Faculty Profiles - SUGIU Kenji

Papers - SUGIU Kenji

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Challenges in the treatment of giant cavernous carotid aneurysm associated with hemophilia A: illustrative case

Yuichi Hirata, Masafumi Hiramatsu, Kenji Sugiu, Juntaro Fujita, Yuta Sotome, Masato Kawakami, Ryu Kimura, Yuki Ebisudani, Jun Haruma, Shota Tanaka

Journal of Neurosurgery: Case Lessons 9 ( 8 ) 2025.2

Publishing type：Research paper (scientific journal) Publisher：Journal of Neurosurgery Publishing Group (JNSPG)

BACKGROUND

Hemophilia A is characterized by a deficiency of factor VIII, leading to severe bleeding disorders. Abnormal blood coagulation can complicate the treatment of cerebral aneurysms.

OBSERVATIONS

A 20-year-old man with congenital hemophilia A presented with abducens nerve palsy caused by a giant cavernous carotid aneurysm (CCA). Because of the coagulopathy, simple internal carotid artery ligation was chosen, and the aneurysm initially shrank following treatment. However, it recurred due to collateral arteries from the posterior communicating artery and branches of the external carotid artery. These arteries were occluded using endovascular techniques, resulting in complete obliteration of the aneurysm.

LESSONS

To the best of the authors’ knowledge, this is the first reported case of treating a giant CCA associated with hemophilia A. In patients with coagulopathy, surgical options are limited, and standard treatments may not achieve a complete cure. Careful consideration of treatment strategies is crucial when managing giant CCA in the context of a coagulation disorder.

https://thejns.org/doi/10.3171/CASE24693

DOI： 10.3171/case24693

Other Link： https://thejns.org/downloadpdf/journals/j-neurosurg-case-lessons/9/8/article-CASE24693.xml

Challenges in the treatment of giant cavernous carotid aneurysm associated with hemophilia A: illustrative case

Yuichi Hirata, Masafumi Hiramatsu, Kenji Sugiu, Juntaro Fujita, Yuta Sotome, Masato Kawakami, Ryu Kimura, Yuki Ebisudani, Jun Haruma, Shota Tanaka

Journal of Neurosurgery: Case Lessons 9 ( 8 ) 2025.2

Publishing type：Research paper (scientific journal) Publisher：Journal of Neurosurgery Publishing Group (JNSPG)

BACKGROUND

Hemophilia A is characterized by a deficiency of factor VIII, leading to severe bleeding disorders. Abnormal blood coagulation can complicate the treatment of cerebral aneurysms.

OBSERVATIONS

A 20-year-old man with congenital hemophilia A presented with abducens nerve palsy caused by a giant cavernous carotid aneurysm (CCA). Because of the coagulopathy, simple internal carotid artery ligation was chosen, and the aneurysm initially shrank following treatment. However, it recurred due to collateral arteries from the posterior communicating artery and branches of the external carotid artery. These arteries were occluded using endovascular techniques, resulting in complete obliteration of the aneurysm.

LESSONS

To the best of the authors’ knowledge, this is the first reported case of treating a giant CCA associated with hemophilia A. In patients with coagulopathy, surgical options are limited, and standard treatments may not achieve a complete cure. Careful consideration of treatment strategies is crucial when managing giant CCA in the context of a coagulation disorder.

https://thejns.org/doi/10.3171/CASE24693

DOI： 10.3171/case24693

Other Link： https://thejns.org/downloadpdf/journals/j-neurosurg-case-lessons/9/8/article-CASE24693.xml

【髄膜腫の現在-最新の知識を活かした最善の治療のために】髄膜腫に対する集学的治療髄膜腫に対する血管内腫瘍塞栓術

五月女悠太, 杉生憲志, 平松匡文, 春間純, 胡谷侑貴, 木村颯, 枝木久典, 川上真人, 藤田淳太郎, 田中將太

Neurological Surgery 52 ( 4 ) 794 - 804 2024.7

Language：Japanese Publisher：(株)医学書院

＜文献概要＞Point・大型や頭蓋底部髄膜腫に対する術前塞栓術は,開頭術の補助的手術として有用である.・開頭術者と十分な術前検討を行った上で,戦略的な塞栓術を行うことが肝要である.・目的に応じた塞栓物質を選択し,合併症を起こさない塞栓術を心掛ける.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01228&link_issn=&doc_id=20240725160016&doc_link_id=10.11477%2Fmf.1436204978&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204978&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

[Preoperative Embolization of Intracranial Meningioma].

Yuta Soutome, Kenji Sugiu, Masafumi Hiramatsu, Jun Haruma, Yuki Ebisudani, Ryo Kimura, Hisanori Edaki, Masato Kawakami, Juntaro Fujita, Shota Tanaka

No shinkei geka. Neurological surgery 52 ( 4 ) 794 - 804 2024.7

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

Preoperative embolization(POE)of intracranial meningioma is performed worldwide. Although clear evidence of the effectiveness of POE has not been reported in the literature, the technique plays an important role in open surgery, especially for large or skull base meningiomas. The purposes of embolization include: 1)induction of tumor necrosis, resulting in a safer operation, 2)reduction in intraoperative bleeding, and 3)decrease in operative time. Knowledge of the functional vascular anatomy, embolic materials, and endovascular techniques is paramount to ensure safe embolization. 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 prior to surgery; 3)patients undergo the procedure under local anesthesia; 4)the microcatheter is inserted 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. The JR-NET study previous showed the situation regarding intracranial tumor embolization in Japan. Endovascular neurosurgeons should fully discuss the indications and strategies for POE with tumor neurosurgeons to ensure safe and effective procedures.

DOI： 10.11477/mf.1436204978

【脳血管内治療に必要な血管解剖学】静脈編上錐体静脈洞と錐体静脈の血管解剖と関連する硬膜動静脈瘻

平松匡文, 春間純, 杉生憲志, 田中將太

Neurological Surgery 52 ( 3 ) 596 - 604 2024.5

Language：Japanese Publisher：(株)医学書院

＜文献概要＞Point ・上錐体静脈洞と錐体静脈は後頭蓋窩の静脈還流を担う重要な血管であり,さまざまな変異や側腹路が存在する.・この部位の硬膜動静脈瘻では,錐体静脈から後頭蓋窩に逆流するため,神経症候を呈しやすく治療リスクが高い.・周囲の硬膜動静脈瘻から錐体静脈に逆流する場合は,この逆流を確実に遮断する治療戦略が必要である.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01228&link_issn=&doc_id=20240531170018&doc_link_id=10.11477%2Fmf.1436204953&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204953&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

【頭蓋頸椎移行部病変】頭蓋頸椎移行部動静脈瘻の臨床的特徴,診断と治療

平松匡文, 杉生憲志, 安原隆雄

脊椎脊髄ジャーナル 37 ( 4 ) 275 - 279 2024.5

[Angioarchitecture and Associated Dural Arteriovenous Fistulas of the Superior Petrosal Sinus and Petrosal Vein].

Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka

No shinkei geka. Neurological surgery 52 ( 3 ) 596 - 604 2024.5

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

The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.

DOI： 10.11477/mf.1436204953

Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case. International journal

Toru Satoh, Kenji Sugiu, Masafumi Hiramatsu, Jun Haruma, Isao Date

Journal of neurosurgery. Case lessons 7 ( 16 ) 2024.4

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

BACKGROUND: Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS: The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS: Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.

DOI： 10.3171/CASE24141

【ITを駆使した術前シミュレーション-トラブル回避と時短手術習得】これからの新しい術前シミュレーション 3Dプリンタ作成テーラーメード中空型脳動脈瘤モデルを使用した脳血管内治療術前シミュレーション

春間純, 木村颯, 平松匡文, 杉生憲志

Neurological Surgery 52 ( 2 ) 299 - 308 2024.3

Language：Japanese Publisher：(株)医学書院

＜文献概要＞Point ・3Dプリンタでテーラーメード中空型脳動脈瘤モデルを作成することが可能である.・中空型脳動脈瘤モデルを使用してさまざまな脳血管内治療手技を行うことができ,脳血管内治療術前シミュレーションに非常に有用である.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01228&link_issn=&doc_id=20240325230012&doc_link_id=10.11477%2Fmf.1436204914&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204914&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Power suppression in EEG after the onset of SAH is a significant marker of early brain injury in rat models. International journal

Yuji Takasugi, Tomohito Hishikawa, Tomohisa Shimizu, Satoshi Murai, Jun Haruma, Masafumi Hiramatsu, Koji Tokunaga, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific reports 14 ( 1 ) 2277 - 2277 2024.1

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

We analyzed the correlation between the duration of electroencephalogram (EEG) recovery and histological outcome in rats in the acute stage of subarachnoid hemorrhage (SAH) to find a new predictor of the subsequent outcome. SAH was induced in eight rats by cisternal blood injection, and the duration of cortical depolarization was measured. EEG power spectrums were given by time frequency analysis, and histology was evaluated. The appropriate frequency band and recovery percentage of EEG (defined as EEG recovery time) to predict the neuronal damage were determined from 25 patterns (5 bands × 5 recovery rates) of receiver operating characteristic (ROC) curves. Probit regression curves were depicted to evaluate the relationships between neuronal injury and duration of depolarization and EEG recovery. The optimal values of the EEG band and the EEG recovery time to predict neuronal damage were 10-15 Hz and 40%, respectively (area under the curve [AUC]: 0.97). There was a close relationship between the percentage of damaged neurons and the duration of depolarization or EEG recovery time. These results suggest that EEG recovery time, under the above frequency band and recovery rate, may be a novel marker to predict the outcome after SAH.

DOI： 10.1038/s41598-024-52527-0

【脳血管内治療のベーシックと最先端2024】疾患別解説頭蓋内腫瘍塞栓術

春間純, 杉生憲志, 五月女悠太, 川上真人, 枝木久典, 木村颯, 平松匡文

脳神経外科速報 34 ( 1 ) 68 - 73 2024.1

Endovascular Treatment for Intracranial Artery Dissections in Posterior Circulation.

Jun Haruma, Kenji Sugiu, Yuki Ebisudani, Ryu Kimura, Hisanori Edaki, Yoko Yamaoka, Masato Kawakami, Yuta Soutome, Masafumi Hiramatsu

Journal of neuroendovascular therapy 18 ( 3 ) 92 - 102 2024

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

Characteristics and outcomes of subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies. International journal

Shu Oshita, Tetsuya Yumoto, Shunta Jinno, Ippei Matsuo, Takashi Hongo, Hiromichi Naito, Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka, Atsunori Nakao

Acute medicine & surgery 11 ( 1 ) e70031 2024

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

AIM: Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture. METHODS: This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into "VAD rupture" and "other etiologies" groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3-6. RESULTS: A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, p = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, p = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, p < 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, p = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months. CONCLUSIONS: VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.

DOI： 10.1002/ams2.70031

【脊椎脊髄疾患のインターベンショナルラジオロジー(IVR)】胸腰椎の脊髄硬膜・硬膜外動静脈瘻に対する血管内治療

平松匡文, 杉生憲志, 安原隆雄

脊椎脊髄ジャーナル 36 ( 11 ) 787 - 792 2023.12

Language：Japanese Publisher：(株)三輪書店

＜文献概要＞脊髄の動静脈シャント疾患は10万人・年あたりの罹患率が0.234人とまれな疾患であり,脊髄髄内に発生するarteriovenous malformation(AVM),脊髄表面に生じるperimedullary arteriovenous fistula(PAVF),硬膜動静脈瘻(dural arteriovenous fistula:DAVF),硬膜外動静脈瘻(epidural arteriovenous fistula:EDAVF)などが含まれる.その中で胸腰椎のDAVFとEDAVFを合わせた罹患率は10万人・年あたり0.125人と,脊髄動静脈シャント疾患の過半数を占める重要な疾患である.DAVF・EDAVFいずれも血管内治療・直達術ともに適応となるが,いずれにしても可及的速やかに硬膜内逆流静脈を遮断して,脊髄のうっ血状態を解除する必要がある.本稿では,病態と診断についてまとめた後に,実際の血管内治療についてポイントを絞って論じる.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02317&link_issn=&doc_id=20240111060007&doc_link_id=10.11477%2Fmf.5002202195&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.5002202195&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

硬膜動静脈瘻画像診断の新展開

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

脳卒中の外科 51 ( 6 ) 503 - 507 2023.11

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)

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

Non-Sinus-Type Dural Arteriovenous Fistula at the Foramen Magnum: A Review of the Literature Invited Reviewed

Masafumi Hiramatsu, Tomohiko Ozaki, Rie Aoki, Shinri Oda, Jun Haruma, Tomohito Hishikawa, Kenji Sugiu, Isao Date

Journal of Neuroendovascular Therapy 2023.7

Relation between duration of dual antiplatelet therapy and risk of ischemic stroke after stent-assisted treatment of cerebral aneurysm (DAPTS ACE-registry). Reviewed International journal

Tomohiko Ozaki, Hiroshi Yamagami, Masafumi Morimoto, Hirotoshi Imamura, Taketo Hatano, Hidenori Oishi, Koichi Haraguchi, Shinichi Yoshimura, Tetsu Satow, Kenji Sugiu, Koji Iihara, Yuji Matsumaru, Mikito Hayakawa, Yasushi Matsumoto, Chiaki Sakai, Susumu Miyamoto, Kazuo Kitagawa, Tatsuo Kagimura, Nobuyuki Sakai

Journal of neurointerventional surgery 2023.7

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

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) in patients with cerebral aneurysm who undergo stent-assisted coil embolization (SACE) has not been established. We aimed to clarify the association between duration of DAPT and incidence of ischemic stroke in patients with cerebral aneurysm. METHODS: We registered patients with cerebral aneurysm who underwent SACE in 27 hospitals in Japan. Those treated with DAPT (aspirin and clopidogrel) were eligible for inclusion in a previously reported randomized control trial (RCT). Patients who were ineligible or refused to participate to the RCT were followed-up for 15 months after SACE as the non-RCT cohort. Our study examined both the RCT and non-RCT cohorts. The primary and secondary outcomes were ischemic stroke and hemorrhagic events. RESULTS: Among the 313 patients registered, 296 were included for analysis (of these, 136 were RCT patients and 160 were non-RCT patients). Patients who were treated with DAPT for more than 6 months (n=191) were classified as the long-term DAPT group. Those treated less than 6 months (n=105) were classified as the short-term group. The incidence of ischemic stroke did not significantly differ between the long-term group (2.5 per 100 person-years) and the short-term group (3.2 per 100 person-years); nor did incidence of hemorrhagic events (0.8 and 3.2 per 100 person-years, respectively). The period of DAPT was not significantly associated with incidence rates of ischemic stroke or hemorrhagic events. CONCLUSIONS: Duration of DAPT was not associated with the incidence of ischemic stroke in the first 15 months after SACE.

DOI： 10.1136/jnis-2023-020495

医学生の脳神経外科カテーテル及び顕微鏡下縫合実習に対するブルームのタキソノミーは履修時期で変化する

胡谷侑貴, 春間純, 三好智子, 平松匡文, 佐々田晋, 山岡陽子, 菅原千明, 木村颯, 枝木久典, 永瀬喬之, 川上真人, 五月女悠太, 杉生憲志

医学教育 54 ( Suppl. ) 203 - 203 2023.7

SAH/Spasmの基礎研究高脂血症ラットにおけるくも膜下出血後脳血管攣縮および早期脳損傷の検討

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

くも膜下出血と脳血管攣縮 38 65 - 65 2023.7

日本脳神経血管内治療学会アンケート調査結果脳血管内治療の「ダイバーシティ」と「ワンチーム」

坂井千秋, 榎本由貴子, 杉生憲志, 岡原美香, 坂本誠, 寿美田一貴, 檜垣鮎帆, 松丸祐司, 矢澤由加子

脳血管内治療 8 ( 1 ) 1 - 8 2023.6

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

【目的】1999年6月に男女共同参画社会基本法が公布・施行され,現在は第5次男女共同参画基本計画に沿った取り組みが各所で進められている.2021年には日本脳神経血管内治療学会(以下,JSNET(The Japanese Society for Neuroendovascular Therapy))においても男女共同参画委員会が設置され,「ダイバーシティ推進委員会」として活動を開始した.今回,学会員の現状と多様性社会に対するニーズを調査するため,全医師会員に向け職場環境等に関する調査を実施した.【方法】JSNET医師会員4,374名に対し,アンケート調査を行った.調査期間は2021年8月2日から同年9月12日までとした.【結果】848名,19.4%から回答を得た.男性95%,女性5%,脳神経外科医91%,神経内科医6%,放射線科医1%で,専門医は77%であった.育児等のライフイベントによる周囲への負担,また自身のキャリア形成への影響等の問題はあるが,両性が在籍する環境が望ましいという意見が多数を占めた.【結論】男女ともに,キャリア継続は労働環境の改善に寄与する.相互理解の下,性差なくキャリア継続を目指せる仕組み作りが重要である.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J06751&link_issn=&doc_id=20230629220001&doc_link_id=10.20626%2Fnkc.oa.2022-0013&url=https%3A%2F%2Fdoi.org%2F10.20626%2Fnkc.oa.2022-0013&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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)

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

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

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

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

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.

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

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

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

Cone-beam CTを用いたlateral spinal arteryの正常解剖と頭蓋頸椎移行部動静脈瘻の血管解剖の解析

平松匡文, 杉生憲志, 安原隆雄, 菱川朋人, 春間純, 村井智, 西和彦, 山岡陽子, 佐藤悠, 胡谷侑貴, 伊達勲

脳血管内治療 6 ( Suppl. ) S40 - S40 2021.11

脳脊髄動静脈シャント疾患の罹患率に対して地域性が与える影響

村井智, 高杉祐二, 平松匡文, 鈴木越治, 石橋良太, 宮崎裕子, 春間純, 菱川朋人, 安原隆雄, 杉生憲志, 伊達勲

脳血管内治療 6 ( Suppl. ) S308 - S308 2021.11

視神経管部硬膜動静脈瘻の2例報告

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

脳血管内治療 6 ( Suppl. ) S305 - S305 2021.11

経時的CBCT fusion画像を用いたPipeline embolization device留置術後の脳動脈瘤閉塞率の検討

胡谷侑貴, 春間純, 杉生憲志, 菱川則人, 平松匡文, 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. ) S274 - S274 2021.11

動脈瘤破裂による内頸動脈海綿静脈洞瘻に対してpterygoid plexus経由で経静脈的塞栓術を行った一例

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

脳血管内治療 6 ( Suppl. ) S250 - S250 2021.11

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 2021.11

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 2021.11

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 2021.11

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 2021.11

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 2021.11

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 2021.11

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

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 2021.10

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

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

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 2021.7

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

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

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

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

Acta neurochirurgica 2021.6

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

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

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. International journal

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 2021.6

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

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

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

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 2021.4

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

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 2021.4

脳出血 Invited

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 2021.3

[Intracerebral Hemorrhage].

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

No shinkei geka. Neurological surgery 49 ( 2 ) 284 - 292 2021.3

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

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

【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 2021.3

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.

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01228&link_issn=&doc_id=20210406190012&doc_link_id=10.11477%2Fmf.1436204390&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204390&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

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

脳血管攣縮 36 133 - 133 2021.2

Dural arteriovenous fistulas in the parasellar region other than the cavernous sinus Reviewed International journal

Hiramatsu M, Sugiu K, Haruma J, Hishikawa T, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Date I

Journal of Neuroendovascular Therapy 14 ( 12 ) 593 - 604 2020.12

脳血管内治療の知っておきたい最新情報2020 Invited

杉生憲志

BRAIN NURSING 36 ( 11 ) 63 - 66 2020.11

軟骨性骨に発生したosseous arteriovenous fistulaの特徴と治療

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

脳血管内治療 5 ( Suppl. ) 52 - 52 2020.11

くも膜下出血後の早期脳障害においてspreading depolarizationと細胞外グルタミン酸濃度が与える影響

佐藤悠, 村井智, 菱川朋人, 平松匡文, 春間純, 高橋悠, 西和彦, 山岡陽子, 胡谷侑貴, 杉生憲志, 武田吉正, 伊達勲

脳循環代謝 32 ( 1 ) 127 - 127 2020.11

破裂解離性動脈瘤の母血管温存治療の中長期成績

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, 西和彦, 胡谷侑貴, 佐藤悠, 伊達勲

脳血管内治療 5 ( Suppl. ) 16 - 16 2020.11

ラット中大脳動脈閉塞モデルにおけるcrossed cerebellar diaschisis

西和彦, 木谷尚哉, 杉生憲志, 菱川朋人, 安原隆雄, 平松匡文, 西廣真吾, 高橋悠, 村井智, 山岡陽子, 佐藤悠, 胡谷侑貴, 伊達勲

脳循環代謝 32 ( 1 ) 125 - 125 2020.11

Posterior Condylar Canal硬膜動静脈瘻に対して経静脈的塞栓術を行った1例

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

脳血管内治療 5 ( 4 ) 155 - 160 2020.11

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)

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

右上腕動脈アプローチでの左内頸動脈選択可否の検討

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

脳血管内治療 5 ( Suppl. ) 123 - 123 2020.11

硬膜動静脈瘻の経静脈的塞栓術に対する内頸静脈直接穿刺の有用性

木村颯, 春間純, 菱川朋人, 胡谷侑貴, 佐藤悠, 西和彦, 村井智, 高橋悠, 平松匡文, 杉生憲志, 伊達勲

脳血管内治療 5 ( Suppl. ) 87 - 87 2020.11

頸部内頸動脈のfenestrationと頸部内頸動脈解離を併発した一例

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

脳血管内治療 5 ( Suppl. ) 120 - 120 2020.11

当院でのFlow diverterを用いた血管内治療成績の検討

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

脳血管内治療 5 ( Suppl. ) 47 - 47 2020.11

Cone-beam CT fusion画像を用いたflow diverter留置後の経時的変化の検討

胡谷侑貴, 春間純, 杉生憲志, 菱川朋人, 平松匡文, 高橋悠, 村井智, 西和彦, 山岡陽子, 佐藤悠

脳血管内治療 5 ( Suppl. ) 51 - 51 2020.11

Terminal type動脈瘤に対するsingle neck-bridging techniqueの適応と限界

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

脳血管内治療 5 ( Suppl. ) 42 - 42 2020.11

未破裂前大脳動脈-副中大脳動脈分岐部動脈瘤に対しコイル塞栓術を施行した1例

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, 佐藤悠, 胡谷侑貴, 伊達勲

脳血管内治療 5 ( Suppl. ) 46 - 46 2020.11

複雑な中大脳動脈瘤に対する血管内治療の有用性

菱川朋人, 春間純, 平松匡文, 杉生憲志, 伊達勲

脳血管内治療 5 ( Suppl. ) 25 - 25 2020.11

Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery. International journal

M Hiramatsu, K Sugiu, T Hishikawa, J Haruma, Y Takahashi, S Murai, K Nishi, Y Yamaoka, Y Shimazu, K Fujii, M Kameda, K Kurozumi, I Date

AJNR. American journal of neuroradiology 2020.10

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

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

脳血管疾患の画像読み解きトレーニング─AVM─ Invited

西和彦、杉生憲志

BRAIN NURSING 36 ( 10 ) 982 - 982 2020.10

脳血管疾患の画像読み解きトレーニング─頚動脈狭窄─ Invited

胡谷侑貴、杉生憲志

BRAIN NURSING 36 ( 10 ) 978 - 978 2020.10

頭部外傷の画像読み解きトレーニング─びまん性軸索損傷─

佐藤悠、杉生憲志

BRAIN NURSING 36 ( 10 ) 1014 - 1014 2020.10

Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image International journal

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

NEURORADIOLOGY 62 ( 10 ) 1285 - 1292 2020.10

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

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

Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image International journal

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

Neuroradiology 62 ( 10 ) 1285 - 1292 2020.10

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

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

Other Link： http://link.springer.com/article/10.1007/s00234-020-02466-0/fulltext.html

脳神経血管内治療領域のインパクトのあった最新論文

胡谷侑貴、村井智、杉生憲志

Rad Fan 18 ( 11 ) 52 - 55 2020.9

脳神経領域の意義とやりがい─神経科学に必要な知識・技術・夢─特別座談会 Invited

阿部康二、伊達勲、山下徹、杉生憲志、小笠原邦昭

脳神経外科速報 30 ( 8 ) 808 - 818 2020.8

Osseous arteriovenous fistulas in the dorsum sellae, clivus, and condyle International journal

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

NEURORADIOLOGY 63 ( 1 ) 133 - 140 2020.8

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

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

【良性脳腫瘍】頭蓋内腫瘍塞栓術の役割と可能性

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 2020.8

Language：Japanese Publisher：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)

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=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007890362&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3) International journal

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 2020.7

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

</sec>

DOI： 10.3171/2019.4.jns183458

Other Link： 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. International journal

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 ) 2020.6

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

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

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

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 2020.6

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

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 2020.4

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

脳血管攣縮に対する薬物療法と髄液管理の治療成績 Invited

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 2020.2

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

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 2020.2

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 2020.2

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 2020.2

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 Reviewed

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 2020.1

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 International journal

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 2020.1

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

[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 2020.1

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

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

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 2020.1

Language：Japanese Publisher：(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。

Other Link： 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

Publishing type：Research paper (scientific journal)

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

Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus Invited Reviewed

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

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

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 2019.12

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

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 2019.12

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

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 2019.11

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 2019.11

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 2019.11

結節性硬化症に合併した海綿静脈洞部巨大内頸動脈瘤に対してflow diverter stentを留置した一例

川上真人, 平松匡文, 杉生憲志, 菱川朋人, 木谷尚哉, 高橋悠, 村井智, 西和彦, 山岡陽子, 伊達勲

脳血管内治療 4 ( Suppl. ) S350 - S350 2019.11

多発脊髄硬膜動静脈瘻診断にfusion imagingが有用であった1例

胡谷侑貴, 平松匡文, 杉生憲志, 菱川朋人, 木谷尚哉, 高橋悠, 村井智, 西和彦, 山岡陽子, 伊達勲

脳血管内治療 4 ( Suppl. ) S368 - S368 2019.11

上腕動脈アプローチによる頸動脈ステント留置術の治療成績

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

脳血管内治療 4 ( Suppl. ) S234 - S234 2019.11

内頸動脈結紮術後に再増大した海綿静脈洞部内頸動脈瘤に対し、後交通動脈経由でinternal trappingを行った1例

菅原千明, 平松匡文, 杉生憲志, 菱川朋人, 木谷尚哉, 高橋悠, 村井智, 西和彦, 山岡陽子, 伊達勲

脳血管内治療 4 ( Suppl. ) S271 - S271 2019.11

内頸動脈-眼動脈分岐部周辺の動脈瘤に対する眼動脈の側副血行評価

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

脳血管内治療 4 ( Suppl. ) S207 - S207 2019.11

頭蓋底腫瘍に対する術前塞栓術の治療成績

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

脳血管内治療 4 ( Suppl. ) S227 - S227 2019.11

岡山県における脊椎脊髄動静脈シャント疾患の悉皆調査

平松匡文, 石橋良太, 高井洋樹, 村井智, 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. ) S161 - S161 2019.11

Flow diverter時代における75歳以上の内頸動脈海綿静脈洞部未破裂脳動脈瘤に対する治療成績

高橋悠, 杉生憲志, 菱川朋人, 平松匡文, 木谷尚哉, 村井智, 西和彦, 山岡陽子

脳血管内治療 4 ( Suppl. ) S94 - S94 2019.11

血栓回収機器の種類─閉塞性疾患─ Reviewed

高橋悠、杉生憲志

Clinical Neuroscience 37 ( 10 ) 1244 - 1247 2019.10

当院における脳主幹動脈閉塞に対する急性期血栓回収療法の取り組み

藤原賢次郎, 服部靖彦, 吉本祐介, 高橋悠, 村井智, 木谷尚哉, 杉生憲志

広島医学 72 ( 9 ) 425 - 425 2019.9

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

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

ACTA NEUROCHIRURGICA 161 ( 8 ) 1675 - 1682 2019.8

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER WIEN

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

DOI： 10.1007/s00701-019-03970-w

脳動脈瘤コイリング・クリッピング治療後のネック・ドームの新しい画像評価─Silent MRAとFSE MRCの３D 融合画像の応用─ Reviewed

佐藤透、菱川朋人、杉生憲志、平松匡文、伊達勲

脳神経外科速報 29 ( 7 ) 762 - 772 2019.7

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)メディカ出版

脳動脈瘤に対する脳血管内コイリング治療後や開頭ネック・クリッピング手術後のネックやドームの解剖学的形態の描出に、Silent MRAとfast spin-echo(FSE)MR cisternography(MRC)の3D融合画像を新しく考案した。これまでのtime-of-flight(TOF)MRAでは、金属による磁化率アーチファクトやRF遮断効果の影響で、コイルやクリップ近傍のネック形態を描出することは困難であった。Silent MRAでは、金属による磁化率アーチファクトの影響を受け難く、コイリング治療後やクリッピング手術後のネックや母血管の形態が良好に描出された。また、FSE MRCでは、コイリング治療後のドームやネック部の形態、クリッピング処理されたネックの形態が詳細に描出された。Silent MRAとFSE MRC、それぞれの3D画像を重量描画する、Silent MRAとFSE MRCの3D融合画像を、コイリング治療後の15例、クリッピング手術後の19例に応用した結果、脳動脈瘤治療後のネック・ドームの画像評価に有用であった。本稿では、Silent MRAとFSE MRCの3D融合画像の作成技術と臨床応用につき報告する。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03120&link_issn=&doc_id=20190703140011&doc_link_id=issn%3D0917-1495%26volume%3D29%26issue%3D7%26spage%3D762&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D29%26issue%3D7%26spage%3D762&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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

平松匡文、杉生憲志、菱川朋人、西廣真吾、木谷尚哉、高橋悠、村井智、伊達勲

脳卒中の外科 47 ( 3 ) 167 - 173 2019.5

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(一社)日本脳卒中の外科学会

当院でIC-PC AN(未破裂内頸動脈後交通動脈分岐部瘤)に対し初回塞栓術を行った42例を対象に、後交通動脈(Pcom A)の発達程度に基づきfetal type(F群)17例、adult type(A群)9例、hypoplastic type(H群)16例に分け、検討した。その結果、再発率はF群18%、A群11%、H群19%で、再治療率はF群6%、A群0%、H群13%であった。再発に関わる因子を検討すると、単変量解析では7mm以上の最大径と高難度瘤で有意差を認めたが、Pcom Aの有無では有意差を認められなかった。今回の検討から、Pcom Aが描出される症例でPcom Aの温存を重視してコイル塞栓術を行っても再発や再治療には影響しないことが判明した。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02079&link_issn=&doc_id=20190617210003&doc_link_id=%2Fcp4strok%2F2019%2F004703%2F003%2F0167-0173%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2019%2F004703%2F003%2F0167-0173%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography. International journal

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

AJNR. American journal of neuroradiology 40 ( 5 ) 802 - 807 2019.5

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

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

DOI： 10.3174/ajnr.A6026

[Endovascular therapy for acute stroke-An important role of neurologists].

Kenji Sugiu

Rinsho shinkeigaku = Clinical neurology 59 ( 4 ) 173 - 176 2019.4

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

Previous randomized clinical trials have revealed significant benefit of the endovascular thrombectomy for the patients with acute ischemic stroke. In this short communication, I would like to introduce the history of endovascular treatment for acute ischemic stroke in Japan, and give a positive message to the neurologists who might contribute to the treatment for acute ischemic stroke.

DOI： 10.5692/clinicalneurol.cn-001257

Comparison between spinal dural arteriovenous fistula and spinal epidural arteriovenous fistula Reviewed International journal

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

Journal of Neuroendovascular Therapy 13 ( 3 ) 114 - 119 2019.3

【出血性脳血管障害】未破裂脳動脈瘤の自然歴最新の知識と臨床判断へのフィードバック

菱川朋人, 平松匡文, 杉生憲志, 伊達勲

脳神経外科ジャーナル 28 ( 3 ) 120 - 126 2019.3

Language：Japanese Publisher：日本脳神経外科コングレス

未破裂脳動脈瘤における自然歴、リスクスコア、治療成績、高齢者未破裂脳動脈瘤に関する最新の知見を紹介する。本邦の自然歴の理解はUCAS Japanが基本となる。UCAS Japanのデータから構築された3年間の破裂リスク予測スコアは信頼性が高く有用である。本邦の未破裂脳動脈瘤の治療成績はクリッピング術、コイル塞栓術ともに良好である。本邦での高齢者未破裂脳動脈瘤は年間破裂率1.6%で年齢、サイズ、部位が破裂に関与する。当科の治療成績はクリッピング術とコイル塞栓術でほぼ同等であったが、海外からの報告ではコイル塞栓術がより良好とするものが多い。本邦独自の治療リスクスコアの確立や高齢者未破裂脳動脈瘤に対するガイドライン策定が望ましい。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02632&link_issn=&doc_id=20190524170001&doc_link_id=130007618622&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007618622&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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

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

NEUROLOGIA MEDICO-CHIRURGICA 59 ( 2 ) 41 - 47 2019.2

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN NEUROSURGICAL SOC

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

DOI： 10.2176/nmc.st.2018-0220

脊髄血管奇形の新知見脊髄硬膜・硬膜外動静脈瘻と脳神経外科救急

安原隆雄, 平松匡文, 菱川朋人, 守本純, 杉生憲志, 伊達勲

Neurosurgical Emergency 23 ( 3 ) 247 - 247 2019.2

Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization. International journal

Mikito Hayakawa, Kenji Sugiu, Shinichi Yoshimura, Tomohito Hishikawa, Hiroshi Yamagami, Mayumi Fukuda-Doi, Nobuyuki Sakai, Koji Iihara, Kuniaki Ogasawara, Hidenori Oishi, Yasushi Ito, Yuji Matsumaru

Journal of neurosurgery 1 - 11 2019.1

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

OBJECTIVECerebral hyperperfusion syndrome (CHS) is a serious complication after carotid artery stenting (CAS). Staged angioplasty (SAP)-i.e., angioplasty followed by delayed CAS-has been reported as a potential CHS-avoiding procedure. The purpose of this study was to clarify the effectiveness of SAP in avoiding CHS after carotid revascularization for patients at high risk for this complication.METHODSThe authors retrospectively studied cases involving patients at high risk for CHS from 44 Japanese centers who were scheduled for SAP, regular CAS, angioplasty, or staged procedures other than SAP between October 2007 and March 2014. They investigated the rate of CHS in the population scheduled for SAP or regular CAS, and for safety analysis, the composite rate of transient ischemic attack (TIA) and ischemic stroke in the population eventually receiving SAP or regular CAS.RESULTSData from a total of 525 patients (532 lesions, mean age 72.5 ± 7.5 years, 74 women ) were analyzed. Scheduled procedures included SAP for 113 lesions and regular CAS for 419 lesions. The rate of CHS was lower in the SAP group than in the regular CAS group (4.4% vs 10.5%, p = 0.047). Multivariate analysis showed that SAP was negatively related to CHS (OR 0.315; 95% CI 0.120-0.828). In the population eventually receiving SAP (102 lesions) or regular CAS (428 lesions), the composite rate of TIA and ischemic stroke was comparable between the SAP group and the regular CAS group (9.8% vs 9.3%).CONCLUSIONSSAP may be an effective and safe carotid revascularization procedure to avoid CHS.

DOI： 10.3171/2018.8.JNS18887

Endovascular treatment for craniofacial arteriovenous fistula/malformation Reviewed International journal

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

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

急性期脳梗塞に対する血管内治療─新たな時代における脳神経内科医の役割─ Invited

杉生憲志

臨床神経学 59 ( 4 ) 173 - 176 2019

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

Tomohito Hishikawa, Masafumi Hiramatsu, Kenji Sugiu, Isao Date

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

Publishing type：Research paper (scientific journal)

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

DOI： 10.7887/jcns.28.120

Comparison between Spinal Dural Arteriovenous Fistula and Spinal Epidural Arteriovenous Fistula Reviewed

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

Journal of Neuroendovascular Therapy 13 ( 3 ) 114 - 119 2019

Recurrent Risk of Posterior Communicating Artery-preserving Coil Embolization for Internal Carotid Artery-Posterior Communicating Artery Aneurysm Reviewed

Masafumi Hiramtasu, Kenji Sugiu, Tomohito Hishikawa, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai

Surgery for Cerebral Stroke 47 ( 3 ) 167 - 173 2019

Changing paradigms of periprocedural antithrombotic therapy in neuroendovascular therapy: Analysis of JR-NET 3

Yukiko Enomoto, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators, Daisuke Mizutani, Shinichi Yoshimura, Nobuyuki Sakai, Nobuyuki Sakai, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura

Neurologia Medico-Chirurgica 59 ( 7 ) 247 - 256 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

To evaluate the changing paradigms of periprocedural antithrombotic management in neuroendovascular therapy in Japan, we analyzed the details of the current periprocedural antithrombotic therapy and compared it with those of the previous generations. We retrospectively analyzed the data from the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey in Japan for neuroendovascular therapy between January 2010 and December 2014. A total of 26,233 patients underwent endovascular treatments to usually perform periprocedural antithrombotic therapy were retrospectively analyzed. We compared the results of JR-NET 3 with those of JR-NET 1 (January 2005 and December 2007) and JR-NET 2 (January 2008-December 2009). Post-procedural anticoagulant therapy was less utilized in JR-NET 3 than in JR-NET 2 (53.9% vs. 60.6%, P &lt
0.001). Pre-procedural antiplatelet therapy became more frequent and more intensive with each generation. The frequency of aggressive therapy (dual, and triple or more therapy) was 65.2% in JR-NET 3, which was significantly higher than that of JR-NET 1 and JR-NET 2 (41.5% and 61.2%, respectively, P &lt
0.001). However, periprocedural ischemic complications (2.0% vs. 5.8%, P &lt
0.001) significantly increased, despite aggressive antiplatelet therapy. Neuroendovascular periprocedural antithrombotic therapy is focused more on antiplatelet therapy than on anticoagulant therapy. Currently, antiplatelet therapy is more frequently used with a larger number of multiple agents, however, periprocedural ischemic complications significantly increased.

DOI： 10.2176/nmc.st.2018-0265

Real-world experience of carotid artery stenting in Japan: Analysis of 8458 cases from the JR-NET3 nationwide retrospective multi-center registries

Ryo Tokuda, The Japanese Registry of NeuroEndovascular Therapy (JR-NET) investigators, Shinichi Yoshimura, Kazutaka Uchida, Kiyofumi Yamada, Tetsu Satow, Koji Iihara, Nobuyuki Sakai, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada

Neurologia Medico-Chirurgica 59 ( 4 ) 117 - 125 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

We aimed to clarify the outcomes of carotid artery stenting (CAS) in the Japanese population. For this purpose, we reviewed data from the Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3), a retrospective, nation-wide, multi-center, observational study of neuroendovascular treatments in Japan. Of the 9207 patients who underwent CAS between January 2010 and December 2014, 8458 satisfied the inclusion criteria for our analysis. The outcome statistics of this JR-NET3 cohort were compared to those of JR-NET1 and 2 cohorts fitting the same inclusion criteria. Of the 8458 JR-NET3 patients analyzed, 8042 (95.1%) were treated by surgeons with board certification from the Japanese Society for NeuroEndovascular Therapy. Technical success was achieved in 8417 patients (99.5%), whereas 198 patients (2.3%) had clinically significant complications (CSCs). These findings mirrored those obtained for the JR-NET1 and 2 cohorts. On multivariate analysis, risk factors for CAS-associated CSC included symptomatic lesion [odds ratio (OR), 1.91
95% confidence interval (CI), 1.23-3.00
P = 0.003] and hypoechoic lesion on carotid artery ultrasound (OR, 1.85
95% CI, 1.21-2.84
P = 0.005), whereas use of closed-cell stents was a predictor of better outcome (OR, 0.53
95% CI, 0.35-0.79
P = 0.002). The findings of JR-NET3 reflect good outcomes of CAS, but non-modifiable risk factors reflecting lesion characteristics remain of concern. Using closed-cell stents is advisable. Technological advances such as the introduction of new materials may help further improve CAS outcomes in Japanese patients.

DOI： 10.2176/nmc.st.2018-0264

Japanese surveillance of neuroendovascular therapy in JR-NET - part ii. Japanese registry of neuroendovascular treatment 3. main report

Nobuyuki Sakai, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators, Kazutaka Uchida, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Shinichi Yoshimura, Hirotoshi Imamura, Chiaki Sakai, Yuji Matsumaru, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yasushi Matsumoto, Ichiro Nakahara, Kenji Sugiu, Tomoaki Terada

Neurologia Medico-Chirurgica 59 ( 3 ) 106 - 115 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

This study, following Japanese Registry of NeuroEndovascular Treatment 1 and 2 (JR-NET 1 &amp
2), shows an annual trend of cases including adverse events and clinical outcomes at 30 days after NET. JR-NET3 was registered by 749 cumulative total number of physicians, certified by the Japanese Society of Neuroendovascular Therapy in 166 centers, between 2010 and 2014. Medical information about the patients was anonymized and retrospectively registered through a website. A total of 40,177 patients were recruited, 632 patients were excluded because data of preprocedural status were not available. So we analyzed 39,545 patients retrospectively. The proportion of octogenarians is increasing year-by-year and 14.7% in 2014 compared with 10.4% in 2010. Most frequent target disease is intracranial aneurysm. For the proportion of the treatment of intracranial aneurysm, 50.0% in 2010, but that has decreased to 44.8% in 2014. However, number of procedures were increased from 3150 in 2010 to 3419 in 2014. Although before the positive clinical evidence of mechanical thrombectomy for acute ischemic stroke (AIS) was established, the proportion of endovascular treatment for AIS increased 13.8% in 2014 compared with 6.3% in 2010. The number of patients requiring neuroendovascular treatment in Japan is increasing since 2010-2013, but that declined a little in 2014 caused by study operation suspended at the end of 2013. The outcomes of such therapy are clinically acceptable. Details of each type of treatment will be investigated in sub-analyses of the database.

DOI： 10.2176/nmc.oa.2018-0267

Endovascular therapy for ruptured vertebral artery dissecting aneurysms: Results from nationwide, retrospective, multi-center registries in Japan (JR-NET3)

Hajime Nakamura, Toshiyuki Fujinaka, Takeo Nishida, Haruhiko Kishima, Nobuyuki Sakai, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura, JR-NET3 study group

Neurologia Medico-Chirurgica 59 ( 1 ) 10 - 18 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade
however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.

DOI： 10.2176/nmc.st.2018-0191

Parent artery occlusion for unruptured cerebral aneurysms: Results of the Japanese registry of neuroendovascular therapy 3

Hidehisa Nishi, Akira Ishii, Tetsu Satow, Koji Iihara, Nobuyuki Sakai, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators

Neurologia Medico-Chirurgica 59 ( 1 ) 1 - 9 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR)
2.34, 95% confidence interval (CI)
1.02–5.25
P = 0.04] and a small aneurysm size (&lt
5 mm) was associated with hemorrhagic complications (OR
9.85, 95% CI
1.07–221.0
P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.

DOI： 10.2176/nmc.st.2018-0190

JR-NET3解析における硬膜動静脈瘻に対する塞栓術の合併症と危険因子の解析

平松匡文, 杉生憲志, 菱川朋人, 西廣真吾, 木谷尚哉, 高橋悠, 村井智, 伊達勲, 桑山直也, 佐藤徹, 飯原弘二, 坂井信幸

脳血管内治療 3 ( Suppl. ) S48 - S48 2018.11

バルーン派術者によるバルーンリモデリングテクニック下コイル塞栓術の長期治療成績

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

脳血管内治療 3 ( Suppl. ) S157 - S157 2018.11

前頭蓋底硬膜動静脈瘻に対する血管内治療 4症例の報告

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

脳血管内治療 3 ( Suppl. ) S213 - S213 2018.11

本邦における頭蓋内腫瘍に対する塞栓術の治療成績 JR-NET2とJR-NET3の比較検討

菱川朋人, 杉生憲志, 村井智, 高橋悠, 木谷尚哉, 西廣真吾, 平松匡文, 佐藤徹, 飯原弘二, 伊達勲, 坂井信幸

脳血管内治療 3 ( Suppl. ) S91 - S91 2018.11

ラット中大脳動脈閉塞モデルにおけるcrossed cerebellar diaschisis

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

脳循環代謝 30 ( 1 ) 135 - 135 2018.10

幼児もやもや病の手術成績と長期予後

菱川朋人, 平松匡文, 杉生憲志, 伊達勲

脳循環代謝 30 ( 1 ) 105 - 105 2018.10

Ex vivo release of pipeline embolization device polytetrafluoroethylene sleeves: a technical note Reviewed International journal

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

Journal of Neuroendovascular Therapy 12 ( 9 ) 463 - 468 2018.9

【Hybrid Neurosurgeonのための疾患別臨床脳血管解剖テキスト】(第1章)開頭手術と血管内治療の選択 dAVF 脊髄dAVF 脊髄dAVFの血管内治療

平松匡文, 杉生憲志

脳神経外科速報 ( 2018増刊 ) 161,163,165,167,169,171 - 161,163,165,167,169,171 2018.9

Language：Japanese Publisher：(株)メディカ出版

＜血管内治療のポイント(まとめ)＞(1)脊髄梗塞を予防するため、術前の詳細な画像診断、術中provocation testが重要(2)Drainer側までNBCAを注入するための術前画像診断を行い、治療戦略を立てる(3)術後の遅発性静脈血栓化を予防するため、術後のヘパリン投与を行う(著者抄録)

Efficacy and Safety of REVIVE SE Thrombectomy Device for Acute Ischemic Stroke: River JAPAN (Reperfuse Ischemic Vessels with Endovascular Recanalization Device in Japan). Reviewed

Sakai N, Ota S, Matsumoto Y, Kondo R, Satow T, Kubo M, Tsumoto T, Enomoto Y, Kataoka T, Imamura H, Todo K, Hayakawa M, Yamagami H, Toyoda K, Ito Y, Sugiu K, Matsumaru Y, Yoshimura S, RIVER JAPAN Investigators

Neurologia medico-chirurgica 58 ( 4 ) 164 - 172 2018.4

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

REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a. Secondary endpoints were clot migration/embolization; recanalization without symptomatic intracranial hemorrhage (ICH) at 24 h; symptomatic ICH; good neurological outcome (modified Rankin Scale score ≤2 National Institute of Health Stroke Scale (NIHSS) score decrease ≥10) at day 90; device- or procedure-related serious adverse events (SAEs) and mortality at day 90. To confirm non-inferiority of REVIVE, results were compared with historical data of the Merci Retriever. About 49 patients were enrolled (median age 73 years; males 46.9%; middle cerebral artery (MCA) occlusion 83.7%; median NIHSS score 17). A post-procedure TICI score ≥2a was observed in 73.5% (36/49, 95% confidence interval [CI] 58.9-85.1) of patients. No post-procedural clot migration/embolization events occurred. Successful recanalization without symptomatic ICH was observed in 62.5% (30/48, 95% CI 47.4-76.0). The good neurological outcome was achieved in 66.7% (32/48) patients. Symptomatic ICH and device- or procedure-related SAEs were reported in 6.3% and 12.2% of patients, respectively. Two deaths were reported. REVIVE demonstrated equivalent efficacy and safety as the Merci Retriever. Results suggest that REVIVE is effective and safe in recanalizing occluded intracranial arteries in AIS.

DOI： 10.2176/nmc.oa.2017-0145

ラットくも膜下出血モデルにおける皮質脱分極、脳波、脳組織障害の評価

高杉祐二, 菱川朋人, 清水智久, 新治有径, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 33 56 - 56 2018.2

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

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

Journal of Neurosurgery 128 ( 1 ) 137 - 143 2018.1

Language：English Publishing type：Research paper (scientific journal) Publisher：American Association of Neurological Surgeons

OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P50) was estimated to be 22.4 minutes (95% confdence 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?uorescence 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?uorescence. 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

Coil Embolization through Collateral Pathway for Ruptured Vertebral Artery Dissecting Aneurysm with Bilateral Vertebral Artery Occlusion Reviewed International journal

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

Journal of Stroke and Cerebrovascular Diseases 27 ( 9 ) e215-e218 2018

Endovascular treatment for vasospasm after aneurysmal subarachnoid hemorrhage based on data of JR-NET3

Hirotoshi Imamura, Nobuyuki Sakai, Tetsu Satow, Koji Iihara, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura, JR-NET investigators

Neurologia Medico-Chirurgica 58 ( 12 ) 495 - 502 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

Endovascular treatments for vasospasm after subarachnoid hemorrhage are typically performed for patients who are refractory to recommended medical therapies. We analyzed the current status of endovascular treatments based on the data of Japanese Registry of Neuroendovascular Therapy (JR-NET)3, and evaluated factors related to improvement of imaging findings and neurological condition, and to mechanical hemorrhage complications. We collected data of 1211 treatments performed from 2010 to 2014. Target vessels for treatments were anterior circulation (n = 1079), posterior circulation (n = 91), and both (n = 32)
the distribution of vasospasm was the proximal vessel (n = 754) to the Circle of Willis, distal vessel (n = 329), and both (n = 119). Of the treatments, 948 cases (78.3%) were intra-arterial administration of vasodilators and 259 (21.4%) were percutaneous transluminal angioplasty (PTA)
879 cases were the first intervention. The treatment time from onset was within 3 h in 378 (31.2%) cases, between 3 and 6 h in 349 (28.8%) cases, and over 6 h in 245 (20.2%) cases. The statistically significant factors associated with improvement on imaging findings was the first treatment, and treatment within 3 h from onset compared with that after 6 h. Additionally, the first and early treatments after the symptoms were associated with significantly improved neurological condition. All complications of mechanical hemorrhage occurred along with PTA. The findings show that endovascular treatment for vasospasm was effective, especially for cases who suffered from symptomatic vasospasm with a short interval after onset.

DOI： 10.2176/nmc.oa.2018-0212

専門医に求められる最新の知識脳血管障害もやもや病手術モデルに対する血管新生増強療法臨床応用を目指して

平松匡文, 菱川朋人, 西廣真吾, 木谷尚哉, 杉生憲志, 伊達勲

脳神経外科速報 27 ( 12 ) 1251 - 1255 2017.12

Language：Japanese Publisher：(株)メディカ出版

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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03120&link_issn=&doc_id=20171204180003&doc_link_id=issn%3D0917-1495%26volume%3D27%26issue%3D12%26spage%3D1251&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D27%26issue%3D12%26spage%3D1251&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

顔面痙攣を呈した椎骨動脈瘤に対して血管内治療を行った一例

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

脳血管内治療 2 ( Suppl. ) S283 - S283 2017.11

後方循環の症候性未破裂脳動脈瘤に対する血管内治療の長期成績

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

脳血管内治療 2 ( Suppl. ) S122 - S122 2017.11

75歳以上の破裂脳動脈瘤に対するコイル塞栓術

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

脳血管内治療 2 ( Suppl. ) S92 - S92 2017.11

内頸動脈閉塞試験(balloon test occlusion:BTO)における合併症と妥当性の検討

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

脳血管内治療 2 ( Suppl. ) S105 - S105 2017.11

椎骨動脈解離性動脈瘤に対する血管内治療

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

脳血管内治療 2 ( Suppl. ) S51 - S51 2017.11

頭蓋内腫瘍に対する術前塞栓術の治療成績

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

脳血管内治療 2 ( Suppl. ) S84 - S84 2017.11

脳動静脈奇形に対する塞栓術

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

脳血管内治療 2 ( Suppl. ) S31 - S31 2017.11

硬膜動静脈瘻に対する経静脈塞栓術の治療成績

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

脳血管内治療 2 ( Suppl. ) S47 - S47 2017.11

ラット慢性脳虚血モデルに対するHMGB1投与を併用した間接バイパス術の治療効果の検討

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

脳循環代謝 29 ( 1 ) 178 - 178 2017.11

成人虚血型もやもや病の手術成績と長期予後

菱川朋人, 平松匡文, 杉生憲志, 伊達勲

脳循環代謝 29 ( 1 ) 153 - 153 2017.11

内頸動脈閉塞試験(balloon test occlusion:BTO)における合併症と妥当性の検討

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

脳循環代謝 29 ( 1 ) 168 - 168 2017.11

Lvisステントを4本留置して治療したserpentine basilar aneurysmの1例

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

脳血管内治療 2 ( Suppl. ) S285 - S285 2017.11

3D-DSA 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

脳血管内治療 2 ( Suppl. ) S324 - S324 2017.11

外傷性脳動脈瘤に対してステント併用コイル塞栓術を施行した一例

西廣真吾, 杉生憲志, 菱川朋人, 安原隆雄, 春間純, 久壽米木亮, 平松匡文, 木谷尚哉, 高橋悠, 村井智, 伊達勲

脳血管内治療 2 ( Suppl. ) S251 - S251 2017.11

Flow Diverter留置にて根治が得られた外傷性内頸動脈瘤の1例

春間純, 杉生憲志, 岡哲生, 有澤正, 高橋悠, 木谷尚哉, 西廣真吾, 平松匡文, 菱川朋人, 伊達勲

脳血管内治療 2 ( Suppl. ) S252 - S252 2017.11

Posterior condylar canal近傍のdural AVFに対し経静脈的塞栓術を施行した一例

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

脳血管内治療 2 ( Suppl. ) S205 - S205 2017.11

"バルーン派"の術者が用いるLVISステントの適応と有用性の検討

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

脳血管内治療 2 ( Suppl. ) S140 - S140 2017.11

顔面頭頸部動静脈奇形・血管腫に対する血管内治療

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

脳血管内治療 2 ( Suppl. ) S151 - S151 2017.11

脊髄硬膜動静脈瘻と脊髄硬膜外動静脈瘻の比較

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

脳血管内治療 2 ( Suppl. ) S109 - S109 2017.11

Dissociated recovery between dementia and parkinsonism by transvenous embolization of recurrent dural arteriovenous fistula

Yumiko Nakano, Emi Nomura, Masafumi Hiramatsu, Mami Takemoto, Kota Sato, Nozomi Hishikawa, Toru Yamashita, Yasuyuki Ohta, Kenji Sugiu, Isao Date, Koji Abe

NEUROLOGY AND CLINICAL NEUROSCIENCE 5 ( 5 ) 159 - 161 2017.9

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

Dementia and parkinsonism are rarely observed in dural arteriovenous fistula. Here, we report a case of a 63-year-old man with recurrent dural arteriovenous fistula, who developed progressive dementia and parkinsonism as a result of a dural arteriovenous fistula at the torcular herophili. A sinus thrombosis induced the abnormal cortical venous reflux from the isolated straight sinus, resulting in the deep venous congestion of the thalamus and basal ganglia, which led to dementia and parkinsonism. However, the third endovascular embolization ameliorated memory disturbance and apathy with a slight improvement of parkinsonism. Although recoveries from dural arteriovenous fistula-associated neurological deficits are variable depending on the severity, duration and, furthermore, selective vulnerability of the responsible ischemic lesions, early treatment should be essential for better recovery.

DOI： 10.1111/ncn3.12138

ラットSAH single injection modelにおいて超急性期の頭蓋内圧が皮質電位と脳波に及ぼす影響

高杉祐二, 菱川朋人, 西廣真吾, 新治有径, 春間純, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 32 77 - 77 2017.2

ラットくも膜下出血に対する抗HMGB-1抗体の有効性の評価

春間純, 菱川朋人, 劉克約, 西廣真吾, 新治有径, 高杉祐二, 平松匡文, 杉生憲志, 西堀正洋, 伊達勲

脳血管攣縮 32 74 - 74 2017.2

Outcome of Coil Embolization for Symptomatic Unruptured Cerebral Aneurysms

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

Journal of Neuroendovascular Therapy 2017

Language：English Publisher：The Japanese Society for Neuroendovascular Therapy

<p>Purpose: We examined the outcome of coil embolization for symptomatic unruptured cerebral aneurysms, and investigated factors contributing to symptom relief after surgery.</p><p>Methods: We retrospectively reviewed 19 patients who underwent coil embolization between January 2008 and April 2016.</p><p>Results: After surgery, symptoms reduced in 13 patients (68%), but not in 6 (32%). In the improved group, the mean duration of disease was significantly shorter than in the unimproved group (1.3 vs. 16.2 months, respectively, p <0.05). There was a significant reduction in the aneurysmal size in the former (mean rate of reduction: 3.51 mm), whereas there was an increase in the latter (mean increase: 1.63 mm) (p <0.05).</p><p>Conclusion: Early therapeutic intervention and a postoperative reduction in the aneurysmal size may be important to achieve the relief of symptoms of symptomatic unruptured cerebral aneurysms after surgery.</p>

DOI： 10.5797/jnet.oa.2017-0045

ラット慢性脳虚血モデルに対するHMGB1を用いた間接バイパス術の治療効果の検討

西廣真吾, 菱川朋人, 杉生憲志, 平松匡文, 春間純, 高杉祐二, 新治有径, 木谷尚哉, 高橋悠, 檜垣佑輔, 伊達勲

脳循環代謝 28 ( 1 ) 236 - 236 2016.11

血管内治療における術中経頭蓋MEP(motor-evoked potential)モニタリングの有用性

高橋悠, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 木谷尚哉, 大西巧真, 亀田雅博, 伊達勲

脳血管内治療 1 ( Suppl. ) S293 - S293 2016.11

開頭術当日のNBCAによる術前塞栓術が有用であった充実性小脳血管芽腫の2例

木谷尚哉, 杉生憲志, 市川智継, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 高橋悠, 桑原研, 伊達勲

脳血管内治療 1 ( Suppl. ) S295 - S295 2016.11

ステント併用コイル塞栓術後の画像における"metal artifact reduction(MAR)"softwareの有用性

高杉祐二, 平松匡文, 杉生憲志, 菱川朋人, 春間純, 新治有径, 西廣真吾, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S203 - S203 2016.11

頸動脈ステント留置術後の急性期ステント内血症に対してステント留置術を追加した2例

西廣真吾, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 木谷尚樹, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S229 - S229 2016.11

内頸動脈分岐部未破裂脳動脈瘤に同側内頸動脈低形成を伴いアプローチの選択に迷った1例

高橋悠, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 木谷尚哉, 伊達勲

脳血管内治療 1 ( Suppl. ) S164 - S164 2016.11

パーキンソン症候群を呈した静脈洞交会部硬膜動静脈瘻の一例

高杉祐二, 平松匡文, 杉生憲志, 菱川朋人, 春間純, 新治有径, 西廣真吾, 木谷尚哉, 本倉恵美, 山下徹, 阿部康二, 伊達勲

脳血管内治療 1 ( Suppl. ) S170 - S170 2016.11

Pipelineの初期使用経験

木谷尚哉, 杉生憲志, 平松匡文, 菱川朋人, 春間純, 高杉祐二, 新治有径, 西廣真吾, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S113 - S113 2016.11

症候性未破裂脳動脈瘤に対するコイル塞栓術の治療成績

西廣真吾, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S129 - S129 2016.11

高齢者頸動脈狭窄症に対するstaged angioplastyの有効性

菱川朋人, 西廣真吾, 高橋悠, 木谷尚哉, 新治有径, 高杉祐二, 春間純, 平松匡文, 杉生憲志, 伊達勲

脳血管内治療 1 ( Suppl. ) S103 - S103 2016.11

テント部硬膜動静脈瘻の血管構築と治療

平松匡文, 杉生憲志, 菱川朋人, 春間純, 高杉祐二, 西廣真吾, 新治有径, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S104 - S104 2016.11

後交通動脈を温存した内頸動脈後交通動脈分岐部瘤の塞栓術後の再発リスク

平松匡文, 杉生憲志, 菱川朋人, 春間純, 高杉祐二, 西廣真吾, 新治有径, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療 1 ( Suppl. ) S85 - S85 2016.11

高齢者頸動脈ステント留置術における頭蓋内血行動態の特徴と対応

菱川朋人, 西廣真吾, 高橋悠, 木谷尚哉, 新治有径, 高杉祐二, 春間純, 平松匡文, 杉生憲志, 伊達勲

脳循環代謝 28 ( 1 ) 174 - 174 2016.11

脳血行再建と次世代型治療過灌流症候群高リスクの頸動脈ステント留置術施行例における術前SPECT所見の検討 STOP CHS後ろ向き研究

早川幹人, 梶本勝文, 杉生憲志, 菱川朋人, 山上宏, 坂井信幸, 飯原弘二, 小笠原邦昭, 大石英則, 伊藤靖, 松丸祐司, 吉村紳一

脳循環代謝 28 ( 1 ) 106 - 106 2016.11

右総頸動脈に収縮期に逆行性血流を呈した腕頭動脈閉塞の1例 Reviewed

武本梨佳, 戸田洋伸, 戸田由香, 勢井麻梨, 中村知子, 渡辺修久, 江尻健太郎, 麻植浩樹, 杉生憲志, 岡田健, 大塚文男, 伊藤浩

超音波検査技術 41 ( Suppl. ) S230 - S230 2016.6

ラットくも膜下出血後脳血管攣縮に対する抗HMGB-1抗体の攣縮抑制効果造影CTと血中HMGB-1濃度

春間純, 菱川朋人, 劉克約, 西廣真吾, 新治有径, 高杉佑二, 平松匡文, 杉生憲志, 西堀正洋, 伊達勲

脳血管攣縮 31 64 - 64 2016.2

Single injectionによるラットくも膜下出血モデルの急性期におけるspreading depressionの可視化

高杉祐二, 菱川朋人, 清水智久, 西廣真吾, 新治有径, 春間純, 平松匡文, 杉生憲志, 伊達勲

脳血管攣縮 31 55 - 55 2016.2

Clinical Analysis of Fever, Headache, and Gastrointestinal Symptoms after Endosaccular Coil Embolization in Patients with Unruptured Cerebral Aneurysms— A Study of "Post Coiling Syndrome"

Okuma Yu, Sugiu Kenji, Tokunaga Koji, Nishida Ayumi, Hishikawa Tomohito, Itami Hisakazu, Hiramatsu Masafumi, Date Isao

Journal of Neuroendovascular Therapy 2016

Language：English Publisher：The Japanese Society for Neuroendovascular Therapy

<p>Objective: Unidentified fever, headache, and gastrointestinal symptoms after endosaccular coil embolization are occasionally observed in patients with unruptured cerebral aneurysms. We defined these symptoms as post coiling syndrome (PCS) and analyzed the clinical risk factors involved.</p><p>Methods: We applied the PCS diagnostic criteria based on the scoring of symptoms, which include fever, headache, nausea, and/or vomiting. Thirty-six consecutive patients were included in this retrospective study. Systematic follow-up included clinical and blood examinations.</p><p>Results: Based on our criteria, 11 of 36 patients were diagnosed with PCS. Between patients in the PCS group and patients in the non-PCS group, we recognized significant differences in age (63.4 ± 12.5 vs. 53.8 ± 12.9, respectively; p <0.029) as patient background and in aneurysmal diameter (9.96 ± 4.24 vs. 6.48 ± 3.06, respectively; p <0.049), aneurysmal volume (242 ± 254 vs. 87.9 ± 70.1, respectively; p <0.015), total coil length (122 ± 106 vs. 39.1 ± 25.7, respectively; p <0.0021), and volume embolization ratio as aneurysmal data (41.9 ± 8.1 vs. 30.7 ± 8.5, respectively; p <0.0019). In addition, we recognized a significant difference in postoperative leukocytosis as an inflammatory factor.</p><p>Conclusions: Patient age, aneurysmal diameter, aneurysmal volume, total coil length, and volume embolization may enable the prediction of PCS.</p>

DOI： 10.5797/jnet.oa.2016-0036

Stent-assisted coil embolization of a dissecting aneurysm of the posterior cerebral artery: A case report Reviewed

Jun Haruma, Kenji Sugiu, Tadato Yukiue, Tatsuya Sasaki, Yasuhiko Hattori, Kazuki Kobayashi, Hideyuki Yoshida, Koji Muneda, Isao Date

Neurological Surgery 43 ( 12 ) 1099 - 1104 2015.12

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Igaku-Shoin Ltd

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 peari-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

未破裂脳動脈瘤コイル塞栓術後に多発性の大脳病変を呈した一例

出口健太郎, 出口章子, 河原由子, 佐藤恒太, 武本麻美, 菱川望, 太田康之, 山下徹, 徳永浩司, 杉生憲志, 河井信行, 阿部康二

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S358 - S358 2015.11

コイル塊の三次元的評価によるコイル塞栓術後動脈瘤再発のスクリーニング

平松匡文, 杉生憲志, 菱川朋人, 春間純, 高杉祐二, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S307 - S307 2015.11

硬膜動静脈瘻に対する経動脈的ONYX塞栓術の初期使用成績

春間純, 杉生憲志, 菱川朋人, 平松匡文, 高杉祐二, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S251 - S251 2015.11

Embosphere時代の腫瘍塞栓術本邦における頭蓋内腫瘍塞栓術の変遷と現状

春間純, 杉生憲志, 菱川朋人, 平松匡文, 高杉祐二, 新治有径, 西廣真吾, 伊達勲, 坂井信幸

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S205 - S205 2015.11

Embosphere時代の腫瘍塞栓術エンボスフィアを使用した髄膜腫に対する術前塞栓術の有用性

菱川朋人, 杉生憲志, 新治有径, 高杉祐二, 春間純, 平松匡文, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S207 - S207 2015.11

CASが第一選択となる日が来るのか? CASのエビデンスと本邦の現状

菱川朋人, 杉生憲志, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S178 - S178 2015.11

CAS 二刀流術者からの提言二刀流術者のCASとCEAによる頸動脈狭窄症治療の有用性と限界

徳永浩司, 渡邊恭一, 河内哲, 大谷理浩, 井上智, 桐山英樹, 菱川朋人, 杉生憲志, 松本健五

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S193 - S193 2015.11

Cone-Beam CTにおける新たなプロトコルの検討水晶体被ばく線量

山内崇嗣, 山口卓也, 大西治彦, 田原誠司, 高杉祐二, 平松匡文, 菱川朋人, 杉生憲志, 小嶋巌

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S457 - S457 2015.11

ステント併用コイル塞栓術後の画像におけるMARの有用性

高杉祐二, 平松匡文, 杉生憲志, 菱川朋人, 春間純, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S308 - S308 2015.11

Cone-Beam CTにおける新たなプロトコルの検討画像特性

山口卓也, 山内崇嗣, 大西治彦, 田原誠司, 高杉祐二, 平松匡文, 菱川朋人, 杉生憲志, 小嶋巌

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S455 - S455 2015.11

ONYX塞栓術はdAVFの治療を変えるか? 硬膜静脈瘻に対するOnyxを用いた経動脈的塞栓術の文献レビュー

平松匡文, 杉生憲志, 菱川朋人, 春間純, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S210 - S210 2015.11

血管内治療シミュレーターを用いたシミュレーション教育

新治有径, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 西廣真吾, 伊野英男, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S294 - S294 2015.11

未破裂脳動脈瘤コイル塞栓術後に出現する発熱、頭痛、消化器症状"post coiling syndrome"の検討と長期追跡結果

大熊佑, 杉生憲志, 徳永浩司, 廣常信之, 目黒俊成, 西田あゆみ, 菱川朋人, 村岡賢一郎, 伊丹尚多, 平松匡文, 西野繁樹, 伊達勲

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S302 - S302 2015.11

HPへのstaged CASは有効か? 日本からの発信過灌流症候群高リスクの頸動脈ステント留置術施行例におけるリスク判定術前画像検査の検討 STOP CHS retrospective study

早川幹人, 梶本勝文, 杉生憲志, 菱川朋人, 山上宏, 坂井信幸, 飯原弘二, 小笠原邦昭, 大石英則, 伊藤靖, 松丸祐司, 吉村紳一, STOP CHS研究班

JNET: Journal of Neuroendovascular Therapy 9 ( 6 ) S199 - S199 2015.11

内頸動脈に対するバルン閉塞試験の合併症と妥当性の検討

菱川朋人, 西廣真吾, 新治有径, 高杉祐二, 春間純, 平松匡文, 杉生憲志, 伊達勲

脳循環代謝 27 ( 1 ) 156 - 156 2015.10

ラット慢性脳虚血モデルに対する血行再建術後の脳血流評価

西廣真吾, 菱川朋人, 新治有径, 高杉祐二, 春間純, 平松匡文, 杉生憲志, 檜垣佑輔, 伊達勲

脳循環代謝 27 ( 1 ) 176 - 176 2015.10

80歳以上の破裂脳動脈瘤に対するコイル塞栓術

西廣真吾, 杉生憲志, 菱川朋人, 新治有径, 高杉祐二, 清水智久, 春間純, 平松匡文, 徳永浩司, 伊達勲

日本血管内治療学会誌 16 ( 1 ) 18 - 22 2015.5

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。

Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization. International journal

Akihiro Inoue, Masahiko Tagawa, Yoshiaki Kumon, Hideaki Watanabe, Daisuke Shoda, Kenji Sugiu, Takanori Ohnishi

Journal of neurointerventional surgery 7 ( 4 ) e15 2015.4

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

Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. In particular, this entity with reflux drainage directly into the ophthalmic vein is extremely rare. We report a case of ethmoidal dural AVF with direct drainage of the superior ophthalmic vein (SOV) and inferior ophthalmic vein (IOV), successfully treated by endovascular surgery. A 58-year-old man presented with progressive diplopia. Angiography and contrast-enhanced CT showed an ethmoidal dural AVF supplied via the bilateral anterior ethmoidal arteries and venous drainage through the left SOV and IOV. A transarterial approach through the bilateral anterior ethmoidal arteries was used to place the microcatheter close to the fistula site. After intra-arterial embolization with 20% N-butyl cyanoacrylate, the dural AVF was completely occluded. In patients with good vascular access, endovascular transarterial embolization may be an effective and less invasive treatment strategy for ethmoidal dural AVF.

DOI： 10.1136/neurintsurg-2013-011098.rep

A patient develops transient unique cerebral and cerebellar lesions after unruptured aneurysm coiling. Reviewed International journal

Deguchi K, Kawahara Y, Deguchi S, Morimoto N, Kurata T, Ikeda Y, Ichikawa T, Tokunaga K, Kawai N, Sugiu K, Abe K

BMC neurology 15 49 - 49 2015.3

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

BACKGROUND: We describe a case of a very unusual complication following a coiling procedure in which the patient developed transient unique cerebral and cerebellar lesions. Lesions were examined not only by magnetic resonance imaging (MRI) but also by positron emission tomography-computed tomography (PET-CT) and proton magnetic resonance spectroscopy ((1)H-MRS). CASE PRESENTATION: A 33-year-old woman presented an incidental 3.7 × 3.3-mm unruptured cerebral aneurysm (CAn) in her basilar artery, which was successfully coiled with balloon assistance. A follow-up brain MRI at 1 and 2 months showed a gradual increase in several white matter hyperintense lesions in the left cerebellar, bilateral occipitotemporal and left parietoccipital lobe during fluid-attenuated inversion recovery (FLAIR). These were the only lesions associated with perfused CAn. However, the patient did not show any additional symptoms such as visual disturbance throughout the entire course. (11)C-methionine-PET (MET-PET) showed an obvious increase in methionine uptake in the lesion corresponding to enhanced areas with gadolinium-enhanced MRI. MRS showed a decrease in the N-acetylaspartate/creatine (NAA/cr) ratio and a slight elevation of the choline/creatine (cho/cr) ratio and a lactate peak in the lesion. A follow-up MRI at 6 and 12 months showed a gradual decrease in the initial hyperintense lesions in FLAIR without any treatment. CONCLUSION: We present a case of an unusual complication after a coiling procedure. Although it is difficult to identify this etiology without a pathological examination, it is importance to increase awareness of such a potential complication arising from coiling procedures, because interventional procedures have become the first choice of treatment for cerebrovascular diseases in many countries.

DOI： 10.1186/s12883-015-0303-7

ラットsingle injection modelを用いたくも膜下出血急性期におけるspreading depressionの可視化の試み

高杉祐二, 菱川朋人, 清水智久, 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

脳血管攣縮 30 50 - 50 2015.3

NADH蛍光によるラットくも膜下出血急性期におけるspreading depressionの可視化及びその組織学的検討

清水智久, 菱川朋人, 高杉祐二, 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

脳血管攣縮 30 54 - 54 2015.3

Cervical Spinal dural arteriovenous fistula with rapidly progressive brainstem dysfunction due to venous congestion: A case report Reviewed

Tatsuya Sasaki, Hiroaki Manabe, Takao Yasuhara, Yasuyuki Miyoshi, Kenji Sugiu, Isao Date

Neurological Surgery 43 ( 1 ) 51 - 56 2015.1

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Igaku-Shoin Ltd

Spinal dural arteriovenous fistulas (S-dAVFs) are rare vascular malformations of the spine. We experienced a case that presented with rapidly progressive brainstem dysfunction due to venous congestion of cervical dAVFs. A 56-year-old man diagnosed with cervical dAVF four years prior presented with gait disturbance and abnormal thermal nociception on his right side. In addition to the high-intensity lesion from the lower pons to the medulla oblongata on T2-weighted magnetic resonance imaging, diffusion-weighted imaging demonstrated cerebral infarction of the left ventrolateral medulla oblongata. Left vertebral angiography revealed that a feeding artery supplied by the radicular artery at the C4 level formed a fistula with the dilated ascending anterior perimedullary vein. We made a diagnosis of venous congestion due to cervical dAVFs. Numbness on the left upper limb occurred five days after the first symptom. Subsequently, hemiparesis on the left upper limb and swallowing disturbance occurred two weeks after the first symptom. The patient underwent surgical ligation of the dilated abnormal vein, with gradual improvement of his symptoms. Myelopathy due to venous congestion of S-dAVFs usually progresses slowly for several years. However, this case report warns about the possibility that some cases of S-dAVF with rapidly exacerbated symptoms may require prompt therapy.

DOI： 10.11477/mf.1436202944

脊髄硬膜動静脈瘻の治療時期と予後の相関

新治有径, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 高杉祐二, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 281 - 281 2014.12

内頸動脈-上下垂体動脈瘤(IC-SHA動脈瘤)に対する血管内治療 100例の検討

春間純, 杉生憲志, 菱川朋人, 西廣真吾, 新治有径, 高杉祐二, 清水智久, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 272 - 272 2014.12

脳動脈瘤コイル塞栓術後の再発評価における頭部単純X線検査の有用性

冨田祐介, 杉生憲志, 菱川朋人, 西廣真吾, 新治有径, 高杉祐二, 清水智久, 春間純, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 264 - 264 2014.12

前交通動脈瘤に対するコイル塞栓術の治療成績

西廣真吾, 杉生憲志, 菱川朋人, 新治有径, 高杉祐二, 清水智久, 春間純, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 272 - 272 2014.12

止血デバイスAngiosealとExosealの比較検討

冨田祐介, 杉生憲志, 菱川朋人, 西廣真吾, 新治有径, 高杉祐二, 清水智久, 春間純, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 245 - 245 2014.12

未破裂脳動脈瘤コイル塞栓術におけるVerifyNow使用の有用性

新治有径, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 高杉祐二, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 252 - 252 2014.12

症候性海綿静脈洞部内頸動脈瘤に対するコイル塞栓術と直達術の比較検討

菱川朋人, 杉生憲志, 平松匡文, 春間純, 清水智久, 高杉祐二, 新治有径, 西廣真吾, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 211 - 211 2014.12

当院におけるStaged carotid artery stenting(Staged-CAS)の検討

春間純, 杉生憲志, 菱川朋人, 平松匡文, 清水智久, 高杉祐二, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 218 - 218 2014.12

椎骨動脈解離性動脈瘤に対する血管内治療(internal trapping)後の延髄梗塞は高率に発生するのか?

清水智久, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 冨田祐介, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 210 - 210 2014.12

大型・巨大脳動脈瘤に対するコイル塞栓術の治療成績

高杉祐二, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 210 - 210 2014.12

バルーン閉塞試験その判定方法とバイパス術の適応内頸動脈閉塞試験(balloon test occlusion:BTO)における合併症と妥当性の検討

清水智久, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 新治有径, 西廣真吾, 冨田祐介, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 184 - 184 2014.12

コイル塞栓術後再発脳動脈瘤に対するコイル塞栓術の治療成績

菱川朋人, 杉生憲志, 平松匡文, 春間純, 清水智久, 高杉祐二, 新治有径, 西廣真吾, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 206 - 206 2014.12

dAVFに対するTVEとTAE OnyxによるTAEは有効か? 硬膜動静脈瘻(dAVF)に対する経動脈的塞栓術(TAE) 液体塞栓物質の有用性と問題点

杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 高杉祐二, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 180 - 180 2014.12

血管造影室にて全身麻酔で初めて未破裂脳動脈瘤塞栓術を受けた患者の思い

臂香代子, 藤澤芳基, 野込真由美, 眞鍋佳子, 祇園由美, 菱川朋人, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 449 - 449 2014.12

IVRセンターにおけるパートナーシップの有用性

祇園由美, 青井淑恵, 沼本千誉, 菱川朋人, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 463 - 463 2014.12

脳底動脈解離性動脈瘤に対するコイル塞栓術の治療成績

高杉祐二, 杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 新治有径, 西廣真吾, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 335 - 335 2014.12

FDPによるCT like images CBCT最新のトレンドは? ステント描出を目的としたコーンビームCT造影剤濃度の検討

大西治彦, 市川大樹, 山口卓也, 山内崇嗣, 松浦龍太郎, 森光祐介, 氏福亜矢子, 田原誠司, 平松匡文, 菱川朋人, 杉生憲志

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 436 - 436 2014.12

JR-NET 2解析における硬膜動静脈瘻に対する血管内治療の有害事象と短期予後経動脈及び経静脈塞栓術の比較

平松匡文, 杉生憲志, 菱川朋人, 春間純, 伊達勲, 徳永浩司, 桑山直也, 坂井信幸

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 284 - 284 2014.12

頭蓋内血管病変に対する3次元回転画像を用いたfusion imageの活用法

平松匡文, 杉生憲志, 菱川朋人, 春間純, 清水智久, 高杉祐二, 西廣真吾, 新治有径, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 308 - 308 2014.12

内頸動脈前脈絡叢動脈分岐部動脈瘤に対するコイル塞栓術の治療成績

西廣真吾, 杉生憲志, 菱川朋人, 新治有径, 高杉祐二, 清水智久, 春間純, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 273 - 273 2014.12

過灌流高危険に対するCAS Staged CASは有効か? 「過灌流症候群高リスクの頸動脈狭窄症に対する頸動脈ステント留置術」に関する全国アンケート調査結果

早川幹人, 松丸祐司, 坂井信幸, 山上宏, 飯原弘二, 小笠原邦昭, 伊藤靖, 杉生憲志, 吉村紳一, STOP CHS研究班

JNET: Journal of Neuroendovascular Therapy 8 ( 6 ) 189 - 189 2014.12

再灌流障害と急性期血管内治療急性期脳梗塞に対する血管内再開通療法の現状

杉生憲志, 菱川朋人, 平松匡文, 春間純, 清水智久, 高杉祐二, 西廣真吾, 新治有径, 伊達勲

脳循環代謝 26 ( 1 ) 118 - 118 2014.11

ラット慢性脳虚血モデルに対する血行再建術におけるVEGFおよびapelin遺伝子の血管新生効果についての検討

平松匡文, 杉生憲志, 菱川朋人, 西廣真吾, 春間純, 清水智久, 高杉祐二, 新治有径, 伊達勲, 徳永浩司, 木戸屋浩康, 高倉伸幸

脳循環代謝 26 ( 1 ) 225 - 225 2014.11

ラットくも膜下出血後脳血管攣縮に対する抗HMGB-1抗体の攣縮抑制効果の検討

春間純, 菱川朋人, 劉克約, 西廣真吾, 新治有径, 高杉佑二, 清水智久, 平松匡文, 杉生憲志, 西堀正洋, 伊達勲

脳循環代謝 26 ( 1 ) 178 - 178 2014.11

ADH蛍光によるラットくも膜下出血急性期におけるspreading depressionの可視化及びその組織学的検討

清水智久, 菱川朋人, 高杉祐二, 新治有径, 西廣真吾, 春間純, 平松匡文, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 26 ( 1 ) 183 - 183 2014.11

Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization. International journal

Akihiro Inoue, Masahiko Tagawa, Yoshiaki Kumon, Hideaki Watanabe, Daisuke Shoda, Kenji Sugiu, Takanori Ohnishi

BMJ case reports 2014 2014.3

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

Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. In particular, this entity with reflux drainage directly into the ophthalmic vein is extremely rare. We report a case of ethmoidal dural AVF with direct drainage of the superior ophthalmic vein (SOV) and inferior ophthalmic vein (IOV), successfully treated by endovascular surgery. A 58-year-old man presented with progressive diplopia. Angiography and contrast-enhanced CT showed an ethmoidal dural AVF supplied via the bilateral anterior ethmoidal arteries and venous drainage through the left SOV and IOV. A transarterial approach through the bilateral anterior ethmoidal arteries was used to place the microcatheter close to the fistula site. After intra-arterial embolization with 20% N-butyl cyanoacrylate, the dural AVF was completely occluded. In patients with good vascular access, endovascular transarterial embolization may be an effective and less invasive treatment strategy for ethmoidal dural AVF.

DOI： 10.1136/bcr-2013-011098

Spontaneous indirect revascularization through the failed radial artery bypass in a patient with a giant intracavernous internal carotid artery aneurysm Reviewed

Koji Tokunaga, Tomohito Hishikawa, Kenji Sugiu, Isao Date

Neurological Surgery 42 ( 1 ) 59 - 64 2014.1

Epidemiology of Dural Arteriovenous Fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2) Reviewed

Masafumi Hiramatsu, Kenji Sugiu, Tomohito Hishikawa, Jun Haruma, Koji Tokunaga, Isao Date, Naoya Kuwayama, Nobuyuki Sakai

NEUROLOGIA MEDICO-CHIRURGICA 54 ( 1 ) 63 - 71 2014.1

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN NEUROSURGICAL SOC

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.

DOI： 10.2176/nmc.st.2013-0172

本邦における硬膜動静脈瘻の臨床的特徴 JR-NET2の解析より

平松匡文, 杉生憲志, 菱川朋人, 春間純, 徳永浩司, 伊達勲, 桑山直也, 坂井信幸

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 182 - 182 2013.11

本邦における硬膜動静脈瘻に対する治療成績の検討 JR-NET2の解析より

春間純, 平松匡文, 杉生憲志, 菱川朋人, 徳永浩司, 伊達勲, 桑山直也, 坂井信幸

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 182 - 182 2013.11

本邦における頭蓋内腫瘍に対する塞栓術の治療成績(JR-NET2解析)

菱川朋人, 杉生憲志, 平松匡文, 春間純, 高杉祐二, 徳永浩司, 伊達勲, 坂井信幸

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 180 - 180 2013.11

後大脳動脈瘤に対する血管内治療

春間純, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 清水智久, 高杉祐二, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 169 - 169 2013.11

頸動脈狭窄症に対するtailored CASの治療成績と臨床研究

徳永浩司, 杉生憲志, 高杉祐二, 春間純, 清水智久, 平松匡文, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 172 - 172 2013.11

Angio machineを使いこなせ血管撮影装置の多面的活用画質向上、血行動態評価、データ管理の視点から

平松匡文, 杉生憲志, 菱川朋人, 徳永浩司, 高杉祐二, 清水智久, 春間純, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 156 - 156 2013.11

症候性脳動脈瘤に対するコイル塞栓術の治療効果の検討

高杉祐二, 杉生憲志, 徳永浩司, 菱川朋人, 清水智久, 春間純, 平松匡文, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 165 - 165 2013.11

小児もやもや病における年齢別虚血病態の検討

菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳循環代謝 25 ( 1 ) 144 - 144 2013.11

ラットくも膜下出血急性期におけるspreading depressionの新しい観察方法

清水智久, 菱川朋人, 高杉祐二, 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 25 ( 1 ) 184 - 184 2013.11

外科治療と循環代謝ラット慢性脳虚血モデルに対する血行再建術におけるVEGFおよびapelin遺伝子の血管新生効果についての検討

平松匡文, 徳永浩司, 杉生憲志, 菱川朋人, 春間純, 清水智人, 高杉祐二, 伊達勲, 木戸屋浩康, 高倉伸幸

脳循環代謝 25 ( 1 ) 113 - 113 2013.11

middle temporal veinアプローチによる経静脈塞栓術を施行した硬膜動静脈瘻の2症例

西廣真吾, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 清水智久, 春間純, 高杉祐二, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 324 - 324 2013.11

対側頸動脈閉塞を伴う頸動脈狭窄症に対するCarotid artery stentingの有用性の検討

清水智久, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 春間純, 高杉祐二, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 326 - 326 2013.11

コイルのaccidental detachmentに対する対処法症例報告

豊嶋敦彦, 杉生憲志, 徳永浩司, 高杉祐二, 清水智久, 春間純, 平松匡文, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 292 - 292 2013.11

80歳以上の破裂脳動脈瘤に対するコイル塞栓術

新治有径, 菱川朋人, 高杉祐二, 清水智久, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 297 - 297 2013.11

複合テクニックを駆使した脳動脈瘤塞栓術の治療成績

菱川朋人, 杉生憲志, 徳永浩司, 平松匡文, 春間純, 高杉祐二, 清水智久, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 193 - 193 2013.11

未破裂脳動脈瘤に合併した脳底動脈閉塞の1例

守本純, 杉生憲志, 豊嶋敦彦, 清水智久, 春間純, 大熊佑, 平松匡文, 菱川朋人, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 7 ( 6 ) 279 - 279 2013.11

Endovascular treatment of basilar artery aneurysms associated with fenestration Reviewed

Hisakazu Itami, Kenji Sugiu, Masafumi Hiramatsu, Koji Tokunaga, Jun Haruma, Yu Okuma, Tomohito Hishikawa, Ayumi Nishida, Isao Date

Neurological Surgery 41 ( 7 ) 583 - 592 2013.7

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.

Endovascular treatment for cervical carotid artery aneurysm: A case report Reviewed

Yasuhiko Hattori, Kenji Sugiu, Tomohito Hishikawa, Koji Tokunaga, Kazuya Takahashi, Isao Date

Neurological Surgery 41 ( 6 ) 515 - 523 2013.6

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

We report here a case of cervical carotid artery aneurysm. This 37-year-old male suffered from acute neck swelling when he was taking lunch after physical work. Ultrasonography demonstrated a cervical pseudoaneurysm and a jet flow, which was blowing into the dome from the carotid artery. Angiogram revealed an aneurysm with a diameter of 3 cm at the bifurcation of the common carotid artery. Coil embolization using double-catheter technique was performed and complete occlusion of the aneurysm was obtained without any complications. The patient returned to his normal life. Cervical carotid artery aneurysms are rare and they induce pain by swelling in the neck, hoarseness, swallowing disturbance, hemorrhage, and cerebral ischemia due to embolism. In case of a cervical carotid artery aneurysm, safe and effective treatments are required and endovascular treatment should be considered. Although stent-assisted coil embolization or covered-stent placement were reported as an effective treatment for cervical aneurysms, coil embolization without using a stent was performed in this particular patient who is a young, blue-collar worker because the avoidance of long-term anti-platelet therapy was desirable Preoperative evaluation is important to select adequate treatment.

A case of a paraspinal arteriovenous fistula presenting with retroperitoneal hemorrhage treated by staged transarterial and transvenous embolization Reviewed

Atsuhiko Toyoshima, Koji Tokunaga, Hiroaki Manabe, Kenji Sugiu, Masafumi Hiramatsu, Hisakazu Itami, Tomohito Hishikawa, Isao Date

Neurological Surgery 41 ( 5 ) 429 - 435 2013.5

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

We report a rare case of a paraspinal arteriovenous fistula (AVF) treated by combined transarterial and transvenous embolization (TAE/TVE) A 72-year-old woman was admitted after a traffic accident. Abdominal enhanced CT disclosed pre-existing large varices at the L3-L4 level in the right retropentoneum with multiple feeding arteries and veins draining into the extradural venous plexus in the spinal canal. The lesion was diagnosed as a paraspinal AVF. Four days later, the patient went into a state of shock. Emergency abdominal CT showed retroperitoneal hemorrhage due to rupture of the varix. TAE of the feeders from the right L1-L4 arteries was performed, and rebleeding from the varix was prevented. Three months later, follow-up CTA showed regrowth of the AVF, and TVE was performed. Two microcatheters were navigated transveriously into the varix, and detachable coils were delivered into the small compartment just downstream to the shunts, leading to complete obliteration. We conclude that transarterial flow reduction followed by occlusion of the venous side of the shunts is effective to achieve cure of a complex and high-flow paraspinal AVF.

Fatal outcomes of pediatric patients with moyamoya disease associated with pulmonary arterial hypertension. Report of two cases Reviewed International journal

Koji Tokunaga, Tomohito Hishikawa, Kenji Sugiu, Isao Date

CLINICAL NEUROLOGY AND NEUROSURGERY 115 ( 3 ) 335 - 338 2013.3

Required knowledge for neuroendovascular surgeon (6) embolization of cranial dural arteriovenous fistulae and high flow arteriovenous fistulae Reviewed

Koji Tokunaga, Kenji Sugiu, Isao Date

Neurological Surgery 41 ( 2 ) 153 - 162 2013.2

Surgical and endovascular treatment for superior cerebellar artery aneurysms: Report of two cases Reviewed

Jun Haruma, Kenji Sugiu, Yosuke Shimazu, Hiroyuki Michiue, Koji Tokunaga, Isao Date

Neurological Surgery 41 ( 1 ) 45 - 51 2013.1

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

Aneurysms located on the supenor 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 vanety of reasons.

Endovascular coiling of thrombosed basilar tip aneurysm using double stents in a Y-configuration Reviewed

Yoshihiro Otani, Kenji Sugiu, Koji Tokunaga, Tomohito Hishikawa, Hisakazu Itami, Masafumi Hiramatsu, Yu Okuma, Isao Date

Neurological Surgery 40 ( 11 ) 1005 - 1012 2012.11

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

Recent advances in endovascular techniques greatly improved the ability to treat complex cerebral aneurysms. However, patients with wide-necked cerebral aneurysms have posed a special challenge to conventional endovascular therapy. We report a novel method of embolizing wide-necked basilar apex aneurysms by employing a Y-configuration, double stent technique. A 40-year-old woman with a partially thrombosed basilar apex aneurysm transferred to our hospital after diagnosis of subarachnoid hemorrhage. Cerebral angiography revealed a wide-necked aneurysm which neck was incorporating the origins of both the posterior cerebral arteries. In treatment procedure, a microcatheter was inserted into the aneurysm followed by coiling of the upper half of the dome. Next, the first stent was deployed in the right P2 segment extending down to the mid basilar artery and the second stent was then deployed with half of the stent in the left P2 and the other half within the lumen of the previously placed stent. Finally, the microcatheter was withdrawn near the neck, and the rest of the aneurysmal dome was packed by additional coils. The result was favorable. Successful coil embolization of a widenecked bifurcation aneurysm can be achieved by using the double stenting Y-configuration in this case. This result continues to provide highly encouraging support of this novel technique to treat a subset of complex, wide-necked aneurysms that until recently were considered poor candidates for endovascular therapies.

脊髄硬膜動静脈瘻における外科治療介入のタイミングと予後との相関

大熊佑, 杉生憲志, 徳永浩司, 三好康之, 眞鍋博明, 菱川朋人, 平松匡文, 豊嶋敦彦, 春間純, 清水智久, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 423 - 423 2012.11

脳血管内治療医にできるのはコイルを入れることだけか? dural AVFの新たな展開硬膜動静脈瘻に対する集学的治療

杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 大熊佑, 春間純, 清水智久, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 178 - 178 2012.11

内頸動脈-上下垂体動脈瘤に対する血管内治療 86例の検討

春間純, 杉生憲志, 清水智久, 大熊佑, 平松匡文, 菱川朋人, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 316 - 316 2012.11

当院における急性期血行再建術の検討

春間純, 杉生憲志, 高橋悠, 清水智久, 大熊佑, 平松匡文, 菱川朋人, 小林和樹, 河田幸波, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 391 - 391 2012.11

解離性椎骨動脈瘤に対するinternal trapping後の対側椎骨動脈の長期的形態変化

清水智久, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 大熊佑, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 342 - 342 2012.11

頸動脈ステント留置術安全に行うための工夫頸動脈狭窄症に対する我々のtailored CAS手技のupdates

徳永浩司, 杉生憲志, 平松匡文, 春間純, 清水智久, 大熊佑, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 189 - 189 2012.11

脳血管内治療医にできるのはコイルを入れることだけか? dural AVFの新たな展開難治性硬膜動静脈瘻に対するサイバーナイフ治療の有効性の検討

清水智久, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 大熊佑, 伊達勲, 佐藤健吾, 馬場義美

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 180 - 180 2012.11

血管内アプローチを用いた低侵襲サル中大脳動脈閉塞モデルの作製法

大熊佑, 杉生憲志, 徳永浩司, 菱川朋人, 平松匡文, 春間純, 清水智久, 西堀正洋, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 281 - 281 2012.11

高難度動脈瘤塞栓術における複合補助テクニック

杉生憲志, 徳永浩司, 菱川朋人, 春間純, 平松匡文, 大熊佑, 清水智久, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 207 - 207 2012.11

頸部内頸動脈瘤に対して血管内治療を行った1例

服部靖彦, 平松匡文, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 299 - 299 2012.11

破裂動脈瘤コイル塞栓術後、脳内出血とDVT合併のHITに対しダナパロイドナトリウムが有効であった1例

早瀬仁志, 木下公久, 遠部英昭, 海野正俊, 大西学, 菱川朋人, 徳永浩司, 杉生憲志

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 282 - 282 2012.11

前脈絡叢動脈瘤に対するコイル塞栓術の長期治療成績

菱川朋人, 大熊佑, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 314 - 314 2012.11

バルーンによる圧着でコイルループの親動脈への突出を改善することができた脳動脈瘤コイル塞栓術

平松匡文, 杉生憲志, 徳永浩司, 春間純, 大熊祐, 清水智久, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 301 - 301 2012.11

経動脈的および経静脈的根治的塞栓術を行ったKlippel-Trenaunay-Weber症候群に合併する脊髄辺縁部動静脈瘻の1例

金恭平, 徳永浩司, 春間純, 菱川朋人, 眞鍋博明, 三好康之, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 417 - 417 2012.11

海綿静脈洞部硬膜動静脈瘻に対する経静脈的アプローチ法の検討

平松匡文, 杉生憲志, 徳永浩司, 春間純, 大熊祐, 清水智久, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 413 - 413 2012.11

胸椎硬膜外動静脈瘻に対する血管内塞栓術の1例

木谷尚哉, 杉生憲志, 清水智久, 春間純, 大熊佑, 豊嶋敦彦, 平松匡文, 菱川朋人, 眞鍋博明, 三好康之, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 421 - 421 2012.11

後腹膜出血で発症したSpinal extradural AVFの1例

豊嶋敦彦, 杉生憲志, 清水智久, 春間純, 大熊祐, 平松匡文, 菱川朋人, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 6 ( 5 ) 418 - 418 2012.11

後大脳動脈病変を有する虚血型もやもや病における長期予後の検証小児例と成人例の比較

菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳循環代謝 24 ( 1 ) 171 - 171 2012.11

Endovascular treatment for basilar tip aneurysms Reviewed

Kenji Sugiu, Koji Tokunaga, Tomohito Hishikawa, Hisakazu Itami, Yu Okuma, Masafumi Hiramatsu, Jun Haruma, Isao Date

Neurological Surgery 40 ( 9 ) 765 - 774 2012.9

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 reembolization. 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.

Periprocedural cilostazol treatment and restenosis after carotid artery stenting: the Retrospective Study of In-Stent Restenosis after Carotid Artery Stenting (ReSISteR-CAS). International journal

Hiroshi Yamagami, Nobuyuki Sakai, Yuji Matsumaru, Chiaki Sakai, Yutaka Kai, Kenji Sugiu, Toshiyuki Fujinaka, Yasushi Matsumoto, Shigeru Miyachi, Shinichi Yoshimura, Toshio Hyogo, Naoya Kuwayama, Akio Hyodo

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 21 ( 3 ) 193 - 9 2012.4

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

Restenosis after carotid artery stenting (CAS) is a critical issue. Cilostazol can reduce restenosis after interventions in coronary or femoropopliteal arteries. We investigated whether periprocedural cilostazol treatment was related to the incidence of in-stent restenosis (ISR) or target vessel revascularization (TVR) after CAS. The study group comprised 553 of 580 patients who underwent CAS between April 2003 and August 2006 and were followed for 30 months after the procedure. ISR was defined as stenosis of at least 50% detected on angiography or ultrasonography. TVR was defined as revascularization of the treated carotid artery. During CAS, 207 patients (37.4%) were treated with cilostazol. Over 30 months, ISR occurred in 23 patients (4.2%), TVR occurred in 16 patients (2.9%), and either ISR or TVR occurred in 25 patients (4.5%). The incidence of ISR or TVR was significantly lower in the cilostazol-treated group than in the untreated group (1.4% vs 6.4%; log-rank P = .006). In a multivariate analysis, cilostazol treatment (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.08-0.95; P = .041) and stent diameter (HR, 0.73/1-mm increase; 95% CI, 0.54-0.99; P = .044) were independent factors for the occurrence of ISR or TVR. The incidence of a composite of events, including thromboembolism, hemorrhage, death, and TVR, tended to be lower in the cilostazol-treated group than in the untreated group (15.0% vs 19.9%; log-rank P = .17). Periprocedural cilostazol treatment was associated with lower rates of ISR and retreatment after CAS. A prospective randomized controlled trial is needed to clarify the effect of cilostazol on ISR after CAS.

DOI： 10.1016/j.jstrokecerebrovasdis.2010.06.007

Usefulness of endovascular treatment for delayed massive epistaxis following endoscopic endonasal transsphenoidal surgery: A case report Reviewed

Tetsuo Oka, Kenji Sugiu, Joji Ishida, Tomohito Hishikawa, Shigeki Ono, Koji Tokunaga, Isao Date

Neurological Surgery 40 ( 1 ) 55 - 60 2012.1

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

We report here a case of massive nasal bleeding from the sphenopalatine artery three weeks after endonasal transsphenoidal surgery. This 66-year-old male suffered from massive nasal bleeding with the status of hypovolemic shock. Under general anesthesia, an emergent angiography revealed an extravasation from the sphenopalatine artery. Trans-arterial embolization using coil and n-butyl-cyanoacrylate (NBCA) was performed following the diagnostic angiography. Complete occlusion of the injured artery was achieved. The patient showed good recovery from general anesthesia. Delayed nasal bleeding after endonasal transsphenoidal surgery is a rare but important complication. The sphenopalatine artery and its branch are located in the hidden inferior lateral corner of the sphenoid sinus and may be injured during enlargement of the sphenoid opening. When massive delayed nasal bleeding follows transsphenoidal surgery and damage of the internal carotid artery has been ruled out, endovascular treatment of the external carotid artery should be considered.

Improvement of depression after treatment of dural arteriovenous fistula: a case report and a review. International journal

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Chihoko Sakamoto, Kenjiro Fujiwara

Case reports in psychiatry 2012 730151 - 730151 2012

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

Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

DOI： 10.1155/2012/730151

Cavernous sinus dural arteriovenous fistulas treated with percutaneous transvenous embolization using liquid material: Two case reports Reviewed

Masafumi Hiramatsu, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Mitsuo Kuriyama, Tomohide Maeshiro, Kaoru Terasaka, Isao Date

Neurological Surgery 39 ( 12 ) 1189 - 1196 2011.12

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

Introduction: Percutaneous transvenous embolization (TVE) using coils is a well-established treatment of cavernous sinus dural arteriovenous fistula (CSdAVF). However, it is sometimes difficult to achieve complete occlusion by coil embolization. In these two cases, we were able to obtain complete angiographic obliteration of the fistulas without complications by means of percutaneous TVE using n-butyl-cyanoacrylate (NBCA) after we failed when TVE using coils. Case 1: An 89-year-old woman presented with double vision. She was diagnosed as Barrow type D right CSdAVF draining only to the cortical vein. We treated the patient by TVE using coils, but the microcatheter was withdrawn before complete occlusion was attained. The repositioning of the microcatheter was difficult, so we used 30% NBCA for TVE, and obtained complete obliteration of the fistula. Case 2: An 87-year-old woman presented with right exophthalmos, and chemosis. She was diagnosed as Barrow type C right CSdAVF draining only to the right superior ophthalmic vein with very slow flow. We planned to treat her, using TVE with coils, but we could place only 3 coils and obtained only partial obliteration of the fistula. So we additionally used 25% NBCA for TVE, and obtained complete obliteration of the fistula. Conclusion: Compared to TVE using coils, TVE using NBCA gives rise to many problems, but, we can use NBCA as a second option if TVE using coils results in only partial obliteration as in these cases.

Carotid artery stenting(CAS)におけるstaged angioplastyの有用性

大熊佑, 杉生憲志, 伊丹尚多, 菱川朋人, 小野成紀, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 310 - 310 2011.11

CASの治療成績向上のために MRIによるプラーク診断とSPECTによる過灌流リスク判定

杉生憲志, 徳永浩司, 菱川朋人, 大熊佑, 伊丹尚多, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 171 - 171 2011.11

頸動脈ステント留置術におけるdebrisの組織学的評価

伊丹尚多, 菱川朋人, 大熊佑, 眞鍋博明, 小野成紀, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 171 - 171 2011.11

無バルーン時代のhigh flow CCFの治療皆さん、どうしています?

杉生憲志, 徳永浩司, 菱川朋人, 伊丹尚多, 大熊佑, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 185 - 185 2011.11

Onyxを用いた脳動静脈奇形の塞栓術臨床的および組織学的検討

徳永浩司, 杉生憲志, 大熊佑, 伊丹尚多, 菱川朋人, 黒住和彦, 眞鍋博明, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 182 - 182 2011.11

未破裂脳動脈瘤アシストテクニックの功罪 Adjunctive techniqueを併用した未破裂脳動脈瘤の血管内治療

徳永浩司, 杉生憲志, 大熊佑, 伊丹尚多, 菱川朋人, 眞鍋博明, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 149 - 149 2011.11

両側椎骨動脈起始部閉塞に合併した破裂右椎骨動脈解離性動脈瘤

豊嶋敦彦, 杉生憲志, 徳永浩司, 菱川朋人, 大熊佑, 伊丹尚多, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 391 - 391 2011.11

プラーク性状と頭蓋内血行動態評価に基づいたCAS手技の選択

菱川朋人, 大熊佑, 伊丹尚多, 徳永浩司, 杉生憲志, 伊達勲

脳循環代謝 23 ( 1 ) 119 - 119 2011.11

脳動脈瘤に対するENTERPRISE stentを併用したコイル塞栓術の治療成績

菱川朋人, 大熊佑, 伊丹尚多, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 251 - 251 2011.11

脳動脈瘤治療における"Sheep technique"の有用性

伊丹尚多, 杉生憲志, 徳永浩司, 大熊佑, 菱川朋人, 眞鍋博明, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 249 - 249 2011.11

未破裂脳動脈瘤コイル塞栓術後に出現する発熱、頭痛、消化器症状"post coiling syndrome"の検討

大熊佑, 杉生憲志, 伊丹尚多, 菱川朋人, 小野成紀, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 301 - 301 2011.11

神経線維腫症に合併した椎骨動静脈瘻の1例

大谷理浩, 杉生憲志, 徳永浩司, 菱川朋人, 大熊佑, 伊丹尚多, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 289 - 289 2011.11

Davidoff and Schechter動脈に対する術前塞栓術が有用であったhemangiopericytomaの1例

春間純, 杉生憲志, 徳永浩司, 菱川朋人, 大熊佑, 伊丹尚多, 伊達勲

JNET: Journal of Neuroendovascular Therapy 5 ( 4 ) 387 - 387 2011.11

Computational fluid dynamics of carotid arteries after carotid endarterectomy or carotid artery stenting based on postoperative patient-specific computed tomography angiography and ultrasound flow data. Reviewed International journal

Hitoshi Hayase, Koji Tokunaga, Toshio Nakayama, Kenji Sugiu, Ayumi Nishida, Seiji Arimitsu, Tomohito Hishikawa, Shigeki Ono, Makoto Ohta, Isao Date

Neurosurgery 68 ( 4 ) 1096 - 101 2011.4

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

BACKGROUND: There are significant differences in the postoperative morphological and hemodynamic conditions of the carotid arteries between carotid artery stenting (CAS) and endarterectomy (CEA). OBJECTIVE: To compare the postoperative rheological conditions after CAS with those after CEA with patch angioplasty (patch CEA) through the use of computational fluid dynamics (CFD) based on patient-specific data. METHODS: The rheological conditions in the carotid arteries were simulated in 2 patients after CAS and in 2 patients after patch CEA by CFD calculations. Three-dimensional reconstruction of the carotid arteries was performed with the images obtained with computed tomography angiography. The streamlines and wall shear stress (WSS) were calculated by a supercomputer. Adequate boundary conditions were determined by comparing the simulation results with ultrasound flow data. RESULTS: CFD was successfully calculated for all patients. The differences between the flow velocities of ultrasound data and those of the simulation results were limited. In the streamline analysis, the maximum flow velocities in the internal carotid artery after patch CEA were around two-thirds of those after CAS. Rotational slow flow was observed in the internal carotid artery bulb after patch CEA. WSS analysis found regional low WSS near the outer wall of the bulb. High WSS was observed at the distal end of the arteriotomy after patch CEA and at the residual stenosis after CAS. CONCLUSION: CFD of postoperative carotid arteries disclosed the differences in streamlines and WSS between CAS and patch CEA. CFD may allow us to obtain adequate rheological conditions conducive to achieving the best clinical results.

DOI： 10.1227/NEU.0b013e318208f1a0

[Vasospasm of Adamkiewicz artery after subarachnoid hemorrhage].

Yasuyuki Miyoshi, Akihiko Kondo, Takao Yasuhara, Ayumi Nishida, Koji Tokunaga, Kenji Sugiu, Isao Date

Brain and nerve = Shinkei kenkyu no shinpo 63 ( 2 ) 182 - 3 2011.2

脳血管攣縮に対する全身管理の意義くも膜下出血後脳血管攣縮に対する集学的治療困難症例の検討

小野成紀, 菱川朋人, 西田あゆみ, 徳永浩司, 杉生憲志, 伊達勲

脳血管攣縮 26 34 - 37 2011.2

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

過去5年間にくも膜下出血発症48時間以内にクリッピングまたはコイル塞栓術を施行し、術後シルビウス裂末梢部に血腫が残存した92例のうち、World Federation Neurological Surgery(WFNS) grade 1〜3で、脳血管攣縮(VS)治療プロトコールに沿った治療においても治療困難であった5症例について検討した。その結果、2例はINVOSによるVS検知が不十分で、局所の攣縮や末梢性の攣縮を来たした。2例は循環器、呼吸器合併例で、VSの治療とは相反する脱水の是正、昇圧等を優先しなければならず、脳梗塞を引き起こしていた。1例は腹壁出血例であった。脳槽ドレーン脱落等によって、早期にくも膜下血腫線溶治療が行えず、結果としてVSを来した症例も散見された。

未破裂脳動脈瘤コイル塞栓術後に出現する発熱、頭痛、消化器症状の検討 "postcoiling syndrome"の検討

大熊佑, 杉生憲志, 伊丹尚多, 菱川朋人, 小野成紀, 徳永浩司, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 255 - 255 2010.11

MRIプラーク診断のCAS protection device選択への介入

菱川朋人, 伊丹尚多, 大熊佑, 徳永浩司, 杉生憲志, 飯原弘二, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 220 - 220 2010.11

新世代のCAS 治療適応とデバイス選択頸動脈狭窄症に対する治療法およびデバイスの選択と治療成績

徳永浩司, 杉生憲志, 大熊佑, 伊丹尚多, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 151 - 151 2010.11

バルーン保護下の頸動脈ステント留置術におけるdebrisの組織学的評価

伊丹尚多, 菱川朋人, 大熊佑, 小野成紀, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 282 - 282 2010.11

Percutaneous Balloon Angioplasty for Acute Occlusion of Intracranial Arteries Reviewed International journal

Koji Tokunaga, Kenji Sugiu, Kimihiro Yoshino, Yoshinori Terai, Takashi Imaoka, Akira Handa, Nobuyuki Hirotsune, Noboru Kusaka, Isao Date

NEUROSURGERY 67 ( 3 ) 189 - 196 2010.9

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited.
OBJECTIVE: To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries.
METHODS: Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed.
RESULTS: The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 x 103 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case.
CONCLUSIONS: Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications.

DOI： 10.1227/01.NEU.0000380954.29925.CE

脳血管攣縮と脳保護くも膜下出血後脳血管攣縮の基礎

小野成紀, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

Neurosonology 23 ( 増刊 ) 44 - 44 2010.6

脳血管攣縮検出のための簡易型脳内酸素飽和度監視装置INVOSの長所・短所

小野成紀, 有光帥二, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳血管攣縮 25 43 - 46 2010.3

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

脳血管攣縮(CV)検出のための簡易型脳内酸素飽和度監視装置(INVOS)をくも膜下出血(SAH)術後に頭皮上に装着することにより、CV期における脳血流変化の検知の可能性について検討した。その結果、他の目的におけるINVOSの有用性と同様にCV検知でもINVOSモニターの有用性が示された。また、経時的にASH発症初期・CV期・CV回復期でのそれぞれの脳血流状態がリアルタイムに示されたことは特記すべきことであった。一方、SAH発症期では脳にうっ血性の変化を生じ、回復するに従って局所血流も低下、CV期には更に局所血流が低下して、回復期にはCVの程度、神経学所見と一致したINVOS値の上昇が認められた。一部症例ではSPECTとの比較を行うことができ、INVOS値と実際の脳血流の整合性も確認可能であったが、INVOSセンサー自体が貼付できない、うまくdetectできないなど技術的な問題と、ごく局所のCVや末梢性CVではdetect困難な場合があるなどCVの性質による問題点も挙げられた。以上、これらのことより、INVOSは簡便で非侵襲的な検査法であり、リアルタイムに脳内酸素飽和度の測定が可能で、脳血流モニターとして有用であると考えられた。

Bioactive coilの中期成績 Cerecyte coilあるいはMatrix2 coilを用いた脳動脈瘤塞栓術の手術手技と治療成績

徳永浩司, 杉生憲志, 西田あゆみ, 大熊佑, 伊丹尚多, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 3 ( 4 ) 145 - 145 2009.11

頸動脈ステント留置術において回収されたdebrisの組織学的検討

伊丹尚多, 大熊佑, 菱川朋人, 西田あゆみ, 小野成紀, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 3 ( 4 ) 292 - 292 2009.11

簡易型脳内酸素飽和度監視装置INVOSによるくも膜下出血後脳血管攣縮の検出

小野成紀, 有光帥二, 小川智之, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳血管攣縮 24 67 - 69 2009.3

頸部内頸動脈狭窄症におけるCEAとCAS術後の医用画像を用いた患者特異的モデルと仮想モデルの流体力学シミュレーション

早瀬仁志, 中山敏男, 徳永浩司, 杉生憲志, 西田あゆみ, 有光帥二, 菱川朋人, 小野成紀, 太田信, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 297 - 297 2008.11

内頸動脈窩部動脈瘤に対する血管内治療

西田あゆみ, 杉生憲志, 徳永浩司, 早瀬仁志, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 154 - 154 2008.11

無症候性病変の安全な血管内治療はどうあるべきか? 無症候性病変に対する脳神経血管内治療

杉生憲志, 徳永浩司, 西田あゆみ, 早瀬仁志, 平松匡文, 小野成紀, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 133 - 133 2008.11

経皮的後頭部皮下静脈穿刺による硬膜動静脈動瘻の塞栓術を施行した一例

平松匡文, 杉生憲志, 徳永浩司, 早瀬仁志, 西田あゆみ, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 277 - 277 2008.11

頸動脈狭窄症に対するAngioguard XPを用いた頸動脈ステント留置術(CAS)の周術期神経学的合併症 GuardWire使用CASの前期および後期の成績と比較して

徳永浩司, 杉生憲志, 西田あゆみ, 平松匡文, 早瀬仁志, 有光帥二, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 160 - 160 2008.11

頸部頸動脈狭窄症 CEA vs CAS 頸動脈狭窄症に対するステント留置術と内膜剥離術治療成績、術後の頸動脈形状、血流速度およびcomputational flow dynamicsの比較検討

徳永浩司, 杉生憲志, 早瀬仁志, 有光帥二, 菱川朋人, 西田あゆみ, 小野成紀, 中山敏男, 太田信, 伊達勲

日本脳神経外科学会総会CD-ROM抄録集 67回 2E - 08 2008.10

Multimodality therapy for cerebral vasospasm after SAH: Importance of intensive care and intraarterial injection of fasudil hydrochloride

Shigeki Ono, S. Arimitsu, T. Ogawa, K. Onoda, K. Tokunaga, K. Sugiu, I. Date

Acta Neurochirurgica, Supplementum ( 104 ) 279 - 281 2008

Language：English Publishing type：Research paper (international conference proceedings) Publisher：Springer-Verlag Wien

Until now, no absolute therapy for cerebral vasospasm (VS) after subarachnoid haemorrhage (SAH) has been established. Here we examine the efficacy of intensive multimodality therapy, contrasting with the treatment in the non-multimodality period in our institute. For 10 years, a total of 108 patients who suffered subarachnoid haemorrhage (SAH) were divided into two groups. Group A patients are from a period of time when there was no particular standardized protocol for treating SAH, i.e. 1996-2000. Group B patients include the intensive care group for treating SAH, and we employed multimodality therapy on Group B by using intraventricular urokinase (UK) injection, lumbar (LD) or cisternal drainages (CD) and timely intraarterial fasudil hydrochloride (FH) injection in the second half of the period with a standardized protocol. Urokinase was given as a bolus administration from a ventricular drain 12 h after surgery, and prophylactic mild hypertension and normovolemia were strictly performed. If symptomatic spasm were detected, immediate intraarterial FH injection or percutaneous transluminal angioplasty was performed. Angiographic and symptomatic vasospasm and the Glasgow outcome scale score 3 months post SAH were evaluated. Angiographic vasospasm occurred in 64.2% and 59% in groups A and B, respectively. Symptomatic vasospasm was observed in 56.5% of Group A and 37.1% of Group B. There was a statistical significance between the percentages of symptomatic vasospasm in Groups A and B (p = 0.0422), but no significant differences were seen in angiographic vasospasm between these 2 groups. As for the outcome, 25.7% of Group A and 10.8% of Group B were poor outcome, and statistical significance (p = 0.001) was seen between these two groups. It is worth noting that there were no deaths due to vasospasm in Group B, in contrast to the 14.8% death rate in Group A. Introduction of multimodality therapy was effective to prevent symptomatic vasospasm and improved the patients' outcome. © 2008 Springer-Verlag.

DOI： 10.1007/978-3-211-75718-5_57

Continuous evaluation of regional oxygen saturation using invosr for monitoring of cerebral vasospasm after subarachnoid hemorrhage

Shigeki Ono, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of Cerebral Blood Flow and Metabolism 27 ( 1 ) BP55 - 08 2007.11

Language：English Publishing type：Research paper (international conference proceedings)

Objective: There are several tools for detection of cerebral vasospasm (VS) after subarachnoid hemorrhage (SAH), however, transcranial Doppler (TCD) is not always accurate for detecting VS, and microdialysis is, somehow, an invasive method. Although angiography is a gold-standard method to make a diagnosis of VS, it is not continuous and is not a bed-side examination for detecting VS. INVOSR monitoring which measures the regional oxygen saturation (rSO2) by using near inflated spectroscopy has been used for detecting cerebral ischemia during operations as reported elsewhere. We here use this noninvasive monitoring system for detecting cortical ischemia due to VS by measuring the continuous rSO2 after SAH, and determine whether it is useful for detecting VS and beneficial for treatment of VS. Methods: Six patients who suffered from SAH were nominated in this study. The probes of INVOSR (INVOS 5100R, Somanetics Corporation, MI, USA) were attached to the scalp in the areas anticipated to show VS considering the thickness of clots, from day 3 to the end of VS. After clipping or coiling, angiography was routinely performed around day 7 after SAH, or, at the timing if rSO2 continuously decreased by 10% compared to that of the contralateral side, or when the patients showed additional neurological deficits. If VS was detected, interventional treatment was performed using superselective intraarterial injection of Fasudil hydrochloride by microcatheters or percutaneous transluminal angioplasty if possible. This performance was once in a day at a maximum, and if the patients deteriorated the next day, the interventional therapy was repeatedly performed until the neurological deficits recovered. Results: The locations of ruptured aneurysms were 2 distal anterior cerebral artery, and 2 internal carotidposterior communicating artery, one middle cerebral artery, and one basilar artery-superior cerebral artery. Angiographic VS was seen in 4 of 6 patients. Symptomatic VS was seen in 2 of the patients having angiographic VS. Generally, INVOS value was around 70-65 in the both side in the early phase of the hemorrhagic attack, and then, gradually stabilized around the value of 60 from around the day 4 to 6. When INVOS value became less than 55, angiographic or symptomatic VS tended to occur. Recovery from ischemia seen on angiography or single photon emission CT also correlated with reincrease of rSO2 by INVOSR. Discussion: INVOSR is handy and noninvasive monitor for detecting VS after SAH. And it also evaluates chronological real-time rSO2 in the region of VS. This monitoring system may be superior to the conventional monitoring systems such as TCD or single photon emission CT.

When cerebral vasospasm after subarachnoid hemorrhage begins and ends?: Definition of vasospasm using angiography

Shigeki Ono, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of Cerebral Blood Flow and Metabolism 27 ( 1 ) BP54 - 09 2007.11

Language：English Publishing type：Research paper (international conference proceedings)

Cerebral vasospasm (VS) after subarachnoid hemorrhage (SAH) is one of the fatal strokes causing severe brain ischemia. So far, many types of treatments for VS have been applied, such as triple H therapy, clot fibrinolysis, spinal drainage, endovascular treatment, or administration of vasodilatory agents, but its pathophysiology has been still unknown, and absolute therapeutic strategies have not been established yet. One of the reasons why the strategies of VS treatment has not been confirmed is that clear definition of VS has not given until now. For instance, there are many cases which have no symptoms while these patients have obvious angiographic VS, or it is difficult to distinguish between real VS symptoms and neurological deterioration due to fever, abnormal blood levels of electrolytes, primary brain damages from SAH. Therefore, incidence of VS and the timing of its treatment are sometimes different among each facility. From 2000, we define VS as angiographic VS in our institute. When symptomatic VS is suspected clinically, emergency angiography is immediately performed and confirm VS. And then if necessary, endovascular therapy is given. Even if there are no VS symptoms during spasm periods, we routinely perform angiography on around day 7 as shown in the following protocol (see table). Under this protocol, angiographic VS was seen in 59.7% of the 57 patients, while, symptomatic VS was seen in 37.1%. In this study, we discuss the advantages of this definition of VS by angiography. Table: A. Treatment after surgery 1) Drains(always inserted) Ventricular drainage (VD) + cisternal (CD) or lumber drainage (LD) 2) Fibrinolysis UK 30,000IU/day, injected through VD Repeated if necessary by Day 4 3) General management(under strict control) Normo-hypertension, normovolemia (≧120mmHg, CVP≒8-10) Hct(≦9.0mg/dl), ICP(≧20mmH2O),and electrolytes(≧130meq/L) Ozagrel Na (i.v.) Fasudil (i.v.) 4) Intravascular treatment (if severe angiographic VS was detected.) Fasudil (i.a.) Percutaneous transluminal angioplasty (PTA) B. Detection of VS 1) TCD monitor 2) Neurological changes 3) Angiography When TCD or neurological changes are detected On day 7 (routine exam.) 4) INVOS5100R(Somanetics, USA): 2005∼ Near infrared spectroscopy, measuring rSO2.

A case of a ruptured vertebral artery dissecting aneurysm recanalized after internal trapping Reviewed

Yoichiro Kikuchi, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Takushi Nishimura, Isao Date

NEUROLOGICAL SURGERY 35 ( 8 ) 813 - 819 2007.8

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

A 35-year-old male experienced a sudden onset of severe headache. A CT scan revealed subarachnoid hemorrhage. By cerebral angiography, he was diagnosed as having a ruptured right vertebral artery dissecting aneurysm (VADA). It was successfully treated by endovascular occlusion of the affected site, including the aneurysm and parent artery, by using detachable coils. A follow-up angiography obtained seven months after the first treatment revealed the recanalization of the right vertebral artery and dissected aneurysm in an antegrade fashion. A skull X-ray image was useful for detecting the change in appearance of the coils. The second embolization was successfully performed in the same manner Based on this rare case, the authors emphasize that a careful angiographic analysis and complete internal trapping of the dissecting site are important in the treatment of the ruptured VADA.

Endovascular treatment of adult pial arteriovenous fistula Reviewed

Naohisa Itami, Kenji Sugiu, Koji Tokunaga, Shigeki Ono, Keisuke Onoda, Isao Date

NEUROLOGICAL SURGERY 35 ( 6 ) 599 - 605 2007.6

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

The authors report a case of adult pial arteriovenous fistula successfully treated by endovascular glue embolization. A 65-year-old man presented with left hemiparesis and was admitted to the local hospital. Computed tomography scan showed a cerebral hematoma. Cerebral angiography revealed pial single-channel arteriovenous fistula at the right angular artery. An emergent craniotomy was performed and hematoma was successfully evacuated on the next day. Since the post-operative angiography revealed a persisting arteriovenous fistula, the patient was referred to our institute for additional treatment. With the patient under local anesthesia, endovascular treatment was performed through the trans-femoral artery approach. A flow-guided microcatheter was successfully navigated just proximal to the fistula site. Histoacryl was then injected, and complete obliteration of the fistula was obtained. The subsequent course was uneventful and the patient returned to his daily life with only very mild left hemiparesis. Endovascular glue embolization plays an important role in the treatment of pial arteriovenous fistula.

[Preoperative assessment of microvascular decompression for hemifacial spasm with fusion imaging of 3D MR cisternogram/angiogram]. Reviewed

Onoda K, Satoh T, Miyosnhi Y, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 34 ( 8 ) 785 - 791 2006.8

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

The preoperative assessment of microvascular decompression (MVD) for hemifacial spasm has been performed with MRI, but assessment of the compressive status by 2D imaging has a number of limitations. We used a fusion image of the 3D MR cisternogram and co-registered 3D MR angiogram, reconstructed from MR cisternogram, obtained by 3D fast spin-echo sequence, and MR angiography, 3D time-of-flight and spoiled-gradient recalled sequences, for the preoperative assessment of the offending artery in 10 patients with hemifacial spasm. The anatomical relationship of the nerve-vessel complex was assessed on the simulated images, and compared with the intraoperative findings. The fusion image of the 3D MR cisternogram/angiogram depicted contours of the brain, nerves, and vessels clearly, and that allowed precise assessment of the pathogenic compression of the facial nerve by the offending vessels, comparative to the operative findings. The fusion imaging of the 3D MR cisternogram/angiogram may provide useful information in the surgical planning of MVD for hemifacial spasm.

Direct surgery for paraclinoid aneurysm arising from the anterolateral wall of the internal carotid artery Reviewed

K Onoda, K Tokunaga, K Sugiu, S Ono, Date, I

NEUROLOGICAL SURGERY 34 ( 3 ) 267 - 272 2006.3

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

The internal carotid aneurysm (ICA) arising from the paraclinoid region is associated with the origins of the superior hypophyseal artery and the ophthalmic artery. Recently, other aneurysms which can arise in this region without imvolvement of the arterial branches has been reported. Among those aneurysms, there are very rare type of aneurysms located on the anterolateral aspect of the internal carotid artery.
In this report, we described our experience with direct surgery for five cases of the unruptuted paraclinoid aneurysm arising from the anterolateral aspect of the ICA.
Firstly, the conmon carotid artery was exposed to carry out proximal flow control. We used the pterional approach. The anterior clinoid process was deleted after having confirmed aneurysm and the dural ring was incised. Extreme care had to be taken during this step. All patients underwent Successful neck clipping.
In recent two cases we employed the neuroendoscope (EndoArmTM) to observe the unrecognized area of surgical microscope and untrasonic bone curette (SONOPETTM) to perform the safe removal of the anterior clinoid process. This procedure is very useful for carring out the neck clipping for aneurysms which are located oil the anterolateral aspect of the internal carotid artery.

経皮的椎体形成術による多発性骨髄腫腰椎病変の1治験例

大西学, 徳永浩司, 杉生憲志, 小野田惠介, 三好康之, 生口俊浩, 金澤右, 増成太郎, 谷本光音, 伊達勲

岡山医学会雑誌 117 ( 3 ) 256 - 256 2006.1

[Percutaneous vertebroplasty combined with radiofrequency ablation for a patient with a spinal metastatic tumor: case report].

Koji Tokunaga, Kenji Sugiu, Yasuyuki Miyoshi, Hidefumi Mimura, Susumu Kanazawa, Isao Date

No shinkei geka. Neurological surgery 33 ( 8 ) 811 - 5 2005.8

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

Recent technological development has allowed expanding applications of radiofrequency ablation (RFA) for malignant tumor therapy. We report a case with a spinal metastatic tumor treated with combination of percutaneous vertebroplasty (PVP) that provides pain relief and spinal stabilization and RFA. A 68-year-old male who had undergone resection of left ureteric carcinoma was referred to our hospital with lower back pain due to the fifth lumbar (L5) vertebral metastatic tumor. Conventional radiation therapy was discontinued because of pneumonia. One year later, the patient was admitted again with weakness of the right knee and foot and severe pain of the back and the right lower extremity. Radiographs demonstrated a compressive fracture of the L5 vertebra predominantly on the right side. CT and MRI showed a tumor of the L5 body invading the right pedicle, the intervertebral foramen, and the retroperitoneal space. RFA was performed in the ventral part of the L5 body, and then around the right L5/the first sacral intervertebral foramen. Temperature and time for ablation ranged from 74 degrees C to 95 degrees C and from 11 min. to 30 min., respectively. Next, PVP was performed by the right transpedicular approach. Bone cement was injected into the L5 body and the pedicle by an amount of 3.0 ml in total without technical complications. Postoperatively, visual analogue scale demonstrated decreased pain degree from 10 cm to 5.4 cm. Combined treatment with RFA and PVP is a feasible and promising procedure for spinal metastatic tumors. Further evaluation is necessary to confirm its long-term efficacy.

[Assessment of the perianeurysmal environment of unruptured internal carotid-posterior communicating artery aneurysms with fusion imaging of three-dimensional magnetic resonance cisternography and angiography]. Reviewed

Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Onoda K, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 33 ( 6 ) 569 - 577 2005.6

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

The anatomical relationship of an unruptured internal carotid-posterior communicating artery aneurysm and the perianeurysmal environment was investigated by using three-dimensional (3D) magnetic resonance cisternography (MRC), angiography (MRA) and newly developed fusion images of 3D MRC and 3D MRA. Contact of an aneurysm with the adjacent intra- and pericisternal structures was observed in cases with the aneurysm developing and extending beyond the capacity of the surrounding subarachnoid space. Deformation and bleb formation of the aneurysmal dome was depicted at the dome in contact with the perianeurysmal environment, including the tentorial edge, the anterior petroclinoid dural fold, the oculomotor nerve, the posterior clinoid process, the dorsum sellae and the cranial base bone. By using the fusion imaging technique of 3D MRC and 3D MRA, assessment of the contact of an unruptured cerebral aneurysm with its perianeurysmal environment can be made. Such contact gives ride to risk of deformation and bleb formation of the aneurysmal dome; and may result in cranial nerve symptoms and accelerate rupture from an unruptured cerebral aneurysm.

Local intraarterial fibrinolysis in central retinal artery occlusion: Case report Reviewed

M Tagawa, K Sugiu, K Tokunaga, W Sasahara, K Watanabe, N Tamesa, S Ono, K Onoda, Date, I

NEUROLOGICAL SURGERY 33 ( 6 ) 619 - 623 2005.6

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

The authors report a case of local intraarterial fibrinolysis (LIF) in central retinal artery occlusion (CRAO). A 79-year-old man with stenosis of the left internal carotid artery (ICA) suffered sudden loss of vision in his left eye. LIF was carried out using a microcatheter in the origin of the ophthalmic artery on the side of the CRAO. Treatment was performed with 120,000 IU of urokinase. After LIF, marked improvement of vision was established. No complication occurred during LIF One month later, carotid artery stenting was performed for the left ICA stenosis. We consider LIF in CRAO is effective treatment.

[Assessment of the signal intensity distribution pattern within the unruptured cerebral aneurysms using color-coded 3D MR angiography]. Reviewed

Satoh T, Omi M, Ohsako C, Katsumata A, Yoshimoto Y, Tsuchimoto S, Kunishio K, Onoda K, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 33 ( 5 ) 445 - 454 2005.5

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

To evaluate the interaction between the MR signal intensity distribution pattern and bleb formation/ deformation of the aneurysmal dome, fifty cases of the unruptured cerebral aneurysms were investigated with the color-coded 3D MR angiography. Patterns were categorized into central-type, neck-type and peripheral-type according to the distribution of MR signals with low-, moderate- and high signal intensity areas. Imaging analysis revealed the significant relationship (P < 0.02) of the peripheral-type aneurysms to the bleb formation and deformation of the dome, compared with those of central- and neck-type. Additionally, peripheral-type signal intensity distribution pattern was shown with aneurysms harboring relatively large dome size and lateral-type growth including internal carotid aneurysms. Prospective analysis of intraaneurysmal flow pattern with the color-coded 3D MR angiography may provide patient-specific analysis of intraaneurysmal flow status in relation to the morphological change of the corresponding aneurysmal dome in the management of unruptured cerebral aneurysms.

Combination therapy for cerebral vasospasm after SAH: Importance of spinal drainage and Intraarterial injection of fasudil hydrochloride Reviewed

S Ono, K Onoda, K Tokunaga, K Sugiu, Date, I

Proceedings of the 13th World Congress of Neurological Surgery, Vols 1 and 2 379 - 385 2005

Language：English Publishing type：Research paper (international conference proceedings) Publisher：MEDIMOND S R L

Introduction: We hypothesize that the combination therapy of lumbar drainage (LD) with intraarterial injection of Fasudil hydrochloride for cerebral vasospasm (VS) can improve the prognosis of the patients of SAH compared with the therapy of cisternal drainage (CD) with the arterial injection of Fasudil hydrochloride (FH). Materials and Methods: Forty-four patients with aneurysmal SAH who were admitted to our University between January 2003 and April 2005. The treatment group consisted of 30 patients in whom a LD had been placed with intraarterial FH, if necessary, whereas the control group was composed of 14 patients who received the CD with same interventional treatment, if necessary. Age, gender, Hunt and Kosnik grade (H & K), Fisher group, a VS rate, and a rate of normal pressure hydrocephalus (NPH) were compared between these two groups. Primary endpoint was set using Glasgow outcome scale (GOS) after 3 months from onset. Results: There was no difference of age, gender, H & K, and Fisher group between these two groups. Intraarterial FH injection was performed in 20% and 50% of the LD and CD groups, respectively. The rate of angiographic VS in the CD group was significantly higher than that in the LD group (36.7% and 85.7% respectively). Symptomatic VS occurred frequently in the CD group compared with that in the LD group. There was statistically significance between these groups (64.3% vs 23.3%). NPH was noted in 13.3% of the LD group and 42.9% of the CD group. However, regarding GOS there was no statistical difference between these two groups. Conclusions: Although outcome of these groups have no statistical difference, these results indicate that LD was more effective for preventing VS after SAH compared with CD. The combination therapies for VS using LD and intraarterial FH injection can improve the prognosis of VS after SAH, and it should be considered as a new multimodality therapy for the treatment of the patients with SAH.

Endovascular treatment for ruptured vertebral artery dissecting aneurysms Reviewed

K Sugiu

NEUROLOGICAL SURGERY 32 ( 12 ) 1229 - 1238 2004.12

Complications of embolization for cerebral arteriovenous malformations Reviewed

K Sugiu, K Tokunaga, W Sasahara, K Watanabe, A Nishida, S Ono, S Nishio, Date, I, DA Rufenacht

INTERVENTIONAL NEURORADIOLOGY 10 59 - 61 2004.12

Language：English Publishing type：Research paper (scientific journal) Publisher：EDIZIONI CENTAURO

Embolization is recognized as an important adjunct in the treatment of cerebral arteriovenous malformations (AVMs). We reviewed our results of embolizations for AVMs and discussed procedure-related complications. Eleven complications were recorded in 68 consecutive patients (16%). Of these, four were technical problems including a glued catheter, inability to withdraw the catheter, vessel perforation by the microcatheter, and coil migration. Other complications included three cases of ischemic symptoms due to retrograde thrombosis, two cases of asymptomatic cerebral infarction, one case of asymptomatic small haemorrhage due to venous occlusion, and one case of post-embolization haemorrhage of unknown etiology. Our morbidity rate was 7%, mortality rate was 0%, and asymptomatic complication rate was 9%, retorospectively. Further improvements to endovascular techniques and devices are required.

[A case of convulsion during selective intra-arterial infusion of fasudil hydrochloride for treatment of vasospasm following subarachnoid hemorrhage].

Wataru Sasahara, Shigeki Ono, Koji Tokunaga, Kenji Sugiu, Hiroyuki Nakashimia, Isao Date, Takashi Ohmoto

No shinkei geka. Neurological surgery 32 ( 5 ) 487 - 91 2004.5

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

The authors report a case of convulsion during intra-arterial selective infusion of fasudil hydrochloride (FSD) for treatment of vasospasm following subarachnoid hemorrhage (SAH). A 47-year-old man (Hunt and Kosnik grade I) presented with sudden onset of headache and was diagnosed with SAH on CT, and admitted to our hospital. Digital subtraction angiography (DSA) performed on admission revealed an anterior communicating artery aneurysm. Neck clipping of the aneurysm was performed on the same day and no neurological deficits were noted postoperatively. Motor aphasia appeared on day 11 after the operation, and emergency DSA revealed vasospasm of the left middle cerebral artery and its branches. Emergency percutaneous transluminal angioplasty was performed with successful dilation of the left M1 artery, and 25 milligrams of FSD was injected into the left M1 artery selectively. During this injection, right hemifacial convulsion appeared, and three minutes later disappeared. No treatment was needed for the seizure. Additional injection of 30 milligrams of FSD into the left internal carotid artery resulted in vasodilatation of the left M1 artery and its branches, improvement of their blood flow on angiography, and recovery from motor aphasia. The patient was discharged 1 month later with no neurological deficits. Intra-arterial selective infusion of FSD plays an important role in treatment for vasospasm following SAH, however, we must be aware of risks of complications such as convulsion.

[Evaluation of the contours and perianeurysmal environment of unruptured cerebral aneurysms, using three-dimensional magnetic resonance cisternogram]. Reviewed

Satoh T, Ekino C, Ohsako C, Katsumata A, Onoda K, Tsuchimoto S, Yunoki M, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 32 ( 3 ) 215 - 221 2004.3

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

To evaluate the anatomical relationship between cerebral aneurysm and the perianeurysmal environment within a cisternal space, the contours of an unruptured cerebral aneurysm and pericisternal structures were depicted on a three-dimensional (3D) MR cisternogram. By using perspective volume-rendering algorithm, the 3D MR cisternograms were reconstructed from the source axial volume data set obtained by the T2-weighted 3D fast spin-echo sequence. Those images were shown together with the coordinated 3D MR angiograms through similar visual projections, and then compared with the intraoperative findings. The outer wall configurations of cerebral aneurysms within the cisternal space were shown in conjunction with the accompanying surface veins, adjacent cranial nerves, dura mater and tentorial edge, cranial base bone, and surrounding pericisternal brain surfaces. With application of 3D MR cisternograms in the management of unruptured cerebral aneurysm, the anatomical relationship between the aneurysmal contours and the perianeurysmal environment could be evaluated the within the cisternal space. This might provide another clinical factor when considering the potential risk of growth, rupture, and symptomatic cranial nerve signs of an unruptured cerebral aneurysm.

サル脳動脈瘤モデルへのアデノウイルスによるTGF-b-1遺伝子治療の試み

小野成紀, 菱川朋人, 西口充久, 西尾晋作, 徳永浩司, 杉生憲志, 伊達勲

脳卒中 26 ( 1 ) 208 - 208 2004.3

TGF-b-1遺伝子導入による血管反応性の変化:脳血管への遺伝子導入を目指して

小野成紀, 菱川朋人, 西口充久, 西尾晋作, 徳永浩司, 杉生憲志, 伊達勲

脳卒中 26 ( 1 ) 209 - 209 2004.3

[Spontaneous thrombosis of a fusiform aneurysm arising from the distal posterior cerebral artery: case report].

Akihiko Kondo, Takao Yasuhara, Kenji Sugiu, Takashi Ohmoto

No shinkei geka. Neurological surgery 31 ( 2 ) 189 - 93 2003.2

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

A 58-year-old woman complaining of a mild headache was admitted to our hospital. MRI 3 months before admission revealed a round lesion at the right quadrigeminal cistern. Cerebral angiograms demonstrated a fusiform aneurysm arising from the parietooccipital artery, which is the distal branch of the right posterior cerebral artery. Repeated MRI and cerebral angiograms performed on admission demonstrated complete thrombosis of an aneurysm and the parent artery without any clinical symptoms. This is the first case of complete spontaneous thrombosis of an aneurysm of the distal posterior cerebral artery. The mechanism of its development and spontaneous thrombosis in a fusiform aneurysm is discussed.

[Percutaneous vertebroplasty--indications and procedural techniques].

Koji Tokunaga, Kenji Sugiu, Hiroyuki Nakashima, Isao Date, Takashi Ohmoto, Jean-Baptiste Martin, Daniel A Rüfenacht

No shinkei geka. Neurological surgery 31 ( 1 ) 7 - 14 2003.1

Training in neurovascular intervention Reviewed

K Sugiu, K Tokunaga, Date, I, T Ohmoto

NEUROLOGICAL SURGERY 30 ( 11 ) 1231 - 1237 2002.11

[A review of dural arteriovenous fistulas with hemorrhagic onset].

Ayumi Nishida, Kenji Sugiu, Atsushi Katsumata, Noboru Kusaka, Hiroyuki Nakashima, Takashi Ohmoto

No shinkei geka. Neurological surgery 30 ( 10 ) 1059 - 64 2002.10

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

The majority of dural arteriovenous fistulas are considered to have a benign clinical course, but some behave more aggressively, causing progressive neurological symptoms and/or intracranial hemorrhage. Several classifications of angiographic findings have been reported to predict what findings might result in catastrophic presentation. Cortical venous drainage has been described as one of the major risk factors of hemorrhage. We reviewed the records of 50 patients with dural arteriovenous fistulas admitted to our institution from 1991 to 2001 and analyzed their venous drainage patterns with reference to Cognard's classification. Six patients had hemorrhagic episodes caused by dural arteriovenous fistula and all of them had retrograde drainage through cerebral veins. The frequency of hemorrhage in Type I and IIa was 0%, in Type IIb it was 33.3%, in Type IIa + b it was 9.1%, in Type III and Type IV it was 50%, and in Type V it was 100%. These results agreed with those of Cognard reported in 1994, and we reconfirmed the usefulness of Cognard's classification. In order to adapt a firm strategy and treat them promptly and aggressively, it is important to be able to recognize what type of dural arteriovenous fistulas are perilous.

[Ruptured fenestrated aneurysm of vertebral artery union successfully treated by endovascular surgery with GDC].

Mitsuhisa Nishiguchi, Kenji Sugiu, Takashi Ohmoto, Toshikazu Saijyo, Hiroyuki Fujisawa

No shinkei geka. Neurological surgery 30 ( 8 ) 875 - 9 2002.8

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

It is difficult to operate on ruptured basilar artery aneurysms in the acute phase because of the anatomical complexity, brain swelling, patients' medical condition, etc., but because there is some risk of rebleeding and/or vasospasm if surgery is delayed, early surgery is recommended. We encountered a rare case of ruptured fenestrated aneurysm of the vertebral artery (VA) union, treated it safely by endovascular surgery with Guglielmi detachable coils (GDCs) in the acute phase, and obtained a good outcome after intensive care. We therefore conclude that endovascular surgery with GDCs is a first-line therapy for fenestrated aneurysms of the VA union in the acute phase after subarachnoid hemorrhage. Fenestrated aneurysms of the VA union are very rare, and long-term follow-up is mandatory.

Usefulness of dynamic digitized cerebral parenchymography for cerebral vascular disease Reviewed

K Sugiu, A Nishida, A Katsumata, N Kusaka, H Nakashima, T Ohmoto

NEUROLOGICAL SURGERY 30 ( 4 ) 379 - 388 2002.4

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

Aortic arch injections according to Theron's method have been performed in patients with cerebral ischemia. Digital subtraction angiograms with modified windowing (low and narrow) have been used for better visualization of cerebral parenchymal condition. This "cerebral parenchymography" allows much easier understanding of cerebral parenchymal vascularization on angiographic imaging. Although further study is necessary to estimate accurate cerebral blood flow, this technique can enable an easy and quick understanding of the overall cerebral hemodynamics.

Successful embolization of a spinal perimedullary arteriovenous fistula with cellulose acetate polymer solution: Technical case report Reviewed

K Sugiu, T Meguro, H Nakashiama, T Ohmoto

NEUROSURGERY 49 ( 5 ) 1257 - 1260 2001.11

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE AND IMPORTANCE: Spinal perimedullary arteriovenous fistulae are rarely reported in the literature and can be treated via both endovascular and direct surgical approaches. Coils, glues, and balloons have all been used to embolize these fistulae. Cellulose acetate polymer (CAP) solution is a liquid embolic material that was originally developed for thrombosis of cerebral aneurysms. This is the first report of CAP solution being used to treat a spinal perimedullary arteriovenous fistula, with changes in the viscosity of the solution.
CLINICAL PRESENTATION: A 15-year-old boy experienced spinal subarachnoid hemorrhage without any neurological deficits. A radiological examination revealed a spinal perimedullary arteriovenous fistula (Type 2) at the L1 level.
INTERVENTION: Transarterial embolization was performed with local anesthesia. The microcatheter was navigated through the anterior spinal artery to a site just proximal to the fistula. After provocative testing demonstrated negative results, CAP solution was injected and the fistula was completely closed, without complications. The patient experienced an uneventful postoperative course.
CONCLUSION: We describe the usefulness of CAP solution in the treatment of a spinal perimedullary arteriovenous fistula. This procedure must be performed for a larger series of patients for assessment of its long-term results.

Neurology: Reflections on the past millennium as we enter the next

Koji Tokunaga, Kazushi Kinugasa, Toshinari Meguro, Kenji Sugiu, Hiroyuki Nakashima, Shinya Mandai, Takashi Ohmoto

Journal of Clinical Neuroscience 7 ( 1 ) 1 - 2 2000

Ribbon enchephalo-duro-arterio-myo-synangiosis for moyamoya disease

Kazushi Kinugasa, Shinya Mandai, Koji Tokunaga, Ichiro Kamata, Kenji Sugiu, Akira Handa, Takashi Ohmoto

Surgical Neurology 41 ( 6 ) 455 - 461 1994

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

In patients with advanced moyamoya disease, reconstructive surgery alone may not prevent the deterioration of blood flow in the territory of the anterior cerebral artery. These types of surgery include superficial temporal artery-to-middle cerebral artery anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS). Bilateral encephalo-duro-arterio-synangiosis (EDAS) gradually reduced the transient ischemic attacks in one of our patients who experienced motor weakness in the left extremities. After surgery, however, persistent bilateral attacks still occurred in the patient's legs. In a subsequent maneuver, we inserted the pedicle of the galea on both sides into the interhemispheric fissure, which induced marked vascularization in the territory of the anterior cerebral artery, and the attacks disappeared. Since then, we have combined this "ribbon" technique with EDAMS to treat eight patients with moyamoya disease. Postoperative angiograms showed widespread collateral circulation on the ischemic brain surface in six patients undergoing ribbon EDAS or EDAMS. Postoperative measurements of cerebral blood flow revealed improved circulation in the frontal region in four patients. The clinical results were excellent in six patients, and good in one, and we lost follow-up in one. The ribbon EDAMS procedure is effective on moyamoya disease with symptomatic cerebral ischemia of the anterior circulation. © 1994.

DOI： 10.1016/0090-3019(94)90007-8

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