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

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

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Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

近年,画像診断の進歩により硬膜動静脈瘻(dural arteriovenous fistula:dAVF)の血管解剖について詳細な理解が可能となってきた.われわれの施設ではdigital subtraction angiography(DSA)のslab maximum intensity projection(MIP)画像を駆使して,dAVFの質的診断に努めてきた.このような,画像診断の進歩は,血管内治療を主体とする外科的治療の戦略決定にも大きく寄与しており,治療成績の向上につながっている.今回はテーマごとにわれわれの知見や最近の文献を交えながら,dAVFに関する画像診断の新展開を紹介する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02079&link_issn=&doc_id=20231212130006&doc_link_id=%2Fcp4strok%2F2023%2F005106%2F006%2F0503-0507%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2023%2F005106%2F006%2F0503-0507%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society for Neuroendovascular Therapy  

DOI： 10.5797/jnet.ra.2023-0019

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：SAH  

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BACKGROUND AND PURPOSE: The lateral spinal artery (LSA) perfuses the dorsolateral part of the spinal cord at the craniocervical junction (CCJ). We analyzed the angioarchitecture of the normal LSA and CCJ arteriovenous fistula (AVF). METHODS: The first study included 26 patients with a cerebral aneurysm of the posterior circulation. Using slab maximum intensity projection (MIP) images from three-dimensional rotational angiography (3D-RA) and contrast-enhanced cone-beam CT (CE-CBCT), we analyzed the origin of the LSA, its anastomosis with the posterior inferior cerebellar artery (PICA), the point where it reaches the spinal cord, and the visualized range. In the second study, we analyzed the angioarchitecture and treatment results of 7 CCJAVF lesions treated in our department between 2016 and 2021. RESULTS: We visualized the normal LSA for all patients. In 23 patients with an intradural origin PICA, all LSAs originated from the C1 or C2 radicular artery, and 8 patients had an anastomosis with the PICA. In three patients with a C1 level origin PICA, all LSAs originated from the PICA. All LSAs reached the dorsolateral part of the spinal cord. The mean visualized range of the LSA was 27.4 mm. The LSA was involved in five of seven CCJAVF lesions (71%). There was one lesion with a spinal infarction after LSA embolization. Other lesions were treated by direct interruption of the AVF, and the ASA and LSA were preserved. CONCLUSION: This is the first report that visualized the LSA's normal anatomy using slab MIP images from 3D-RA and CE-CBCT. Knowledge of LSA anatomy is critical to avoid complications during the treatment of CCJAVF.

DOI： 10.1007/s00062-022-01218-2

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

<h4>Background</h4>Endovascular treatment is the mainstay of treatment for carotid-cavernous fistulas, but endovascular approaches vary widely. The authors report a rare case of a direct carotid-cavernous fistula with cranial nerve symptoms caused by rupture of a giant aneurysm in which selective transvenous embolization via the pterygoid plexus was performed.<h4>Observations</h4>An 81-year-old man presented with headache and various progressive cranial nerve symptoms due to a direct carotid-cavernous fistula caused by a ruptured giant aneurysm. All the draining veins visualized on preoperative examination immediately before the treatment were occluded except for the pterygoid plexus. Therefore, the authors chose the dilated pterygoid plexus to approach the shunted pouch at the cavernous sinus and achieve shunt obliteration by selective embolization with coils and n-butyl cyanoacrylate.<h4>Lessons</h4>Careful study of the three-dimensional rotational images in the preoperative examination is important when considering the various approaches to surgery. The pterygoid plexus can be an effective venous approach route to reach the cavernous sinus area.

DOI： 10.3171/CASE22558

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

Ribbon手技は前大脳動脈領域に対する間接血行再建術である.当科でribbon手技を行った連続7例(初回治療4例,追加治療3例)を対象に有効性を検証した.周術期合併症を2例に認めたが,全例で下肢の虚血発作頻度の改善を認め6例で前大脳動脈領域に良好な側副路の形成を認めた.術後脳卒中の発生を認めた例はなく生活の質の維持に貢献していた.小児もやもや病においてribbon手技は初回治療または追加治療として行うことができ,前大脳動脈領域に対する血行再建術として安全かつ有効な治療法と考えられる.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00650&link_issn=&doc_id=20230622280003&doc_link_id=%2Fco2socie%2F2023%2F004801%2F003%2F0015-0020%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2023%2F004801%2F003%2F0015-0020%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Publishing type：Research paper (scientific journal)   Publisher：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

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Other Link： https://www.nature.com/articles/s41598-022-14360-1

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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

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Language：Japanese   Publisher：(一社)日本脳循環代謝学会  

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

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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

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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

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OBJECTIVE: There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs. METHODS: The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed. RESULTS: The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advancing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001). CONCLUSIONS: The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

DOI： 10.3171/2021.7.SPINE21233

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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

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Language：Japanese   Publisher：SAH  

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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：(一社)日本脳循環代謝学会  

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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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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

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

BACKGROUND AND PURPOSE: To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan. METHODS: We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated. RESULTS: Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018. CONCLUSIONS: In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.

DOI： 10.1161/STROKEAHA.120.032052

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Language：Japanese  

J-GLOBAL

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CT angiography(CTA)plays a crucial role in the diagnosis of intracerebral hemorrhage(ICH). An 85-year-old woman presented with a disturbance of consciousness and right hemiparesis. Non-contrast CT of the brain revealed intracerebral hemorrhage in the left thalamus spreading to the internal capsule, corona radiata, and midbrain and a "swirl sign." CTA revealed no vascular anomaly. The early and delayed CTA phases revealed the"spot sign" and "leakage sign," respectively. Non-contrast CT three hours after the initial CT showed the enlargement of the hematoma. After the detection of ICH by initial non-contrast CT, CTA should be performed to differentiate between the causes of secondary ICH and detect the imaging markers of hematoma expansion or rebleeding. Previous studies have demonstrated that the "spot sign" detected by CTA is a valid imaging marker for hematoma expansion. In this article, the differential diagnosis of ICH and the detection of the imaging markers of hematoma expansion using non-contrast CT and CTA have been discussed.

DOI： 10.11477/mf.1436204390

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ・脳出血急性期にCTAを撮影する意義は大きい.・CTAで二次的な脳出血を鑑別し,出血源が明らかであれば外科的治療を検討する.・単純CTやCTAで,血腫増大・再出血の危険因子となる所見を検出する必要がある.

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PURPOSE: Arteriovenous fistulas (AVFs) located in the cavernous sinus (CS), clivus, and condyle can be osseous shunts in nature. Here, we reviewed the angioarchitecture, clinical characteristics, and treatment results of AVFs in these lesions. METHODS: Twenty-five patients with 27 lesions who underwent rotational angiography in our department between May 2013 and December 2019 were reviewed. We examined 20 CS AVFs, 2 clival AVFs, and 5 condylar AVFs. We divided the anatomical shunted pouches into five locations: the dorsum sellae (posteromedial of the CS), posterolateral wall of the CS, lateral wall of the CS, clivus, and condyle. We divided the AVFs into three categories: intraosseous, transitional, and nonosseous shunts. We analyzed the characteristics and treatment results. RESULTS: A total of 33 shunted pouches or points were identified in 27 lesions. The dorsum sellae (n = 16) was the most frequent location. Fourteen AVFs (88%) in the dorsum sellae were osseous (intraosseous or transitional) shunts. All AVFs in the clivus or condyle were also osseous shunts. Eleven lesions (92%) of intraosseous and all lesions of transitional shunts exhibited bilateral external carotid artery involvement as feeders. Ten lesions (83%) of intraosseous shunts were treated with selective transvenous embolization of the shunted pouch with or without additional partial embolization of the sinus. Eleven (92%) intraosseous shunts were completely occluded, and symptom resolution was achieved in all intraosseous shunts. CONCLUSION: Most of the CS AVFs with shunted pouches in the dorsum sellae and all of the AVFs in the clivus and condyle share similar characteristics.

DOI： 10.1007/s00234-020-02506-9

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Background and Purpose: Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. Materials and Methods: This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. Results: We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. Conclusions: Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.

DOI： 10.3174/ajnr.A6790

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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：(一社)日本脳循環代謝学会  

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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  

【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)

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Other Link： 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

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PURPOSE: Endovascular therapy to the spinal dural arteriovenous fistula (SDAVF) with a common origin of the radiculomedullary artery and the feeder of the shunt has the risk of spinal cord infarction. This study aimed to retrospectively assess the detection rate of normal spinal arteries from the feeder of SDAVF. METHODS: We retrospectively collected the angiographic and clinical data of SDAVFs. This study included 19 patients with 20 SDAVF lesions admitted to our department between January 2007 and December 2018. We assessed the detection rate of normal radiculomedullary artery branched from the feeder of SDAVF between the period using the image intensifier (II) and flat panel detector (FPD) and evaluated the treatment results. RESULTS: The detection rates of the radiculomedullary artery branched from the feeder of SDAVF were 10% (1/10 lesions) during the II period and 30% (3/10 lesions) during the FPD period. During the FPD period, all normal radiculomedullary arteries branched from the feeder were only detected on slab maximum intensity projection (MIP) images of rotational angiography, and we could not detect them in 2D or 3D digital subtraction angiography. All lesions that had a common origin of a normal radiculomedullary artery and the feeder were completely obliterated without complications. There was no recurrence during the follow-up period. CONCLUSIONS: The flat panel detector and slab MIP images seem to show the common origin of the normal radiculomedullary arteries from the feeder more accurately. With detailed analyses, SDAVF can be safety treated.

DOI： 10.1007/s00234-020-02466-0

PubMed

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Central vein disease (CVD) is a well-known complication of central venous cannulations, indwelling dialysis catheters, and arteriovenous grafts. Brachiocephalic vein (BCV) stenosis or thrombotic occlusion can occur in dialysis patients, and the presence of an ipsilateral arteriovenous fistula can cause cerebral venous hypertension due to retrograde flow in the ipsilateral jugular vein. A 53-year-old man receiving hemodialysis (left brachiocephalic hemodialysis fistula) presented with impaired consciousness and seizures related to status epilepticus due to left temporal multifocal hemorrhages. Brain computed tomography and angiogram showed left cortical vein congestion without intracranial arteriovenous shunt. Complementary left brachial angiogram showed a left BCV stenosis and jugular and cerebral high-flow venous reflux with cortical venous reflux from the hemodialysis fistula. The left arm shunt resulted in severe cerebral venous hypertension due to ipsilateral stenosis of the BCV. BCV angioplasty immediately resolved the cerebral reflux. Patients with hemodialysis fistulas are at a higher risk of developing these intracerebral hemorrhage complications.

DOI： 10.1007/s00234-020-02457-1

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本脳神経外科コングレス  

脳腫瘍塞栓術は多くの場合開頭術前の補助療法であり安全性が重要である。当科での過去12年間169塞栓術で、恒久的合併症は1例(0.6%)であった。外頸動脈を主栄養血管とする髄外腫瘍(髄膜腫)の塞栓術は安全だが、血管芽腫などの髄内腫瘍では合併症の危険性は高くなる。合併症として、術後腫瘍内出血、塞栓物質の神経栄養血管への迷入による脳神経麻痺や視障害、および脳梗塞などがあるが、十分な血管機能解剖の知識と技術をもってすればその多くは回避できる。術前塞栓術の有用性は知られているが、摘出術への貢献を科学的に証明することは困難である。当科では一貫して開頭術者が術前塞栓を依頼しており、有効性の表れと感じている。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02632&link_issn=&doc_id=20200803230002&doc_link_id=130007890362&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007890362&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(NPO)日本脳神経外科救急学会  

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Development of extracranial carotid artery aneurysm (ECCA) after carotid endarterectomy (CEA) is a rare complication, occurring in connection with <1% of all CEAs. The main causes are infection, suture failure, and degeneration of arterial wall or patch. The traditional treatment has been operative repair, which can present a significant technical challenge owing to reoperative neck inflammation and potential cranial nerve injuries. Here, we report a case of successful stent-assisted coil embolization for right noninfectious ECCA. A 63-year-old female was admitted to our hospital for a 3-cm pulsating mass in her right midneck. Doppler examination and digital subtraction angiography revealed a large (15 mm) ECCA at the right common carotid artery (CCA). Thirteen years earlier, eversion CEA with patch angioplasty and abbreviation of the internal carotid artery (ICA) had been performed for a symptomatic 80% diameter stenosis with transient ischemic attack at another hospital. As the patient refused blood transfusion for religious reasons, we treated her with stent-assisted coil embolization, which achieved nearly complete obliteration of the aneurysm while preserving the parent artery patency. Three months after initial treatment, ultrasound revealed complete occlusion of the ECCA, but also showed stent shortening. Hence, we performed an additional stent placement so as to overlap the previous stent by 2.5 cm. Six months after initial treatment, carotid duplex ultrasound confirmed a good outcome. This procedure is an excellent choice for high-risk patients, and a larger case series is needed to establish this technique as the treatment of choice for ECCAs.

DOI： 10.2176/nmccrj.cr.2019-0030

PubMed

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

PURPOSE: The 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. METHODS: We 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. RESULTS: MAR 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. CONCLUSIONS: This 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

PubMed

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DOI： 10.5797/jnet.ra.2020-0042

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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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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 (P50) 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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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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OBJECTIVE The aim of this study was to evaluate whether combined gene therapy with vascular endothelial growth factor (VEGF) plus apelin during indirect vasoreconstructive surgery enhances brain angiogenesis in a chronic cerebral hypoperfusion model in rats. METHODS A chronic cerebral hypoperfusion model induced by the permanent ligation of bilateral common carotid arteries (CCAs; a procedure herein referred to as "CCA occlusion" [CCAO]) in rats was employed in this study. Seven days after the CCAO procedure, the authors performed encephalo-myo-synangiosis (EMS) and injected plasmid(s) into each rat's temporal muscle. Rats were divided into 4 groups based on which plasmid was received (i.e., LacZ group, VEGF group, apelin group, and VEGF+apelin group). Protein levels in the cortex and attached muscle were assessed with enzyme-linked immunosorbent assay (ELISA) on Day 7 after EMS, while immunofluorescent analysis of cortical vessels was performed on Day 14 after EMS. RESULTS The total number of blood vessels in the cortex on Day 14 after EMS was significantly larger in the VEGF group and the VEGF+apelin group than in the LacZ group (p < 0.05, respectively). Larger vessels appeared in the VEGF+apelin group than in the other groups (p < 0.05, respectively). Apelin protein on Day 7 after EMS was not detected in the cortex for any of the groups. In the attached muscle, apelin protein was detected only in the apelin group and the VEGF+apelin group. Immunofluorescent analysis revealed that apelin and its receptor, APJ, were expressed on endothelial cells (ECs) 7 days after the CCAO. CONCLUSIONS Combined gene therapy (VEGF plus apelin) during EMS in a chronic cerebral hypoperfusion model can enhance angiogenesis in rats. This treatment has the potential to be a feasible option in a clinical setting for patients with moyamoya disease.

DOI： 10.3171/2016.8.JNS16366

PubMed

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We present the case of a de novo vertebral artery dissecting aneurysm (VADA) after endovascular trapping of a ruptured VADA on the contralateral side. The first ruptured VADA involved the posterior inferior cerebellar artery, which was successfully treated by endovascular internal trapping using a stent. A follow-up study at 3 months revealed a de novo VADA on the contralateral side. The second VADA was successfully embolized using coils while normal arterial flow in the vertebral artery was preserved using a stent. Increased hemodynamic stress may cause the development of a de novo VADA on the contralateral side.

DOI： 10.1007/s00701-017-3204-2

PubMed

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

Surgical resection of solid cerebellar hemangioblastomas can be challenging because of the profuse blood supply and tight space. We report two cases of solid cerebellar hemangioblastomas treated via surgical resection with the aid of preoperative endovascular embolization on the day of surgery. Case 1: A 36-year-old woman presented with a two-month history of headache and vomiting. Magnetic resonance imaging(MRI)revealed a right cerebellar solid mass, mild hydrocephalus, and apparent peritumoral edema. Angiogram showed a highly vascularized mass, three feeding arteries from the superior cerebellar artery(SCA), and a dilated vein draining into the confluence. We performed preoperative embolization of the three feeders with 15% n-butyl-2-cyanoacrylate(NBCA). Final angiogram showed an absence of tumor staining. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. Case 2: A 36-year-old man presented with a four-month history of headache and numbness in the left upper extremity. MRI revealed a right cerebellar solid mass with peritumoral edema. Angiogram showed a highly vascularized mass with two feeding arteries from the right SCA, one from the left posterior inferior cerebellar artery(PICA), and a dilated vein draining into the confluence. Preoperative embolization was performed with 15% NBCA, and complete devascularization was achieved. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. In conclusion, preoperative embolization with NBCA on the day of surgery is a safe and effective adjunctive treatment for solid cerebellar hemangioblastoma.

DOI： 10.11477/mf.1436203560

PubMed

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

当科では医学生やメディカルスタッフに対して、血管内治療シミュレーターVascular Intervention Simulator Trainer(VIST)を用いたシミュレーション教育を行っており、その有効性について検討した。実習は3名1組となり、VISTを用いてデバイスの選択、血管造影、カテーテル操作、コイル塞栓術の手技を行った。実習終了後に行った筆記試験やアンケートでは血管内治療への理解度向上の効果が得られた。VISTを用いた血管内治療シミュレーション教育は血管内治療や血管解剖の理解度向上に効果があり、医学生に対して脳神経外科や脳血管内治療への興味喚起につながり、メディカルスタッフに対してより良いチーム医療の形成に役立つと考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03120&link_issn=&doc_id=20170705170012&doc_link_id=issn%3D0917-1495%26volume%3D27%26issue%3D7%26spage%3D751&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D27%26issue%3D7%26spage%3D751&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

2013年9月〜2015年10月に脳血管障害に対する開頭手術術前に3DDSA-MRI fusion画像を作成した3例を対象に、画像作成法を紹介し、脳血管障害に対する手術の術前シミュレーションとして有用か検討した。fusion画像は10〜15分程度で、全例問題なく作成できた。全例、fusion画像の有用性が認められ、手術戦略や手術アプローチに影響を与えていた。血管位置の最大誤差は平均2.5±0.1mmであったが、実際の術野での脳表上の血管構造物の同定には全例支障がなかった。頭蓋内血管病変に対する3DDSA-MRI fusionを活用することで、脳血管障害に対する術前シミュレーションとして有効と思われた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02079&link_issn=&doc_id=20170810180005&doc_link_id=%2Fcp4strok%2F2017%2F004504%2F005%2F0270-0275%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2017%2F004504%2F005%2F0270-0275%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医学書院  

症例1は36歳女性で、2ヵ月前から頭痛と嘔吐があり、右小脳半球腫瘍を指摘された。MRIでは右小脳半球にT1強調画像で等信号、FLAIR画像で高信号、拡散強調画像で低信号を呈し、ガドリニウム造影ではほぼ均一に造影される最大径30mmの境界明瞭な腫瘍を認めた。嚢胞を伴わない充実性腫瘍で、また強い浮腫を伴っていることから、手術リスク軽減のために術前塞栓術を施行し、その後開頭腫瘍摘出術の方針とした。術後も神経学的脱落所見なく経過し、MRIで腫瘍の全摘出を確認し、術後8日に独歩退院した。症例2は36歳男性で、4ヵ月前より頭痛があり、しばらくして左上肢の異常感覚を自覚した。MRIで右小脳半球にT1強調画像でやや高信号、T2強調画像でやや高信号、拡散強調画像では低信号を呈する最大径35mmの境界明瞭な腫瘍を認め、ガドリニウム造影によりほぼ均一に造影された。嚢胞を伴わない充実性腫瘍で、また強い浮腫を伴っていることから、摘出術リスク軽減のために術前塞栓術を施行し、同日に開頭腫瘍摘出術の方針とした。術後も神経学的脱落所見なく経過した。MRIでは腫瘍は全摘出されていた。術後15日目に独歩退院した。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01228&link_issn=&doc_id=20170727030009&doc_link_id=10.11477%2Fmf.1436203560&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203560&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

Language：Japanese   Publisher：スパズム・シンポジウム事務局  

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Although delayed cerebral vasospasm (DCV) following subarachnoid hemorrhage (SAH) is closely related to the progression of brain damage, little is known about the molecular mechanism underlying its development. High mobility group box-1 (HMGB1) plays an important role as an initial inflammatory mediator in SAH. In this study, an SAH rat model was employed to evaluate the effects of anti-HMGB1 monoclonal antibody (mAb) on DCV after SAH. A vasoconstriction of the basilar artery (BA) associated with a reduction of nuclear HMGB1 and its translocation in vascular smooth muscle cells were observed in SAH rats, and anti-HMGB1 mAb administration significantly suppressed these effects. Up-regulations of inflammation-related molecules and vasoconstriction-mediating receptors in the BA of SAH rats were inhibited by anti-HMGB1 mAb treatment. Anti-HMGB1 mAb attenuated the enhanced vasocontractile response to thrombin of the isolated BA from SAH rats and prevented activation of cerebrocortical microglia. Moreover, locomotor activity and weight loss recovery were also enhanced by anti-HMGB1 mAb administration. The vasocontractile response of the BA under SAH may be induced by events that are downstream of responses to HMGB1-induced inflammation and inhibited by anti-HMGB1 mAb. Anti-HMGB1 mAb treatment may provide a novel therapeutic strategy for DCV and early brain injury after SAH.

DOI： 10.1038/srep37755

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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：(一社)日本脳循環代謝学会  

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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：(一社)日本脳循環代謝学会  

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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   Publishing type：Research paper (scientific journal)  

BACKGROUND: Traumatic vertebral arteriovenous fistula (TVAVF) is an uncommon disease that occurs after traumatic injury. Here we report a case of TVAVF presenting with cervical bruit successfully treated by internal trapping using coils. CASE PRESENTATION: A 66-year-old man was transferred to our hospital after falling into a ditch. Initial CT revealed a C2 fracture into the right transverse foramen, and the patient had been treated with conservative management. A vascular abnormality was suspected because the patient exhibited cervical bruit on admission. CT angiography revealed right TVAVF at the V2 segment of the right vertebral artery (VA) near the C2 fracture. Digital subtraction angiography also revealed right TVAVF between the V2 segment of the right VA and the vertebral venous plexus, draining into the right internal jugular vein and the deep cervical vein as well as the intracranial venous system. The fistula was also opacified by retrograde flow from the contralateral VA through the union, while the flow in the basilar artery was antegrade. The patient was diagnosed with TVAVF with large transection of the right VA, and underwent endovascular treatment with internal trapping of the right VA using coils starting distal to the transection and proceeding in a proximal direction. After treatment, the right VAVF and right VA were completely occluded. The patient achieved clinical symptom resolution with no neurological deficits. CONCLUSION: Endovascular treatment with internal trapping of the VA using coils is safe and effective against TVAVF.

DOI： 10.11477/mf.1436203245

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Language：Japanese   Publisher：スパズム・シンポジウム事務局  

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Language：Japanese   Publisher：(株)医学書院  

66歳男。岩場で伐採作業中に誤って5m下の溝に滑落して前額部を打撲受傷し、直ちにドクターヘリで当院へ搬送された。頭部CTでは頭蓋内出血は認めず、頸椎CTにてC2椎体骨折、C6頸椎の右外側塊に骨折線を認めたため、頸椎カラーを装着して保存的加療となった。入院後に頸部雑音が出現したため頭頸部MRA・CTAを行ったところ、C2椎体骨折に伴う外傷性椎骨動静脈瘻が確認されたため、血管内治療によるinternal trappingを行った。治療後に頸部雑音は消失し、神経症状なく受傷後17日目にリハビリテーション目的に転院となった。

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

Dissecting aneurysms of the posterior cerebral artery (PCA) are rare, especially those at the P1 segment. Here, we describe the case of a 57-year-old woman with a subarachnoid hemorrhage (SAH). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) revealed a small (3 mm) dissecting aneurysm with the typical pearl-and-string sign at the right P1 segment. Fourteen days after onset, the patient developed aphasia. DSA revealed vasospasm of the right middle cerebral artery, and we performed endovascular treatment by the intra-arterial injection of 1-(5-isoquinolinesulfonyl) homopiperazine. After this treatment, the patient's symptoms recovered immediately. Vertebral angiography revealed enlargement of the dissecting aneurysm (up to 7 mm diameter). We started a loading dose of 300 mg aspirin and 400 mg clopidogrel after observing growth of the aneurysm. Fifteen days after onset, we performed a stent-assisted coil embolization, and obtained nearly complete obliteration of the aneurysm with preserved patency of the parent artery. Six-month follow-up DSA demonstrated complete occlusion of the aneurysm with good patency of the stented PCA; the patient was at modified Rankin Scale 1. In the treatment of ruptured dissecting aneurysms, parent vessel occlusion (PVO) with aneurysm is common. However, PVO may cause both cerebral infarction of the distal area and perforator occlusion of the occluded vessel. Stent-assisted coil embolization can preserve parent vessel flow and obliterate the aneurysm. Stents offer a therapeutic alternative for PCA dissecting aneurysms, especially when PVO cannot be tolerated.

DOI： 10.11477/mf.1436203187

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：(一社)日本脳循環代謝学会  

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Language：Japanese   Publisher：(一社)日本血管内治療学会  

コイル塞栓術を施行した破裂脳動脈瘤の連続46例を80歳以上(A群)と80歳未満(B群)に分類し、治療成績と予後に関する因子について検討した。その結果、A群は12例、B群は34例であった。A群はB群に比べ症候性脳血管攣縮の発生頻度が有意に高く、腰椎ドレナージ挿入の頻度が有意に低かった。退院時のmodified Rankin Scaleが0-2を予後良好例、3-6を予後不良例としたところ、予後良好例は10例、予後不良例は36例であった。予後良好例はA群0/12例(0%)、B群10/34例(29%)で、A群で有意に少なかった。症候性脳血管攣縮が予後不良に関与する割合はA群4/12例(33%)、B群1/24例(4%)で、A群で有意に高かった。

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Language：Japanese   Publisher：スパズム・シンポジウム事務局  

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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：Japanese   Publisher：(一社)日本脳循環代謝学会  

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

Glycyrrhizin (GL) is a major constituent of licorice root and has been suggested to inhibit the release of high mobility group box-1 (HMGB1), a protein considered representative of damage-associated molecular patterns. We found that GL bound HMGB1 but not RAGE with a moderate equilibrium dissociation constant value based on surface plasmon resonance analysis. This complex formation prevented HMGB1 from binding to RAGE in vitro. The effects of glycyrrhizin on traumatic brain injury (TBI) induced by fluid percussion were examined in rats or mice in the present study. GL was administered intravenously after TBI. Treatment of rats with GL dose-dependently suppressed the increase in BBB permeability and impairment of motor functions, in association with the inhibition of HMGB1 translocation in neurons in injured sites. The beneficial effects of GL on motor and cognitive functions persisted for 7 days after injury. The expression of TNF-α, IL-1β and IL-6 in injured sites was completely inhibited by GL treatment. In RAGE-/- mice, the effects of GL were not observed. These results suggested that GL may be a novel therapeutic agent for TBI through its interference with HMGB1 and RAGE interaction.

DOI： 10.1016/j.neuropharm.2014.05.007

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INTRODUCTION: Embolization of intracranial tumor is widely performed in Japan, mainly before neurosurgical resection. A retrospective, multicenter, observational study in Japan was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. METHODS: Patients were derived from the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2). A total of 20,854 patients were enrolled in JR-NET2, of which 1,018 patients (4.88 %) 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. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the occurrence of complications were studied. RESULTS: The proportion of patients with mRS scores ≤2 at 30 days after procedure was 91.3 %. Complications occurred in 15 of the 1,012 patients (1.48 %). Multivariate analysis showed that embolization for tumors other than meningioma (OR, 4.626; 95 % CI, 1.347-14.59; p = 0.0105) was significantly associated with the development of complications. CONCLUSION: The frequency of complications after intracranial tumor embolization was relatively low in this large Japanese cohort. Embolization for tumors other than meningioma was the only significant risk factor for the occurrence of complications.

DOI： 10.1007/s00234-013-1300-4

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We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65 ± 13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.

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

OBJECT: The effect on clinical outcomes of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) in patients over 80 years who underwent coil embolization was evaluated. METHODS: Forty-four cases were reviewed and divided into two groups according to patient age: Group A, 79 years or younger, and Group B, 80 or older. Patient characteristics, prevalence of symptomatic vasospasm, modified Rankin Scale (mRS) scores at discharge and frequency of symptomatic vasospasm in patients with mRS scores of 3-6 were analyzed. RESULTS: Thirty-two (73%) of the 44 cases were categorized as Group A and 12 (27%) as Group B. Group B had a significantly higher prevalence of symptomatic vasospasm compared to Group A (P=0.0040). mRS scores at discharge were significantly higher in Group B than in Group A (P=0.0494). Among cases with mRS scores of 3-6, there was a significantly higher frequency of symptomatic vasospasm in Group B than in Group A (P=0.0223). CONCLUSIONS: In our cohort of aneurysmal SAH patients treated by coil embolization, patients over 80 years of age were more likely to suffer symptomatic vasospasm, which significantly correlated with worse clinical outcomes, than those 79 years and under.

DOI： 10.1155/2014/253867

PubMed

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

We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65±13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.

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：English   Publishing type：Research paper (scientific journal)  

Traumatic brain injury (TBI) sustained in a traffic accident or a fall is a major cause of death that affects a broad range of ages. The aim of this study was to investigate the therapeutic effects of intra-arterial transplantation of mesenchymal stem cells (MSCs) combined with hypertonic glycerol (25%) or mannitol (25%) in a TBI model of rats. TBI models were produced with a fluid percussion device. At 24h after TBI, MSCs (1×10(6)cells/100μl) with glycerol or mannitol were administered via the right internal carotid artery. Rats were evaluated behaviorally and immunohistochemically, and hyperpermeability of the blood-brain barrier (BBB) induced by hypertonic solutions was explored. Compared to PBS or glycerol, the administration of mannitol resulted in increased BBB disruption. The mannitol-treated rats showed significant improvement in motor function. Intra-arterial transplantation of MSCs caused no thromboembolic ischemia. Immunohistochemically, more MSCs were observed in the injured brain tissues of mannitol-treated rats than in glycerol or PBS-treated rats at 24h after transplantation. Intra-arterial transplantation of MSCs combined with mannitol is an effective treatment in a TBI model of rats. This technique might be used for patients with diseases of the central nervous system including TBI.

DOI： 10.1016/j.neulet.2013.08.058

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

Aneurysms at the vertebrobasilar junction are often found with basilar artery(BA)fenestration. We encountered 10 consecutive cases of aneurysms associated with BA fenestration. The purpose of this study is to describe the frequency, clinical features, and outcome of these aneurysms treated by endovascular procedure. The incidence of these aneurysms in our series was 1.9%. All aneurysms were successfully treated by coil embolization. Half of them were treated by using simple technique, and the other half were treated by using adjunctive techniques such as balloon remodeling technique. 70% of these cases were ruptured, and all except one case showed good recovery at the time of discharge. We found 63 reported cases of this aneurysm in the literature between 2000 and 2012. 57 out of 63 aneurysms were treated by endovascular means with good clinical results. The usefulness of endovascular procedure is reported to be superior to surgical clipping because of their anatomical complexity and the difficulty of surgical exposure for clipping. We conclude that outcome of these aneurysms is favorable and endovascular procedure has become their standard treatment for these aneurysms.

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Language：Japanese   Publisher：(株)医学書院  

血管内治療を行った脳動脈瘤539例中脳底動脈窓形成部動脈瘤10例(男性2例、女性8例、平均51.6歳)について検討した。発症頻度は1.9%、動脈瘤の最大径は平均4.6cmで、動脈瘤破裂が7例(平均47.7歳)であった。窓形成は9例で、椎骨脳底動脈(VA-BA)合流部に認め、全例で動脈瘤は窓形成部の近位側から発生していた。血管内治療方法は、5例でsimple technique、4例でballoon remodeling technique、1例でdouble-catheter techniqueによるコイル塞栓術を行った。画像上の塞栓結果は、8例がcomplete occlusion、2例がneck remnantであった。手技に伴う合併症は認めず、Glasgow Outcome Scaleによる退院時転帰は9例がgood recoveryであり、転帰不良の1例はクモ膜下出血による一次脳損傷のため、重篤な後遺症が残存したものであった。

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

Aneurysms located on the superior cerebellar artery (SCA) are uncommon and their presentation, natural history, and clinical management are poorly understood. Reports related to the endovascular or surgical management of SCA aneurysms are rare. Herein, we report two cases of SCA aneurysm. The first is that of a 70-year-old woman who presented with subarachnoid hemorrhage (SAH). Surgical treatment (neck clipping) of the ruptured SCA aneurysm was performed, and the flow of the parent artery disappeared. The second is that of a 69-year-old woman with an unruptured SCA aneurysm who underwent endovascular surgery to occlude the parent artery. Neither patients exhibited any additional neurological deficits. SCA aneurysms often have either relatively wide or undefinable necks, so it is difficult to preserve the parent artery. According to several surgical reports, occlusion of the SCA appears well tolerated for a variety of reasons.

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Intracranial dural arteriovenous fistulas (dAVFs) are pathologic dural-based shunts and distinguished from parenchymal AVM by the presence of a dural arterial supply and the absence of a parenchymal nidus. Their symptoms and prognosis are strongly related to the pattern of their venous drainage system. The presence of cortical venous reflux (CVR) is an aggressive feature indicating that there is a high risk of cerebral bleeding or progressive neurological deficits. Endovascular treatment has become the mainstream dAVF therapy. In general, trans-venous coil embolization is adapted to sinusal type dAVFs (i.e. cavernous sinus or transverse-sigmoid dAVFs) and trans-arterial glue embolization is applied to non-sinusal type dAVFs (i.e. anterior skull base or tentorial dAVFs). Direct surgery and stereotactic radiosurgery are indicated in cases in which endovascular approaches have failed or are not feasible.

DOI： 10.7887/jcns.22.37

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Language：Japanese   Publisher：The Japanese Society for Neuroendovascular Therapy  

Objective: The "Sheep technique" is a special technique for navigating a balloon catheter that is difficult to navigate because of the steep angle of the branching vessel.<br>Case presentation: We treated two patients having intracranial aneurysms by endovascular therapy with the sheep technique. In both cases, initial balloon catheter navigation failed because the branch near the aneurysm was steep. With the aid of the sheep technique, the balloon catheter was successfully delivered into the target vessel. Coil embolization was then performed using a balloon remodeling technique.<br>Conclusion: The sheep technique is effective when balloon catheter delivery is difficult because the branch near the aneurysm is steep.

DOI： 10.5797/jnet.7.3

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

The aim of this study was to analyze the effect of endovascular treatment of basilar (BA) tip aneurysms. The authors performed a retrospective analysis of 79 aneurysms of the BA tip that had been treated using endovascular coil embolization for the last 11 years. Fifty-six patients were women, and 23 were men. The average age of the patients was 63.7 years (range, 35-83 year). The average maximum diameter of the aneurysms was 8.0 mm (range, 2-30 mm). Forty-seven patients (60%) presented with acute subarachnoid hemorrhage (SAH), 1 patient (1%) had an unruptured aneurysm with mass effect, and 31 patients (39%) had incidental aneurysms. Immediate anatomic outcomes demonstrated complete occlusion (CO) in 53 aneurysms (67%), residual neck (RN) in 22 aneurysms (28%), and residual aneurysm (RA) in 4 aneurysms (5%). One patient died from rebleeding 6 hours after the embolization. Another patient suffered from rebleeding 6 years after the initial embolization, and was successfully treated with re-embolization. Four patients suffered from asymptomatic P1 occlusion. No symptomatic complication was observed in the unruptured group. Retreatment was performed in 5 patients, including 4 broad-neck large ruptured aneurysms and 1 giant thrombosed aneurysm. Angiographic and clinical results have been improving in recent cases in this study. Technical advances such as highly compliant balloon remodeling microcatheter and 3D-reconstructed digital angiography contributed to this improvement. Our results indicate that endovascular treatment of BA tip aneurysm is safe and effective. The long-term stability after coil embolization is still a matter of concern. Further improvement is expected.

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Language：Japanese   Publisher：(株)医学書院  

血管内治療(コイル塞栓術)を行った脳底動脈先端部動脈瘤79例(男性23例、女性56例、平均63.7歳)を対象に、その成績について検討した。破裂瘤は47例、瘤の最大径は平均7.9mmであり、未破裂瘤は32例、瘤の最大径は平均8.2mmであった。1例(grade Iで治療当日に再出血にて死亡)を除き、破裂瘤の術前Hunt & Kosnik gradeと転帰(Glasgow Outcome Scale)は良く相関していた。破裂瘤47例の塞栓結果はcomplete obliteration(CO):27例、residual neck(RN):16例、residual aneurysm(RA):4例、未破裂瘤32例ではCO:26例、RN:6例と成績が良かった。合併症は無症候性後大脳動脈P1部閉塞4例(破裂瘤3例、未破裂瘤1例)が認められた。破裂瘤2例で治療後再出血を認め、4例で経過観察中に再発をきたしコイル塞栓術を追加した。未破裂瘤に出血は認めなかったが、3cm大の部分血栓化巨大動脈瘤の1例で再発し再治療を要した。全体で再出血2例(2.5%)、再発で再治療5例(6.3%)であった。

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

Intracranial cavernous sinus dural arteriovenous fistula (CS-dAVF) rarely causes intracranial hemorrhage. We report a case of CS-dAVF presenting with intracranial hemorrhage. A 62-year-old man presented tonic clonic convulsion with consciousness disturbance and was transferred to our hospital. CT scan revealed subarachnoid hemorrhage and right frontal subcortical hemorrhage. Angiography revealed right CS-dAVF which drained only into the vein of the right sylvian fissure. Transvenous embolization was performed using detachable coils. After embolization, CS-dAVF had completely disappeared and the patient was discharged without any symptom. We summarized the fourteen reported cases, including ours, of CS-dAVF with intracranial hemorrhage. All of them had retrograde drainage through cerebral veins.

PubMed

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

A 61-year-old woman suffered cisternal coil migration in the follow-up period after endovascular coil embolization for a ruptured cerebral aneurysm. She presented with sudden onset of headache. Computed tomography demonstrated diffuse subarachnoid hemorrhage, and cerebral angiography disclosed a left anterior choroidal artery aneurysm. The aneurysm was treated by endovascular embolization with Guglielmi detachable coils. During the embolization procedure, the microcatheter perforated the aneurysm. For direct closure of the perforation site with coils, the microcatheter was withdrawn and coils were deployed partially in the subarachnoid space and partially in the aneurysm sac. The coil mass was spread in the subarachnoid space around the aneurysm immediately after embolization. The patient was discharged with no neurological deficit. Three months later, follow-up radiography demonstrated obvious reduction in the size and compaction of the coil mass. Magnetic resonance angiography and digital subtraction angiography demonstrated stable occlusion of the aneurysm. The coil mass probably spread in the cistern around the aneurysm and was compacted by the shape memory of the coils and pulsation of the brain and vessels, as the subarachnoid clots around the aneurysm had disappeared. This case suggests that cisternal coil migration should be considered in the follow up of intracranial aneurysm treated with detachable coils.

PubMed

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

The authors report a case of 74-year-old woman suffering thrombosis of the confluence of sinuses after the left occipital transtentorial removal of a pineal region epidermoid cyst. Four days after the operation, the patient developed left homonymous hemianopsia. Magnetic resonance imaging revealed a venous infarct in the right occipital lobe and magnetic resonance venography disclosed a signal defect of the posterior part of the confluence of sinuses. The patients' neurological symptom recovered soon after anticoagulation treatment, and magnetic resonance venography after the sixth week showed recanalization of the confluence of sinuses. Although it might be rare, thrombosis of the dural sinus should be recognized as a complication of craniotomy.

PubMed

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

A case of arterial stenosis after coil migration in intracranial aneurysm embolization is presented. A 51-year-old woman suffered sudden onset of headache and unconsciousness. Computed tomography demonstrated diffuse subarachnoid hemorrhage and cerebral angiography disclosed a right internal carotid artery (ICA) bifurcation aneurysm and a right ICA-anterior choroidal artery aneurysm. The aneurysms were treated by endovascular embolization with Guglielmi detachable coils. During the embolization procedure of the ICA bifurcation aneurysm, a coil strand detached in the sac had migrated into the ICA. We did not retrieve the migrated coil, because the free coil strand was stable in the ICA and did not cause distal flow reduction. The patient suffered vasospasm of the right ICA and underwent intra-arterial infusion of fasudil hydrochloride and percutaneous transluminal angioplasty of the ICA on day 9. The patient experienced infarction in the territory of the right anterior cerebral artery area and needed a ventriculo-peritoneal shunt for hydrocephalus. The patient was discharged with mild right hemiparesis. Follow-up angiography after six months revealed right ICA and middle cerebral artery stenosis, but the free strand of the migrated coil had not moved in the right ICA. We suspect that the coil strand might have induced thrombosis or intimal hyperplasia of the proximal M1 segment and right ICA. Although late stenosis of the parent artery might be rare, it should be recognized as a long term complication of a migrated free coil strand in the endovascular treatment of intracranial aneurysms.

PubMed

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

A catheter-assisted technique is a technical option that has been developed to allow the endovascular treatment of wide-neck aneurysms. We report our experience of the catheter-assisted technique in treating a wide-neck aneurysm in the posterior inferior cerebellar artery.

PubMed

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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

【目的】2016年秋の日本脳神経血管内治療学会(JSNET)中国四国地方会における「脳梗塞急性期血行再建」の特別シンポジウムの中から、医療資源を集中させることが困難な山間部過疎地におけるtissue-plasminogen activator(t-PA)静注から血栓回収療法のモデルケースとして下記の3つを報告する。【方法・結果】1)地域の中核病院に集約してcomprehensive stroke center(CSC)に準じる施設を構築し、それまでゼロであった血栓回収療法が急増し、治療成果をあげた。2)大学病院と連携して血管内治療専門医の応援によるMobile Endovascular-therapyを展開し、血栓回収療法施行件数が急増し、それに伴って地元医師の技量も向上し、応援医師が不要となった。3)ドクターヘリ(場合によっては救急車)による全県型のhub-and-spokeモデルによる大学病院のCSC化により、専門医不在地域から遠隔画像を駆使した診療支援により効率的に患者搬送を行い成果をあげた。【結論】これらの取り組みが、日本各地の同様の問題を抱える地域に対して、参考になることを期待する一方、多大なマンパワーが必要で、医師およびメディカルスタッフへの大きな負担の上に成り立っているため、今後の社会整備・サポートの必要性も強調したい。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06751&link_issn=&doc_id=20190402280006&doc_link_id=%2Fcf5nokec%2F2019%2F000401%2F007%2F0037-0043%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2019%2F000401%2F007%2F0037-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese  

CiNii Article

CiNii Books

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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：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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

Web of Science

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J-GLOBAL

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Language：Japanese   Publisher：Okayama Medical Association  

DOI： 10.4044/joma.125.97

CiNii Article

CiNii Books

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Event date： 2022.11.10 - 2022.11.12

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.11.10 - 2022.11.12

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：大阪  

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Event date： 2022.11.10 - 2022.11.12

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.11.10 - 2022.11.12

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.11.10 - 2022.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.10.28 - 2022.10.29

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：甲府  

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Event date： 2022.10.12

Language：English   Presentation type：Oral presentation (invited, special)  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2022.9.28 - 2022.10.1

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：広島  

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Event date： 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：広島  

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Event date： 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：広島  

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Event date： 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：広島  

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Event date： 2022.9.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：広島  

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Event date： 2022.8.25 - 2022.8.27

Language：English   Presentation type：Oral presentation (general)  

Venue：Okayama  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.21 - 2022.8.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Kyoto  

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Event date： 2022.8.5 - 2022.8.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高崎  

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Event date： 2022.4.15 - 2022.4.16

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京  

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Event date： 2022.4.8 - 2022.4.9

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：WEB  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Poster presentation  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：大阪  

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Event date： 2022.3.17 - 2022.3.20

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：大阪  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Poster presentation  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Poster presentation  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Poster presentation  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Poster presentation  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.11.25 - 2021.11.27

Language：Japanese   Presentation type：Poster presentation  

Venue：福岡  

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Event date： 2021.11.12 - 2021.11.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岐阜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.10.27 - 2021.10.30

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.9.25

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2021.6.4 - 2021.6.5

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福島  

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Event date： 2021.5.13 - 2021.5.16

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：横浜  

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Event date： 2021.4.23 - 2021.4.24

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：札幌  

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Event date： 2021.4.17

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：秋田  

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Event date： 2021.4.3 - 2021.4.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：松江  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2021.3.11 - 2021.3.13

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Poster presentation  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2020.11.19 - 2020.11.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都  

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Event date： 2020.11.13 - 2020.11.14

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Poster presentation  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Event date： 2020.10.15 - 2020.10.17

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：岡山  

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Event date： 2020.9.29 - 2020.9.30

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜（Web併催）  

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Event date： 2020.8.23

Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：横浜  

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Event date： 2020.8.23

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2020.8.23

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：横浜  

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Event date： 2020.8.23

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Event date： 2020.8.23

Language：Japanese   Presentation type：Poster presentation  

Venue：横浜  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：高知  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：名古屋  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：倉敷（誌上開催）  

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Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：倉敷（誌上開催）  

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Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：名古屋  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：川越  

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Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：岡山  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山  

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Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：岡山  

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Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡  

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Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：福岡  

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Language：Japanese   Presentation type：Oral presentation (keynote)  

Venue：福岡  

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Language：English   Presentation type：Poster presentation  

Venue：Osaka  

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