MISC - 杉生　憲志

地方中核病院における超急性期脳梗塞血栓回収術の現状と課題

高橋 悠, 木村 颯, 牧野 圭悟, 小林 和樹, 杉生 憲志, 吉田 秀行

脳血管内治療   3 ( Suppl. )   S188 - S188   2018年11月

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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Angioarchitecture of arteriovenous fistulas at the craniocervical junction: A multicenter cohort study of 54 patients 国際誌

Masafumi Hiramatsu, Kenji Sugiu, Tomoya Ishiguro, Hiro Kiyosue, Kenichi Sato, Keisuke Takai, Yasunari Niimi, Yuji Matsumaru

Journal of Neurosurgery   128 ( 6 )   1839 - 1849   2018年6月

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記述言語：英語   出版者・発行元：American Association of Neurological Surgeons  

OBJECTIVE The aim of this retrospective multicenter cohort study was to assess the details of the angioarchitecture of arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) and to determine the associations between the angiographic characteristics and the clinical presentations and outcomes. METHODS The authors analyzed angiographic and clinical data for patients with CCJ AVFs from 20 participating centers that are members of the Japanese Society for Neuroendovascular Therapy (JSNET). Angiographic findings (feeding artery, location of AV shunt, draining vein) and patient data (age, sex, presentation, treatment modality, outcome) were tabulated and stratified based on the angiographic types of the lesions, as diagnosed by a member of the CCJ AVF study group, which consisted of a panel of 6 neurointerventionalists and 1 spine neurosurgeon. RESULTS The study included 54 patients (median age 65 years, interquartile range 61-75 years) with a total of 59 lesions. Five angiographic types were found among the 59 lesions: Type 1, dural AVF (22 [37%] of 59)
Type 2, radicular AVF (17 [29%] of 59)
Type 3, epidural AVF (EDAVF) with pial feeders (8 [14%] of 59)
Type 4, EDAVF (6 [10%] of 59)
and Type 5, perimedullary AVF (6 [10%] of 59). In almost all lesions (98%), AV shunts were fed by radiculomeningeal arteries from the vertebral artery that drained into intradural or epidural veins through AV shunts on the dura mater, on the spinal nerves, in the epidural space, or on the spinal cord. In more than half of the lesions (63%), the AV shunts were also fed by a spinal pial artery from the anterior spinal artery (ASA) and/or the lateral spinal artery. The data also showed that the angiographic characteristics associated with hemorrhagic presentations-the most common presentation of the lesions (73%)-were the inclusion of the ASA as a feeder, the presence of aneurysmal dilatation on the feeder, and CCJ AVF Type 2 (radicular AVF). Treatment outcomes differed among the angiographic types of the lesions. CONCLUSIONS Craniocervical junction AVFs commonly present with hemorrhage and are frequently fed by both radiculomeningeal and spinal pial arteries. The AV shunt develops along the C-1 or C-2 nerve roots and can be located on the spinal cord, on the spinal nerves, and/or on the inner or outer surface of the dura mater.

DOI： 10.3171/2017.3.JNS163048

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Angioarchitecture of arteriovenous fistulas at the craniocervical junction: A multicenter cohort study of 54 patients

Masafumi Hiramatsu, Kenji Sugiu, Tomoya Ishiguro, Hiro Kiyosue, Kenichi Sato, Keisuke Takai, Yasunari Niimi, Yuji Matsumaru

Journal of Neurosurgery   128 ( 6 )   1839 - 1849   2018年6月

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記述言語：英語   出版者・発行元：American Association of Neurological Surgeons  

OBJECTIVE The aim of this retrospective multicenter cohort study was to assess the details of the angioarchitecture of arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) and to determine the associations between the angiographic characteristics and the clinical presentations and outcomes. METHODS The authors analyzed angiographic and clinical data for patients with CCJ AVFs from 20 participating centers that are members of the Japanese Society for Neuroendovascular Therapy (JSNET). Angiographic findings (feeding artery, location of AV shunt, draining vein) and patient data (age, sex, presentation, treatment modality, outcome) were tabulated and stratified based on the angiographic types of the lesions, as diagnosed by a member of the CCJ AVF study group, which consisted of a panel of 6 neurointerventionalists and 1 spine neurosurgeon. RESULTS The study included 54 patients (median age 65 years, interquartile range 61-75 years) with a total of 59 lesions. Five angiographic types were found among the 59 lesions: Type 1, dural AVF (22 [37%] of 59)
Type 2, radicular AVF (17 [29%] of 59)
Type 3, epidural AVF (EDAVF) with pial feeders (8 [14%] of 59)
Type 4, EDAVF (6 [10%] of 59)
and Type 5, perimedullary AVF (6 [10%] of 59). In almost all lesions (98%), AV shunts were fed by radiculomeningeal arteries from the vertebral artery that drained into intradural or epidural veins through AV shunts on the dura mater, on the spinal nerves, in the epidural space, or on the spinal cord. In more than half of the lesions (63%), the AV shunts were also fed by a spinal pial artery from the anterior spinal artery (ASA) and/or the lateral spinal artery. The data also showed that the angiographic characteristics associated with hemorrhagic presentations-the most common presentation of the lesions (73%)-were the inclusion of the ASA as a feeder, the presence of aneurysmal dilatation on the feeder, and CCJ AVF Type 2 (radicular AVF). Treatment outcomes differed among the angiographic types of the lesions. CONCLUSIONS Craniocervical junction AVFs commonly present with hemorrhage and are frequently fed by both radiculomeningeal and spinal pial arteries. The AV shunt develops along the C-1 or C-2 nerve roots and can be located on the spinal cord, on the spinal nerves, and/or on the inner or outer surface of the dura mater.

DOI： 10.3171/2017.3.JNS163048

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Combined gene therapy with vascular endothelial growth factor plus apelin in a chronic cerebral hypoperfusion model in rats

Masafumi Hiramatsu, Tomohito Hishikawa, Koji Tokunaga, Hiroyasu Kidoya, Shingo Nishihiro, Jun Haruma, Tomohisa Shimizu, Yuji Takasugi, Yukei Shinji, Kenji Sugiu, Nobuyuki Takakura, Isao Date

JOURNAL OF NEUROSURGERY   127 ( 3 )   679 - 686   2017年9月

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記述言語：英語   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

OBJECTIVE The aim of this study was to evaluate whether combined gene therapy with vascular endothelial growth factor (VEGF) plus apelin during indirect vasoreconstructive surgery enhances brain angiogenesis in a chronic cerebral hypoperfusion model in rats.
METHODS A chronic cerebral hypoperfusion model induced by the permanent ligation of bilateral common carotid arteries (CCAs; a procedure herein referred to as "CCA occlusion" [CCAO]) in rats was employed in this study. Seven days after the CCAO procedure, the authors performed encephalo-myo-synangiosis (EMS) and injected plasmid(s) into each rat's temporal muscle. Rats were divided into 4 groups based on which plasmid was received (i.e., LacZ group, VEGF group, apelin group, and VEGF+apelin group). Protein levels in the cortex and attached muscle were assessed with enzyme-linked immunosorbent assay (ELISA) on Day 7 after EMS, while immunofluorescent analysis of cortical vessels was performed on Day 14 after EMS.
RESULTS The total number of blood vessels in the cortex on Day 14 after EMS was significantly larger in the VEGF group and the VEGF+apelin group than in the LacZ group (p < 0.05, respectively). Larger vessels appeared in the VEGF+apelin group than in the other groups (p < 0.05, respectively). Apelin protein on Day 7 after EMS was not detected in the cortex for any of the groups. In the attached muscle, apelin protein was detected only in the apelin group and the VEGF+apelin group. Immunofluorescent analysis revealed that apelin and its receptor, APJ, were expressed on endothelial cells (ECs) 7 days after the CCAO.
CONCLUSIONS Combined gene therapy (VEGF plus apelin) during EMS in a chronic cerebral hypoperfusion model can enhance angiogenesis in rats. This treatment has the potential to be a feasible option in a clinical setting for patients with moyamoya disease.

DOI： 10.3171/2016.8.JNS16366

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Combined gene therapy with vascular endothelial growth factor plus apelin in a chronic cerebral hypoperfusion model in rats 国際誌

Masafumi Hiramatsu, Tomohito Hishikawa, Koji Tokunaga, Hiroyasu Kidoya, Shingo Nishihiro, Jun Haruma, Tomohisa Shimizu, Yuji Takasugi, Yukei Shinji, Kenji Sugiu, Nobuyuki Takakura, Isao Date

JOURNAL OF NEUROSURGERY   127 ( 3 )   679 - 686   2017年9月

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記述言語：英語   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

OBJECTIVE The aim of this study was to evaluate whether combined gene therapy with vascular endothelial growth factor (VEGF) plus apelin during indirect vasoreconstructive surgery enhances brain angiogenesis in a chronic cerebral hypoperfusion model in rats.
METHODS A chronic cerebral hypoperfusion model induced by the permanent ligation of bilateral common carotid arteries (CCAs; a procedure herein referred to as "CCA occlusion" [CCAO]) in rats was employed in this study. Seven days after the CCAO procedure, the authors performed encephalo-myo-synangiosis (EMS) and injected plasmid(s) into each rat's temporal muscle. Rats were divided into 4 groups based on which plasmid was received (i.e., LacZ group, VEGF group, apelin group, and VEGF+apelin group). Protein levels in the cortex and attached muscle were assessed with enzyme-linked immunosorbent assay (ELISA) on Day 7 after EMS, while immunofluorescent analysis of cortical vessels was performed on Day 14 after EMS.
RESULTS The total number of blood vessels in the cortex on Day 14 after EMS was significantly larger in the VEGF group and the VEGF+apelin group than in the LacZ group (p < 0.05, respectively). Larger vessels appeared in the VEGF+apelin group than in the other groups (p < 0.05, respectively). Apelin protein on Day 7 after EMS was not detected in the cortex for any of the groups. In the attached muscle, apelin protein was detected only in the apelin group and the VEGF+apelin group. Immunofluorescent analysis revealed that apelin and its receptor, APJ, were expressed on endothelial cells (ECs) 7 days after the CCAO.
CONCLUSIONS Combined gene therapy (VEGF plus apelin) during EMS in a chronic cerebral hypoperfusion model can enhance angiogenesis in rats. This treatment has the potential to be a feasible option in a clinical setting for patients with moyamoya disease.

DOI： 10.3171/2016.8.JNS16366

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PubMed

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Training guidelines for endovascular stroke intervention: an international multi-society consensus document (vol 58, pg 537, 2016)

S. D. Lavine, K. Cockroft, B. Hoh, N. Bambakidis, A. A. Khalessi, H. Woo, H. Riina, A. Siddiqui, J. A. Hirsch, W. Chong, H. Rice, J. Wenderoth, P. Mitchell, A. Coulthard, T. J. Signh, C. Phatouros, M. Khangure, P. Klurfan, K. ter Brugge, D. Iancu, T. Gunnarsson, O. Jansen, M. Muto, I. Szikora, L. Pierot, P. Brouwer, J. Gralla, S. Renowden, T. Andersson, J. Fiehler, F. Turjman, P. White, A. C. Januel, L. Spelle, Z. Kulcsar, R. Chapot, A. Biondi, S. Dima, C. Taschner, M. Szajner, A. Krajina, N. Sakai, Y. Matsumaru, S. Yoshimura, M. Ezura, T. Fujinaka, K. Iihara, A. Ishii, T. Higashi, M. Hirohata, A. Hyodo, Y. Ito, M. Kawanishi, H. Kiyosue, E. Kobayashi, S. Kobayashi, N. Kuwayama, Y. Matsumoto, S. Miyachi, Y. Murayama, I. Nagata, I. Nakahara, S. Nemoto, Y. Niimi, H. Oishi, J. Satomi, T. Satow, K. Sugiu, M. Tanaka, T. Terada, H. Yamagami, O. Diaz, P. Lylyk, M. V. Jayaraman, A. Patsalides, C. D. Gandhi, S. K. Lee, T. Abruzzo, B. Albani, S. A. Ansari, A. S. Arthur, B. W. Baxter, K. R. Bulsara, M. Chen, J. E. Delgado Almandoz, J. F. Fraser, D. V. Heck, S. W. Hetts, M. S. Hussain, R. P. Klucznik, T. M. Leslie-Mawzi, W. J. Mack, R. A. McTaggart, P. M. Meyers, J. Mocco, C. J. Prestigiacomo, G. L. Pride, P. A. Rasmussen, R. M. Starke, P. J. Sunenshine, R. W. Tarr, D. F. Frei, M. Ribo, R. G. Nogueira, O. O. Zaidat, T. Jovin, I. Linfante, D. Yavagal, D. Liebeskind, R. Novakovic, S. Pongpech, G. Rodesch, M. Soderman, A. Taylor, T. Krings, D. Orbach, L. Picard, D. C. Suh, H. Q. Zhang

NEURORADIOLOGY   59 ( 8 )   829 - 829   2017年8月

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00234-017-1861-8

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De novo vertebral artery dissecting aneurysm after internal trapping of the contralateral vertebral artery 国際誌

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

ACTA NEUROCHIRURGICA   159 ( 7 )   1329 - 1333   2017年7月

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記述言語：英語   出版者・発行元：SPRINGER WIEN  

We present the case of a de novo vertebral artery dissecting aneurysm (VADA) after endovascular trapping of a ruptured VADA on the contralateral side. The first ruptured VADA involved the posterior inferior cerebellar artery, which was successfully treated by endovascular internal trapping using a stent. A follow-up study at 3 months revealed a de novo VADA on the contralateral side. The second VADA was successfully embolized using coils while normal arterial flow in the vertebral artery was preserved using a stent. Increased hemodynamic stress may cause the development of a de novo VADA on the contralateral side.

DOI： 10.1007/s00701-017-3204-2

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PubMed

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Efficacy of Staged Angioplasty to Prevent Cerebral Hyperperfusion Syndrome After Endovascular Revascularization for Carotid Artery Stenosis

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

STROKE   48   2017年2月

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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子どもたちだけではなく大人達にも夢を、100年続くような…─リレーエッセイ 時間の風景─.

杉生憲志

Medical Tribune   50 ( 36 )   24 - 24   2017年

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頭痛のみを契機に発見された椎骨動脈解離性動脈瘤─内科治療で乗り切る？ステント留置を勧める？─.

天野達雄, 早川幹人, 村井 智, 杉生憲志

脳神経外科速報   27 ( 12 )   1266 - 1272   2017年

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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非もやもや病小児脳梗塞・脳虚血症例の治療におけるチーム医療の重要性.

安原隆雄, 菱川朋人, 亀田雅博, 平松匡文, 杉生憲志, 野坂宣之, 塚原紘平, 八代将登, 林裕美子, 伊達 勲

脳卒中の外科   45 ( 6 )   476 - 482   2017年

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

症例1:9歳女児。左片麻痺で発症し、右内包後脚脳梗塞と診断された。aspirin内服を行い、24ヵ月再発なく外来加療中である。症例2:13歳男児。けいれん発作、意識障害、左片麻痺が生じ、動脈炎として加療開始された。右中大脳動脈領域に脳梗塞を認めたため外減圧術を施行したが、第62病日に頭蓋骨形成術を施行後に意識障害が生じ、けいれん重積状態となった。barbitalを用いた2週間にわたる鎮静・呼吸循環管理にて徐々に改善したが、左不全麻痺の悪化、右不全麻痺を生じた。17ヵ月経過現在、両杖をついた歩行訓練を行っている。症例3:10ヵ月女児。左不全片麻痺で発症し、3日後に意識障害が生じた。右側の血栓性脳梗塞と考えaspirin内服を開始したが、脳梗塞の再発、左側に新規の脳梗塞を来たした。warfarinとaspirinの内科加療を開始し、16ヵ月再発なく経過している。症例4:2歳女児。Klippel-Trenaunay症候群として経過観察されていた。繰り返す左片麻痺とけいれん発作が生じ、右内頸動脈の閉塞ないし狭窄に伴う脳虚血と診断し、aspirin内服加療を開始した。16ヵ月間再発なく経過している。

DOI： 10.2335/scs.45.476

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LVIS & LVIS Jr stent.

杉生憲志

Rad Fan   15 ( 12 )   72 - 74   2017年

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dAVFの治療─横S状静脈洞部─.

平松匡文, 菱川朋人, 杉生憲志

Clinical Neuroscience   35 ( 10 )   1222 - 1225   2017年

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急性期脳梗塞の血管内治療最前線.

杉生憲志, 平松匡文, 菱川朋人, 伊達 勲

日本内科学会雑誌   106 ( 8 )   1646 - 1651   2017年

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硬膜動静脈瘻─動脈・静脈の疾患（臓器別）：脳血管疾患─.

菱川朋人, 杉生憲志, 伊達 勲

日本臨床 増刊号 動脈・静脈の疾患 下   75 ( Suppl 5 )   715 - 718   2017年

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3DDSA-MRI fusion画像を用いた脳血管障害に対する開頭手術術前シミュレーション.

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, 伊達 勲

脳卒中の外科   45 ( 4 )   270 - 275   2017年

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

2013年9月〜2015年10月に脳血管障害に対する開頭手術術前に3DDSA-MRI fusion画像を作成した3例を対象に、画像作成法を紹介し、脳血管障害に対する手術の術前シミュレーションとして有用か検討した。fusion画像は10〜15分程度で、全例問題なく作成できた。全例、fusion画像の有用性が認められ、手術戦略や手術アプローチに影響を与えていた。血管位置の最大誤差は平均2.5±0.1mmであったが、実際の術野での脳表上の血管構造物の同定には全例支障がなかった。頭蓋内血管病変に対する3DDSA-MRI fusionを活用することで、脳血管障害に対する術前シミュレーションとして有効と思われた。

DOI： 10.2335/scs.45.270

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手術当日術全塞栓術が有用であった充実性小脳血管芽腫の2例.

桑原 研, 市川智継, 春間 純, 菱川朋人, 平松匡文, 杉生憲志, 伊達 勲

脳神経外科   45 ( 7 )   615 - 622   2017年

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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, 村井 智, 春間 純, 菱川朋人, 平松匡文, 高橋 悠, 木谷尚哉, 西廣真吾, 伊野英男, 伊達 勲

脳神経外科速報   27 ( 7 )   751 - 754   2017年

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

当科では医学生やメディカルスタッフに対して、血管内治療シミュレーターVascular Intervention Simulator Trainer(VIST)を用いたシミュレーション教育を行っており、その有効性について検討した。実習は3名1組となり、VISTを用いてデバイスの選択、血管造影、カテーテル操作、コイル塞栓術の手技を行った。実習終了後に行った筆記試験やアンケートでは血管内治療への理解度向上の効果が得られた。VISTを用いた血管内治療シミュレーション教育は血管内治療や血管解剖の理解度向上に効果があり、医学生に対して脳神経外科や脳血管内治療への興味喚起につながり、メディカルスタッフに対してより良いチーム医療の形成に役立つと考えられた。(著者抄録)

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Preoperative embolization for solid cerebellar hemangioblastoma on the day of surgery

Ken Kuwahara, Tomotsugu Ichikawa, Jun Haruma, Tomohito Hishikawa, Masafumi Hiramatsu, Kenji Sugiu, Isao Date

Neurological Surgery, No shinkei geka. Neurological surgery   45 ( 7 )   615 - 622   2017年

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記述言語：日本語  

DOI： 10.11477/mf.1436203560

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Post coiling syndrome might predict recurrence after coil embolization of unruptured cerebral aneurysms.

Okuma Y, Sugiu K, Hirotsune N, Hishikawa T, Muraoka K, Hiramatsu M, Nishino S, Date I

Journal of Neuroendovascular Therapy   11 ( 5 )   235 - 239   2017年

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DOI： 10.5797/jnet.oa.2016-0092

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