Faculty Profiles - SUGIU Kenji

Papers - SUGIU Kenji

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Transvenous embolization of the direct carotid-cavernous fistula via the pterygoid plexus: illustrative case. Reviewed International journal

Matsuda Y, Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Nishi K, Yamaoka Y, Ebisudani Y, Kimura R, Edaki H, Date I

Journal of neurosurgery. Case lessons 5 ( 11 ) 2023.3

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

DOI： 10.3171/CASE22558

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小児もやもや病におけるribbon手技の有用性

菱川朋人, 平松匡文, 春間純, 杉生憲志, 伊達勲

小児の脳神経 48 ( 1 ) 15 - 20 2023.3

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

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

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

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

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

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

Scientific Reports 12 ( 1 ) 2022.12

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

脳脊髄の微小血管解剖を可視化する Invited

平松匡文、杉生憲志、伊達勲

脳神経外科 50 ( 6 ) 1361 - 1372 2022.11

Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience. International journal

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

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 31 ( 12 ) 106811 - 106811 2022.10

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

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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Angioarchitecture of the Normal Lateral Spinal Artery and Craniocervical Junction Arteriovenous Fistula Using Contrast-enhanced Cone-beam CT. International journal

Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Jun Haruma, Kazuhiko Nishi, Yoko Yamaoka, Yuki Ebisudani, Hisanori Edaki, Ryu Kimura, Isao Date

Clinical neuroradiology 33 ( 2 ) 375 - 382 2022.10

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

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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くも膜下出血の病態ラットSAH single injection modelにおける脳波抑制時間がearly brain injuryに及ぼす影響

高杉祐二, 菱川朋人, 清水智久, 村井智, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 34 ( 1 ) 84 - 84 2022.10

脳血管内治療と感染症 Invited

平松匡文、春間純、菱川朋人、杉生憲志、伊達勲

脳神経外科 50 ( 5 ) 969 - 976 2022.9

Hemifacial spasm due to vertebral artery dissecting aneurysm treated with stent-in-stent placement; Pre- and post-treatment evaluation by 3D multifusion imaging using silent MR angiography Reviewed International journal

Satoh T, Sato Y, Sugiu K, Hishikawa T, Hiramatsu M, Haruma J , Date I

Surgical neurology international 2022 Jun 3; 13:232. 232 - 232 2022.6

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

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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Association of bleb formation with peri-aneurysmal contact in unruptured intracranial aneurysms Reviewed International journal

Satoh T, Yagi T, Sawada S, Sugiu K, Sato Y, Date I

Scientific Reports 2022 Apr 12; 12(1):6075 2022.4

高脂血症ラットにおけるくも膜下出血後脳血管攣縮の検討

西和彦, 菱川朋人, 高橋悠, 劉克約, 胡谷侑貴, 佐藤悠, 山岡陽子, 村井智, 春間純, 平松匡文, 杉生憲志, 西堀正洋, 伊達勲

脳血管攣縮 37 79 - 79 2022.2

A case of delayed foreshortening and disconnection of pipeline embolization device detected by chronological cone-beam computed tomography fusion image Reviewed International journal

Ebisudani Y, Sugiu K, Haruma J, Murai S, Hishikawa T, Hiramatsu M, Takahashi Y, Nishi K, Yamaoka Y, Sato Y, Kimura R, Edaki H, Date I

Acta Neurochir (Wien) 164 ( 8 ) 2203 - 2206 2022

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

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

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

World neurosurgery 159 e113-e119 2021.12

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

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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高脂血症ラットにおけるくも膜下出血後脳血管攣縮

西和彦, 菱川朋人, 高橋悠, 劉克約, 枝木久典, 木村颯, 胡谷侑貴, 佐藤悠, 山岡陽子, 村井智, 春間純, 平松匡文, 杉生憲志, 西堀正洋, 伊達勲

脳循環代謝 33 ( 1 ) 87 - 87 2021.11