishihiro, Yukei Shinji, Jun Haruma, Tomohito Hishikawa, Kenji Sugiu, Isao Date

Neuroradiology 62 ( 1 ) 89 - 96 2020年1月

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

PurposeThe aim of the present study was to assess image quality improvement using a metal artifact reduction (MAR) algorithm in cases of medium or large cerebral aneurysms treated with stent-assisted coil embolization (SAC), and to analyze factors associated with the usefulness of the MAR algorithm.MethodsWe retrospectively evaluated the cone-beam computed tomography (CBCT) data sets of 18 patients with cerebral aneurysms treated with SAC. For subjective analysis, images of all cases with and without MAR processing were evaluated by five neurosurgeons based on four criteria using a five-point scale. For objective analysis, the CT values of all cases with and without MAR processing were calculated. In addition, we assessed factors associated with the usefulness of the MAR by analyzing the nine cases in which the median score for criterion 1 improved by more than two points.ResultsMAR processing improved the median scores for all four criteria in 17/18 cases (94.4%). Mean CT values of the region of interest at the site influenced by metal artifacts were significantly reduced after MAR processing. The maximum diameter of the coil mass (<17 mm; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.2-13.9; p=0.02) and vessel length covered by metal artifacts (<24 mm; OR, 2.3; 95% CI, 1.1-4.7; p=0.03) was significantly associated with the usefulness of the MAR.ConclusionsThis study suggests the feasibility of a MAR algorithm to improve the image quality of CBCT images in patients who have undergone SAC for medium or large aneurysms.

DOI： 10.1007/s00234-019-02297-8

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経時的 3DDSA fusion 画像で仮性動脈瘤の位置を同定し target embolization を行い得た破裂 AVM の 1 例査読

村井智, 杉生憲志, 菱川朋人, 平松匡文, 西廣真吾, 木谷尚哉, 高橋悠, 伊達勲

脳神経外科 48 ( 1 ) 39 - 45 2020年1月

Important role and future perspective of embolization for intra‒cranial tumors

Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Jun Haruma, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Yuki Ebisudani, Yu Sato, Kentarou Fujii, Isao Date

Japanese Journal of Neurosurgery 29 ( 8 ) 543 - 552 2020年

掲載種別：研究論文（学術雑誌）

Purpose：Embolization for intracranial tumors currently plays a supporting role to open surgery. The reasons for embo-lization include：1）tumor necrosis resulting in a safer operation and more aggressive surgery, 2）reduction in intraoperative bleeding and avoidance of blood transfusion, and 3）decrease in operative time. Functional vascular anatomy and endovascular technique are the most important issues for safe embolization. Herein we report our standard techniques for tumor emboliza-tion and compare our results with those of the Japanese Registry of NeuroEndovascular Therapy（JR‒NET）. Methods：Our standard procedure is as follows：1）embolization is performed several days before open surgery, 2）in cases with strong peritumoral edema, steroid administration or embolization may be performed immediately before surgery, 3）patients undergo the procedure under local anesthesia, 4）insertion of the microcatheter is as close as possible to the tumor, 5）particulate emboli are the first line material, 6）embolization is occasionally performed with N‒butyl cyanoacrylate （NBCA）glue, and 7）if possible, additional proximal feeder occlusion with coils is performed. Results：During the past 12 years, 169 intra‒cranial tumor embolization procedures were performed in our department. Meningioma was the main target of embolization（154 of 169 patients, 91.1%）. Seven procedure‒related complications were observed, with one permanent complication（0.6%）of hearing loss after anterior inferior cerebellar artery embolization for hemangioblastoma with NBCA. Transient complications included three middle meningeal arterio‒venous fistulas, two cranial nerve paresis, and a pseudoaneurysm of the femoral artery（puncture site）. We conducted the JR‒NET 2（2007‒2009）and JR‒NET 3（2010‒2014）in Japan. Complications of tumor embolization occurred in 57 of 1,544 JR‒NET 3 patients（3.69%）, although the complication rate for JR‒NET 2 was only 1.48%（15 of 1,012 patients）. Tumors other than meningioma were a significant risk factor for the occurrence of JR‒NET 2 complications. Further, embolization of vessels other than the external carotid artery（ECA）and use of liquid embolic material were significantly associated with the development of JR‒NET 3 complications. We suggest that more aggressive embolization targeted to vessels other than the ECA and increased applica-tion of liquid embolic materials might worsen the risk of complications. Conclusions：Although embolization was safe for extra‒axial tumors such as meningiomas fed by the ECA, embolization of vessels other than the ECA as occurs in hemangioblastomas was a significant risk factor for complications. Use of liquid embolic material increased the risk for complications. Endovascular neurosurgeons should fully discuss the indications and strategies for preoperative embolization with tumor neurosurgeons to perform safe and effective procedures.

DOI： 10.7887/jcns.29.543

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Intracranial invasive fungal aneurysm due to Aspergillus sinusitis successfully treated by voriconazole plus internal carotid artery ligation therapy in an aged woman 査読

Mami Takemoto, Yasuyuki Ohta, Koh Tadokoro, Ryo Sasaki, Yoshiaki Takahashi, Kota Sato, Toru Yamashita, Nozomi Hishikawa, Jingwei Shang, Masafumi Hiramatsu, Kenji Sugiu, Tomohito Hishikawa, Isao Date, Koji Abe

Neurology Asia 24 ( 4 ) 363 - 367 2019年12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：ASEAN NEUROLOGICAL ASSOC

A fungal carotid aneurysm is an infrequently occurring infectious aneurysm that is usually treated by antifungal therapy plus surgical debridement of the infected vessel. We herein report an extremely rare case involving a patient with a medical history of bladder cancer treated by Bacillus Calmette-Guerin (BCG) who developed a fungal aneurysm of the internal carotid artery and thrombosis of the superior ophthalmic vein caused by maxillary Aspergillus sinusitis. The patient was successfully treated by antifungal, anticoagulant, and antiplatelet drugs combined with internal carotid artery ligation therapy. Internal carotid artery fungal aneurysm is associated with a high mortality rate, but the present case suggests that it can be successfully treated by antifungal therapy combined with a less invasive endovascular therapy.

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High-Mobility Group Box-1-Induced Angiogenesis After Indirect Bypass Surgery in a Chronic Cerebral Hypoperfusion Model 査読

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

Neuromolecular Medicine 21 ( 4 ) 391 - 400 2019年12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：HUMANA PRESS INC

High-mobility group box-1 (HMGB1) is a nuclear protein that promotes inflammation during the acute phase post-stroke, and enhances angiogenesis during the delayed phase. Here, we evaluated whether indirect revascularization surgery with HMGB1 accelerates brain angiogenesis in a chronic cerebral hypoperfusion model. Seven days after hypoperfusion induction, encephalo-myo-synangiosis (EMS) was performed with or without HMGB1 treatment into the temporal muscle. We detected significant increments in cortical vasculature (p<0.01), vascular endothelial growth factor (VEGF) expression in the temporal muscle (p<0.05), and ratio of radiation intensity on the operated side compared with the non-operated side after EMS in the HMGB1-treated group than in the control group (p<0.01). Altogether, HMGB1 with EMS in a chronic hypoperfusion model promoted brain angiogenesis in a VEGF-dependent manner, resulting in cerebral blood flow improvement. This treatment may be an effective therapy for patients with moyamoya disease.

DOI： 10.1007/s12017-019-08541-x

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A comparison of the prevalence and risk factors of complications in intracranial tumor embolization between the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and JR-NET3 査読

Tomohito Hishikawa, Kenji Sugiu, Satoshi Murai, Yu Takahashi, Naoya Kidani, Shingo Nishihiro, Masafumi Hiramatsu, Isao Date, Tetsu Satow, Koji Iihara, Nobuyuki Sakai, Akio Hyodo, Shigeru Miyachi, Yoji Nagai, Chiaki Sakai, Tetsu Satoh, Waro Taki, Tomoaki Terada, Masayuki Ezura, Toshio Hyogo, Shunji Matsubara, Kentaro Hayashi, Toshiyuki Fujinaka, Yasushi Ito, Shigeki Kobayashi, Masaki Komiyama, Naoya Kuwayama, Yuji Matsumaru, Yasushi Matsumoto, Yuichi Murayama, Ichiro Nokahara, Shigeru Nemoto, Koichi Sato, Shinichi Yoshimura, Susumu Miyamoto, Kunihiro Nishimura, Kazunori Toyoda, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Hidenori Oishi

Acta Neurochirurgica 161 ( 8 ) 1675 - 1682 2019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 WIEN

BackgroundThe Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and 3 (JR-NET3) were nationwide surveys that evaluated clinical outcomes after neuroendovascular therapy in Japan. The aim of this study was to compare the prevalence and risk factors of complications of intracranial tumor embolization between JR-NET2 and JR-NET3.MethodsA total of 1018 and 1545 consecutive patients with intracranial tumors treated with embolization were enrolled in JR-NET2 and JR-NET3, respectively. The prevalence of complications in intracranial tumor embolization and related risk factors were compared between JR-NET2 and JR-NET3.ResultsThe prevalence of complications in JR-NET3 (3.69%) was significantly higher than that in JR-NET2 (1.48%) (p=0.002). The multivariate analysis in JR-NET2 showed that embolization for tumors other than meningioma was the only significant risk factor for complication (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.13-12.10; p=0.032), and that in JR-NET3 revealed that embolization for feeders other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03-6.25; p<0.001) and use of liquid materials (OR, 2.65; 95% CI, 1.50-4.68; p<0.001) were significant risks for complications. The frequency of embolization for feeders other than ECA in JR-NET3 (15.3%) was significantly higher than that in JR-NET2 (9.2%) (p<0.001). Also, there was a significant difference in the frequency of use of liquid materials between JR-NET2 (21.2%) and JR-NET3 (41.2%) (p<0.001).ConclusionsEmbolization for feeders other than ECA and use of liquid materials could increase the complication rate in intracranial tumor embolization.

DOI： 10.1007/s00701-019-03970-w

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Cerebral circulation improves with indirect bypass surgery combined with gene therapy

Alex Shear, Shingo Nishihiro, Tomohito Hishikawa, Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Isao Date

Brain Circulation 5 ( 3 ) 119 - 123 2019年7月

記述言語：英語出版者・発行元：WOLTERS KLUWER MEDKNOW PUBLICATIONS

Angiogenesis involves new blood vessels sprouting from preexisting blood vessels. This process may serve to improve brain circulation. Moyamoya disease (MMD) is a cerebrovascular disorder causing intracranial stenosis which significantly reduces the blood supply to the brain. Mainly stroke is the first symptom of the disorder, so treatments that reduce the risk of stroke are used for patients with MMD. To prevent stroke for those with chronic cerebral hypoperfusion, more blood needs to flow to the brain, which was thought to be achieved by enhancing angiogenesis. Indirect bypass surgery, such as encephalo-myo-synangiosis (EMS), is used for revascularization. However, EMS alone sometimes cannot provide enough circulation to avoid ischemic strokes. The current study examined if EMS combined with high-mobility group box-1 (HMGB1) and vascular endothelial growth factor (VEGF) enhanced angiogenesis and increased cerebral circulation. The results indicated that HMGB1 administered with EMS increased angiogenesis through a VEGF-dependent mechanism. In addition, exercising and stem cell transplantation possess possible means to increase angiogenesis. Overall, EMS with gene therapy, maintaining fitness, and stem cell utilization may prevent or help one recover from stroke by enhancing brain angiogenesis. Thus, these treatments may be applicable for patients with MMD. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed.

DOI： 10.4103/bc.bc_33_19

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Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography. 査読国際誌

T Satoh, T Hishikawa, M Hiramatsu, K Sugiu, I Date

American Journal of Neuroradiology 40 ( 5 ) 802 - 807 2019年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND PURPOSE: Our aim was to visualize the precise configuration of the aneurysmal neck and dome with/without remnants combined with a coiled dome after coiling treatment for cerebral aneurysms. We developed 3D multifusion imaging of silent MRA and FSE-MR cisternography. MATERIALS AND METHODS: We examined 12 patients with 3D multifusion imaging by composing 3D images reconstructed from TOF-MRA, silent MRA, and FSE-MR cisternography. The influence of magnetic susceptibility artifacts caused by metal materials affecting the configuration of the aneurysmal complex with coiling was assessed in a single 3D image. RESULTS: In all cases, TOF-MRA failed to depict the aneurysmal neck complex precisely due to metal artifacts, whereas silent MRA delineated the neck and parent arteries at the coiled regions without serious metal artifacts. FSE-MR cisternography depicted the shape of the coiled aneurysmal dome and parent artery complex together with the brain parenchyma. With the 3D multifusion images of silent MRA and FSE-MR cisternography, the morphologic status of the coiled neck and parent arteries was clearly visualized with the shape of the dome in a single 3D image. CONCLUSIONS: Silent MRA is a non-contrast-enhanced form of MRA. It depicts the coiled neck complex without serious metal artifacts. FSE-MR cisternography can delineate the shape of the coiled dome. In this small feasibility study, 3D multifusion imaging of silent MRA and FSE-MR cisternography allowed good visualization of key features of coiled aneurysms. This technique may be useful in the follow-up of coiled aneurysms.

DOI： 10.3174/ajnr.A6026

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Endovascular treatment for unruptured aneurysm associated with persistent primitive trigeminal artery: a case report and literature review 査読

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

Acta Neurochirurgica 161 ( 2 ) 407 - 411 2019年2月

記述言語：英語出版者・発行元：SPRINGER WIEN

The persistent primitive trigeminal artery (PPTA) is the most common carotid-basilar anastomosis, and the incidence of cerebral aneurysms associated with the PPTA is approximately 4%. Since PPTA aneurysms often have a wide neck and other vascular anomalies, endovascular treatment using an adjunctive technique is the current first-line therapy. Here, we report a case of PPTA aneurysm treated by coil embolization with a stent-assisted technique. A detailed evaluation of the size and course of all vessels and collateral flow, including the Allcock test and balloon test occlusion, is necessary when deciding on the treatment strategy.

DOI： 10.1007/s00701-018-3767-6

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Treatment Outcome of Intracranial Tumor Embolization in Japan: Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3) 査読

Kenji Sugiu, Tomohito Hishikawa, Satoshi Murai, Yu Takahashi, Naoya Kidani, Shingo Nishihiro, Masafumi Hiramatsu, Isao Date, Tetsu Satow, Koji Iihara, Nobuyuki Sakai

Neurologia Medico-Chirurgica 59 ( 2 ) 41 - 47 2019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：JAPAN NEUROSURGICAL SOC

Embolization for intracranial tumor is performed as a standard endovascular treatment. A retrospective, multicenter, observational study was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. Patients were derived from the Japanese Registry of NeuroEndovascular Therapy (JR-NET3) using data taken from January 2010 through December 2014 in Japan. A total of 40,169 patients were enrolled in JR-NET3, of which, 1,545 patients (3.85%) with intracranial tumors underwent embolization. The primary end point was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 (independency) at 30 days after embolization. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the development of complications were analyzed. The proportion of patients with mRS scores <= 2 at 30 days after procedure was 89.5%. Complications occurred in 57 of the 1544 patients (3.7%). Multivariate analysis showed that target vessels other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03-6.25; P < 0.001) and use of liquid material (OR, 2.65; 95% CI, 1.50-4.68; P < 0.001) were significantly associated with the development of complications. In JR-NET3, the primary end point was 89.5%, and the procedure-related complication rate was 3.7%. Embolization from other than ECA was significant risk factor of the complications. In addition, increasing usage of liquid embolic material worsened the risk of complications.

DOI： 10.2176/nmc.st.2018-0220

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内頚動脈後交通動脈分岐部瘤に対する後交通動脈を温存した塞栓術後の再発リスク査読

平松匡文, 杉生憲志, 菱川朋人, 西廣真吾, 木谷, 尚哉, 高橋悠, 村井智, 伊達勲

脳卒中の外科 47 ( 3 ) 167 - 173 2019年

Endovascular Treatment for Craniofacial Arteriovenous Fistula/Malformation 査読

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

Journal of Neuroendovascular Therapy 13 ( 5 ) 206 - 215 2019年

Natural course of unruptured cerebral aneurysms: Cutting-edge knowledge and clinical decision feedback

Tomohito Hishikawa, Masafumi Hiramatsu, Kenji Sugiu, Isao Date

Japanese Journal of Neurosurgery 28 ( 3 ) 120 - 126 2019年

掲載種別：研究論文（学術雑誌）

In this article, we present cutting-edge knowledge on the natural course, risk scores, treatment results of unruptured cerebral aneurysms (UCAs), and characteristics of UCAs in elderly patients. Data from the Unruptured Cerebral Aneurysm Study of Japan (UCAS Japan) are important for understanding the natural course of UCAs in Japanese patients. The prediction model for 3-year rupture risk of UCAs based on UCAS Japan data is reliable and useful in the clinical setting. Both surgical clipping and coil embolization for UCAs have favorable outcomes in Japan. The annual rupture rate of UCAs in elderly patients in Japan has been reported to be 1.6%. Age, size and location of aneurysms are significant risks for UCA rupture in elderly patients. The outcomes of surgical clipping and coil embolization for UCAs in elderly patients were equal in Okayama University Hospital. Numerous foreign studies have, however, demonstrated that the results of coil embolization are superior to those of surgical clipping in elderly patients. In the future, the establishment of treatment risk scores for UCAs and guidelines for UCAs in elderly patients in Japan are warranted.

DOI： 10.7887/jcns.28.120

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Coil Embolization through Collateral Pathway for Ruptured Vertebral Artery Dissecting Aneurysm with Bilateral Vertebral Artery Occlusion 査読

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

Journal of Stroke & Cerebrovascular DIseases 27 ( 9 ) E215 - E218 2018年9月

副鼻腔真菌症に続発した海綿静脈洞血栓症と内頸動脈瘤による眼窩先端部症候群の1例

戸田亜以子, 坂口紀子, 伊丹雅子, 宮本加織, 渡邊恭一, 木林並樹, 荒木亮一, 瀬口次郎, 平松匡文

臨床眼科 72 ( 9 ) 1277 - 1283 2018年9月

Ex vivo release of pipeline embolization device polytetrafluoroethylene sleeves: a technical note 査読

Takahashi Y, Sugiu K, Haruma J, Murai S, Kidani N, Nishihiro S, Hiramatsu M, Hishikawa T, Date I

Journal of Neuroendovascular Therapy 12 ( 9 ) 463 - 468 2018年9月

NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats 査読

Tomohisa Shimizu, Tomohito Hishikawa, Shingo Nishihiro, Yukei Shinji, Yuji Takasugi, Jun Haruma, Masafumi Hiramatsu, Hirokazu Kawase, Sachiko Sato, Ryoichi Mizoue, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Journal of Neurosurgery 128 ( 1 ) 137 - 143 2018年1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 Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH.METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites.RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 +/- 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P-50) was estimated to be 22.4 minutes (95% confidence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 +/- 2.2 minutes after initiation of SAH. On NADH fluorescence images CSD was initially observed in the anterior cortex; it propagated through the entire hemisphere in the direction of the occipital cortex at a rate of 3 mm/minute, with repolarization in 2.3 +/- 1.2 minutes. DC potential recording sites that had undergone CSD were found to have intact tissue 24 hours later. Compared with depolarization that caused 50% neuronal damage, the duration of CSD was too short to cause histological damage.CONCLUSIONS CSD was successfully visualized using NADH fluorescence. It propagated from the anterior to the posterior cortex along with an increase in CBF. The duration of depolarization in CSD (2.3 +/- 1.2 minutes) was far shorter than that causing 50% neuronal damage (22.4 minutes) and was not associated with histological damage in the current experimental setting.

DOI： 10.3171/2016.9.JNS161385

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Combination of the tubular retractor and brain spatulas provides an adequate operative field in surgery for deep-seated lesions: Case series and technical note. 査読国際誌

Yoshihiro Otani, Kazuhiko Kurozumi, Joji Ishida, Masafumi Hiramatsu, Masahiro Kameda, Tomotsugu Ichikawa, Isao Date

Surgical Neurology International 9 220 - 220 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）

Background: Surgeries for deep-seated lesions are challenging because making a corridor and observing the interface between lesions and normal brain tissue are difficult. The ViewSite Brain Access System, which is a clear plastic tubular retractor system, is used for resection of deep-seated lesions. However, the tapered shape of this system may result in limitation of the surgical field and cause brain injury to observe the interface between lesions and normal tissue. In this study, we evaluated the usefulness of the combination of ViewSite and brain spatulas. Methods: Nine patients were retrospectively identified who underwent resection of deep-seated lesions with the combination of Viewsite and brain spatulas. We assessed the extent of resection, prognosis, and quantitative brain injury from postoperative diffusion-weighed imaging (DWI). Results: There were four total radiographically confirmed resections. Subtotal resection in four patients and partial resection in one with central neurocytoma were achieved because these tumors were strongly adherent to the choroid plexus and ependymal veins. Only one case of metastatic tumor relapsed 6 months after surgery. The mean postoperative high signal on DWI was 3.68 ± 0.80 cm3. Conclusions: The combination of ViewSite and brain spatulas provides wide and adequate operative fields to observe the interface between lesions and normal tissue, and to prevent brain injury from excessive retraction pressure on the brain derived from repositioning of the ViewSite. Postoperative 3D volumetric analysis shows minimal damage to normal brain tissue. This report may provide new insight into the use of the ViewSite tubular retractor.

DOI： 10.4103/sni.sni_62_18

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平松匡文, 菱川朋人, 西廣真吾, 木谷尚哉, 杉生憲志, 伊達勲

脳神経外科速報 27 ( 12 ) 1251 - 1255 2017年12月

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

もやもや病(Moyamoya disease)に対する間接血行再建術の有効性は多く報告されている一方、効果が不十分な症例も存在する。われわれは慢性脳虚血モデル(両側総頸動脈結紮ラット)に間接血行再建術(encephalo-myo-synangiosis:EMS)を加えることにより、もやもや病手術モデルとし、さらに血管新生を促進させるような遺伝子治療を加える血管新生増強療法の研究を行ってきた。最近ではapelinという新規血管新生因子とvascular endothelial growth factor(VEGF)を併用することで成熟した血管新生を生じ得ることを報告した。今後は血管新生増強療法として蛋白製剤を用い、さらに脳血流の評価も行っていくことにより、臨床応用につなげていきたいと考えている。(著者抄録)

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