Faculty Profiles - SUGIU Kenji

Vertebroplasty : clinical experience and follow-up results..(共著)

MARTIN JB

Bone 25(2 Suppl) ( 2 ) 11S-15S - 15S 1999

Malignant cerebellar astrocytoma developing 15 years after radiation therapy for a medulloblastoma

T. Furuta, K. Sugiu, T. Tamiya, K. Matsumoto, T. Ohmoto

Clinical Neurology and Neurosurgery 100 ( 1 ) 56 - 59 1998.3

Language：English

A case of malignant cerebellar astrocytoma occurring 15 years after the radiation therapy for a medulloblastoma is reported. The tumor developed at the same site of irradiation after a sufficient latent period and was completely different from medulloblastoma in its histology. This tumor fulfilled the criteria of radiation-induced neoplasm. Only seven similar cases have been reported up to the present. Whole neuraxis irradiation following a gross total resection is a standard treatment for medulloblastoma, but the possibility of the development of radiation-induced tumors must be borne in mind for a long time after the radiation therapy for medulloblastoma.

DOI： 10.1016/S0303-8467(97)00122-4

Malignant cerebellar astrocytoma developing 15 years after radiation therapy for a medulloblastoma

T. Furuta, K. Sugiu, T. Tamiya, K. Matsumoto, T. Ohmoto

Clinical Neurology and Neurosurgery 100 ( 1 ) 56 - 59 1998.3

Language：English

DOI： 10.1016/S0303-8467(97)00122-4

Neurovascular embolization of cerebral and spinal arteriovenous malformations and fistulas with liquid cellulose acetate polymer

K Sugiu, S Mandai, Kamata, I, K Kinugasa, T Ohmoto, KJ Murphy

RADIOLOGY 205 1450 - 1450 1997.11

Prophylactic thrombosis to prevent new bleeding and to delay aneurysm surgery

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

Neurosurgery 36 ( 4 ) 661 - 667 1995

Language：English

SIX ANEURYSMS IN five patients with acute aneurysmal subarachnoid hemorrhages were treated with direct thrombosis using cellulose acetate polymer within 4 hours of rupture. The aneurysms involved the internal carotid and posterior communicating arteries (two patients), the anterior choroidal artery (one patient), the bifurcation of the basilar artery (one patient), and the middle cerebral artery (two patients). Four patients underwent aggressive volume expansion after direct thrombosis with cellulose acetate polymer. The aneurysms remained thrombosed until operations on the necks were performed 2 to 7 weeks after the subarachnoid hemorrhages. Three patients were given intrathecal tissue plasminogen activator. One patient, who remained at neurological Grade V, was not treated surgically and died from cardiac failure. Five aneurysms in the remaining four patients were successfully clipped. These preliminary data suggest that immediate aneurysmal thrombosis, then aggressive preoperative prophylactic volume expansion and/or administration of intrathecal tissue plasminogen activator, can help prevent new bleeding and reduce delayed cerebral ischemia in patients after aneurysmal subarachnoid hemorrhages. © by the Congress of Neurological Surgeons.

DOI： 10.1227/00006123-199504000-00004

Prophylactic thrombosis to prevent new bleeding and to delay aneurysm surgery

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

Neurosurgery 36 ( 4 ) 661 - 667 1995

Language：English

DOI： 10.1227/00006123-199504000-00004

Early treatment of subarachnoid hemorrhage after preventing rerupture of an aneurysm

K. Kinugasa, I. Kamata, N. Hirotsune, K. Tokunaga, K. Sugiu, A. Handa, H. Nakashima, T. Ohmoto, S. Mandai, Y. Matsumoto

Journal of Neurosurgery 83 ( 1 ) 34 - 41 1995

Language：English Publisher：American Association of Neurological Surgeons

Twelve patients with Hunt and Hess neurological Grades III to V underwent thrombosis of aneurysms using cellulose acetate polymer within 23 hours of aneurysm rupture. On computerized tomography (CT), nine of these patients had diffuse or localized thick subarachnoid blood clots, two had diffuse thin clots, and one had intraventricular clots. Immediately after thrombosis, all patients were administered tissue plasminogen activator (TPA) through spinal or ventricular catheters. The pressure of the lumbar cerebrospinal fluid was maintained at 100 to 150 mm H2O. The TPA was given as multiple injections of 2 mg on Day 0 and 1 to 2 mg on the following 1 to 2 days. In two patients the second injection of TPA was not given because of severe brain damage resulting from the initial subarachnoid hemorrhage. Ten patients showed complete clearance of the cisternal clot on CT within 72 hours after thrombosis. Seven partially thrombosed aneurysms and five multiple aneurysms were clipped during delayed surgery. Only one patient experienced mild vasospasm as shown on the follow-up angiogram. Eight patients improved clinically and had a good recovery, two had severe disability, and two died. Urgent thrombosis of a ruptured aneurysm followed by immediate postthrombotic administration of TPA may be a safe and reasonable means of preventing vasospasm and improving patient outcome.

DOI： 10.3171/jns.1995.83.1.0034

Direct thrombosis of experimental aneurysms with cellulose acetate polymer (CAP): Technical aspects, angiographic follow up, and histological study

K. Sugiu, K. Kinugasa, S. Mandai, K. Tokunaga, T. Ohmoto

Journal of Neurosurgery 83 ( 3 ) 531 - 538 1995

Language：English Publisher：American Association of Neurological Surgeons

Experimental aneurysms were created using a microsurgical technique to produce anastomosed venous pouches in the bilateral common carotid arteries of 12 dogs. The 24 aneurysms were then thrombosed via an endovascular approach with injection of a cellulose acetate polymer (CAP) solution that the authors have developed for use as a liquid thrombotic material. Angiography performed 1 to 4 weeks after CAP injection revealed complete thrombosis of the aneurysm with patency of the parent artery in 16 aneurysms. Histological analysis disclosed that the aneurysmal orifice in these cases was completely covered with newly formed endothelial cells 2 weeks after CAP thrombosis. Three other aneurysms exhibited parent artery occlusion caused by protrusion of the CAP mass through the aneurysmal orifice into the parent artery
this was thought to be caused by over-injection of the CAP solution. Histological analysis of the remaining five aneurysms, initially shown to have incomplete occlusion, revealed that they each possessed a residual neck that was partially covered with endothelial cells. No rupture of the aneurysms or migration of CAP into the distal arteries was observed. These results suggest that using an endovascular approach, direct thrombosis of cerebral aneurysms with CAP is safe and effective. This technique may prove to be an alternative treatment for such aneurysms. However, there is a potential risk of regrowth or rupture of aneurysms that retain a residual neck and long-term follow-up studies will be required to evaluate this issue.

DOI： 10.3171/jns.1995.83.3.0531

Intravascular Thrombosis of Aneurysm Followed by Spinal Drainage Using tPA in the Ultra-early Stage (Day 0) of Subarachnoid Hemorrhage

KKINUGASA Kazushi, KAMATA Ichiro, TOKUNAGA Koji, SUGIU Kenji, HANDA Akira, HIROTSUNE Nobuyuki, NAKASHIMA Hiroyuki, OHMOTO Takashi, MANDAI Shinya, MATSUMOTO Yuzo

Surgery for Cerebral Stroke 23 ( 4 ) 265 - 269 1995

Language：Japanese Publisher：The Japanese Society on Surgery for Cerebral Stroke

This paper describes 12 patients with aneurysmal subarachnoid hemorrhage treated with cellulose acetate polymer (CAP) delivered intra-aneurysmally, to prevent early rebleeding, and then with tissue plasminogen activator (tPA) delivered via spinal catheter to lyse and draw off the subarachnoid clot. All the patients were Grade 3 to 5. Seven incomplete thrombotic aneurysms underwent direct clipping 2 to 7 weeks after CAP thrombosis, when intracranial pressure was normal, subarachnoid blood had cleared and the patients was presumably a more favorable clinical grade. There was no rebleeding and no severe symptomatic vasospasm in this treatment. The overall outcomes were satisfactory (including good in 8, disabled in 2, dead in 2).

DOI： 10.2335/scs1987.23.4_265

CiNii Article

Cellulose acetate polymer thrombosis for the emergency treatment of aneurysms: Angiographic findings, clinical experience, and histopathological study

Kazushi Kinugasa, Shinya Mandai, Shohei Tsuchida, Kenji Sugiu, Ichiro Kamata, Kouji Tokunaga, Takashi Ohmoto, Kohji Taguchi

Neurosurgery 34 ( 4 ) 694 - 701 1994

Language：English

CELLULOSE ACETATE POLYMER solution is a liquid thrombotic material that hardens into the shape of an aneurysm into which it is injected. Therapy using this solution is a rapid technique that helps prevent the rupture of aneurysms, especially those that extravasate contrast material during angiography in the acute stage of subarachnoid hemorrhage. Using this polymer solution and an endovascular technique, we treated two patients who had aneurysms of the basilar and anterior communicating arteries with extravasation of contrast material during angiography a few hours after the initial subarachnoid hemorrhage. In one patient with an aneurysm of the anterior communicating artery, the aneurysm's wall was perforated with the catheter during neurointerventional procedures. In both patients, postoperative angiograms demonstrated obliteration of the aneurysmal dome, including the site of extravasation or perforation. The parent artery and surrounding perforating branches were preserved. Although we do not advocate aggressive therapy for patients who bleed during angiography, we pursued this therapy in these two patients because of the opportunity to introduce cellulose acetate polymer in an attempt to preserve the patients' lives. Unfortunately, both patients died. Histopathological studies performed at the time of autopsy demonstrated that the luminal surface of cellulose acetate polymer was covered with thrombus by 6 days after cellulose acetate polymer thrombosis. By 10 days, the thrombus had a prominent fibrin network, a concentrated plasma component, and few fibrocytes adhering to its luminal surface. The clinical description and results of treatment and histopathological studies are presented here. Copyright © by the Congress of Neurological Surgeons.

DOI： 10.1227/00006123-199404000-00019

Selection and Combination of Techniques for Treating Spontaneous Carotid-cavernous Sinus Fistulas

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

Neurologia Medico-Chirurgica 34 ( 9 ) 597 - 606 1994

Language：English

Twenty-eight patients with spontaneous carotid-cavernous sinus fistulas (CCFs) were treated using a variety of techniques. Three of four patients with direct CCFs underwent intravascular embolization with a detachable balloon. Embolization with polyvinyl alcohol particles through an external carotid endoarterial route was used in six patients with indirect CCFs, and with ethylene-vinyl alcohol copolymer solution in two. Patients undergoing these conventional treatments, including embolization of the meningeal branches of the external carotid artery, had less satisfactory outcomes. The transvenous approach using minicoils through the inferior petrosal sinus was successful in eight patients. One patient treated using the transvenous approach using copper wire through the ophthalmic vein had worsening of visual acuity and field. Unsuccessful transvenous embolization in four patients required direct surgical exposure and embolization with spring coils. Spontaneous cures occurred in four patients. Direct CCFs with high flow rates were best treated with the detachable balloon or coil technique through a internal carotid endoarterial route. Indirect CCFs were best treated with the minicoil through the inferior petrosal sinus. If these techniques fail, direct surgical exposure allows placement of coils into the cavernous sinus. Copyright © 1994, The Japan Neurosurgical Society. All rights reserved.

DOI： 10.2176/nmc.34.597

Selection and Combination of Techniques for Treating Spontaneous Carotid-cavernous Sinus Fistulas

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

Neurologia Medico-Chirurgica 34 ( 9 ) 597 - 606 1994

Language：English

DOI： 10.2176/nmc.34.597

Cellulose acetate polymer thrombosis for the emergency treatment of aneurysms: Angiographic findings, clinical experience, and histopathological study

Kazushi Kinugasa, Shinya Mandai, Shohei Tsuchida, Kenji Sugiu, Ichiro Kamata, Kouji Tokunaga, Takashi Ohmoto, Kohji Taguchi

Neurosurgery 34 ( 4 ) 694 - 701 1994

Language：English

DOI： 10.1227/00006123-199404000-00019

Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience

K. Kinugasa, S. Mandai, Y. Terai, I. Kamata, K. Sugiu, T. Ohmoto, A. Nishimoto

Journal of Neurosurgery 77 ( 4 ) 501 - 507 1992

Language：English

The authors report the treatment of seven intracranial aneurysms in six patients with direct infusion of cellulose acetate polymer solution, a new liquid thrombotic material. These aneurysms were considered inoperable because of their size or location, or because of the patient's neurological condition. This material avoids the difficulties associated with balloon occlusion, and completely fills even irregularly shaped aneurysms. Cellulose acetate polymer solution hardens in about 5 minutes and remains solid once inside the aneurysm. Because this technique is less invasive than surgery, it can be used for high-risk patients in the acute stage of subarachnoid hemorrhage. Transient motor aphasia occurred in one patient. A small residual neck, which caused rebleeding 3 months after the treatment, remained in another patient. This article describes the new material, the procedure for direct thrombosis, and preliminary clinical results.

DOI： 10.3171/jns.1992.77.4.0501

Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience

K. Kinugasa, S. Mandai, Y. Terai, I. Kamata, K. Sugiu, T. Ohmoto, A. Nishimoto

Journal of Neurosurgery 77 ( 4 ) 501 - 507 1992

Language：English

DOI： 10.3171/jns.1992.77.4.0501