研究者詳細 - 杉生　憲志

論文 - 杉生　憲志

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杉生憲志, 菱川朋人, 平松匡文, 春間純, 西廣真吾, 木谷尚哉, 高橋悠, 村井智, 西和彦, 山岡陽子, 胡谷侑貴, 佐藤悠, 藤井謙太郎, 伊達勲

脳神経外科ジャーナル 29 ( 8 ) 543 - 552 2020年8月

記述言語：日本語出版者・発行元：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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Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3) 国際誌

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

Journal of Neurosurgery 133 ( 1 ) 166 - 173 2020年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery Publishing Group (JNSPG)

<sec><title>OBJECTIVE</title>Embolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization.

</sec><sec><title>METHODS</title>Patient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization.

</sec><sec><title>RESULTS</title>Transarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non–sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications.

</sec><sec><title>CONCLUSIONS</title>Complication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.

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DOI： 10.3171/2019.4.jns183458

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その他リンク： https://thejns.org/downloadpdf/journals/j-neurosurg/133/1/article-p166.xml

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

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

International journal of molecular sciences 21 ( 11 ) 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.3390/ijms21114137

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

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

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

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

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

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

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

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

DOI： 10.1007/s00234-019-02343-5

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脳血管攣縮に対する薬物療法と髄液管理の治療成績招待

菱川朋人、村井智、高橋悠、木谷尚哉、平松匡文、杉生憲志、伊達勲

脳血管攣縮 35 16 - 19 2020年2月

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

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

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破裂椎骨動脈解離性動脈瘤に対するステント併用コイル塞栓術

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

Neurosurgical Emergency 24 ( 3 ) 365 - 365 2020年2月

高脂肪食投与ラットにおける脳組織及び頭蓋内血管とHMGB1との関連

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

脳血管攣縮 35 96 - 96 2020年2月

くも膜下出血超急性期における皮質脱分極と細胞外グルタミン酸濃度が脳障害に与える影響

村井智, 菱川朋人, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 35 97 - 97 2020年2月

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

村井智、杉生憲志、菱川朋人、平松匡文、西廣真吾、木谷尚哉、高橋悠、伊達勲

脳神経外科速報 48 ( 1 ) 39 - 45 2020年1月

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

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

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

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

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

DOI： 10.1007/s00234-019-02297-8

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[A Case of Ruptured Arteriovenous Malformation Successfully Treated with Target Embolization for Pseudoaneurysm Detected Using Chronological Three-dimensional Digital Subtraction Angiography Fusion Images].

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

No shinkei geka. Neurological surgery 48 ( 1 ) 39 - 45 2020年1月

記述言語：日本語掲載種別：研究論文（学術雑誌）

We herein report a case of ruptured arterio-venous malformation(AVM)detected using three-dimensional digital subtraction angiography(3DDSA)fusion images and successfully treated with target embolization for pseudoaneurysm. A 50-year-old man with a history of AVM was admitted to our department for the treatment of ruptured high-grade AVM in the right parietal lobe. Although a bleeding point was not evident on DSA, the patient had re-rupture in the right ventricle, one month after admission. Chronological 3DDSA fusion images generated from 3DDSA images taken on admission and after re-rupture revealed a newly visualized intranidal pseudoaneurysm near a hematoma. Contrast-enhanced magnetic resonance imaging showed vessel wall enhancement along the posterior horn of the right ventricle;this enhancement corresponded to the location of the pseudoaneurysm. We planned target embolization for the intranidal pseudoaneurysm to prevent re-bleeding. The origin of the feeder was so steep that a microcatheter could not be advanced deeply, and embolization with 20% n-butyl-2-cyanoacrylate resulted in proximal occlusion. Follow-up angiography 1 week after embolization showed complete disappearance of the pseudoaneurysm, and the patient had no recurrence of aneurysm until one year.

DOI： 10.11477/mf.1436204131

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

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

Neurological Surgery 48 ( 1 ) 39 - 45 2020年1月

記述言語：日本語出版者・発行元：(株)医学書院

症例は50歳男性で、脳室内出血にて紹介搬送された。頭部CTで右側脳室内出血、右頭頂葉に5cm大のdiffuseなnidusを伴うSpetzler-Martin Grade IVの脳動静脈奇形を認め、MRIでは右側脳室後角近傍の血腫を確認した。塞栓術1週間前(発症1ヵ月後)に右側脳室内に再出血を生じたため、1ヵ月前と術直前のthree-dimensional digital subtraction angiography(3DDSA)とMRIの画像から、経時的3DDSA fusion画像を作成したところ、MRIでの破裂部と3DDSAでの仮性動脈瘤の位置が一致していた。新規に発生した仮性動脈瘤が出血源と考えてtarget embolizationを行い、仮性動脈瘤は消失した。diffuseで複雑な血管構造の変化を時間的・空間的に鋭敏に捉えられる点で、fusion画像は非常に有用であった。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01228&link_issn=&doc_id=20200128040008&doc_link_id=10.11477%2Fmf.1436204131&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204131&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

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

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

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

掲載種別：研究論文（学術雑誌）

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

DOI： 10.7887/jcns.29.543

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Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus 招待査読

Masafumi Hiramatsu, Kenji Sugiu, Jun Haruma, Tomohito Hishikawa, Yu Takahashi, Satoshi Murai, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Journal of Neuroendovascular Therapy 14 ( 12 ) 593 - 604 2020年

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

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

NEUROMOLECULAR MEDICINE 21 ( 4 ) 391 - 400 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：HUMANA PRESS INC

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

DOI： 10.1007/s12017-019-08541-x

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

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

NEUROLOGY ASIA 24 ( 4 ) 363 - 367 2019年12月

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

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

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蝶形骨縁および前頭蓋底髄膜腫の動脈解剖

平松匡文, 杉生憲志, 菱川朋人, 木谷尚哉, 村井智, 西和彦, 山岡陽子, 藤井謙太郎, 黒住和彦, 伊達勲

脳血管内治療 4 ( Suppl. ) S239 - S239 2019年11月

岡山県における脳脊髄動静脈シャント疾患の悉皆調査

村井智, 平松匡文, 石橋良太, 高井洋樹, 鈴木越治, 高橋悠, 木谷尚哉, 菱川朋人, 安原隆雄, 杉生憲志, 伊達勲

脳血管内治療 4 ( Suppl. ) S153 - S153 2019年11月

Cortical spreading depolarizationがくも膜下出血後のearly brain injuryに与える影響

村井智, 菱川朋人, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 31 ( 1 ) 111 - 111 2019年11月

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