Faculty Profiles - SUGIU Kenji

頸部内頸動脈狭窄症におけるCEAとCASの術前後の3D-CTA,3D-DSA画像を使った生体力学シミュレーション

早瀬仁志, 徳永浩司, 中山敏男, 西田あゆみ, 杉生憲志, 小野成紀, 小野田惠介, 太田信, 伊達勲

日本脳神経外科学会総会抄録集(CD-ROM) 66th 2007

Chronic brain ischemia and revascularization - Response

Noboru Kusaka, Kenji Sugiu, Koji Tokunaga, Isao Date

JOURNAL OF NEUROSURGERY 105 ( 2 ) 340 - 341 2006.8

Differential diagnosis of the infundibular dilation and aneurysm of internal carotid artery: Assessment with fusion imaging of 3D MR cisternography/angiography

T Satoh, M Omi, C Ohsako, K Fujiwara, K Tsuno, W Sasahara, K Onoda, K Tokunaga, K Sugiu, Date, I

AMERICAN JOURNAL OF NEURORADIOLOGY 27 ( 2 ) 306 - 312 2006.2

Language：English Publisher：AMER SOC NEURORADIOLOGY

Fusion imaging of 3D MR cisternography/angiography was used for the assessment of the vascular bulging finding detected by MR angiography from the viewpoint of the outer wall configuration of the corresponding internal carotid artery depicted by MR cisternography. With a fusion image, useful information was obtained to distinguish an infundibular dilation and enlarged origin of the normal posterior communicating artery from an aneurysm. This imaging technique can be a feasible addition to a noninvasive screening of cerebrovascular lesions with MR angiography alone.

Adult unilateral moyamoya disease with familial occurrence in two definite cases: a case report and review of the literature

N Kusaka, T Tamiya, Y Adachi, S Katayama, S Namba, K Tokunaga, K Sugiu, Date, I, T Ohmoto

NEUROSURGICAL REVIEW 29 ( 1 ) 82 - 87 2006.1

Language：English Publisher：SPRINGER

We documented an interesting case of adult "unilateral (probable)" moyamoya disease displaying familial occurrence in two "definite" cases. A 55-year-old female presented with motor aphasia, involuntary movement of the right hand and right homonymous hemianopia due to cerebral infarction. Cerebral angiography revealed typical angiographic findings on the left side and normal findings on the right side; consequently, the patient was diagnosed with probable moyamoya disease. Previously, her mother and nephew had been diagnosed with definite moyamoya disease with bilateral involvement. The patient continued to exhibit unilateral involvement on angiography for more than 4 years. Clinical features such as absence of familial occurrence suggest that most cases of probable moyamoya disease are distinct from definite cases, especially in adults. To the best of our knowledge, this report appears to be the first involving an adult probable case characterized by familial occurrence. The literature pertaining to adult probable moyamoya disease was reviewed and the etiology of this disease was discussed.

DOI： 10.1007/s10143-005-0406-5

Adult unilateral moyamoya disease with familial occurrence in two definite cases: a case report and review of the literature International journal

N Kusaka, T Tamiya, Y Adachi, S Katayama, S Namba, K Tokunaga, K Sugiu, Date, I, T Ohmoto

NEUROSURGICAL REVIEW 29 ( 1 ) 82 - 87 2006.1

Language：English Publisher：SPRINGER

DOI： 10.1007/s10143-005-0406-5

片側顔面痙攣に対するmicrovascular decompressionの新しい術前画像評価─3D MR cisternogram/angiogram fusion imagingの応用─.

小野田惠介, 佐藤透, 三好康之, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科 2006

脳血管への11Rを用いた蛋白質導入─脳血管攣縮への新しい治療戦略の開発─.

小川智之, 小野成紀, 市川智継, 有光帥二, 小野田惠介, 徳永浩司, 杉生憲志, 松下正之, 富澤一仁, 松井秀樹, 伊達勲

脳卒中の外科 2006

くも膜下出血後脳血管攣縮に対する当科の治療戦略の変遷─集学的治療は脳血管攣縮を解説できたか─.

小野成紀, 有光帥二, 小川智之, 小野田惠介, 徳永浩司, 杉生憲志, 伊達勲

脳卒中の外科 2006

前床突起下前外側壁に生じた内頸動脈瘤に対する直達手術.

小野田惠介, 徳永浩司, 杉生憲志, 小野成紀, 伊達勲

脳神経外科 2006

EBMに基づく動脈硬化性疾患の外科的治療とその成績─脳血管障害─.

杉生憲志, 徳永浩司, 伊達勲

循環器科 59(Suppl 3), 496-503 2006

Enhanced brain angiogenesis in chronic cerebral hypoperfusion after administration of plasmid human vascular endothelial growth factor in combination with indirect vasoreconstructive surgery International journal

N Kusaka, K Sugiu, K Tokunaga, A Katsumata, A Nishida, K Namba, H Hamada, H Nakashima, Date, I

JOURNAL OF NEUROSURGERY 103 ( 5 ) 882 - 890 2005.11

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

Object. Vascular endothelial growth factor (VEGF) is a secreted mitogen associated with angiogenesis. The conceptual basis for therapeutic angiogenesis after plasmid human VEGF gene (phVEGF) transfer has been established in patients presenting with limb ischemia and myocardial infarction. The authors hypothesized that overexpression of VEGF using a gene transfer method combined with indirect vasoreconstruction might induce effective brain angiogenesis in chronic cerebral hypoperfusion, leading to prevention of ischemic attacks.
Methods. A chronic cerebral hypoperfusion model induced by permanent ligation of both common carotid arteries in rats was used in this investigation. Seven days after induction of cerebral hypoperfusion, encephalomyosynangiosis (EMS) and phVEGF administration in the temporal muscle were performed. Fourteen days after treatment, the VEGF gene therapy group displayed numbers and areas of capillary vessels in temporal muscles that were 2.2 and 2.5 times greater, respectively, in comparison with the control group. In the brain, the number and area of capillary vessels in the group treated with the VEGF gene were 1.5 and 1.8 times greater, respectively, relative to the control group.
Conclusions. In rat models of chronic cerebral hypoperfusion, administration of phVEGF combined with indirect vaso-reconstructive surgery significantly increased capillary density in the brain. The authors' results indicate that administration of phVEGF may be an effective therapy in patients with chronic cerebral hypoperfusion, such as those with moyamoya disease.

DOI： 10.3171/jns.2005.103.5.0882

Brain stem ischemia from intracranial dural arteriovenous fistula: Case report International journal

M Satoh, M Kuriyama, T Fujiwara, K Tokunaga, K Sugiu

SURGICAL NEUROLOGY 64 ( 4 ) 341 - 345 2005.10

Language：English Publisher：ELSEVIER SCIENCE INC

Background: Intracranial dural arteriovenous fistulas (AVFs) with spinal perimedullary venous drainage are rarely reported, but most of the patients initially have presented with myelopathy or subarachnoid hemorrhage. This is the first report of the intracranial dural AVF patient who presented with brain stem infarction.
Case Description: A 38-year-old woman experienced nausea and vomiting with an acute onset, followed by vertigo. Magnetic resonance imaging showed ischemic lesion in the medulla oblongata, and she was then sent to our hospital. On admission, she had nystagmus, swallowing difficulties, Homer syndrome, and right hemiparesis and hemisensory disturbance. Cerebral angiography revealed dural AVF draining into spinal perimedullary veins at the left transverse-sigmoid sinus. The patient was treated by transvenous ernbolization under local anesthesia. A microcatheter proceeded to the left sigmoid sinus via the internal jugular vein, and embolization of the sinus was performed using coils without complications. The patient's swallowing difficulties improved over a few days after the embolization, and I month later, there remained only a right mild hemiparesis and hemisensory disturbance. Six months after the onset, there was no ischemic lesion in the brain stem on magnetic resonance imaging.
Conclusions: In this case, we showed the possibility of brain stem infarction, caused by the intracranial dural AVE (c) 2005 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surneu.2004.12.029

Influence of perianeurysmal environment on the deformation and bleb formation of the unruptured cerebral aneurysm: Assessment with fusion imaging of 3D MR cisternography and 3D MR angiography International journal

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

AMERICAN JOURNAL OF NEURORADIOLOGY 26 ( 8 ) 2010 - 2018 2005.9

Language：English Publisher：AMER SOC NEURORADIOLOGY

BACKGROUND AND PURPOSE: Surface irregularity and bleb formation are anatomical factors that are associated with aneurysm rupture. The perianeurysmal environment has been proposed as one factor that may influence aneurysm morphology. We have developed a fusion imaging technique of 3D MR cisternography and angiography that allows clear visualization of an aneurysm and its environment. This technique may prove useful in further understanding of the natural history of intracranial aneurysms.
METHODS: Fusion images of 3D MR cisternography and angiography were reconstructed by a perspective volume-rendering algorithm from the volume datasets of MR cisternography, obtained by a T2-weighted 3D fast spin-echo sequence, and coordinated MR angiography, by a 3D time-of-flight sequence. On the fusion images, the anatomic relationship of an aneurysm to the perianeurysmal structures was assessed, and the influence of perianeurysmal environment on the deformation and bleb formation of the aneurysm was investigated.
RESULTS: Marked and minor deformation and bleb formation of the aneurysmal dome were found at the areas confronted or adjacent to a certain contact with perianeurysmal structures, including cranial nerves, brain parenchyma, cranial base bones, petroclinoidal dural folds, and dura mater.
CONCLUSION. Fusion images of 3D MR cisternography and angiography can depict the contact of an aneurysm with its perianeurysmal environment; this may provide an additional parameter in consideration for the natural history of cerebral aneurysms.

血管造影室, カテーテル類のセットアップ(LS-12 動脈瘤塞栓術の基本と応用, 第25回日本脳神経外科コングレス総会)

杉生憲志, 徳永浩司, 伊達勲

脳神経外科ジャーナル 14 ( 4 ) 275 - 275 2005.4

Visualization of aneurysmal contours and perianeurysmal environment with conventional and transparent 3D MR cisternography International journal

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

AMERICAN JOURNAL OF NEURORADIOLOGY 26 ( 2 ) 313 - 318 2005.2

Language：English Publisher：AMER SOC NEURORADIOLOGY

We have developed conventional and transparent 3D MR cisternography to investigate the spatial relationship between the contours of aneurysmal complex and the perianeurysmal structures including the cranial nerves, dural fold, cranial base bone, and brain parenchyma. Volume data obtained by a T2-weighted 3D fast spin-echo sequence were reconstructed by using a perspective volume-rendering algorithm with a transluminal imaging technique. 3D MR cisternograms provide useful anatomic information in the therapeutic and follow-up management of unruptured cerebral aneurysms.

Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms

K Sugiu, K Tokunaga, K Watanabe, W Sasahara, S Ono, T Tamiya, Date, I

NEURORADIOLOGY 47 ( 2 ) 158 - 164 2005.2

Language：English Publisher：SPRINGER

The goal of this study was to evaluate the results of endovascular and surgical treatments for ruptured vertebral artery dissecting aneurysms ( VADAs) to determine which treatment is preferable. We evaluated the cases of 25 consecutive patients with ruptured VADAs treated in our institution. From 1992 to 1997,. five patients were treated surgically. Since 1998, 20 patients with VADAs have been treated with endovascular therapy. The goal of the treatment was to exclude the aneurysm from the circulation. Among the five patients undergoing surgery, three aneurysms were treated with proximal clipping, one with trapping, and one with dome clipping. None of the patients were treated during the acute stage of rupture. Transient complications occurred in two patients. Of the 20 patients treated through the endovascular approach, 15 were treated within 24 h of rupture, but 12 had rebleeding before treatment. Eighteen aneurysms were occluded, along with the affected vertebral artery (VA), by using detachable coils (internal trapping), and one was occluded with the VA preserved. A stent-assisted occlusion of one aneurysm was done in a patient who had a contralateral hypoplastic VA. In both groups, the outcome of each patient depended greatly on the patient's condition before treatment and whether there was rebleeding. No posttreatment bleeding occurred. All procedures were effective, but endovascular treatment was less invasive and easier to use during the acute stage of subarachnoid hemorrhage. Although this report does not describe a controlled study, we found that endovascular treatment is preferable for treating ruptured VADAs in the acute stage.

DOI： 10.1007/s00234-005-1341-4

脳血管障害への新しい治療戦略としての11Rによる脳血管壁への蛋白導入.

小川智之, 小野成紀, 市川智継, 有光帥二, 道上宏之, 小野田惠介, 徳永浩司, 杉生憲志, 富澤一仁, 松井秀樹, 伊達勲

脳卒中の外科 2005

Endovascular treatment for elderly patients with ruptured aneurysm

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

New Trends of Surgery for Stroke and Its Perioperative Management 94 7 - 9 2005

Language：English Publisher：SPRINGER-VERLAG WIEN

We report our results of endovascular treatment for elderly patients with ruptured aneurysm and discuss the indication for treatment. One hundred and thirty four consecutive patients with ruptured aneurysm treated in our institute during the last 4 years were retrospectively evaluated. Fifty eight patients were included in group A (over 70 years old), and 76 patients in group B (under 69 years old). In both groups, the outcome was strongly related to the preoperative Hunt & Kosnik grade. However, significant risk factors (i.e. pneumonia, rupture of extracranial aneurysm) which make prognosis poor were more common in group A. Group A showed poor outcome in grade III patients, although there were no outcome differences between the two groups in patients of other grades. Endovascular treatment for elderly patients with ruptured aneurysms seemed to be useful. Their outcome was strongly related to their preoperative condition. General risk factors should be evaluated before treatment, especially in elderly patients. Patients with low Hunt & Kosnik grade seem to be most suitable for endovascular treatment. On the other hand, outcome of patients with poor preoperative grade was worse despite the less invasive nature of endovascular treatment. An improvement of outcome in grade III patients is desirable.

DOI： 10.1007/3-211-27911-3-2