Faculty Profiles - SUGIU Kenji

Cerebral Vasospasm in Patients over 80 Years Treated by Coil Embolization for Ruptured Cerebral Aneurysms International journal

Tomohito Hishikawa, Yuji Takasugi, Tomohisa Shimizu, Jun Haruma, Masafumi Hiramatsu, Koji Tokunaga, Kenji Sugiu, Isao Date

BIOMED RESEARCH INTERNATIONAL 2014 253867 - 253867 2014

Language：English Publisher：HINDAWI PUBLISHING CORPORATION

Object. The effect on clinical outcomes of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) in patients over 80 years who underwent coil embolization was evaluated. Methods. Forty-four cases were reviewed and divided into two groups according to patient age: Group A, 79 years or younger, and Group B, 80 or older. Patient characteristics, prevalence of symptomatic vasospasm, modified Rankin Scale (mRS) scores at discharge and frequency of symptomatic vasospasm in patients with mRS scores of 3-6 were analyzed. Results. Thirty-two (73%) of the 44 cases were categorized as Group A and 12 (27%) as Group B. Group B had a significantly higher prevalence of symptomatic vasospasm compared to Group A (P = 0.0040). mRS scores at discharge were significantly higher in Group B than in Group A (P = 0.0494). Among cases with mRS scores of 3-6, there was a significantly higher frequency of symptomatic vasospasm in Group B than in Group A (P = 0.0223). Conclusions. In our cohort of aneurysmal SAH patients treated by coil embolization, patients over 80 years of age were more likely to suffer symptomatic vasospasm, which significantly correlated with worse clinical outcomes, than those 79 years and under.

DOI： 10.1155/2014/253867

Cerebral Vasospasm in Patients over 80 Years Treated by Coil Embolization for Ruptured Cerebral Aneurysms

Tomohito Hishikawa, Yuji Takasugi, Tomohisa Shimizu, Jun Haruma, Masafumi Hiramatsu, Koji Tokunaga, Kenji Sugiu, Isao Date

BIOMED RESEARCH INTERNATIONAL 2014 253867 - 253867 2014

Language：English Publisher：HINDAWI PUBLISHING CORPORATION

DOI： 10.1155/2014/253867

閉塞した頭骨動脈バイパスグラフトに間接的な側副血行の発達を認め治療完遂に至った海綿静脈洞部巨大内頚動脈瘤の1例

Combined transarterial and transvenous approach for curative obliteration of Klippel-Trenaunay-Weber syndrome-associated spinal perimedullary arteriovenous fistulas

Tokunaga K, Hishikawa T, Sugiu K, Date I

Clin Neuroradiol Jul 10. [Epub ahead of print]-Jul 10. [Epub ahead of print] 2014

コイル塞栓術は、なぜ充填率20%で塞栓できるのか？

杉生憲志

BRAIN NURSING 30 ( 10 ) 64 - 64 2014

徳永浩司, 菱川朋人, 杉生憲志, 伊達勲

脳神経外科 42 ( 1 ) 59 - 64 2014

The proposal of subgroups for grade V on World Federation of Neurologic Surgeons Grading for subarachnoid hemorrhage

M. Nakagawa, K. Sugiu, K. Tokunaga, C. Sakamoto, K. Fujiwara

JOURNAL OF NEUROSURGICAL SCIENCES 57 ( 4 ) 303 - 306 2013.12

Language：English Publisher：EDIZIONI MINERVA MEDICA

Aim. Some of cases suffering from subarachnoid hemorrhages (SAHs) in grade V on World Federation of Neurologic Surgeons (WFNS) grading can gain a good prognosis. The outcome of patients of SAN in grade V on WFNS grading in their institute was here investigated.
Methods. Between April 2007 and July 2012, consecutive 37 patients had SAN diagnosed on CT scan and were classified in grade V on WFNS grading in Kosei General Hospital. There were seventeen male and twenty female patients. We were assigned to patients with spontaneous respiration and without oculomotor palsy (N group, N.=11), and patients with oculomotor palsy (O group, N.=26). Patients were evaluated by mRS.
Results. The prognosis in N group was significantly better than in 0 group (P<0.001).
Conclusion. Surgical treatments should be considered for SAN patients without oculomotor palsy. It is necessary to make subgroups in grade V on WFNS grading in order to decide operative indication and evaluate the treatment results of SAN in grade V.

Mannitol enhances therapeutic effects of intra-arterial transplantation of mesenchymal stem cells into the brain after traumatic brain injury

Yu Okuma, Feifei Wang, Atsuhiko Toyoshima, Masahiro Kameda, Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Keyue Liu, Jun Haruma, Masahiro Nishibori, Takao Yasuhara, Isao Date

NEUROSCIENCE LETTERS 554 156 - 161 2013.10

Language：English Publisher：ELSEVIER IRELAND LTD

Traumatic brain injury (TBI) sustained in a traffic accident or a fall is a major cause of death that affects a broad range of ages. The aim of this study was to investigate the therapeutic effects of intra-arterial transplantation of mesenchymal stem cells (MSCs) combined with hypertonic glycerol (25%) or mannitol (25%) in a TBI model of rats. TBI models were produced with a fluid percussion device. At 24 h after TBI, MSCs (1 x 10(6) cells/100 mu l) with glycerol or mannitol were administered via the right internal carotid artery. Rats were evaluated behaviorally and immunohistochemically, and hyperpermeability of the blood-brain barrier (BBB) induced by hypertonic solutions was explored. Compared to PBS or glycerol, the administration of mannitol resulted in increased BBB disruption. The mannitol-treated rats showed significant improvement in motor function. Intra-arterial transplantation of MSCs caused no thromboembolic ischemia. Immunohistochemically, more MSCs were observed in the injured brain tissues of mannitol-treated rats than in glycerol or PBS-treated rats at 24 h after transplantation. Intra-arterial transplantation of MSCs combined with mannitol is an effective treatment in a TBI model of rats. This technique might be used for patients with diseases of the central nervous system including TBI. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2013.08.058

Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease Clinical article International journal

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

JOURNAL OF NEUROSURGERY 119 ( 4 ) 961 - 965 2013.10

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

Object. There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progression and predicting prognosis. The aim of this study was to assess the difference in posterior circulation involvement in pediatric and adult patients with MMD.
Methods. The records of 120 consecutive patients with MMD were reviewed. The clinical manifestations at diagnosis were evaluated on the basis of symptoms and CT and MRI findings. The degree of steno-occlusive internal carotid artery (ICA) lesions and the existence of steno-occlusive PCA lesions were evaluated by observing a total of 240 ICAs and PCAs on angiography. Angiographic correlation between anterior and posterior circulation was assessed in pediatric and adult patients with MMD.
Results. Seventeen (26%) of 66 pediatric patients and 18 (33%) of 54 adult patients exhibited steno-occlusive PCA lesions. There was no significant difference in the prevalence of PCA lesions between pediatric and adult patients with MMD (p = 0.36). The prevalence of infarction in pediatric and adult patients with PCA involvement was significantly higher than that in pediatric and adult patients without PCA involvement (p = 0.0003 and p = 0.003, respectively). There was no significant difference in the distribution of infarction areas between pediatric and adult patients with PCA involvement (p = 0.62). On the basis of the staging system used, steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions were in significantly advanced stages compared with lesions in ICAs ipsilateral to PCAs without lesions in both pediatric and adult cases (p < 0.0001 and p = 0.0008, respectively). Pediatric patients had less advanced steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions compared with adults (p < 0.05).
Conclusions. The clinical significance of posterior circulation involvement in MMD was similar between pediatric and adult patients. The only significant difference was that less advanced ICA lesions could complicate posterior circulation involvement in pediatric patients.

DOI： 10.3171/2013.6.JNS122099

Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of Neurosurgery 119 ( 4 ) 961 - 965 2013.10

Language：English

Object. There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progression and predicting prognosis. The aim of this study was to assess the difference in posterior circulation involvement in pediatric and adult patients with MMD. Methods. The records of 120 consecutive patients with MMD were reviewed. The clinical manifestations at diagnosis were evaluated on the basis of symptoms and CT and MRI findings. The degree of steno-occlusive internal carotid artery (ICA) lesions and the existence of steno-occlusive PCA lesions were evaluated by observing a total of 240 ICAs and PCAs on angiography. Angiographic correlation between anterior and posterior circulation was assessed in pediatric and adult patients with MMD. Results. Seventeen (26%) of 66 pediatric patients and 18 (33%) of 54 adult patients exhibited steno-occlusive PCA lesions. There was no significant difference in the prevalence of PCA lesions between pediatric and adult patients with MMD (p = 0.36). The prevalence of infarction in pediatric and adult patients with PCA involvement was significantly higher than that in pediatric and adult patients without PCA involvement (p = 0.0003 and p = 0.003, respectively). There was no significant difference in the distribution of infarction areas between pediatric and adult patients with PCA involvement (p = 0.62). On the basis of the staging system used, steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions were in significantly advanced stages compared with lesions in ICAs ipsilateral to PCAs without lesions in both pediatric and adult cases (p &lt
0.0001 and p = 0.0008, respectively). Pediatric patients had less advanced steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions compared with adults (p &lt
0.05). Conclusions. The clinical significance of posterior circulation involvement in MMD was similar between pediatric and adult patients. The only significant difference was that less advanced ICA lesions could complicate posterior circulation involvement in pediatric patients. © AANS, 2013.

DOI： 10.3171/2013.6.JNS122099

Scopus

Mannitol enhances therapeutic effects of intra-arterial transplantation of mesenchymal stem cells into the brain after traumatic brain injury International journal

Yu Okuma, Feifei Wang, Atsuhiko Toyoshima, Masahiro Kameda, Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Keyue Liu, Jun Haruma, Masahiro Nishibori, Takao Yasuhara, Isao Date

NEUROSCIENCE LETTERS 554 156 - 161 2013.10

Language：English Publisher：ELSEVIER IRELAND LTD

DOI： 10.1016/j.neulet.2013.08.058

Novel 3D-CT evaluation of carotid stent volume: greater chronological expansion of stents in patients with vulnerable plaques

Hisakazu Itami, Koji Tokunaga, Yu Okuma, Tomohito Hishikawa, Kenji Sugiu, Kentaro Ida, Isao Date

NEURORADIOLOGY 55 ( 9 ) 1153 - 1160 2013.9

Language：English Publisher：SPRINGER

Although self-expanding carotid stents may dilate gradually, the degrees of residual stenosis have been quantified by the NASCET criteria, which is too simple to reflect the configuration of the stented artery. We measured the volumes of the stent lumens chronologically by 3D-CT in patients after carotid artery stenting (CAS), and analyzed the correlations between the volume change and medical factors.
Fourteen patients with carotid artery stenosis were treated using self-expanding, open-cell stents. All patients underwent preoperative plaque MRI (magnetization-prepared rapid acquisition gradient-echo, MPRAGE) and chronological 3D-CT examinations of their stents immediately after their placement and 1 day, 1 week, and 1 month after the procedure. The volume of the stent lumen was measured using a 3D workstation. The correlations between stent volume and various factors including the presence of underlying diseases, plaque characteristics, and the results of the CAS procedure were analyzed.
Stent volume gradually increased in each case and had increased by 1.04-1.55 (mean, 1.25)-fold at 1 postoperative month. The presence of underlying medical diseases, plaque length, the degree of residual stenosis immediately after CAS, and plaque calcification did not have an impact on the change in stent volume. On the other hand, the stent volume increase was significantly larger in the patients with vulnerable plaques that demonstrated high MPRAGE signal intensity (P < 0.05).
A 3D-CT examination is useful for precisely measuring stent volume. Self-expanding stents in carotid arteries containing vulnerable plaques expand significantly more than those without such plaques in a follow-up period.

DOI： 10.1007/s00234-013-1223-0

Novel 3D-CT evaluation of carotid stent volume: greater chronological expansion of stents in patients with vulnerable plaques International journal

Hisakazu Itami, Koji Tokunaga, Yu Okuma, Tomohito Hishikawa, Kenji Sugiu, Kentaro Ida, Isao Date

NEURORADIOLOGY 55 ( 9 ) 1153 - 1160 2013.9

Language：English Publisher：SPRINGER

DOI： 10.1007/s00234-013-1223-0

Clinical and radiographic features of moyamoya disease in patients with both cerebral ischaemia and haemorrhage International journal

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

BRITISH JOURNAL OF NEUROSURGERY 27 ( 2 ) 198 - 201 2013.4

Language：English Publisher：INFORMA HEALTHCARE

Objectives. Patients with moyamoya disease (MMD) very rarely develop both cerebral ischaemia and haemorrhage. The aim of this study was to clarify the clinical and radiographic features of MMD in patients who presented with both ischaemia and haemorrhage, compared with MMD patients who presented with one or the other. Materials and methods. The records of 92 consecutive patients with MMD were reviewed. These patients were divided into three groups, according to the type of presentation: ischaemic presentation (Group I); haemorrhagic presentation (Group H); and haemorrhagic-ischaemic presentation (Group H-I). The patient characteristics, areas of infarction, and angiographic findings were evaluated. Results. Seventy-six (82%) of the 92 patients were categorised as Group I, 7 (8%) as Group H, and 9 (10%) as Group H-I. Median follow-up periods for Group H-I was 55 months (IQR, 36-116 months). There were eight females in Group H-I, in which the median age was 30 years. Of the nine cases in Group H-I, six presented with cerebral haemorrhage as the precedent event and three had complications during the acute phase. In Group H-I, the prevalence of posterior cerebral artery (PCA) lesions was high (42%) and infarctions were most frequently found in PCA-related areas. Conclusions. The presence of steno-occlusive PCA lesions may be of pathogenic importance in MMD patients who develop both cerebral ischaemia and haemorrhage. The prevalence of this type of stroke in MMD patients is higher than expected, and further investigation in clinical settings is thus warranted

DOI： 10.3109/02688697.2012.717983

Clinical and radiographic features of moyamoya disease in patients with both cerebral ischaemia and haemorrhage

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

BRITISH JOURNAL OF NEUROSURGERY 27 ( 2 ) 198 - 201 2013.4

Language：English Publisher：INFORMA HEALTHCARE

DOI： 10.3109/02688697.2012.717983