研究者詳細 - 杉生　憲志

論文 - 杉生　憲志

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中型動脈瘤にはflow diverterよりもstent-assisted coilingが薦められる

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

脳血管内治療 6 ( Suppl. ) S173 - S173 2021年11月

光造形3Dプリンターによる脳動脈瘤モデル作成法の確立とその応用

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

脳血管内治療 6 ( Suppl. ) S172 - S172 2021年11月

当院での高精度テーラーメード脳動脈瘤モデルを利用した脳血管内治療トレーニング

春間純, 杉生憲志, 木村颯, 胡谷侑貴, 佐藤悠, 枝木久典, 山岡陽子, 西和彦, 村井智, 平松匡文, 菱川朋人, 伊藤勲

脳血管内治療 6 ( Suppl. ) S36 - S36 2021年11月

国内研修施設を対象とした脳血管治療のシミュレーショントレーニングに関するアンケート調査の報告

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

脳血管内治療 6 ( Suppl. ) S34 - S34 2021年11月

当院におけるCASのprotection deviceによる治療成績の検討

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

脳血管内治療 6 ( Suppl. ) S124 - S124 2021年11月

当院における頭蓋内腫瘍塞栓術の治療成績 JR-NET3との比較

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

脳血管内治療 6 ( Suppl. ) S138 - S138 2021年11月

Incidence and clinical characteristics of spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. 国際誌

Masafumi Hiramatsu, Ryota Ishibashi, Etsuji Suzuki, Yuko Miyazaki, Satoshi Murai, Hiroki Takai, Yuji Takasugi, Yoko Yamaoka, Kazuhiko Nishi, Yu Takahashi, Jun Haruma, Tomohito Hishikawa, Takao Yasuhara, Masaki Chin, Shunji Matsubara, Masaaki Uno, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of neurosurgery. Spine 36 ( 4 ) 1 - 8 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

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

Neurologia medico-chirurgica 61 ( 7 ) 393 - 396 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

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

Acta neurochirurgica 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1007/s00701-021-04885-1

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Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population. 国際誌

Hirotoshi Imamura, Nobuyuki Sakai, Yasushi Matsumoto, Hiroshi Yamagami, Tomoaki Terada, Toshiyuki Fujinaka, Shinichi Yoshimura, Kenji Sugiu, Akira Ishii, Yuji Matsumaru, Takashi Izumi, Hidenori Oishi, Toshio Higashi, Koji Iihara, Naoya Kuwayama, Yasushi Ito, Masato Nakamura, Akio Hyodo, Kuniaki Ogasawara

Journal of neurointerventional surgery 13 ( 6 ) 524 - 529 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke. OBJECTIVE: To conduct a clinical trial for government approval of the device in patients at either high or normal risk for carotid endarterectomy (CEA). METHODS: Eligible patients had ≥50% symptomatic stenosis or ≥80% asymptomatic stenosis according to the North American Symptomatic Carotid Endarterectomy Trial methods (peak systolic velocity 130 and 230 cm/s on ultrasonography, respectively). The primary endpoint was the lack of major adverse events (MAEs), defined as death, stroke, and myocardial infarction within 30 days, and ipsilateral stroke within 1 year. The performance goal was set at 90.5%. MAE rates were also compared between the CEA high- and normal-risk groups. RESULTS: 140 carotid artery stenting procedures, including 40% of patients at high risk and 60% at normal risk for CEA, were performed in 13 institutes. MAEs occurred in two cases (one intraprocedural and one postprocedural stroke), and the MAE rate was 1.4%. The non-MAE rate was 98.6% according to Kaplan-Meier analysis, which was superior to the previously set performance goal. The deployment success, target lesion revascularization (TLR), in-stent restenosis, and cerebrovascular event rates were 99.3%, 2.4%, 8.5%, and 7.2%, respectively. The MAE rate in patients with normal CEA risk was 1.2%, which was similar to the high-risk CEA group, with no significant difference due to the small number of MAEs. CONCLUSIONS: The MAE rate following use of the CASPER stent was low (1.4%). The MAE, deployment success, TLR, in-stenosis, and cerebrovascular event rates were similar to those of previous reports.

DOI： 10.1136/neurintsurg-2020-016250

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Trends in Incidence of Intracranial and Spinal Arteriovenous Shunts: Hospital-Based Surveillance in Okayama, Japan. 国際誌

Satoshi Murai, Masafumi Hiramatsu, Etsuji Suzuki, Ryota Ishibashi, Hiroki Takai, Yuko Miyazaki, Yuji Takasugi, Yoko Yamaoka, Kazuhiko Nishi, Yu Takahashi, Jun Haruma, Tomohito Hishikawa, Takao Yasuhara, Masaki Chin, Shunji Matsubara, Masaaki Uno, Koji Tokunaga, Kenji Sugiu, Isao Date

Stroke 52 ( 4 ) 1455 - 1459 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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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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 46 ( 2 ) 200 - 200 2021年4月

脳出血招待

平松匡文、春間純、菱川朋人、杉生憲志、伊達勲

脳神経外科 49 ( 2 ) 284 - 292 2021年3月

[Intracerebral Hemorrhage].

Masafumi Hiramatsu, Jun Haruma, Tomohito Hishikawa, Kenji Sugiu, Isao Date

No shinkei geka. Neurological surgery 49 ( 2 ) 284 - 292 2021年3月

記述言語：日本語掲載種別：研究論文（学術雑誌）

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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【脳神経画像Critical Findings-おさえておきたい症状とCT/MRI画像所見】おさえておきたいCT/MRI所見からの鑑別脳出血

平松匡文, 春間純, 菱川朋人, 杉生憲志, 伊達勲

Neurological Surgery 49 ( 2 ) 284 - 292 2021年3月

記述言語：日本語出版者・発行元：(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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くも膜下出血後の早期脳障害における皮質脱分極と細胞外グルタミン酸濃度の関係

村井智, 菱川朋人, 平松匡文, 杉生憲志, 武田吉正, 森松史, 伊達勲