Faculty Profiles - SUGIU Kenji

MISC - SUGIU Kenji

Division display >> ／ All the affair displays 1 - 277 of about 277

慢性硬膜下血腫治療後の治療抵抗性硬膜下膿瘍に対して保存的加療を行った一例

金恭平, 安原隆雄, 石田穣治, 春間純, 三宅隼人, 平田雄一, 永瀬喬之, 菅原千明, 佐々田晋, 杉生憲志

日本脳神経外傷学会プログラム・抄録集 47th 2024

出血発症し,保存的加療を行った神経根軟膜動脈解離性動脈瘤の一例

金恭平, 平松匡文, 安原隆雄, 永瀬喬之, 菅原千明, 藪野諭, 佐々田晋, 菱川朋人, 杉生憲志, 伊達勲

日本脊髄外科学会プログラム・抄録集 38th 2023

Cutting Edge of Micro-vascular Anatomy in Neuroendovascular Therapy

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

脳神経外科ジャーナル 31 ( 6 ) 2022

Neuroendovascular Therapy and Infection

平松匡文, 春間純, 菱川朋人, 杉生憲志, 伊達勲

Neurological Surgery 50 ( 5 ) 2022

Slab MIP画像を用いた蝶形骨縁・嗅窩部髄膜腫動脈解剖の解析

平松匡文, 杉生憲志, 菱川朋人, 春間純, 高橋悠, 村井智, 藤井謙太郎, 亀田雅博, 黒住和彦, 伊達勲

日本脳神経CI学会総会プログラム・抄録集(Web) 44th 2021

当院における80歳以上高齢者における未破裂脳動脈瘤治療の検討

春間純, 杉生憲志, 胡谷佑貴, 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

日本老年脳神経外科学会プログラム・抄録集 34th (CD-ROM) 2021

Impact of Spreading Depolarization and Extracellular Glutamate Levels on Early Brain Injury after Subarachnoid Hemorrhage in Rats

Satoshi Murai, Tomohito Hishikawa, Masafumi Hiramatsu, Jun Haruma, Yu Takahashi, Kenji Sugiu, Yoshimasa Takeda, Isao Date

NEUROSURGERY 67 71 - 71 2020.12

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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

硬膜動静脈瘻の経静脈的塞栓術に対する内頚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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

頚部内頚動脈のfenestrationと頚部内頚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(Web) 5 ( Supplement ) 2020

右上腕動脈アプローチでの左内頚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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

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(Web) 5 ( Supplement ) 2020

Cerebral circulation improves with indirect bypass surgery combined with gene therapy

Alex Shear, Shingo Nishihiro, Tomohito Hishikawa, Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Isao Date

BRAIN CIRCULATION 5 ( 3 ) 119 - 123 2019.7

Language：English Publishing type：Book review, literature introduction, etc. Publisher：WOLTERS KLUWER MEDKNOW PUBLICATIONS

Angiogenesis involves new blood vessels sprouting from preexisting blood vessels. This process may serve to improve brain circulation. Moyamoya disease (MMD) is a cerebrovascular disorder causing intracranial stenosis which significantly reduces the blood supply to the brain. Mainly stroke is the first symptom of the disorder, so treatments that reduce the risk of stroke are used for patients with MMD. To prevent stroke for those with chronic cerebral hypoperfusion, more blood needs to flow to the brain, which was thought to be achieved by enhancing angiogenesis. Indirect bypass surgery, such as encephalo-myo-synangiosis (EMS), is used for revascularization. However, EMS alone sometimes cannot provide enough circulation to avoid ischemic strokes. The current study examined if EMS combined with high-mobility group box-1 (HMGB1) and vascular endothelial growth factor (VEGF) enhanced angiogenesis and increased cerebral circulation. The results indicated that HMGB1 administered with EMS increased angiogenesis through a VEGF-dependent mechanism. In addition, exercising and stem cell transplantation possess possible means to increase angiogenesis. Overall, EMS with gene therapy, maintaining fitness, and stem cell utilization may prevent or help one recover from stroke by enhancing brain angiogenesis. Thus, these treatments may be applicable for patients with MMD. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed.

DOI： 10.4103/bc.bc_33_19

神戸宣言、その後急性期脳梗塞に対する血管内治療の普及の取り組み各地方の取り組み中国地方中国四国地方会の取り組み

杉生憲志, 築家秀和, 浜崎理, 春間純, 石原秀行, 鈴木倫保

脳血管内治療 4 ( 1 ) 37 - 43 2019.3

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

【目的】2016年秋の日本脳神経血管内治療学会(JSNET)中国四国地方会における「脳梗塞急性期血行再建」の特別シンポジウムの中から、医療資源を集中させることが困難な山間部過疎地におけるtissue-plasminogen activator(t-PA)静注から血栓回収療法のモデルケースとして下記の3つを報告する。【方法・結果】1)地域の中核病院に集約してcomprehensive stroke center(CSC)に準じる施設を構築し、それまでゼロであった血栓回収療法が急増し、治療成果をあげた。2)大学病院と連携して血管内治療専門医の応援によるMobile Endovascular-therapyを展開し、血栓回収療法施行件数が急増し、それに伴って地元医師の技量も向上し、応援医師が不要となった。3)ドクターヘリ(場合によっては救急車)による全県型のhub-and-spokeモデルによる大学病院のCSC化により、専門医不在地域から遠隔画像を駆使した診療支援により効率的に患者搬送を行い成果をあげた。【結論】これらの取り組みが、日本各地の同様の問題を抱える地域に対して、参考になることを期待する一方、多大なマンパワーが必要で、医師およびメディカルスタッフへの大きな負担の上に成り立っているため、今後の社会整備・サポートの必要性も強調したい。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06751&link_issn=&doc_id=20190402280006&doc_link_id=%2Fcf5nokec%2F2019%2F000401%2F007%2F0037-0043%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2019%2F000401%2F007%2F0037-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Endovascular treatment for unruptured aneurysm associated with persistent primitive trigeminal artery: a case report and literature review International journal

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

ACTA NEUROCHIRURGICA 161 ( 2 ) 407 - 411 2019.2

Language：English Publisher：SPRINGER WIEN

The persistent primitive trigeminal artery (PPTA) is the most common carotid-basilar anastomosis, and the incidence of cerebral aneurysms associated with the PPTA is approximately 4%. Since PPTA aneurysms often have a wide neck and other vascular anomalies, endovascular treatment using an adjunctive technique is the current first-line therapy. Here, we report a case of PPTA aneurysm treated by coil embolization with a stent-assisted technique. A detailed evaluation of the size and course of all vessels and collateral flow, including the Allcock test and balloon test occlusion, is necessary when deciding on the treatment strategy.

DOI： 10.1007/s00701-018-3767-6

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 2018.11

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

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

Journal of Neurosurgery 128 ( 6 ) 1839 - 1849 2018.6

Language：English Publisher：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

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 2018.6

Language：English Publisher：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

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 2017.9

Language：English Publisher：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

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

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 2017.9

Language：English Publisher：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

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 2017.8

De novo vertebral artery dissecting aneurysm after internal trapping of the contralateral vertebral artery International journal

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

ACTA NEUROCHIRURGICA 159 ( 7 ) 1329 - 1333 2017.7

Language：English Publisher：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

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 2017.2

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

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

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

Language：Japanese Publisher：(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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02079&link_issn=&doc_id=20171211180009&doc_link_id=%2Fcp4strok%2F2017%2F004506%2F009%2F0476-0482%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2017%2F004506%2F009%2F0476-0482%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

LVIS & LVIS Jr stent.

杉生憲志

Rad Fan 15 ( 12 ) 72 - 74 2017

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

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

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

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

Language：Japanese Publisher：(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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02079&link_issn=&doc_id=20170810180005&doc_link_id=%2Fcp4strok%2F2017%2F004504%2F005%2F0270-0275%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2017%2F004504%2F005%2F0270-0275%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03120&link_issn=&doc_id=20170705170012&doc_link_id=issn%3D0917-1495%26volume%3D27%26issue%3D7%26spage%3D751&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D27%26issue%3D7%26spage%3D751&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

[Preoperative Embolization for Solid Cerebellar Hemangioblastoma on the Day of Surgery:Two Case Reports].

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

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

Language：Japanese

Surgical resection of solid cerebellar hemangioblastomas can be challenging because of the profuse blood supply and tight space. We report two cases of solid cerebellar hemangioblastomas treated via surgical resection with the aid of preoperative endovascular embolization on the day of surgery. Case 1: A 36-year-old woman presented with a two-month history of headache and vomiting. Magnetic resonance imaging(MRI)revealed a right cerebellar solid mass, mild hydrocephalus, and apparent peritumoral edema. Angiogram showed a highly vascularized mass, three feeding arteries from the superior cerebellar artery(SCA), and a dilated vein draining into the confluence. We performed preoperative embolization of the three feeders with 15% n-butyl-2-cyanoacrylate(NBCA). Final angiogram showed an absence of tumor staining. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. Case 2: A 36-year-old man presented with a four-month history of headache and numbness in the left upper extremity. MRI revealed a right cerebellar solid mass with peritumoral edema. Angiogram showed a highly vascularized mass with two feeding arteries from the right SCA, one from the left posterior inferior cerebellar artery(PICA), and a dilated vein draining into the confluence. Preoperative embolization was performed with 15% NBCA, and complete devascularization was achieved. Tumor resection was performed on the same day, and gross total resection was achieved with no complications. In conclusion, preoperative embolization with NBCA on the day of surgery is a safe and effective adjunctive treatment for solid cerebellar hemangioblastoma.

DOI： 10.11477/mf.1436203560

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

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

Anti-high mobility group box-1 (HMGB1) antibody attenuates delayed cerebral vasospasm and brain injury after subarachnoid hemorrhage in rats International journal

Jun Haruma, Kiyoshi Teshigawara, Tomohito Hishikawa, Dengli Wang, Keyue Liu, Hidenori Wake, Shuji Mori, Hideo Kohka Takahashi, Kenji Sugiu, Isao Date, Masahiro Nishibori

SCIENTIFIC REPORTS 6 doi: 10.1038/srep37755 - 37755 2016.11

Language：English Publisher：NATURE PUBLISHING GROUP

Although delayed cerebral vasospasm (DCV) following subarachnoid hemorrhage (SAH) is closely related to the progression of brain damage, little is known about the molecular mechanism underlying its development. High mobility group box-1 (HMGB1) plays an important role as an initial inflammatory mediator in SAH. In this study, an SAH rat model was employed to evaluate the effects of anti-HMGB1 monoclonal antibody (mAb) on DCV after SAH. A vasoconstriction of the basilar artery (BA) associated with a reduction of nuclear HMGB1 and its translocation in vascular smooth muscle cells were observed in SAH rats, and anti-HMGB1 mAb administration significantly suppressed these effects. Upregulations of inflammation-related molecules and vasoconstriction-mediating receptors in the BA of SAH rats were inhibited by anti-HMGB1 mAb treatment. Anti-HMGB1 mAb attenuated the enhanced vasocontractile response to thrombin of the isolated BA from SAH rats and prevented activation of cerebrocortical microglia. Moreover, locomotor activity and weight loss recovery were also enhanced by anti-HMGB1 mAb administration. The vasocontractile response of the BA under SAH may be induced by events that are downstream of responses to HMGB1-induced inflammation and inhibited by anti-HMGB1 mAb. Anti-HMGB1 mAb treatment may provide a novel therapeutic strategy for DCV and early brain injury after SAH.

DOI： 10.1038/srep37755

Anti-high mobility group box-1 (HMGB1) antibody attenuates delayed cerebral vasospasm and brain injury after subarachnoid hemorrhage in rats

Jun Haruma, Kiyoshi Teshigawara, Tomohito Hishikawa, Dengli Wang, Keyue Liu, Hidenori Wake, Shuji Mori, Hideo Kohka Takahashi, Kenji Sugiu, Isao Date, Masahiro Nishibori

SCIENTIFIC REPORTS 6 doi: 10.1038/srep37755 2016.11

Language：English Publisher：NATURE PUBLISHING GROUP

Although delayed cerebral vasospasm (DCV) following subarachnoid hemorrhage (SAH) is closely related to the progression of brain damage, little is known about the molecular mechanism underlying its development. High mobility group box-1 (HMGB1) plays an important role as an initial inflammatory mediator in SAH. In this study, an SAH rat model was employed to evaluate the effects of anti-HMGB1 monoclonal antibody (mAb) on DCV after SAH. A vasoconstriction of the basilar artery (BA) associated with a reduction of nuclear HMGB1 and its translocation in vascular smooth muscle cells were observed in SAH rats, and anti-HMGB1 mAb administration significantly suppressed these effects. Upregulations of inflammation-related molecules and vasoconstriction-mediating receptors in the BA of SAH rats were inhibited by anti-HMGB1 mAb treatment. Anti-HMGB1 mAb attenuated the enhanced vasocontractile response to thrombin of the isolated BA from SAH rats and prevented activation of cerebrocortical microglia. Moreover, locomotor activity and weight loss recovery were also enhanced by anti-HMGB1 mAb administration. The vasocontractile response of the BA under SAH may be induced by events that are downstream of responses to HMGB1-induced inflammation and inhibited by anti-HMGB1 mAb. Anti-HMGB1 mAb treatment may provide a novel therapeutic strategy for DCV and early brain injury after SAH.

DOI： 10.1038/srep37755

「過灌流症候群高リスク例に対する頸動脈ステント留置術に関する後ろ向き研究」最終結果報告

早川幹人, 菱川朋人, 杉生憲志, 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

脳血管内治療 1 ( Suppl. ) S25 - S25 2016.11

Moyamoya Disease: A Review of Clinical Research

Tomohito Hishikawa, Kenji Sugiu, Isao Date

ACTA MEDICA OKAYAMA 70 ( 4 ) 229 - 236 2016.8

Language：English Publisher：OKAYAMA UNIV MED SCHOOL

About 5 decades have passed since the concept of moyamoya disease (MMD) was established in Japan. In that time, many clinical MMD studies have been performed from several different points of view, such as epidemiology, pathophysiology, surgical procedures, and prognosis. In addition, rapid developments in MMD genetic analysis have occurred. In light of all this activity, clinicians must continually update their knowledge of MMD in order to improve the prognosis of MMD patients. In this review article, we summarize the clinical MMD studies and introduce cutting-edge findings regarding MMD.

DOI： 10.18926/AMO/54497

Training guidelines for endovascular stroke intervention: an international multi-society consensus document

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. Phatorous, 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 58 ( 6 ) 537 - 541 2016.6

Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document

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. Phatorous, M. Khangure, P. Klurfan, K. terBrugge, 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, L. Spelle, 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, K. terBrugge, A. Taylor, T. Krings, D. Orbach, A. Biondi, L. Picard, D. C. Suh, M. Tanaka, H. Q. Zhang

AMERICAN JOURNAL OF NEURORADIOLOGY 37 ( 4 ) E31 - E34 2016.4

岡山大学におけるHybrid ORでの手術

菱川朋人, 杉生憲志, 安原隆雄, 伊達勲

脳卒中の外科 44 ( 2 ) 125 - 131 2016

LVIS を用いてステント併用コイル塞栓術を行った破裂脳底動脈本幹部紡錘状動脈瘤の1例

村井智, 伊丹尚多, 馬越通有, 大塚真司, 日下昇, 西浦司, 荻原浩太郎, 杉生憲志

脳神経外科速報 26 ( 12 ) 1318 - 1324 2016

Language：Japanese Publisher：(株)メディカ出版

83歳女。頭痛・意識障害を主訴に救急搬送された。頭部CTにてクモ膜下出血を認め、脳血管撮影にて脳底動脈本幹部に10mm×5mm×3mm大の紡錘状動脈瘤を認め、LVISステントのflow diversion効果を期待し、ステント併用瘤内コイル塞栓を行う方針とした。瘤内へTarget Helical Ultraを部分的に挿入したうえでLVISを上小脳動脈起始部直下から前下小脳動脈起始部のやや下方まで瘤を十分カバーして展開し、瘤内の血流が残存していたため、jailing techniqueで瘤内に可能な限りコイルを挿入した。術翌日のMRIにてステントを留置した部分の穿通枝領域以外にカテーテル操作に伴う多発梗塞巣を認め、アスピリン、シロスタゾール、アルガトロバン、ファスジル塩酸塩投与を開始した。意識障害が遷延したが、術後1ヵ月目の脳室腹腔シャント術後より自動運動や発語を認め、術後3ヵ月に行った血管撮影ではLVISステントの良好な開存と動脈瘤の完全閉塞を認めた。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J03120&link_issn=&doc_id=20161205100010&doc_link_id=issn%3D0917-1495%26volume%3D26%26issue%3D12%26spage%3D1318&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D26%26issue%3D12%26spage%3D1318&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

バルーン閉塞試験（BOT）の重要性とピットフォール（Editorial Comment）

杉生憲志

脳神経外科ジャーナル 25 ( 9 ) 783 - 783 2016

急速に発展する急性期脳梗塞への血管内治療

春間純, 杉生憲志

medicina 53 ( 2 ) 284 - 288 2016

Moyamoya disease: A review of clinical research

Tomohito Hishikawa, Kenji Sugiu, Isao Date

Acta Medica Okayama 70 ( 4 ) 229 - 236 2016

Language：English Publishing type：Book review, literature introduction, etc. Publisher：Okayama University

About 5 decades have passed since the concept of moyamoya disease (MMD) was established in Japan. In that time, many clinical MMD studies have been performed from several different points of view, such as epidemiology, pathophysiology, surgical procedures, and prognosis. In addition, rapid developments in MMD genetic analysis have occurred. In light of all this activity, clinicians must continually update their knowledge of MMD in order to improve the prognosis of MMD patients. In this review article, we summarize the clinical MMD studies and introduce cutting-edge findings regarding MMD.

DOI： 10.18926/AMO/54497

急速に発展する急性期脳梗塞への血管内治療.

春間純, 杉生憲志

medicina 53 ( 2 ) 284 - 288 2016

外傷性椎骨動静脈瘻に対してinternal trappingで治療した1例

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

脳神経外科 44 ( 2 ) 135 - 141 2016

Language：Japanese Publisher：(株)医学書院

66歳男。岩場で伐採作業中に誤って5m下の溝に滑落して前額部を打撲受傷し、直ちにドクターヘリで当院へ搬送された。頭部CTでは頭蓋内出血は認めず、頸椎CTにてC2椎体骨折、C6頸椎の右外側塊に骨折線を認めたため、頸椎カラーを装着して保存的加療となった。入院後に頸部雑音が出現したため頭頸部MRA・CTAを行ったところ、C2椎体骨折に伴う外傷性椎骨動静脈瘻が確認されたため、血管内治療によるinternal trappingを行った。治療後に頸部雑音は消失し、神経症状なく受傷後17日目にリハビリテーション目的に転院となった。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01228&link_issn=&doc_id=20160219080011&doc_link_id=10.11477%2Fmf.1436203245&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203245&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

[A Case of Traumatic Vertebral Arteriovenous Fistula Treated by Internal Trapping of the Vertebral Artery].

Shingo Nishihiro, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Jun Haruma, Yukei Shinji, Yuji Takasugi, Isao Date

No shinkei geka. Neurological surgery 44 ( 2 ) 135 - 141 2016

Language：Japanese

BACKGROUND: Traumatic vertebral arteriovenous fistula (TVAVF) is an uncommon disease that occurs after traumatic injury. Here we report a case of TVAVF presenting with cervical bruit successfully treated by internal trapping using coils. CASE PRESENTATION: A 66-year-old man was transferred to our hospital after falling into a ditch. Initial CT revealed a C2 fracture into the right transverse foramen, and the patient had been treated with conservative management. A vascular abnormality was suspected because the patient exhibited cervical bruit on admission. CT angiography revealed right TVAVF at the V2 segment of the right vertebral artery (VA) near the C2 fracture. Digital subtraction angiography also revealed right TVAVF between the V2 segment of the right VA and the vertebral venous plexus, draining into the right internal jugular vein and the deep cervical vein as well as the intracranial venous system. The fistula was also opacified by retrograde flow from the contralateral VA through the union, while the flow in the basilar artery was antegrade. The patient was diagnosed with TVAVF with large transection of the right VA, and underwent endovascular treatment with internal trapping of the right VA using coils starting distal to the transection and proceeding in a proximal direction. After treatment, the right VAVF and right VA were completely occluded. The patient achieved clinical symptom resolution with no neurological deficits. CONCLUSION: Endovascular treatment with internal trapping of the VA using coils is safe and effective against TVAVF.

DOI： 10.11477/mf.1436203245

脳卒中Q & A─自身のスキルも上げつつ、若手に血管内治療を教育する方法は？─

杉生憲志

脳神経外科速報 26 ( 8 ) 860 - 860 2016

第31回日本脳神経血管内治療学会学術総会（JSNET2015岡山）を終えて

杉生憲志

岡山医学会雑誌 128 151 - 153 2016

Transient Middle Cerebral Artery Occlusion Model in the Macaca fuscata Using a Novel Intravascular Technique

Okuma Yu, Liu Keyue, Hishikawa Tomohito, Hirotsune Nobuyuki, Sugiu Kenji, Nishino Shigeki, Nishibori Masahiro, Date Isao

Journal of Neuroendovascular Therapy 10 ( 3 ) 121 - 126 2016

Language：English Publisher：The Japanese Society for Neuroendovascular Therapy

Objective: The preparation of transient ischemic stroke models in monkeys has been highly invasive, and consistent preparation of an infarct area has been difficult. We attempted the preparation of a model by applying a neuroendovascular technique for humans.Methods: Using the Macaca fuscate, a 5 Fr sheath was placed in the right femoral artery under general anesthesia, a 5 Fr catheter was placed in the right internal carotid artery (ICA) via a bovine arch, a 4 Fr catheter was concentrically placed distally to the bifurcation of the posterior communicating artery (Pcom A), and a balloon catheter conventionally used for the prevention of distal embolism was guided to the origin of the M1 segment of the middle cerebral artery in a triple co-axial manner. Under antithrombotic treatment by heparinization, balloon occlusion was performed for 2 h, and neurological and histological evaluations were carried out 48 h after reperfusion.Results: Left hemiplegia was observed after the procedure, and ischemic changes were histopathologically confirmed around the head of the caudate nucleus located in the border zone of the territory of the occluded vessel.Conclusion: Less invasive and highly consistent transient ischemic stroke models may be prepared by an endovascular approach.

DOI： 10.5797/jnet.oa.2016-0044

Other Link： http://search.jamas.or.jp/link/ui/2017039204

Transient middle cerebral artery occlusion model in the macaca fuscata using a novel intravascular technique

Okuma Y, Liu K, Hishikawa T, Hirotsune N, Sugiu K, Nishino S, Nishibori M, Date I

Journal of Neuroendovascular Therapy 10 ( 3 ) 121 - 126 2016

Language：English Publisher：The Japanese Society for Neuroendovascular Therapy

Objective: The preparation of transient ischemic stroke models in monkeys has been highly invasive, and consistent preparation of an infarct area has been difficult. We attempted the preparation of a model by applying a neuroendovascular technique for humans.Methods: Using the Macaca fuscate, a 5 Fr sheath was placed in the right femoral artery under general anesthesia, a 5 Fr catheter was placed in the right internal carotid artery (ICA) via a bovine arch, a 4 Fr catheter was concentrically placed distally to the bifurcation of the posterior communicating artery (Pcom A), and a balloon catheter conventionally used for the prevention of distal embolism was guided to the origin of the M1 segment of the middle cerebral artery in a triple co-axial manner. Under antithrombotic treatment by heparinization, balloon occlusion was performed for 2 h, and neurological and histological evaluations were carried out 48 h after reperfusion.Results: Left hemiplegia was observed after the procedure, and ischemic changes were histopathologically confirmed around the head of the caudate nucleus located in the border zone of the territory of the occluded vessel.Conclusion: Less invasive and highly consistent transient ischemic stroke models may be prepared by an endovascular approach.

DOI： 10.5797/jnet.oa.2016-0044

Other Link： http://search.jamas.or.jp/link/ui/2017039204

Dabigatran内服中の脳梗塞に対し血栓回収術を施行した1例（Editorial Comment）

杉生憲志

脳神経外科ジャーナル 25 ( 7 ) 598 - 598 2016

外科学の根幹は手術である─すべては「患者さんのために」─（スペシャルインタビュー）

松本健五, 杉生憲志

脳神経外科速報 26 ( 6 ) 552 - 563 2016

岡山大学におけるHybrid ORでの手術.

菱川朋人, 杉生憲志, 安原隆雄, 伊達勲

脳卒中の外科 44 ( 2 ) 125 - 131 2016

頚動脈ステント留置術後の急性期ステント内血栓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, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療(Web) 1 ( Supplement ) 2016

高齢者頚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(Web) 1 ( Supplement ) 2016

「過灌流症候群高リスク例に対する頚動脈ステント留置術に関する後ろ向き研究」最終結果報告

早川幹人, 菱川朋人, 杉生憲志, 早川幹人, 菱川朋人, 杉生憲志, 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, 松丸祐司, 吉村紳一

脳血管内治療(Web) 1 ( Supplement ) 2016

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例に対する頸動脈ステント留置術に関する後ろ向き研究」結果報告

菱川朋人, 杉生憲志, 三橋利晴, 早川幹人, 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 ) S200 - S200 2015.11

Combined Transarterial and Transvenous Approach for Curative Obliteration of Klippel-Trenaunay-Weber Syndrome-Associated Spinal Perimedullary Arteriovenous Fistulas

K. Tokunaga, T. Hishikawa, K. Sugiu, I. Date

CLINICAL NEURORADIOLOGY 25 ( 3 ) 291 - 294 2015.9

静脈うっ滞により急速に脳幹症状を呈した頚髄硬膜動静脈瘻の1例

佐々木達也, 眞鍋博明, 安原隆雄, 三好康之, 杉生憲志, 伊達勲

脳神経外科 43 ( 1 ) 51 - 56 2015

NeuroIVR 5年後のカテ

杉生憲志

Rad Fan 13 ( 12 ) 74 - 75 2015

私の手術論no. 77─脳血管内治療の「文武両道」─

杉生憲志, 吉村紳一

脳神経外科速報 25 ( 11 ) 1128 - 1138 2015

Preoperative Embolization for a Cauda Equina Hemangioblastoma—A Case Report with Literature Review—

Umakoshi Michiari, Yasuhara Takao, Miyoshi Yasuyuki, Hiramatsu Masafumi, Toyoshima Atsuhiko, Sasada Susumu, Morimoto Jun, Hishikawa Tomohito, Manabe Hiroaki, Tokunaga Koji, Sugiu Kenji, Date Isao

Spinal Surgery 29 ( 1 ) 53 - 58 2015

Language：Japanese Publisher：The Japanese Society of Spinal Surgery

Spinal hemangioblastomas are benign, and total surgical resection is the standard treatment method used. However, hypervascular tumors may have excessive operative blood loss if the tumors are divided. We encountered a case of cauda equina hemangioblastoma with extraordinary blood supply, which was treated with preoperative embolization. A 49-year-old woman with von Hippel-Lindau disease who had undergone multiple surgeries for intracranial/extracranial hemangioblastomas had lumbago and leg pain. Magnetic resonance images revealed intradural spinal tumors at the L4-S1 vertebral level, with remarkable gadolinium enhancement. The patient was referred to our hospital, after a plan of total resection had been abandoned elsewhere because of the high flow feeders and high pressure of the tumors. Preoperative embolization was performed with consequent disappearance of the arterial blood supply to the tumor. Two days later, the tumor was resected subtotally with reduced tension and a little blood loss. The patient's symptoms resolved soon after surgery. Selective preoperative embolization for a spinal hemangioblastoma with a rich blood supply is a valid option as an adjuvant to the complete surgical resection of a tumor.

DOI： 10.2531/spinalsurg.29.53

Other Link： http://search.jamas.or.jp/link/ui/2015281939

Pathophysiology of moyamoya disease

Tomohito Hishikawa, Masafumi Hiramatsu, Koji Tokunaga, Kenji Sugiu, Isao Date

Japanese Journal of Neurosurgery 24 ( 4 ) 239 - 243 2015

Language：Chinese Publisher：Japanese Congress of Neurological Surgeons

In this article, we introduce cutting-edge knowledge pertaining to the pathophysiology of moyamoya disease from the viewpoint of angioarchitecture and genetic analysis. A complementary relationship among the anterior circulation(AC), the posterior circulation(PC)and the external carotid artery(ECA)system is involved in the pathophysiology of moyamoya disease. Suzuki’s grading is representative of the interaction between the AC and ECA, and it has traditionally played a leading role in evaluating disease progression. The interaction between the AC and PC is related to hemodynamic ischemia. There is a difference between pediatric and adult moyamoya patients in the interaction between the AC and PC. The analysis of the RNF213 gene is noteworthy as a new approach to understanding the pathophysiology of moyamoya disease. The prognosis and responsiveness to revascularization surgery can be predicted on the basis of genetic analysis. Although gene therapy for moyamoya disease is only now just in the basic experimental studies stage, it can be expected to emerge as an assisting modality for indirect revascularization surgery.

DOI： 10.7887/jcns.24.239

Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation International journal

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

ACTA NEUROCHIRURGICA 156 ( 9 ) 1745 - 1751 2014.9

Language：English Publisher：SPRINGER WIEN

The object of this study was to compare the long-term outcomes in adult patients with moyamoya disease (MMD) with posterior circulation involvement (PCi) treated through surgical revascularization with those in adult patients without PCi.
The records of 32 consecutive adult patients with ischemic-type MMD who were treated with revascularization were reviewed. Twelve of these patients (38 %) had PCi at initial onset. Clinical characteristics of the patients with PCi were compared to those without PCi. Neurological outcomes were assessed using the modified Rankin Scale (mRS) in the preoperative and postoperative follow-up periods. A five-year Kaplan-Meier stroke risk was calculated.
The frequency of presenting with infarction was significantly higher among patients with PCi than among those without PCi (p = 0.006). mRS scores in the preoperative period were significantly higher in patients with PCi than in patients without PCi (p = 0.0004). There were no significant differences in mRS scores between the preoperative and postoperative follow-up period in patients with PCi (p = 0.3), nor were there any between the preoperative and postoperative follow-up periods in patients without PCi (p = 0.2). The five-year Kaplan-Meier risk of surgical morbidity and ipsilateral stroke was 14.3 % in surgically treated hemispheres with PCi versus 14.9 % in surgically treated hemispheres without PCi (p = 0.96).
PCi at initial onset was significantly correlated with poor outcome. Revascularization for the middle cerebral artery territory in patients with PCi was effective at preventing recurrent ischemic stroke.

DOI： 10.1007/s00701-014-2136-3

Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation

Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu, Isao Date

ACTA NEUROCHIRURGICA 156 ( 9 ) 1745 - 1751 2014.9

Language：English Publisher：SPRINGER WIEN

The object of this study was to compare the long-term outcomes in adult patients with moyamoya disease (MMD) with posterior circulation involvement (PCi) treated through surgical revascularization with those in adult patients without PCi.
The records of 32 consecutive adult patients with ischemic-type MMD who were treated with revascularization were reviewed. Twelve of these patients (38 %) had PCi at initial onset. Clinical characteristics of the patients with PCi were compared to those without PCi. Neurological outcomes were assessed using the modified Rankin Scale (mRS) in the preoperative and postoperative follow-up periods. A five-year Kaplan-Meier stroke risk was calculated.
The frequency of presenting with infarction was significantly higher among patients with PCi than among those without PCi (p = 0.006). mRS scores in the preoperative period were significantly higher in patients with PCi than in patients without PCi (p = 0.0004). There were no significant differences in mRS scores between the preoperative and postoperative follow-up period in patients with PCi (p = 0.3), nor were there any between the preoperative and postoperative follow-up periods in patients without PCi (p = 0.2). The five-year Kaplan-Meier risk of surgical morbidity and ipsilateral stroke was 14.3 % in surgically treated hemispheres with PCi versus 14.9 % in surgically treated hemispheres without PCi (p = 0.96).
PCi at initial onset was significantly correlated with poor outcome. Revascularization for the middle cerebral artery territory in patients with PCi was effective at preventing recurrent ischemic stroke.

DOI： 10.1007/s00701-014-2136-3

Nationwide survey of the nature and risk factors of complications in embolization of meningiomas and other intracranial tumors: Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) International journal

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

NEURORADIOLOGY 56 ( 2 ) 139 - 144 2014.2

Language：English Publisher：SPRINGER

Embolization of intracranial tumor is widely performed in Japan, mainly before neurosurgical resection. A retrospective, multicenter, observational study in Japan 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 2 (JR-NET2). A total of 20,854 patients were enrolled in JR-NET2, of which 1,018 patients (4.88 %) 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. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the occurrence of complications were studied.
The proportion of patients with mRS scores a parts per thousand currency sign2 at 30 days after procedure was 91.3 %. Complications occurred in 15 of the 1,012 patients (1.48 %). Multivariate analysis showed that embolization for tumors other than meningioma (OR, 4.626; 95 % CI, 1.347-14.59; p = 0.0105) was significantly associated with the development of complications.
The frequency of complications after intracranial tumor embolization was relatively low in this large Japanese cohort. Embolization for tumors other than meningioma was the only significant risk factor for the occurrence of complications.

DOI： 10.1007/s00234-013-1300-4

Nationwide survey of the nature and risk factors of complications in embolization of meningiomas and other intracranial tumors: Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2)

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

NEURORADIOLOGY 56 ( 2 ) 139 - 144 2014.2

Language：English Publisher：SPRINGER

Embolization of intracranial tumor is widely performed in Japan, mainly before neurosurgical resection. A retrospective, multicenter, observational study in Japan 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 2 (JR-NET2). A total of 20,854 patients were enrolled in JR-NET2, of which 1,018 patients (4.88 %) 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. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the occurrence of complications were studied.
The proportion of patients with mRS scores a parts per thousand currency sign2 at 30 days after procedure was 91.3 %. Complications occurred in 15 of the 1,012 patients (1.48 %). Multivariate analysis showed that embolization for tumors other than meningioma (OR, 4.626; 95 % CI, 1.347-14.59; p = 0.0105) was significantly associated with the development of complications.
The frequency of complications after intracranial tumor embolization was relatively low in this large Japanese cohort. Embolization for tumors other than meningioma was the only significant risk factor for the occurrence of complications.

DOI： 10.1007/s00234-013-1300-4

Recent Trends in Neuroendovascular Therapy in Japan: Analysis of a Nationwide Survey-Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2

Nobuyuki Sakai, Shinichi Yoshimura, Waro Taki, Akio Hyodo, Shigeru Miyachi, Yoji Nagai, Chiaki Sakai, Tetsu Satow, 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 Nakahara, Shigeru Nemoto, Koichi Satoh, Kenji Sugiu, Akira Ishii, Hirotoshi Imamura

NEUROLOGIA MEDICO-CHIRURGICA 54 ( 1 ) 1 - 8 2014.1

Language：English Publisher：JAPAN NEUROSURGICAL SOC

The present study retrospectively analyzed the database of the Japanese Registry of Neuroendovascular Therapy 1 and 2 (JR-NET1&2) to determine annual trends, including adverse events and clinical outcomes at 30 days after undergoing neuroendovascular therapy. JR-NET1&2 are surveys that targeted all patients in Japan who underwent neuroendovascular therapy delivered by physicians certified by the Japanese Society of Neuroendovascular Therapy (JSNET) between 2005 and 2009. Medical information about the patients was anonymized and retrospectively registered via a website. Data from 32,608 patients were analyzed. The number of treated patients constantly increased from 5,040 in 2005 to 7,406 in 2009 and the rate of octogenarians increased from 7.0% in 2005 to 10.4% in 2009. The proportion of procedures remained relatively constant, but ratios of angioplasty slightly increased from 32.8% in 2005 to 33.7% in 2009. Procedural complications were associated more frequently with acute stroke (9.6%), ruptured aneurysms (7.4%), intracranial artery disease (ICAD) (5.4%), and arteriovenous malformation (AVM, 5.2%). The number of patients requiring neuroendovascular treatment in Japan is increasing and 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.2013-0197

Recent Trends in Neuroendovascular Therapy in Japan: Analysis of a Nationwide Survey-Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2

Nobuyuki Sakai, Shinichi Yoshimura, Waro Taki, Akio Hyodo, Shigeru Miyachi, Yoji Nagai, Chiaki Sakai, Tetsu Satow, 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 Nakahara, Shigeru Nemoto, Koichi Satoh, Kenji Sugiu, Akira Ishii, Hirotoshi Imamura

NEUROLOGIA MEDICO-CHIRURGICA 54 ( 1 ) 1 - 8 2014.1

Language：English Publisher：JAPAN NEUROSURGICAL SOC

The present study retrospectively analyzed the database of the Japanese Registry of Neuroendovascular Therapy 1 and 2 (JR-NET1&2) to determine annual trends, including adverse events and clinical outcomes at 30 days after undergoing neuroendovascular therapy. JR-NET1&2 are surveys that targeted all patients in Japan who underwent neuroendovascular therapy delivered by physicians certified by the Japanese Society of Neuroendovascular Therapy (JSNET) between 2005 and 2009. Medical information about the patients was anonymized and retrospectively registered via a website. Data from 32,608 patients were analyzed. The number of treated patients constantly increased from 5,040 in 2005 to 7,406 in 2009 and the rate of octogenarians increased from 7.0% in 2005 to 10.4% in 2009. The proportion of procedures remained relatively constant, but ratios of angioplasty slightly increased from 32.8% in 2005 to 33.7% in 2009. Procedural complications were associated more frequently with acute stroke (9.6%), ruptured aneurysms (7.4%), intracranial artery disease (ICAD) (5.4%), and arteriovenous malformation (AVM, 5.2%). The number of patients requiring neuroendovascular treatment in Japan is increasing and 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.2013-0197

岡山大学における症候性脳血管攣縮への対策と現状─過去10年間の治療成績の検討─

菱川朋人, 清水智久, 徳永浩司, 杉生憲志, 小野成紀, 伊達勲

脳血管攣縮 Vol.29 41 ( Suppl ) 23 - 26 2014

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

過去10年間に外科治療を行った脳動脈瘤破裂によるクモ膜下出血88例(男40例、女48例、平均65.4歳)の成績を報告した。治療方法はclip 42例、coil 46例で、2007年以前(前期)の52例ではclip 34例、coil 18例、2008年以降(後期)の36例ではそれぞれ8例、28例とcoilが有意に増加していた。治療直前のHunt and Kosnik gradeは前期と後期で有意差はなく、clipとcoilの比較では前期がcoilで有意にgradeが高かったが、後期は有意差がなかった。症候性血管攣縮は25例に認め、前期35%、後期19%で有意差はなかった。退院時modified Rankin Scaleで0〜2の予後良好は前期32.7%、後期33.3%、3〜6の予後不良例のうち症候性血管攣縮が主な予後規定因子となったのはそれぞれ20%、16.7%と有意差はなかった。

コイル塞栓術─治療編─

杉生憲志

BRAIN NURSING 30 ( 4 ) 387 - 389 2014

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

Bypass Surgery for Intracavernous Large or Giant Internal Carotid Artery Aneurysms and Its Pitfalls

TOKUNAGA Koji, HISHIKAWA Tomohito, SUGIU Kenji, DATE Isao

Surgery for Cerebral Stroke 42 ( 3 ) 189 - 195 2014

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

Our treatment modalities and techniques for intracavernous large or giant internal carotid artery (ICA) aneurysms have been changed based on past clinical experience. We report clinical results and pitfalls of bypass surgery for intracavernous ICA aneurysms. <br>This study included unruptured symptomatic 37 intracavernous ICA aneurysms in 36 patients. Treatment methods were selected based on the anatomical features of the aneurysm and neurological/hemodynamic conditions during balloon test occlusion (BTO).<br>Eleven aneurysms were treated without bypass surgery. Low flow bypass (STA-MCA anastomosis) was performed for 18 aneurysms, and eight aneurysms were treated with high flow bypass. A saphenous vein graft was originally used for high flow bypass, but it was changed with a radial artery because of the problem of long-term patency. ICA occlusion was accomplished by ligation of the cervical ICA alone in the early cases until we encountered a case with brain infarction due to emboli from the aneurysm after ICA ligation. Accordingly, ICA occlusion was performed by endovascular internal trapping two days after bypass surgery. There was, however, a case of graft thrombosis before ICA occlusion. We now occlude ICA by surgical trapping between the neck and the intracranial ICA immediately after revascularization. No patients had permanent ischemic neurological deficits due to cerebral hypoperfusion after ICA occlusion.<br>Our treatment algorithm based on BTO was reliable. When the patients undergo bypass surgery, we perform ICA occlusion by surgical trapping between the neck and the intracranial portion. <br>

DOI： 10.2335/scs.42.189

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

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

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

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

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

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

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

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

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

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

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

Internal carotid artery stenting in patients over 80 years of age

26 11 - 15 2013.3

Transvenous Approach Of Cavernous Sinus Dural Arteriovenous Fistula

Kyohei Kin, Kenji Sugiu, Kouji Tokunaga, Masafumi Hiramatsu, Jun Haruma, Yu Ohkuma, Tomohisa Shimizu, Tomohito Hishikawa, Isao Date

STROKE 44 ( 2 ) 2013.2

Stereotactic Radiosurgery For Dural Arteriovenous Fistula Reflactory To Endovascular Treatment

Tomohisa Shimizu, Kenji Sugiu, Koji Tokunaga, Tomohito Hishikawa, Masafumi Hiramatsu, Yu Okuma, Isao Date, Kengo Sato, Yoshimi Baba

STROKE 44 ( 2 ) 2013.2

Safety and Efficacy of Endovasucular Treatment of Superior Hypophyeal Artery Aneurysms: A Review of 86 Cases

Jun Haruma, Kenji Sugiu, Koji Tokunaga, Tomohito Hishikawa, Kyouhei Kin, Naoya Kidani, Tomohisa Shimizu, Yu Ohkuma, Masafumi Hiramatsu, Isao Date

STROKE 44 ( 2 ) 2013.2

Usefulness of Staged Angioplasty for Carotid Artery Stenting

Naoya Kidani, Kenji Sugiu, Koji Tokunaga, Tomohito Hishikawa, Masafumi Hiramatsu, Atsuhiko Toyoshima, Yu Okuma, Tomohisa Shimizu, Jun Haruma, Isao Date

STROKE 44 ( 2 ) 2013.2

未破裂脳動脈瘤コイル塞栓術後に多発性の脳病変を呈した一例

出口健太郎, 香西由子, 出口章子, 森本展年, 倉田智子, 池田佳生, 松浦徹, 阿部康二, 杉生憲志, 徳永浩司, 河井信行

臨床神経学 53 ( 1 ) 66 - 66 2013.1

他科からみた放射線科

杉生憲志

Rad Fan 11 ( 4 ) 86 - 87 2013

頭部に発生する硬膜動静脈瘻およびhigh flow動静脈瘻に対する塞栓術

徳永浩司, 杉生憲志, 伊達勲

脳神経外科 41 ( 2 ) 153 - 162 2013

Intra-cranial dural arteriovenous fistula: Classification and treatment

Kenji Sugiu, Masafumi Hiramatsu, Koji Tokunaga, Tomohito Hishikawa, Yu Ohkuma, Jun Haruma, Tomohisa Shimizu, Isao Date

Japanese Journal of Neurosurgery 22 ( 1 ) 37 - 43 2013

Language：English Publisher：Japanese Congress of Neurological Surgeons

Intracranial dural arteriovenous fistulas (dAVFs) are pathologic dural-based shunts and distinguished from parenchymal AVM by the presence of a dural arterial supply and the absence of a parenchymal nidus. Their symptoms and prognosis are strongly related to the pattern of their venous drainage system. The presence of cortical venous reflux (CVR) is an aggressive feature indicating that there is a high risk of cerebral bleeding or progressive neurological deficits. Endovascular treatment has become the mainstream dAVF therapy. In general, trans-venous coil embolization is adapted to sinusal type dAVFs (i.e. cavernous sinus or transverse-sigmoid dAVFs) and trans-arterial glue embolization is applied to non-sinusal type dAVFs (i.e. anterior skull base or tentorial dAVFs). Direct surgery and stereotactic radiosurgery are indicated in cases in which endovascular approaches have failed or are not feasible.

DOI： 10.7887/jcns.22.37

脳底動脈窓形成部動脈瘤に対する血管内治療の有用性

伊丹尚多, 杉生憲志, 平松匡文, 徳永浩司, 春間純, 大熊佑, 菱川朋人, 西田あゆみ, 伊達勲

脳神経外科 41 ( 7 ) 583 - 592 2013

Language：Japanese Publisher：(株)医学書院

血管内治療を行った脳動脈瘤539例中脳底動脈窓形成部動脈瘤10例(男性2例、女性8例、平均51.6歳)について検討した。発症頻度は1.9%、動脈瘤の最大径は平均4.6cmで、動脈瘤破裂が7例(平均47.7歳)であった。窓形成は9例で、椎骨脳底動脈(VA-BA)合流部に認め、全例で動脈瘤は窓形成部の近位側から発生していた。血管内治療方法は、5例でsimple technique、4例でballoon remodeling technique、1例でdouble-catheter techniqueによるコイル塞栓術を行った。画像上の塞栓結果は、8例がcomplete occlusion、2例がneck remnantであった。手技に伴う合併症は認めず、Glasgow Outcome Scaleによる退院時転帰は9例がgood recoveryであり、転帰不良の1例はクモ膜下出血による一次脳損傷のため、重篤な後遺症が残存したものであった。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01228&link_issn=&doc_id=20130712110003&doc_link_id=10.11477%2Fmf.1436102031&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436102031&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

頚部頚動脈瘤に対し血管内治療を行った1例

服部靖彦, 杉生憲志, 菱川朋人, 徳永浩司, 高橋和也, 伊達勲

脳神経外科 41 ( 6 ) 515 - 523 2013

後腹膜出血で発症し、経動脈的および経静脈的塞栓術により根治に至ったparaspinal arteriovenous fistulaの1例

豊嶋敦彦, 徳永浩司, 眞鍋博明, 杉生憲志, 平松匡文, 伊丹尚多, 菱川朋人, 伊達勲

脳神経外科 41 ( 5 ) 429 - 435 2013

Language：Japanese Publisher：(株)医学書院

72歳女。幼少期に脊椎疾患で手術加療を受けた既往があった。自転車走行中に乗用車にはねられ救急搬送され、左肘関節骨折・左腓骨骨折・骨盤輪部分不安定型骨折を認めた。また、造影CTでL3、L4レベルの右腸腰筋内に上下2個の静脈瘤と思われる血管拡張と、それに流入する多数のfeeder、右L3/4椎間孔から脊柱管内に入り硬膜外を下行するdrainerを認め、paraspinal arteriovenous fistula(AVF)と診断した。AVFからの出血はなく、脊髄や神経根の症状もなかったが、入院後5日に右鼠径部痛が出現し、造影CTで静脈瘤のうち下方のものが著明に拡大して、一部の血栓化と後腹膜腔への出血も認めた。静脈瘤の破裂による後腹膜出血と診断し、経動脈的コイル塞栓術を行った。術後再出血は認めなかったが、術後約4ヵ月の造影CTでシャント血流の再増大を認め、経静脈的コイル塞栓術を行い、AVFの消失を確認し手術を終了した。術後5日に軽快退院し、術後3ヵ月の造影CTで静脈瘤とdrainerの消失を確認した。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01228&link_issn=&doc_id=20130517090008&doc_link_id=10.11477%2Fmf.1436101995&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101995&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

Analysis of Intraoperative Findings and Therapeutic Results of Thoracolumbar Dural Arteriovenous Fistula

MIYOSHI Yasuyuki, YASUHARA Takao, MANABE Hiroaki, HATTORI Yasuhiko, HISHIKAWA Tomohito, TOKUNAGA Koji, SUGIU Kenji, DATE Isao

27 ( 1 ) 45 - 51 2013

Usefulness of the "sheep technique" in the endovascular treatment for cerebral aneurysms

TOYOSHIMA Atsuhiko, SUGIU Kenji, TOKUNAGA Kouji, SHIMIZU Tomohisa, HARUMA Jun, HIRAMATSU Masafumi, ITAMI Hisakazu, HISHIKAWA Tomohito, DATE Isao

Journal of Neuroendovascular Therapy 7 ( 1 ) 3 - 10 2013

Language：Japanese Publisher：The Japanese Society for Neuroendovascular Therapy

Objective: The "Sheep technique" is a special technique for navigating a balloon catheter that is difficult to navigate because of the steep angle of the branching vessel.<br>Case presentation: We treated two patients having intracranial aneurysms by endovascular therapy with the sheep technique. In both cases, initial balloon catheter navigation failed because the branch near the aneurysm was steep. With the aid of the sheep technique, the balloon catheter was successfully delivered into the target vessel. Coil embolization was then performed using a balloon remodeling technique.<br>Conclusion: The sheep technique is effective when balloon catheter delivery is difficult because the branch near the aneurysm is steep.

DOI： 10.5797/jnet.7.3

脳血管内治療におけるDSA装置の進歩

杉生憲志, 平松匡文

新医療 40 ( 10 ) 93 - 96 2013

術前診断および治療手順に熟慮を要した脊髄血管障害の1例

眞鍋博明, 徳永浩司, 杉生憲志

脳神経外科ジャーナル 22 ( 9 ) 720 - 724 2013

硬膜動静脈瘻

平松匡文, 杉生憲志

BRAIN 3 ( 5 ) 394 - 401 2013

Computational fluid dynamics of carotid arteries after carotid endarterectomy or carotid artery stenting based on postoperative patient-specific medical data

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

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 125 ( 1 ) 5 - 7 2013

5. 硬膜動静脈瘻の分類と治療の課題(PS1-1 血管奇形の基礎と臨床,プレナリーセッション,脳神経外科学の課題,第32回日本脳神経外科コングレス総会)

杉生憲志, 徳永浩司, 菱川朋人, 伊丹尚多, 平松匡文, 大熊佑, 伊達勲

脳神経外科ジャーナル 21 54 - 54 2012.4

4年の期間を経て反対側に新生・出血発症した多発硬膜動静脈瘻の1例

大同茂, 小林和樹, 棟田耕二, 和仁孝夫, 徳永浩司, 杉生憲志

津山中央病院医学雑誌 26 113 - 118 2012

脳底動脈先端部動脈瘤に対するコイル塞栓術

杉生憲志, 徳永浩司, 菱川朋人, 伊丹尚多, 大熊佑, 平松匡文, 春間純, 伊達勲

脳神経外科 40 ( 9 ) 765 - 774 2012

Language：Japanese Publisher：(株)医学書院

血管内治療(コイル塞栓術)を行った脳底動脈先端部動脈瘤79例(男性23例、女性56例、平均63.7歳)を対象に、その成績について検討した。破裂瘤は47例、瘤の最大径は平均7.9mmであり、未破裂瘤は32例、瘤の最大径は平均8.2mmであった。1例(grade Iで治療当日に再出血にて死亡)を除き、破裂瘤の術前Hunt & Kosnik gradeと転帰(Glasgow Outcome Scale)は良く相関していた。破裂瘤47例の塞栓結果はcomplete obliteration(CO):27例、residual neck(RN):16例、residual aneurysm(RA):4例、未破裂瘤32例ではCO:26例、RN:6例と成績が良かった。合併症は無症候性後大脳動脈P1部閉塞4例(破裂瘤3例、未破裂瘤1例)が認められた。破裂瘤2例で治療後再出血を認め、4例で経過観察中に再発をきたしコイル塞栓術を追加した。未破裂瘤に出血は認めなかったが、3cm大の部分血栓化巨大動脈瘤の1例で再発し再治療を要した。全体で再出血2例(2.5%)、再発で再治療5例(6.3%)であった。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01228&link_issn=&doc_id=20120828100005&doc_link_id=10.11477%2Fmf.1436101812&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101812&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

Surgical Resection Following Onyx Embolization for Brain Arteriovenous Malformations

TOKUNAGA Koji, SUGIU Kenji, HISHIKAWA Tomohito, KUROZUMI Kazuhiko, OKUMA Yu, ITAMI Hisakazu, ONO Shigeki, DATE Isao

Nosotchu no Geka Kenkyukai koenshu 40 ( 4 ) 217 - 222 2012

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

A new embolic material for brain arteriovenous malformations (AVMs)—Onyx liquid embolic system—has become available in Japan. We report our initial experience with surgical resection of AVMs after Onyx embolization and the pathological findings of the resected specimens.<br> AVMs of three patients were embolized with Onyx followed by surgical resection. A high rate of Onyx penetration into the nidus was obtained when the plug of Onyx was formed around the tip of the microcatheter navigated as closely to the nidus as possible. Otherwise, Onyx injection resulted in partial occlusion of the nidus or proximal occlusion of the feeders. Total resection of the nidus was safely achieved in every case. The plane of dissection between the brain and the embolized nidus that demonstrated a firm consistency was easily identified. Uncontrollable bleeding from the perinidal capillary network was rarely encountered. Pathological examination did not show angionecrosis in the walls of the embolized vessels. Infiltration of macrophages was observed in the embolized vessels in the specimens resected more than five days after embolization.<br> Onyx embolization followed by surgical resection is a safe and effective treatment for AVMs.<br>

DOI： 10.2335/scs.40.217

Other Link： http://search.jamas.or.jp/link/ui/2013003544

Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms: Prospective registry of subarachnoid aneurysms treatment (PRESAT) in Japan

Taki W, PRESAT grou, Sugiu K, Tokunaga K, Nishida A

Neuroradiology 54 597 - 606 2012

内視鏡下経鼻的経蝶形骨洞手術後の遅発性鼻出血に対し塞栓術が有効であった1例

岡哲生, 杉生憲志, 石田穣治, 菱川朋人, 小野成紀, 徳永浩司, 伊達勲

脳神経外科 40 ( 1 ) 55 - 60 2012

Language：Japanese Publisher：(株)医学書院

66歳男。頭部MRIで下垂体腺腫を指摘された。半年後のMRIで増大傾向を示し、手術目的で入院した。手術は右鼻腔から神経内視鏡を使用してアプローチした、腫瘍を肉眼的にほぼ全摘出した。動脈性の出血を含めmassiveな出血は術中に認めなかった。術後経過は良好で、術後10日目に自宅に退院した。退院14日後、自宅で突然鼻出血を来し、止血困難であった。耳鼻咽喉科医によりボスミンガーゼを挿入され、いったん止血した。自宅で経過をみていたが、再度鼻出血を来し緊急入院した。左外頸動脈造影にて左顎動脈末梢のsphenopalatine arteryより鼻咽頭への血液の流出を確認し、出血点と診断した。塞栓術を施行した。sphenopalatine arteryを血管損傷部とともに完全に閉塞した。再度外頸動脈撮影で完全止血を確認し、手技を終了とした。術後経過は良好で再出血もなく、塞栓術後2週間で退院となった。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01228&link_issn=&doc_id=20120124070013&doc_link_id=10.11477%2Fmf.1436101628&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101628&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

脳底動脈先端部血栓化動脈瘤に対してYステント併用コイル塞栓術を施行した1例

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

脳神経外科 40 ( 11 ) 1005 - 1012 2012

Stent-in-stent treatment for acute in-stent thrombosis after carotid artery stenting: A case report

Yuji Takasugi, Kenji Sugiu, Masafumi Hiramatsu, Yu Ohkuma, Hisakazu Itami, Tomohito Hishikawa, Koji Tokunaga, Isao Date

Journal of Neuroendovascular Therapy 6 ( 3 ) 181 - 188 2012

Language：English

Objective: Symptomatic in-stent thrombosis with or without plaque protrusion is a relatively rare but devastating complication of carotid artery stenting (CAS). Case presentation: A 72-year-old man presented with repeated transient ischemic attacks (TIAs). Digital subtraction angiography (DSA) showed severe stenosis in the left internal carotid artery at its origin. Cervical MRI revealed carotid soft plaque. Balloon-protected CAS was planned. A self-expandable open-cell-type stent (PRECISE™) was successfully placed with a good angiographic result. However, he suffered a recurrent TIA several hours after the CAS procedure. Enhanced computed tomography (CT) scan revealed a contrast defect in the stent suggesting acute thrombus formation. Despite medical treatment including systemic heparinization and triple anti-platelet therapy, a follow-up ultra-sound examination showed enlargement of the thrombus in the stent. His neurological condition deteriorated and we decided to perform another stenting procedure. DSA demonstrated a significant contrast defect in the stent. A self-expandable closed-cell-type stent (Wallstent RPTM) was successfully deployed on the inside of a PRECISE™ stent under distal balloon protection. A satisfactory angiographic result was achieved. After the second procedure, he showed good recovery from the neurological symptoms and no more TIAs. Conclusion: This case demonstrated the usefulness of the stent-in-stent technique for medically refractory in-stent thrombosis with or without plaque protrusion. A closed-cell-type stent would be theoretically more effective in this situation. © 2012, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.6.181

Transcatheter arterial embolisation for paediatric inflammatory pseudotumour of the maxillary sinus

A. Murai, K. Sugiu, S. Kariya, K. Nishizaki

JOURNAL OF LARYNGOLOGY AND OTOLOGY 125 ( 11 ) 1189 - 1192 2011.11

Language：English Publisher：CAMBRIDGE UNIV PRESS

Background: Inflammatory pseudotumours are mostly seen in the lung, and occasionally in the head and neck region including the sinonasal area. Reported treatment modalities comprise corticosteroid treatment, surgical excision and radiotherapy. The latter option is required because wide surgical resection may be difficult for head and neck lesions, especially in children. However, clinicians should be aware of the risk of late-onset side effects of radiotherapy in children.
Case report: We present a two-year-old girl with a massive inflammatory pseudotumour of the maxillary sinus. Transcatheter arterial embolisation was performed, and the lesion was successfully managed without additional therapy. There was no evidence of recurrence over the next five years.
Conclusion: This is the first report presenting the utility of arterial embolisation for inflammatory pseudotumour.

DOI： 10.1017/S0022215111001848

Determinants of Poor Outcome After Aneurysmal Subarachnoid Hemorrhage when both Clipping and Coiling Are Available: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan

Waro Taki, Nobuyuki Sakai, Hidenori Suzuki, Akio Hyodo, Shigeru Nemoto, Toshio Hyogo, Tomoaki Terada, Kouichi Satoh, Naoya Kuwayama, Shigeru Miyachi, Masaki Komiyama, Masayuki Ezura, Yuichi Murayama, Hiroshi Sakaida, Masayuki Maeda, Hiroshi Nagai, Taketo Kataoka, Shoichiro Ishihara, Yorio Koguchi, Shigeki Kobayashi, Yukiko Enomoto, Kiyofumi Yamada, Shinichi Yoshimura, Yasushi Matsumoto, Masaru Hirohata, Nobuyuki Sakai, Hidemitsu Adachi, Yasushi Ueno, Takeharu Kunieda, Chiaki Sakai, Hiroshi Yamagami, Hirotoshi Imamura, Masaomi Koyanagi, Kenichi Todo, Shiro Yamamoto, Yoji Kuramoto, Makoto Sonobe, Noriyuki Kato, Teruyasu Hirayama, Tsuneo Kano, Isao Naito, Shunji Matsubara, Junichiro Satomi, Koichi Satoh, Hidekazu Hamada, Naoki Toma, Fumio Asakura, Hidenori Suzuki, Hiroshi Sakaida, Satoshi Matsushima, Tadashi Shibuya, Hidenori Oishi, Hiroshi Abe, Yoshifumi Konishi, Eishi Sato, Mitsugu Nakamura, Akira Kurata, Katsumi Houya, Takanori Uchida, Akio Hyodo, Ichiro Nakahara, Toshio Higashi, Nozomi Murai, Yasushi Iwamuro, Yoshihiko Watanabe, Hideaki Nakagaki, Masahiro Takezawa, Daiki Murata, Yoichi Murayama, Toshihiro Ishibashi, Takayuki Saguchi, Masaki Ebara, Hideki Arakawa, Koreaki Irie, Naoya Kuwayama, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Katsunori Nanba, Shigeru Nemoto, Masanori Tsutsumi, Kiyoshi Kazekawa, Mikito Hayakawa, Yuji Matsumaru, Yoshihiro Matsubayashi, Tomomi Sakabayashi, Keiko Miyakoda, Wataru Oohashi, Masaki Sano, Emiko Uno, Makiko Toyooka, Kaori Kuronaka, Kazuro Sakamoto, Hiroshi Nagai, Masanori Fukushima, Toshio Hyogo

WORLD NEUROSURGERY 76 ( 5 ) 437 - 445 2011.11

Language：English Publishing type：Book review, literature introduction, etc. Publisher：ELSEVIER SCIENCE INC

OBJECTIVE: To examine current determinants of poor outcome after aneurysmal subarachnoid hemorrhage (SAH) when ruptured aneurysms are treated with either microsurgery (clipping) or endovascular treatment (coiling) depending on each patient's characteristics.
METHODS: Between March 2006 and February 2007, 534 patients with SAH were enrolled in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) project. Patients were treated according to the preference of investigators who were experienced in performing both clipping and coiling. Factors influencing poor outcome (12-month modified Rankin Scale [mRS], 3-6) were determined using multivariate logistic regression analyses.
RESULTS: In this cohort, 32.4% of patients were World Federation of Neurosurgical Societies (WFNS) grade IV-V, and 28.1% had a poor outcome. Clipping was preferably performed for small aneurysms with a wide neck and for middle cerebral artery (MCA) aneurysms, whereas coiling was preferred for larger, internal carotid artery (ICA) and posterior circulation aneurysms. In addition to increasing age, admission WFNS grade IV-V, preadmission aneurysmal rerupture, vasospasm-induced cerebral infarct, pneumonia, sepsis, shunt-dependent hydrocephalus and seizure, postclipping hemorrhagic complications (odds ratio 4.8, 95% confidence interval 1.5-15.3, P < 0.01), and postcoiling ischemic complications (odds ratio 4.4, 95% confidence interval 1.3-15.2, P < 0.05) significantly caused poor outcomes, although the complications did not affect mortality. Type of treatment modality and size and location of aneurysms did not influence outcome.
CONCLUSIONS: Introducing an endovascular treatment option has made aneurysm characteristics less important to outcome, but procedural complications are problematic and should be reduced to improve outcome.

DOI： 10.1016/j.wneu.2011.04.026

Endovascular Coil Embolization of a Ruptured Distal Anterior Choroidal Artery Aneurysm Associated With Ipsilateral Middle Cerebral Artery Occlusion-Case Report

Ayumi Nishida, Koji Tokunaga, Tomohito Hishikawa, Kenji Sugiu, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 51 ( 10 ) 716 - 719 2011.10

Language：English Publisher：JAPAN NEUROSURGICAL SOC

An 84-year-old woman with a history of hypertension and a brain infarction presented with a rare distal anterior choroidal artery (AChoA) aneurysm not associated with moyamoya disease manifesting as sudden onset of headache caused by intraventricular hemorrhage. Digital subtraction angiography revealed a peripheral aneurysm in the left AChoA located distal to the plexal point and steno-occlusive changes of the proximal left middle cerebral artery (MCA) and the left posterior cerebral artery (PCA). Collateral arterial channels to the left MCA and left PCA territories were observed along the left AChoA. No neuroimaging findings were compatible with moyamoya disease. Since the aneurysm did not shrink at 2 months after the onset, endovascular treatment was indicated. Under local anesthesia, a microcatheter was placed into the AChoA proximal to the aneurysm with the aid of a 0.008-inch microguidewire. After a provocation test, three detachable platinum coils were delivered into the aneurysm and the parent artery. Complete obliteration of the aneurysm was achieved without additional neurological sequelae. Successful treatment of a ruptured distal AChoA aneurysm associated with atherosclerotic changes of the intracranial arteries was achieved using a meticulous endovascular technique.

DOI： 10.2176/nmc.51.716

Effectiveness of intraoperative near-infrared indocyanine green videoangiography in a case with recurrent spinal perimedullary arteriovenous fistula International journal

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

CLINICAL NEUROLOGY AND NEUROSURGERY 113 ( 3 ) 239 - 242 2011.4

Posterior reversible encephalopathy syndrome International journal

Takao Yasuhara, Koji Tokunaga, Tomohito Hishikawa, Shigeki Ono, Yasuyuki Miyoshi, Kenji Sugiu, Isao Date

JOURNAL OF CLINICAL NEUROSCIENCE 18 ( 3 ) 406 - 409 2011.3

Language：English Publisher：ELSEVIER SCI LTD

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parieto-occipital lobes on T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. We described three patients with PRES of varied etiologies. Patient 1 was a young man with severe hypertension who presented with headache and visual disturbance. Patient 2 had leukemia and was receiving umbilical cord blood cell transplantation with immunosuppressant, and developed PRES with convulsions. Patient 3 was a pregnant woman with renal failure, who repeatedly developed PRES with convulsions. FLAIR and apparent diffusion coefficient mapping were useful in detecting PRES lesions in our patients, although diffusion-weighted imaging and CT scans had limited use in the diagnosis. Adequate and prompt treatment with antihypertensive medication immediately ameliorated the symptoms, with improvement of abnormal MRI findings. In previous reports, delayed diagnosis might have affected the prognosis. Further work on the clinical manifestations of PRES and its therapy is required. (C) 2010 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2010.06.011

脳血管内治療の最前線.

杉生憲志

医工学治療 23 ( 3 ) 181 - 186 2011

MicroPlexコイル─特にHydroCoilについて─.

杉生憲志

Rad Fan 9 ( 10 ) 68 - 70 2011

ケアミックス型病院におけるくも膜下出血の診療経験 —地域医療におけるケアミックス型病院を再考する—.

中川実, 藤原賢次郎, 坂本千穂子, 城戸由紀子, 徳永浩司, 杉生憲志

脳卒中 33 313 - 318 2011

経静脈的液体塞栓術にて治療した海綿静脈洞部硬膜動静脈瘻の2例

平松匡文, 杉生憲志, 徳永浩司, 西田あゆみ, 栗山充夫, 前城朝英, 寺坂薫, 伊達勲

脳神経外科 39 ( 12 ) 1189 - 1196 2011

Supraclinoid瘤（IC-Achor, IC-PC）のコイル塞栓術.

杉生憲志

脳神経外科速報 21 ( 9 ) 970 - 981 2011

脊髄くも膜下出血後Adamkiewicz動脈に生じた血管攣縮.

三好康之, 近藤聡彦, 安原隆雄, 西田あゆみ, 徳永浩司, 杉生憲志, 伊達勲

BRAIN and NERVE 63 ( 2 ) 182 - 183 2011

Retrospective Survey of Endovascular Treatment for Ruptured Intracranial Aneurysm in Japan: Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) Study

Nobuyuki Sakai, Waro Taki, Shinichi Yoshimura, Toshio Hyogo, Masayuki Ezura, Yasushi Matsumoto, Yasushi Ito, Hiroshi Abe, Makoto Sonobe, Shigeki Kobayashi, Shigeru Nemoto, Yuichi Murayama, Yuji Matsumaru, Hidenori Oishi, Naoya Kuwayama, Shigeru Miyachi, Tomoaki Terada, Masaki Komiyama, Toshiyuki Fujinaka, Kenji Sugiu, Koichi Sato, Ichiro Nakahara, Kiyoshi Kazekawa, Masaru Hirohata, Akio Hyodo, Chiaki Sakai

NEUROLOGIA MEDICO-CHIRURGICA 50 ( 11 ) 961 - 965 2010.11

Language：English Publisher：JAPAN NEUROSURGICAL SOC

Annual retrospective surveys of 20 to 31 medical centers performing endovascular treatment of cerebral aneurysms in Japan from 1997 to 2008 were performed to analyze technical and clinical outcomes of en dovascular treatment for ruptured cerebral aneurysm Patients treated with dome embolization using bare platinum coils within 14 days after onset were retrospectively selected, and clinical features, and technical and clinical outcomes at discharge were studied Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) 1 covers patients treated from 1997, when the Guglielmi detachable coil was introduced, to 2002, lust after International Subarachnoid Aneurysm Trial was reported RESAT 2 to RESAT 7 were conducted annually between 2003 and 2008 Among 5,624 patients with ruptured aneurysms treated within 14 days after onset, 4,782 patients were treated by dome embolization using platinum detachable coils The patients in this large retrospective survey included 35 8% aged over 70 years, 36 6% with posterior circulation aneurysms, and 29 3% with poor grades (Hunt and Kosnik grades IV and V) The proportion of patients aged over 70 years tended to increase each year from 33 4% in RESAT 1 to 39 8% in RESAT 7, and the proportion of those with posterior circulation aneurysms decreased from 44 2% in RESAT 1 to 23 8% in RESAT 7 (p <0 001) Overall technical success was obtained in 4,666 patients (97 6%), and favorable clinical outcome (good recovery and moderate disability) at discharge was obtained in 88 0% of grade I-III cases and 73 6% of grade I-V cases Procedure-related morbidity was 2 9% and mortality was 0 8% Despite this survey involving high proportions of aged, posterior circulation, and poor-grade patients, the technical success rate and immediate clinical results were relatively favorable The patient prognosis and aneurysm changes must be investigated over a longer period, together with the effects of the introduction of new endovascular devices for cerebral aneurysms

DOI： 10.2176/nmc.50.961

Optimal Dose of Plasmid Vascular Endothelial Growth Factor for Enhancement of Angiogenesis in the Rat Brain Ischemia Model

Atsushi Katsumata, Kenji Sugiu, Koji Tokunaga, Noboru Kusaka, Kyoichi Watanabe, Ayumi Nishida, Katsunari Namba, Hirofumi Hamada, Hiroyuki Nakashima, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 50 ( 6 ) 449 - 455 2010.6

Language：English Publisher：JAPAN NEUROSURGICAL SOC

Vascular endothelial growth factor (VEGF) administration has recently been assessed as a therapeutic strategy for ischemic diseases including brain ischemia because of its angiogenic effect. However, VEGF also causes detrimental adverse effects by increasing vascular permeability. This study examined whether plasmid human VEGF (phVEGF) administration induced angiogenic effects in the rat brain ischemia model caused by permanent ligation of both common carotid arteries, and investigated the occurrence of adverse effects. Administration of various doses (0-200 mu g) of phVEGF in the temporal muscle was followed by encephalo-myo-synangiosis. Thirty days after treatment, the numbers and areas of capillaries per field in the extracted brains were analyzed with the National Institutes of Health Image software program. The maximal angiogenic effect occurred with a 100 mu g dose of phVEGF in the numbers and areas of capillaries in the VEGF-treated brains. Histological examination showed no apparent adverse effects in the brain parenchyma even at the highest administration dose (200 mu g) of phVEGF. The maximal angiogenic effect at the optimal dose of phVEGF can be considered under the threshold to cause serious adverse effects in the rat brain.

DOI： 10.2176/nmc.50.449

Percutaneous balloon angioplasty for acute occlusion of intracranial arteries.

Tokunaga K, Sugiu K, Yoshino K, Terai Y, Imaoka T, Handa A, Hirotsune N, Kusaka N, Date I

Neurosurgery 67 ( ONS Suppl 1 ) ons189-ons197 2010

細胞移植療法.

菊池陽一郎, 安原隆雄, 伊達勲, 杉生憲志

総合臨床 59 ( 12 ) 2396 - 2399 2010

Rebleeding From a Vertebral Artery Dissecting Aneurysm After Endovascular Internal Trapping: Adverse Effect of Intrathecal Urokinase Injection or Incomplete Occlusion?-Case Report

Kenji Sugiu, Koji Tokunaga, Shigeki Ono, Ayumi Nishida, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 49 ( 12 ) 597 - 600 2009.12

Language：English Publisher：JAPAN NEUROSURGICAL SOC

A 67-year-old woman suffered rebleeding from a ruptured vertebral artery dissecting aneurysm after endovascular internal trapping. The dissecting aneurysm was initially successfully occluded with the affected vertebral artery using detachable coils. However, rebleeding from the aneurysm occurred on the next day. The rebleeding may have resulted from the thrombolytic effect of urokinase, which was injected intrathecally 3 hours before rebleeding occurred, or the relatively loose coil packing of the aneurysm. This case indicates the potential risk of intrathecal use of thrombolytic agents and the importance of complete tight coil packing of the whole dissected site in the treatment of ruptured vertebral artery dissecting aneurysms.

DOI： 10.2176/nmc.49.597

SIGNIFICANT DIFFERENCES IN THE POSTOPERATIVE MORPHOLOGICAL AND HEMODYNAMIC CONDITIONS OF CAROTID ARTERIES OF PATIENTS UNDERGOING STENTING OR ENDARTERECTOMY WITH PATCH ANGIOPLASTY International journal

Koji Tokunaga, Kenji Sugiu, Hitoshi Hayase, Ayumi Nishida, Isao Date

NEUROSURGERY 65 ( 5 ) 884 - 888 2009.11

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE: Carotid endarterectomy with a patch graft (Patch CEA) has been our Standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of carotid arteries after CAS or Patch CEA.
METHODS: Thirty-one patients undergoing CAS or Patch CEA were included. The pre- and postoperative shapes of the carotid arteries were evaluated by angiography and ultrasonography. Doppler waveforms were recorded in the middle portion of the common carotid artery and in the internal carotid artery bulb to measure flow velocities, including peak systolic, mean, and end-diastolic velocities.
RESULTS: Eighteen patients were treated by CAS, and Patch CEA was performed for 13 patients. Preoperatively, there were no differences in the degrees of stenosis or the flow velocities between the 2 groups. The averages of the diameters of the postoperative internal carotid artery bulbs were 4.5 mm in the CAS group and 7.0 mm in the Ratch CEA group (P < 0.01). The averages of peak systolic, mean, and end-diastolic velocities measured in the internal carotid artery were 80, 42, and 25 cm/s, respectively, in the CAS group, and were significantly greater than those (53, 28, and 16 cm/s, respectively) in the Patch CEA group (P < 0.01).
CONCLUSION: Significant differences in postoperative morphological and hemodynamic conditions between CAS and Patch CEA were observed. The impact of these differences will be determined by further studies.

DOI： 10.1227/01.NEU.0000358952.12917.DF

SIGNIFICANT DIFFERENCES IN THE POSTOPERATIVE MORPHOLOGICAL AND HEMODYNAMIC CONDITIONS OF CAROTID ARTERIES OF PATIENTS UNDERGOING STENTING OR ENDARTERECTOMY WITH PATCH ANGIOPLASTY

Koji Tokunaga, Kenji Sugiu, Hitoshi Hayase, Ayumi Nishida, Isao Date

NEUROSURGERY 65 ( 5 ) 884 - 888 2009.11

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE: Carotid endarterectomy with a patch graft (Patch CEA) has been our Standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of carotid arteries after CAS or Patch CEA.
METHODS: Thirty-one patients undergoing CAS or Patch CEA were included. The pre- and postoperative shapes of the carotid arteries were evaluated by angiography and ultrasonography. Doppler waveforms were recorded in the middle portion of the common carotid artery and in the internal carotid artery bulb to measure flow velocities, including peak systolic, mean, and end-diastolic velocities.
RESULTS: Eighteen patients were treated by CAS, and Patch CEA was performed for 13 patients. Preoperatively, there were no differences in the degrees of stenosis or the flow velocities between the 2 groups. The averages of the diameters of the postoperative internal carotid artery bulbs were 4.5 mm in the CAS group and 7.0 mm in the Ratch CEA group (P < 0.01). The averages of peak systolic, mean, and end-diastolic velocities measured in the internal carotid artery were 80, 42, and 25 cm/s, respectively, in the CAS group, and were significantly greater than those (53, 28, and 16 cm/s, respectively) in the Patch CEA group (P < 0.01).
CONCLUSION: Significant differences in postoperative morphological and hemodynamic conditions between CAS and Patch CEA were observed. The impact of these differences will be determined by further studies.

DOI： 10.1227/01.NEU.0000358952.12917.DF

血管内治療が行われる疾患と適応(2)脳動静脈奇形,頚動脈狭窄症など (特集血管内治療と看護)

杉生憲志

ブレインナーシング 25 ( 10 ) 1082 - 1088 2009.10

血管内治療が行われる疾患と適応(1)脳動脈瘤 (特集血管内治療と看護)

杉生憲志

ブレインナーシング 25 ( 10 ) 1077 - 1081 2009.10

Endovascular Treatment for Bow Hunter's Syndrome: Case Report

K. Sugiu, T. Agari, K. Tokunaga, A. Nishida, I. Date

MINIMALLY INVASIVE NEUROSURGERY 52 ( 4 ) 193 - 195 2009.8

Language：English Publisher：GEORG THIEME VERLAG KG

Introduction: Bow hunter's syndrome is a unique clinical entity caused by mechanical occlusion of the vertebral artery on head rotation. Although it is usually treated by direct surgical intervention, we report successful treatment using endovascular stent placement for contralateral vertebral artery stenosis.
Case Description: A 56-year-old man presented with repeated vertigo and loss of consciousness caused by turning his head to the left. Right vertebral angiogram showed no abnormalities with the head in the neutral position. However, with the head rotated 60 degrees to the left, the right vertebral artery was completely occluded at the C1-2 level. A three-dimensional angiogram with bone window clearly demonstrated vertebral artery compression at the C1-2 level by the bony structure. The left subclavian angiogram revealed severe stenosis at the origin of the left vertebral artery. Left vertebral artery angioplasty followed by stent placement was successfully performed under local anesthesia. The patient showed an uneventful postoperative course and his preoperative symptoms disappeared. At 6 months postoperatively, a left subclavian angiogram showed good patency of the stented left vertebral artery and the patient showed no recurrent symptoms.
Conclusion: Vertebral artery stenting is a useful and less invasive option in the treatment of bow hunter's syndrome in the setting of contralateral vertebral artery stenosis.

DOI： 10.1055/s-0029-1239501

Usefulness of 3-Dimensional CT Angiograms Obtained by 64-Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula International journal

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kohei Tsuda, Matsuhiro Imaoka, Atsushi Kawahara, Kenjiro Fujiwara

JOURNAL OF NEUROIMAGING 19 ( 2 ) 179 - 182 2009.4

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse-sigmoid sinus, in which 3-dimensional computed tomography (CT) angiograms (3D-CTAs) by a 64-section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse-sigmoid sinus appeared on the digital subtraction angiogram. 3D-CTAs were obtained by a 64-section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D-CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D-CTA, showing both the subcutaneous vein and calvalium. 3D-CTAs by a 64-section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.
J Neuroimaging 2009;19:179-182.

DOI： 10.1111/j.1552-6569.2007.00228.x

Usefulness of 3-Dimensional CT Angiograms Obtained by 64-Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kohei Tsuda, Matsuhiro Imaoka, Atsushi Kawahara, Kenjiro Fujiwara

JOURNAL OF NEUROIMAGING 19 ( 2 ) 179 - 182 2009.4

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse-sigmoid sinus, in which 3-dimensional computed tomography (CT) angiograms (3D-CTAs) by a 64-section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse-sigmoid sinus appeared on the digital subtraction angiogram. 3D-CTAs were obtained by a 64-section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D-CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D-CTA, showing both the subcutaneous vein and calvalium. 3D-CTAs by a 64-section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.
J Neuroimaging 2009;19:179-182.

DOI： 10.1111/j.1552-6569.2007.00228.x

Dural Arteriovenous Fistula CT Appearance Case Report and Review

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kenjiro Fujiwara

NEUROSURGERY QUARTERLY 19 ( 1 ) 46 - 49 2009.3

Language：English Publishing type：Book review, literature introduction, etc. Publisher：LIPPINCOTT WILLIAMS & WILKINS

Images of dural arteriovenous fistula (DAVF) on computed tomography (CT) are usually normal when 110 hemorrhages have occurred from the DAVF. Therefore, it is difficult to diagnose DAVF by plain CT scans which are usually performed in an initial examination. We present a rare case with DAVF in the transverse-sigmoid sinus that Could be diagnosed by reversible speckled high-density spots on a plain CT scan. A 46-year-old man had suffered from depression and had taken some antidepressants for 4 years. He developed a Gerstmann's syndrome and came to our hospital. On a plain CT scan obtained on admission, multiple high-density spots were demonstrated scattered in the left temporal, parietal, and occipital lobes. Subsequently, a digital Subtraction angiography was performed. A DAVF in the left transverse-sigmoid sinus was apparent on the angiogram. The DAVF was successfully treated with endovascular Surgery. The speckled high density decreased on the postoperative plain CT scan. Multiple high-density abnormalities in the brain shown on a plain CT scan are a rare but important finding for diagnosis of DAVF. Further examinations such as magnetic resonance angiography or digital subtraction angiography should be performed in case with these changes to access the possibility of DAVF.

DOI： 10.1097/WNQ.0b013e31818242fe

Percutaneous Coil Embolization Using the Direct Puncture Technique for a Subclavian Artery Pseudoaneurysm After Inadvertent Puncture

Hidefumi Mimura, Hideo Gobara, Takao Hiraki, Hiroyasu Fujiwara, Jun Sakurai, Kenji Sugiu, Susumu Kanazawa

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 32 ( 2 ) 371 - 373 2009.3

Percutaneous Coil Embolization Using the Direct Puncture Technique for a Subclavian Artery Pseudoaneurysm After Inadvertent Puncture International journal

Hidefumi Mimura, Hideo Gobara, Takao Hiraki, Hiroyasu Fujiwara, Jun Sakurai, Kenji Sugiu, Susumu Kanazawa

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 32 ( 2 ) 371 - 373 2009.3

スパズムへの新しいアプローチ基礎から臨床まで 11Rを用いた新しいタンパク質導入法脳血管障害治療への効果的な新しい薬物導入システムの確立

小野成紀, 小川智之, 市川智継, 有光帥二, 菱川朋人, 徳永浩司, 杉生憲志, 富澤一仁, 松井秀樹, 伊達勲

脳血管攣縮 24 11 - 14 2009.3

Protein Transduction Method for Cerebrovascular Disorders

Tomoyuki Ogawa, Shigeki Ono, Tomotsugu Ichikawa, Seiji Arimitsu, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Kazuhito Tomizawa, Hideki Matsui, Isao Date

ACTA MEDICA OKAYAMA 63 ( 1 ) 1 - 7 2009.2

Language：English Publishing type：Book review, literature introduction, etc. Publisher：OKAYAMA UNIV MED SCHOOL

Many studies have shown that a motif of 11 consecutive arginines (11R) is one of the most effective protein transduction domains (PTD) for introducing proteins into the cell membrane. By conjugating this "11R", all sorts of proteins can effectively and harmlessly be transferred into any kind of cell. We therefore examined the transduction efficiency of 11R in cerebral arteries and obtained results showing that 11R fused enhanced green fluorescent protein (11R-EGFP) immediately and effectively penetrated all layers of the rat basilar artery (BA), especially the tunica media. This method provides a revolutionary approach to cerebral arteries and ours is the first study to demonstrate the successful transduction of a PTD fused protein into the cerebral arteries. In this review, we present an outline of our studies and other key studies related to cerebral vasospasm and 11R, problems to be overcome, and predictions regarding future use of the 11R protein transduction method for cerebral vasospasm (CV).

Protein Transduction Method for Cerebrovascular Disorders

Tomoyuki Ogawa, Shigeki Ono, Tomotsugu Ichikawa, Seiji Arimitsu, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Kazuhito Tomizawa, Hideki Matsui, Isao Date

ACTA MEDICA OKAYAMA 63 ( 1 ) 1 - 7 2009.2

Language：English Publisher：OKAYAMA UNIV MED SCHOOL

Many studies have shown that a motif of 11 consecutive arginines (11R) is one of the most effective protein transduction domains (PTD) for introducing proteins into the cell membrane. By conjugating this "11R", all sorts of proteins can effectively and harmlessly be transferred into any kind of cell. We therefore examined the transduction efficiency of 11R in cerebral arteries and obtained results showing that 11R fused enhanced green fluorescent protein (11R-EGFP) immediately and effectively penetrated all layers of the rat basilar artery (BA), especially the tunica media. This method provides a revolutionary approach to cerebral arteries and ours is the first study to demonstrate the successful transduction of a PTD fused protein into the cerebral arteries. In this review, we present an outline of our studies and other key studies related to cerebral vasospasm and 11R, problems to be overcome, and predictions regarding future use of the 11R protein transduction method for cerebral vasospasm (CV).

Treatment results of carotid artery stenting under distal protection with the use of Angioguard XP compared with those of PercuSurge GuardWire

Koji Tokunaga, Kenji Sugiu, Ayumi Nishida, Masafumi Hiramatsu, Tomohito Hishikawa, Shigeki Ono, Isao Date

Journal of Neuroendovascular Therapy 3 ( 2 ) 79 - 85 2009

Language：English

Objective: To compare clinical results of carotid artery stenting (CAS) under distal protection with the use of Angioguard XP and PercuSurge GuardWire. Methods: 138 patients treated by CAS under distal protection from September 2002 to November 2008 were included in this study. 85 patients treated with GuardWire were divided into 2 sequential groups, the early GW group (n=42) and the late GW group (n=43). Angioguard XP was used in 53 patients (the AG group) from November 2007. Treatment results from the 3 groups were investigated. Results: A stent was successfully deployed in all patients. 1 patient in the early GW group died of intracerebral hemorrhage which developed 5 days after CAS. In the late GW group, 1 patient died of multiple organ failure after intraoperative abdominal wall hemorrhage and another patient showed persistent hemiparesis due to intracerebral hemorrhage which occurred 1 week after CAS. Procedure-associated learning curve was not demonstrated between the 2 groups. In the AG group, postoperative MRI diffusion-weighted imaging disclosed new high-intensity lesions in the area of the treated carotid artery in 7 patients, in which 2 patients suffered from thromboembolic strokes. Conclusion: Hemorrhagic complications were causes of disability for patients treated with GuardWire. Thromboembolic events were more frequently encountered in patients undergoing CAS with Angioguard XP. © 2009, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.3.79

Rebleeding from a vertebral artery dissecting aneurysm after endovascular internal trapping: Adverse effect of intrathecal urokinase injection or incomplete occlusion? - Case report

Kenji Sugiu, Koji Tokunaga, Shigeki Ono, Ayumi Nishida, Isao Date

Neurologia Medico-Chirurgica 49 ( 12 ) 597 - 600 2009

Language：English

A 67-year-old woman suffered rebleeding from a ruptured vertebral artery dissecting aneurysm after endovascular internal trapping. The dissecting aneurysm was initially successfully occluded with the affected vertebral artery using detachable coils. However, rebleeding from the aneurysm occurred on the next day. The rebleeding may have resulted from the thrombolytic effect of urokinase, which was injected intrathecally 3 hours before rebleeding occurred, or the relatively loose coil packing of the aneurysm. This case indicates the potential risk of intrathecal use of thrombolytic agents and the importance of complete tight coil packing of the whole dissected site in the treatment of ruptured vertebral artery dissecting aneurysms.

DOI： 10.2176/nmc.49.597

Endovascular treatment for Bow hunter's syndrome: Case report

K. Sugiu, T. Agari, K. Tokunaga, A. Nishida, I. Date

Minimally Invasive Neurosurgery 52 ( 4 ) 193 - 195 2009

Language：English

Introduction: Bow hunter's syndrome is a unique clinical entity caused by mechanical occlusion of the vertebral artery on head rotation. Although it is usually treated by direct surgical intervention, we report successful treatment using endovascular stent placement for contralateral vertebral artery stenosis. Case Description: A 56-year-old man presented with repeated vertigo and loss of consciousness caused by turning his head to the left. Right vertebral angiogram showed no abnormalities with the head in the neutral position. However, with the head rotated 60 to the left, the right vertebral artery was completely occluded at the C1-2 level. A three-dimensional angiogram with bone window clearly demonstrated vertebral artery compression at the C1-2 level by the bony structure. The left subclavian angiogram revealed severe stenosis at the origin of the left vertebral artery. Left vertebral artery angioplasty followed by stent placement was successfully performed under local anesthesia. The patient showed an uneventful postoperative course and his preoperative symptoms disappeared. At 6 months postoperatively, a left subclavian angiogram showed good patency of the stented left vertebral artery and the patient showed no recurrent symptoms. Conclusion: Vertebral artery stenting is a useful and less invasive option in the treatment of bow hunter's syndrome in the setting of contralateral vertebral artery stenosis. © Georg Thieme Verlag KG Stuttgart.

DOI： 10.1055/s-0029-1239501

血管内治療が行われる疾患と治療㈪脳動静脈奇形、頚動脈狭窄症など

杉生憲志

BRAIN NURSING 25 ( 10 ) 34 - 40 2009

血管内治療が行われる疾患と適応㈰脳動脈瘤

杉生憲志

BRAIN NURSING 25 ( 10 ) 29 - 33 2009

右中大脳動脈狭窄症に対して、PTAとシロスタゾール（プレタール）の併用にて改善を認めた1例

渡邊恭一, 杉生憲志, 島津洋介, 井上智, 桐山英樹, 松本健五

Progress in Medicine 29 ( 11 ) 2835 - 2838 2009

Percutaneous transvenous embolization of transverse / sigmoid sinus dural arteriovenous fistula through the mastoid emissary vein: Case report

Masafumi Hiramatsu, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Hitoshi Hayase, Yasuyuki Miyoshi, Kenjiro Fujiwara, Minoru Nakagawa, Isao Date

Journal of Neuroendovascular Therapy 3 ( 2 ) 112 - 117 2009

Language：English

Objective: Percutaneous transvenous embolization (TVE) of a transverse/sigmoid sinus dural arteriovenous fistula (TS/SS dAVF) through the mastoid emissary vein (MEV) is reported. Case presentation: A 46-year-old man was admitted to our hospital for cerebral venous infarction. Angiography revealed left TS/SS dAVF with isolated sinus and retrograde cortical venous reflux. Transarterial embolization resulted in successful reduction of the shunt flow and improvement of the clinical symptoms. Transvenous approach through the occluded dural sinus into the affected sinus failed. Direct puncture of the dilated occipital vein was then performed, and TVE using coils was performed successfully through the MEV. This procedure resulted in complete disappearance of the dAVF. Conclusion: This technique is a simple and good alternative treatment in patients for whom conventional approach to the isolated sinus is difficult to adopt, if there is the drainage of the dilated mastoid emissary vein. © 2009, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.3.112

Japanese Society of Neuro-Endovascular Treatment Specialist Qualification System. Six Years' Experience and Introduction of an Animal Model Examination

T. Hyogo, W. Taki, M. Negoro, A. Takahashi, M. Edura, A. Hyodo, S. Kobayashi, M. Komiyama, N. Kuwayama, Y. Matsumaru, S. Miyachi, K. Murao, Y. Murayama, I. Nakahara, S. Nemoto, N. Sakai, K. Satoh, M. Sonobe, K. Sugiu, T. Terada, S. Yoshimura, T. Abe, Y. Itoh, H. Kiyosue, H. Nagashima, M. Nakamura, S. Matsushima

INTERVENTIONAL NEURORADIOLOGY 14 ( 3 ) 235 - 240 2008.9

11Rを用いた脳血管に対する新しい蛋白質導入法

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, 富澤一仁, 松井秀樹, 伊達勲

岡山医学会雑誌 120 ( 2 ) 129 - 133 2008.8

Language：Japanese Publisher：岡山医学会

脳血管に対する外来蛋白質導入法としての「蛋白質セラピー法」の可能性を模索するため、11Rにマーカー蛋白質である緑色蛍光色素タンパク(EGFP)を融合させて(11R-EGFP)、脳血管に対する導入効率を検討した。ラット大槽内に11R-EGFP、EGFPまたは生理食塩水を注入し、注入2、6時間後に脳底動脈を取り出し凍結切片を作成し、蛍光顕微鏡で観察した。その結果、注入2、6時間後に11R-EGFPタンパク質は、脳底動脈壁へ著明に導入されていた。一方、11Rを付加していないEGFPは、くも膜下腔にその存在を認めたが、脳底動脈壁には導入を認めなかった。部位別に導入効果率を検討するため、Scionイメージで蛍光強度の測定を行ったところ、11R-EGFP群は、EGFPおよび生理食塩水注入群と比較して、特に中膜に高い蛍光強度を示した。蛋白質セラピーのこれらの特徴は、くも膜下出血後の脳血管攣縮や脳梗塞等の急性で一過性の脳血管障害の治療に適していると考えられた。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00175&link_issn=&doc_id=20080814230001&doc_link_id=10.4044%2Fjoma.120.129&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.120.129&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Orbital exenteration after transarterial embolization in a patient with Wyburn-Mason syndrome: Pathological findings

Toshihiko Matsuo, Hiroyuki Yanai, Kenji Sugiu, Susumu Tominaga, Yoshihiro Kimata

JAPANESE JOURNAL OF OPHTHALMOLOGY 52 ( 4 ) 308 - 313 2008.7

Language：English Publisher：SPRINGER TOKYO

Background: We present the pathological findings at orbital exenteration in a patient with Wyburn-Mason syndrome who underwent transarterial embolization.
Case: A 31-year-old man with a 10-year history of gradual exacerbation of left exophthalmos and left cheek swelling was found to have facial and orbital arteriovenous malformations on the left side. There was no vascular malformation in the brain. The feeding arteries derived from the left internal maxillary artery, facial artery, and ophthalmic artery. He underwent several courses of transarterial embolization of the feeding arteries from the left internal maxillary artery and then from the facial artery, resulting in no reduction of the arteriovenous malformation. He finally elected to undergo ophthalmic artery embolization in the expectation of a reduction and with the understanding that he would lose sight in his left eye. Two years later, he requested lid-sparing orbital exenteration and reconstruction with cutaneous flap transfer and prosthesis for cosmetic reasons.
Observations: Pathologically, orbital vascular channels of varying sizes were filled with embolizing glue and had degenerating vascular wall cells surrounded by inflammatory cell infiltration. The central retinal artery in the optic nerve was also filled with the embolizing glue, and the retina lost the ganglion cell layer and inner nuclear layer but maintained the outer nuclear layer and outer segments.
Conclusions: Marked anastomoses and hence incomplete embolization among the feeding arteries of facial and orbital vascular malformations in Wyburn-Mason syndrome do not respond well to attempts at feeding vessel embolization, which result in unsuccessful closure of the malformation.

DOI： 10.1007/s10384-008-0563-5

Fenestration of the supraclinoid internal carotid artery with associated aneurysm

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

NEUROLOGIA MEDICO-CHIRURGICA 48 ( 3 ) 118 - 120 2008.3

Language：English Publisher：JAPAN NEUROSURGICAL SOC

A 42-year-old woman presented with a rare case of fenestration of the supraclinoid internal carotid artery (ICA) with associated aneurysm manifesting as headache. Computed tomography (CT) found no abnormalities. Three-dimensional CT angiography showed fenestration of the left ICA with an associated aneurysm. Direct surgery was performed for the aneurysm, and the patient's postoperative course was uneventful. The present case of ICA fenestration associated with aneurysm indicates that surgical treatment should be considered for even small unruptured aneurysms arising from this location, because of the high risk of rupture.

DOI： 10.2176/nmc.48.118

Effects of deferoxamine-activated hypoxia-inducible factor-1 on the brainstem after subarachnoid hemorrhage in rats International journal

Tomohito Hishikawa, Shigeki Ono, Tomoyuki Ogawa, Koji Tokunaga, Kenji Sugiu, Isao Date

NEUROSURGERY 62 ( 1 ) 232 - 240 2008.1

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE: Hypoxia-inducible factor (HIF)-1 is a transcription factor that regulates the expression of various neuroprotective genes. The goal of this study was to clarify the relationship between HIF-1 expression and subarachnoid hemorrhage (SAH) and to characterize the effects of deferoxamine (DFO)-induced increases in HIF-1 protein levels on the brainstem and the basilar artery (BA) after experimental SAH.
METHODS: Rat single- and double-hemorrhage models (injected on Days 0 and 2) of SAH were used. We assessed the time courses for HIF-1 protein levels in the brainstems and the BA diameters within 10 minutes and 6 hours on Days 1 and 2 in the single-SAH model, and also on Day 7 in the double-SAH model. After induction of double hemorrhage in rats, DFO was injected intraperitoneally. We then evaluated HIF-1 protein expression and brainstem activity, BA diameter, and brainstem blood flow.
RESULTS: After the rats experienced SAH, HIF-1 protein expression was significantly greater at 10 minutes in the single-injection model and at 7 days in the double-injection model than at similar time points in the control group, and these increases correlated with degrees of cerebral vasospasm. DFO injection resulted in significant increases in HIF-1 protein expression and activity in the brainstems of rats with SAH, compared with the rats with SAH that were given placebos, and the rats without SAH in the double-hemorrhage model. Cerebral vasospasm and reduction of brainstem blood flow were significantly attenuated in the rats that were administered DFO.
CONCLUSION: These results show that a DFO-induced increase in HIF-1 protein level and activity exerts significant attenuation of BA vasospasm and reduction of brainstem blood flow in the rat model of SAH. DFO may be a promising agent for treating clinical SAH.

DOI： 10.1227/01.NEU.0000296989.61911.81

Continuous evaluation of regional oxygen saturation in cerebral vasospasm after subarachnoid haemorrhage using INVOS (R), portable near infrared spectrography

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

CEREBRAL VASOSPASM: NEW STRATEGIES IN RESEARCH AND TREATMENT 104 215 - 218 2008

Language：English Publisher：SPRINGER-VERLAG WIEN

Background. Although several tools are available for the detection of cerebral vasospasm after subarachnoid haemorrhage, it has remained difficult to identify vasospasm timely and accurately. INVOS (R) monitoring measures the oxygen saturation by using near infrared spectroscopy, and in this study we examined the usefulness of this system for the detection of vasospasm.
Method. Five patients who had suffered SAH were enrolled in this study. In view of the thickness of the clots, the probes of INVOS (R) were attached to the scalp in the areas where vasospasm was likely to occur, from day 3 to the end of vasospasm, up to 14 days post SAH. Patients were monitored every day by INVOS 0) and by neurological exams. Angiography was performed if regional oxygen saturation had continuously decreased by 10% or more as compared to the contralateral side, or if patients showed additional neurological deficits. If vasospasm was detected, interventional treatment using intraarterial fasudil injection or percutaneous, transluminal angioplasty was performed. The same interventional therapy was repeated until neurological deficits improved.
Findings. When the INVOS (R) value decreased to lower than 60, angiographic or symptomatic vasospasm tended to occur, and the response of regional oxygen saturation correlated accurately, both symptomatically and angiographically, with brain ischemia due to vasospasm. Recovery from ischemia on angiography or single photon emission CT also correlated with the return of regional oxygen saturation by INVOS (R).
Conclusions. INVOS (R) monitoring is handy and noninvasive; it is able to evaluate real-time regional oxygen saturation in the region of VS and may be superior to the other existing monitoring systems.

DOI： 10.1007/978-3-211-75718-5-41

Endovascular treatment for ruptured cerebral aneurysms in elderly patients.

Sugiu K, Tokunaga K, Nishida A, Hayase H, Ono S, Onoda K, Date I

Journal of Stroke & Cerebrovascular Disease 17 ( (5)Supplement 1 ) S92 2008

塞栓物質の選び方と使用方法 2. コイル.

杉生憲志

IVR 23 ( -2 ) 195 - 198 2008

頸動脈ステント留置術と抗血小板療法.

平松匡文, 杉生憲志, 徳永浩司, 西田あゆみ, 早瀬仁志, 菱川朋人, 小野成紀, 三好康之, 伊達勲

新薬と臨床 57 ( -12 ) 1987 - 1993 2008

Language：Japanese Publisher：(株)医薬情報研究所

頸動脈ステント留置術(CAS)の初期治療成績と、周術期の抗血小板療法の実際について報告した。頸動脈狭窄症に対して、脳保護フィルターを使用して自己拡張型ステントを留置した50例を対象とした。術前狭窄率はNASCET法で60〜95(平均83)%であったが、術後狭窄率は0〜30(平均8)%に改善した。mRSは、術直後に悪化した症例は5例あったが、24時間後も悪化した状態が継続した症例は1例のみであった。CASの周術期における抗血小板剤の投与については、アスピリン、クロピドグレル、チクロピジン、シロスタゾールの中から、複数の抗血小板剤をCAS施行3日以上前から投与された。

Multimodality Therapy for Large and Giant Intracavernous Internal Carotid Artery Aneurysms

DATE Isao, TOKUNAGA Koji, SUGIU Kenji

Nosotchu no Geka Kenkyukai koenshu 36 ( 1 ) 12 - 18 2008

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

Most patients with intracavernous large and giant aneurysms show cranial nerve signs, and a variety of surgical treatments have been developed. From the viewpoint of multimodality therapy, a combination of bypass and IC ligation or a combination of intravascular therapy and surgery has been performed. <br> We studied 29 consecutive patients with intracavernous large and giant aneurysms during the past 15 years. All the patients presented with cranial nerve signs. Therapeutic modalities for each patient were selected depending on anatomical features of the aneurysm on radiological examinations and neurological/hemodynamic conditions during balloon test occlusion (BTO). <br> ICAs were occluded surgically or endovascularly in 6 patients without bypass surgery. ICA ligation was simultaneously combined with high-flow bypass in 4 patients or with STA-MCA anastomosis in 14 patients, in which 2 patients developed delayed ischemic neurological symptoms due to emboli from the thrombosed aneurysms. STA-MCA anastomosis followed by internal coil trapping of the aneurysm under antiplatelet and anticoagulant therapy was successfully performed in 2 recent patients. Pre-operative neurological symptoms ameliorated when treatment was initiated within 3 months after the onset of symptoms.<br> Favorable clinical outcomes can be expected for patients with an intracavernous large or giant ICA aneurysm treated surgically or endovascularly based on adequate pre-operative radiological, neurological and hemodynamic evaluations. The treatment algorithm for the management of intracavernous large or giant aneurysms of ICA should be reviewed and revised according to the development of new devices and techniques.<br>

DOI： 10.2335/scs.36.12

Endothelial nitric oxide synthase-11R protein therapy for prevention of cerebral vasospasm in rats: a preliminary report

T. Ogawa, S. Ono, T. Ichikawa, S. Arimitsu, K. Onoda, K. Tokunaga, K. Sugiu, K. Tomizawa, H. Matsui, I. Date

CEREBRAL VASOSPASM: NEW STRATEGIES IN RESEARCH AND TREATMENT 104 165 - + 2008

Language：English Publisher：SPRINGER-VERLAG WIEN

Background. In one of our studies we found that enhanced green fluorescent protein (EGFP) fused with consecutive 11 arginines (11R), one of the protein transduction domains (PTDs) [1-6, 11], and effectively penetrated into all layers of the rat basilar artery (BA). We examined whether eNOS (140-kDa) fused 11R (11R-eNOS) was also transduced into the BAs and had a positive effect on the attenuation of cerebral vasospasm.
Method. 11R-eNOS or saline was injected into the cisterna magna of male Sprague-Dawley rats. Two hours after the injection, the BAs were extracted from the rats and transduction efficacy of 11R-eNOS in the BA was evaluated by immunofluorescence staining. To examine the effect of 11R-eNOS on the cerebral arteries exposed to SAH, we measured the post SAH BA diameters six hours after the injection of 11R-eNOS.
Findings. Immunofluorescent study confirmed the presence of 11ReNOS protein in the layers of the cerebral arteries in vivo. 11R-eNOS had a positive effect on attenuation of cerebral vasospasm.
Conclusions. 11R-eNOS was effectively transduced into the walls of the BA. 11R-eNOS inhibited the vasoconstriction after SAH. These results suggest that 11R-eNOS protein therapy has a potential in treating cerebral vasospasm.

DOI： 10.1007/978-3-211-75718-5-32

Direct protein transduction method to cerebral arteries by using 11R: new strategy for the treatment of cerebral vasospasm after subarachnoid haemorrhage

T. Ogawa, S. Ono, T. Ichikawa, H. Michiue, S. Arimitsu, K. Onoda, K. Tokunaga, K. Sugiu, K. Tomizawa, H. Matsui, I. Date

CEREBRAL VASOSPASM: NEW STRATEGIES IN RESEARCH AND TREATMENT 104 161 - + 2008

Language：English Publisher：SPRINGER-VERLAG WIEN

Background. Gene transfer with some vectors may be useful for treatmcnt of cerebral vasospasm after subarachnoid haemorrhage (SAH) [2, 3, 6, 10, 12, 13, 19]. However, this method has some safety problems [18]. Previous studies have shown that direct delivery of therapeutic proteins by using protein transduction domain (PTD) may reduce these problems [14, 15]. Here, we examined the transduction efficiency of eleven consecutive arginines (11R), which is one of the most effective PTD 18, 91, into the rat cerebral arteries by using 11R-enhanced-green fluorescent protein (11R-EGFP).
Method. 11R-EGFP or EGFP was injected into the cisterna magna of the rats with SAH. SAH model was made by autologous blood injection. The proteins were injected just after the autologous blood injection in SAH rats. The expression of 11R-EGFP or EGFP was observed by fluorescence microscope.
Findings. The signal of 11R-EGFP was much stronger than that of EGFP in all the layers of the rat basilar artery (BA). The 11R-EGFP was especially transduced into the tunica media of the basilar artery 2 It after the injection.
Conclusions. Our results demonstrate that 11R-fused fluorescent protein effectively penetrates into the all layers of the rat BA, and especially into the tunica media.

DOI： 10.1007/978-3-211-75718-5-31

Effect of deferoxamine-activated hypoxia inducible factor-1 on the brainstem following subarachnoid haemorrhage

S. Ono, T. Hishikawa, T. Ogawa, M. Nishiguchi, K. Onoda, K. Tokunaga, K. Sugiu, I. Date

CEREBRAL VASOSPASM: NEW STRATEGIES IN RESEARCH AND TREATMENT 104 69 - 73 2008

Language：English Publisher：SPRINGER-VERLAG WIEN

Background. Hypoxia inducible factor-1 (HIF-1) is a transcription factor that regulates the expression of various neuroprotective genes. The goal of this study was to clarify the relationship between HIF-1 a expression and subarachnoid haemorrhage (SAH) and to determine the effects of the deferoxamine (DFO)-induced increase in HIF-1 alpha protein levels on the brainstem and the basilar artery (BA) following experimental SAH.
Method. Rat single- (10min, 6h, Day 1, Day 2) and double-haemorrhage (Day 7) models of SAH were used. The time course of HIF-1 alpha protein levels of the brainstems and the diameter of the BA was assessed. After an induction of double-haemorrhage in rats, DFO was injected intraperitoneally and HIF-1 alpha protein expression, activity in the brainstems, the diameter of the BA and the brainstem blood flow were assessed.
Findings. The expression of HIF-1 alpha protein was significantly greater at 10 min and 7 days after SAH. The increase of HIF-1 alpha protein correlated with the degree of cerebral vasospasm. An injection of DFO resulted in significant increases it) HIF-1 alpha protein expression and activity in the brainstem of rats with SAH.
Conclusions. These results indicate that DFO-induced increase in HIF-1 alpha protein levels and activity exerts neuroprotective and antivasospastic effects. DFO may be a potential therapeutic tool for cerebral vasospasm after SAH.

DOI： 10.1007/978-3-211-75718-5-13

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

日本脳神経外科学会総会抄録集(CD-ROM) 67th 2008

Triple-catheter technique in the transvenous coil embolization of an isolated sinus dural arteriovenous fistula International journal

Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Wataru Sasahara, Kyoichi Watanabe, Shigeki Ono, Keisuke Onoda, Isao Date

NEUROSURGERY 61 ( 3 ) 81 - 85 2007.9

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE: Dural arteriovenous fistulae involving the transverse-sigmoid sinus, which is occluded at its proximal and distal ends (i.e., an isolated sinus), carry a high risk of intracranial hemorrhage or progressive neurological deficits. Although transvenous coil embolization is a useful and safe,treatment for such lesions, it is often difficult to reach into the isolated sinus through the occluded sinus using the percutaneous catheter approach.
METHODS: We report the successful treatment of two patients with transverse-sigmoid dural arteriovenous fistulae with isolated sinus using the percutaneous transvenous triple-catheter technique. A 6-French guiding catheter was placed at the internal jugular vein followed by a second 4-French catheter positioned at the end of the occluded sinus. A third microcatheter was then navigated into the isolated sinus with support of the second catheter.
RESULTS: Although initial attempts to reach into the isolated sinus without the second catheter failed, insertion of the second catheter resulted in successful navigation of the third microcatheter into the affected sinus in both cases. Complete cure was obtained in both cases by coil packing of the affected sinus.
CONCLUSION: Although careful maneuvering is required, this triple-catheter technique is useful for treatment of dural arteriovenous fistulae with isolated sinus.

DOI： 10.1227/01.NEU.0000279984.56050.70

Antivasospastic and antiinflammatory effects of caspase inhibitor in experimental subarachnoid hemorrhage International journal

Keiichi Iseda, Shigeki Ono, Keisuke Onoda, Motoyoshi Saroh, Hiroaki Manabe, Mitsuhisa Nishiguchi, Kenji Takahashi, Koji Tokunaga, Kenji Sugiu, Isao Date

JOURNAL OF NEUROSURGERY 107 ( 1 ) 128 - 135 2007.7

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

Object. Inflammation in the subarachnoid space and apoptosis of arterial endothelial cells have been implicated in the development of delayed cerebral vasospasm after subarachnoid hemorrhage (SAH). The authors investigated mechanisms of possible antivasospastic effects of N-benzyl-oxycarbonyl-Val-Ala-Asp-fluoromethylketone (Z-VAD-FMK), a caspase inhibitor that can inhibit both inflammatory and apoptotic systems., in animal models of SAH.
Methods. Rabbits were assigned to three groups of eight animals each and were subjected to SAH by injection of blood into the cisterna magna. The experiments were performed in the following groups: SAH only, SAH + vehicle, and SAH + Z-VAD-FMK. The Z-VAD-FMK (1 mg) or vehicle (5% dimethyl sulfoxide) was intrathecally administered before SAH induction. Diameters of the basilar artery (BA) were measured on angiograms obtained before and 2 days after SAH. The BA diameter on Day 2 was expressed as a percentage of that before SAH. Interleukin (IL)-1 beta in the cerebrospinal fluid (CSF) was examined using Western blotting, and brains were immunohistochemically examined for caspase-1 and IL-1 beta. In a separate experiment, 20 rats were subjected to SAH and their brains were immunohistochemically assessed for caspase-1, IL-1 beta, and macrophages.
Results. In rabbits, Z-VAD-FMK significantly attenuated cerebral vasospasm (the BA diameter on Day 2 in SAH-only, SAH + vehicle, and SAH + Z-VAD-FMK groups was 66.6 +/- 3.2%, 66.3 +/- 3.7%, and 82.6 +/- 4.9% of baseline, respectively), and suppressed IL-1 beta release into the CSF and also suppressed immunoreactivities of caspase- I and IL-1 beta in macrophages infiltrating into the subarachnoid space. Immunoreactivities for caspase- I and IL-1 beta were observed in immunohistochemically proven infiltrating macrophages in rats.
Conclusions. These results indicate that caspase activation may be involved in the development of SAH-induced vasospasm through inflammatory reaction.

DOI： 10.3171/JNS-07/07/0128

Packing efficacy of hydrocoil embolic system: in vitro study using ruptured aneurysm model International journal

Kyoichi Watanabe, Kenji Sugiu, Koji Tokunaga, Wataru Sasahara, Shigeki Ono, Isao Date

NEUROSURGICAL REVIEW 30 ( 2 ) 127 - 130 2007.4

Language：English Publisher：SPRINGER

After endovascular coil embolization of cerebral aneurysms, coil compaction and late aneurysm recanalization have been ever observed. The HydroCoil Embolic System (HES) was developed to improve the packing efficacy of endovascular treatment of cerebral aneurysms. In this study, we evaluate the packing efficacy of HES using a silicone model of ruptured cerebral aneurysm. This silicone model was connected to a pulsatile flow pump and embolized with the initial framing coils followed by hydro coils (n = 3) or bare platinum coils (n = 3). The coils used in the two groups were identical to each other in size and length. In the hydro coil group, continuous outflow from ruptured aneurysm ceased in two out of three cases. On the other hand, in the bare platinum coil group, outflow from the ruptured point slightly decreased but did not stop in all cases. The hydro coil could result in a higher initial occlusion rate of silicone model. In addition, expanded hydrogel possibly sealed the ruptured point directly. Changes in the size of aneurysms were not detected, from which the risk of over-expansion seemed extremely low. The hydro Coil is a safe and feasible device for improving the packing efficacy in endovascular coil embolization.

DOI： 10.1007/s10143-007-0066-8

Novel protein transduction method by using 11R - An effective new drug delivery system for the treatment of cerebrovascular diseases International journal

Tomoyuki Ogawa, Shigeki Ono, Tomotsugu Ichikawa, Seiji Arimitsu, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Kazuhito Tomizawa, Hideki Matsui, Isao Date

STROKE 38 ( 4 ) 1354 - 1361 2007.4

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background and Purpose-A motif of 11 consecutive arginines (11R) is reported to be one of the most effective protein transduction domains for introducing proteins into the cell membrane. We therefore examined the transduction efficiency of 11R in cerebral arteries.
Methods-Basilar arteries (BAs) obtained from rats were incubated with either 11R-enhanced green fluorescent protein (11R-EGFP) or EGFP without 11R. After incubation, expression of 11R-EGFP or EGFP in BA serial sections was observed by fluorescence microscope. In an additional in vivo experiment, 11R-EGFP or EGFP was injected into the cisterna magna with or without subarachnoid hemorrhage. The 11R-EGFP or EGFP was injected just after the autologous blood injection, and then the expression of 11R-EGFP or EGFP in BA sections was also observed by fluorescence microscope.
Results-The 11R-EGFP signal was much stronger than that of EGFP in all layers of the rat BA, in both in vivo and ex vivo experiments. Moreover, the 11R-EGFP was transduced into the BA immediately ( 2 hours after the injection). Interestingly, 11R-fused fluorescent protein was transduced especially into the tunica media of the BA.
Conclusions-The 11R-fused fluorescent protein effectively penetrates into all layers of the rat BA, especially into the tunica media. This is the first study to our knowledge to demonstrate the successful transduction of a protein transduction domain fused protein into the cerebral arteries.

DOI： 10.1161/01.STR.0000259887.70358.e0

Combined use of TruFill DCS detachable coil system and Guglielmi detachable coil for embolization of meningioma fed by branches of the cavernous internal carotid artery - Technical case report

Noboru Kusaka, Takashi Tamiya, Kenji Sugiu, Koji Tokunaga, Mitsuhisa Nishiguchi, Kazuhiro Takayama, Yasuhiko Maeda, Kotaro Ogihara, Minoru Nakagawa, Tsukasa Nishiura

NEUROLOGIA MEDICO-CHIRURGICA 47 ( 1 ) 29 - 31 2007.1

Language：English Publisher：JAPAN NEUROSURGICAL SOC

A 57-year-old female presented with a left petroclival meningioma fed by the meningohypophyseal trunk of the internal carotid artery (ICA). The enlarged tentorial marginal artery and inferior hypophyseal artery were successfully embolized with the TruFill DCS Detachable Coil System through a 0.019-inch inner diameter microcatheter. Superselective catheterization into the dorsal meningeal artery could not be achieved with the same microcatheter, because the catheter tip was too large to pass into the vessel. Subsequently the feeding artery was successfully embolized with a Guglielmi detachable coil (GDC) through a 0.016-inch inner diameter microcatheter. The patient underwent surgery without blood loss on the day after embolization. Our subjective impression was that the TruFill DCS was softer and had less resistance during insertion, whereas the GDC could be delivered through a smaller caliber system for smaller vessels. Appropriate use of the TruFill DCS and GDCs can allow efficient embolization of the feeding branches of the ICA.

DOI： 10.2176/nmc.47.29

高齢者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, 佐々原渉, 小野成紀, 小野田惠介, 伊達勲

Geriatric Neurosurgery 19 39 - 41 2007

Internal trapping後に再発した破裂椎骨動脈解離性動脈瘤の1例.

菊池陽一郎, 杉生憲志, 徳永浩司, 西田あゆみ, 西村卓士, 伊達勲

脳神経外科 35 ( 8 ) 813 - 819 2007

塞栓術にて完治せしめた成人pial AVFの1例.

伊丹尚多, 杉生憲志, 徳永浩司, 小野成紀, 小野田惠介, 伊達勲

脳神経外科 35 ( 6 ) 599 - 605 2007

Clinical experiences of new detachable coils in the treatment of cerebral aneurysms — Micrusphere & Microplex

Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Hitoshi Hayase, Shigeki Ono, Keisuke Onoda, Isao Date

Journal of Neuroendovascular Therapy 1 ( 1 ) 45 - 53 2007

Language：English

The authors report initial clinical experience of new detachable coils in the treatment of cerebral aneurysms. Micrusphere coils and Microplex complex coils were introduced in Japan in 2006. These coils have a unique three-dimensional shape, suitable for framing the aneurysm. We mainly used these coils for the purpose of initial frame formation in the aneurysmal dome and evaluated their characteristics in this study. Over the last 8 months, 58 patients with intra-cranial aneurysm were treated using detachable coils at our institution. Of them, 14 patients were treated using Micrusphere, and 11 using Microplex. The Micrusphere coil was suitable for initial frame formation into a global shape with a relatively broad neck. The Microplex coil was able to produce a nice basket even in multi-lobulated or spindly aneurysms. It is imperative that all operators have precise understanding of the new coils prior to clinical use. © 2007, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.1.45

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

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

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

網膜中心動脈閉塞症に対する局所線溶療法─症例報告─.

田川雅彦, 杉生憲志, 徳永浩司, 佐々原渉, 渡邊恭一, 為佐信雄, 小野成紀, 小野田惠介, 伊達勲

脳神経外科 2005

ラジオ波凝固療法を併用した経皮的錐体形成術により治療を行った転移性脊椎錐体腫瘍の1例.

徳永浩司, 杉生憲志, 三好康之, 三村秀文, 金澤右, 伊達勲

脳神経外科 2005

脳腫瘍.

杉生憲志, 徳永浩司, 伊達勲

Clinical Neuroscience 23,10,1170-1172 2005

脳血管内治療の国際エビデンス.

杉生憲志, 徳永浩司, 伊達勲

分子脳血管病 4,2,127-134 2005

脳血管攣縮対策としてのspinal drainageとcisternal drainageの治療成績の比較─当科の脳血管攣縮予防プロトコールのもとで─.

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

脳卒中の外科 2005

破裂脳動脈瘤急性期の血管内治療─岡山大学脳神経外科におけるシステム整備と治療成績─.

杉生憲志, 徳永浩司, 渡邊恭一, 佐々原渉, 小野成紀, 小野田惠介, 伊達勲

Neurosurgical Emergency 2005

Endovascular Treatment of Ruptured Vertebral Artery Dissecting Aneurysms : Its Usefulness and Lessons from Complications

SUGIU Kenji, TOKUNAGA Koji, WATANABE Kyoichi, SASAHARA Wataru, ONO Shigeki, ONODA Keisuke, DATE Isao, Kenji SUGIU, Koji TOKUNAGA, Kyoichi WATANABE, Wataru SASAHARA, Shigeki ONO, Keisuke ONODA, Isao DATE, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School, Department of Neurological Surgery Okayama University Medical School

Nosotchu no Geka Kenkyukai koenshu 33 ( 3 ) 200 - 205 2005

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

We evaluated the cases of 32 consecutive patients with ruptured vertebral artery dissecting aneurysm (VADA) treated in our institution during the last 4 years. The goal of treatment was to exclude the aneurysm from the circulation using Guglielmi detachable coils (GDC). Twenty-six out of 32 patients were treated within 24 hours of the initial rupture, but 17 had rebleeding before treatment.<br> The outcome of the patients depended greatly on the patient's condition (Hunt & Kosnik grade) before treatment and whether there was rebleeding. There were 4 complications including 1 case of intra-operative rupture, 2 cases of rebleeding after treatment, and 1 case of cerebral infarction. The lessons from these complications would benefit from further treatment.<br> Although this report does not describe a controlled study, we found that endovascular treatment is preferable for treating ruptured VADAs in the acute stage.<br>

DOI： 10.2335/scs.33.200

Other Link： https://jlc.jst.go.jp/DN/JALC/00254985405?from=CiNii

3D MR Cisternography/Angiography Fusion Imagingによる部分的血栓化椎骨動脈瘤の画像評価.

佐藤透, 尾美賜, 大迫知香, 西田あゆみ, 守山英二, 小野田恵介, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科速報 2005

Color-coded 3D MRAによる個々の未破裂脳動脈瘤における瘤内MR信号強度分布パターンの画像解析.

佐藤透, 尾美賜, 大迫知香, 勝間田篤, 吉本祐介, 土本正治, 国塩勝三, 小野田恵介, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科 2005

未破裂内頸動脈 - 後交通動脈瘤の伸展・変形に及ぼす瘤周囲環境の画像評価─3D MR Cisternography-3D MR angiography fusion imagingによる検討─.

佐藤透, 尾美賜, 大迫知香, 勝間田篤, 吉本祐介, 土本正治, 小野田惠介, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科 2005

3次元MR Cisternographyによる脳内にdome/blebが埋没した内頸動脈─後交通動脈瘤の術前画像評価─.

佐藤透, 尾美賜, 大迫知香, 勝間田篤, 吉本祐介, 土本正治, 小野田惠介, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科速報 2005

くも膜下出血後症候性脳血管攣縮を呈し、塩酸ファスジルの繰り返し動注を試みた7症例.

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

脳卒中の外科 2005

Persistent primitive trigeminal artery-cavernous sinus fistula with intracerebral hemorrhage: endovascular treatment using detachable coils in a transarterial double-catheter technique - Case report and review of the literature International journal

K Tokunaga, K Sugiu, M Kameda, K Sakai, K Terasaka, T Higashi, Dare, I

JOURNAL OF NEUROSURGERY 101 ( 4 ) 697 - 699 2004.10

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

Intracerebral hemorrhage occurred in this 61-year-old woman with preexisting diplopia and proptosis. Results of angiography demonstrated a persistent primitive trigeminal artery (PPTA)-cavernous sinus fistula with cortical venous reflux. Two microcatheters were introduced transarterially through the PPTA into the two draining pathways in the cavernous sinus. Coils were delivered in both pathways simultaneously to prevent further venous overload on either path. The fistula was successfully occluded without complication while the PPTA was preserved. The authors describe this double-catheter technique for coil embolization of a fistula and review the literature concerning PPTA-cavernous sinus fistulas.

DOI： 10.3171/jns.2004.101.4.0697

Combined use of electrolytically and mechanically detachable platinum coils for endovascular treatment of cerebral aneurysms - Technical note

K Sugiu, A Katsumata, N Kusaka, W Sasahara, K Tokunaga, JB Martin, DA Rufenacht, T Ohmoto

NEUROLOGIA MEDICO-CHIRURGICA 44 ( 5 ) 269 - 273 2004.5

Language：English Publisher：JAPAN NEUROSURGICAL SOC

The combined use of Guglielmi detachable coils (GDCs) and newly developed mechanically detachable platinum coils (Detach Coil System: DCS) was evaluated for the endovascular treatment of 10 patients with cerebral aneurysms. The number and total length of detachable coils placed into the aneurysms, the detaching time for each coil, and any technical problems were recorded and evaluated. Sixty GDCs and 60 DCSs were used. The detachment time for the DCS (mean 21 seconds) was faster than that for the GDC (mean 2 minutes 35 seconds). One DCS moved inside the aneurysm during the mechanical detachment maneuver, but was successfully placed. Neither detachment system influenced the behavior of the other system during coil implantation. The DCS includes a useful J-shape coil, whereas the GDC can be detached safely in fragile aneurysms. The DCS is also cheaper. The coil systems complemented one another and the combination optimized cost and operating time.

DOI： 10.2176/nmc.44.269

Rebleeding of a vertebral artery dissecting aneurysm during stent-assisted coil embolization: A pitfall of the "stent and coil" technique International journal

K Sugiu, K Takahashi, K Muneta, T Ohmoto

SURGICAL NEUROLOGY 61 ( 4 ) 365 - 370 2004.4

Language：English Publisher：ELSEVIER SCIENCE INC

BACKGROUND
A stent-assisted coil embolization has been applied as a novel choice of treatment for vertebral artery dissecting aneurysms (VADAs).
CLINICAL PRESENTATION
A 45-year-old man suffered from subarachnoid hemorrhage three times within 2 hours. The left vertebral angiogram showed a VADA at the distal origin of the posterior inferior cerebellar artery. The right vertebral artery was hypoplastic, and collateral circulation to the posterior fossa was poor.
INTERVENTION
Stent-assisted coil embolization was performed under general anesthesia. The aneurysm was excluded from the circulation with good patency of the vertebral artery, although the fourth coil caused rebleeding from the aneurysmal dome during the procedure.
CONCLUSION
This is the first case report that demonstrates rebleeding from VADA during stent-assisted coil embolization in the acute stage of its rupture. We have to be aware of the risks and be ready to prevent fatal complications with this novel technique. (C) 2004 Elsevier Inc. All rights reserved.

DOI： 10.1016/S0090-3019(03)00515-9

Pseudoxanthoma elasticum with carotid rete mirabile International journal

T Yasuhara, K Sugiu, M Kakishita, Date, I

CLINICAL NEUROLOGY AND NEUROSURGERY 106 ( 2 ) 114 - 117 2004.3

Language：English Publisher：ELSEVIER SCIENCE BV

We describe a case of Pseudoxanthoma elasticum (PXE) in a 14-year-old girl. This case is especially rare because of its association with carotid rete mirabile (CRM). Only three cases have been reported previously in the literature. Although the relation between P. elasticum and carotid rete mirabile is unclear, both disorders are believed to be major risk factors for cerebrovascular disease. (C) 2003 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.clineuro.2003.10.008

Training in neurovascular intervention usefulness of in-vitro model and clinical practice

K Sugiu, K Tokunaga, W Sasahara, K Watanabe, A Nishida, A Katsumata, N Kusaka, Date, I, T Ohmoto, DA Rufenacht

INTERVENTIONAL NEURORADIOLOGY 10 107 - 112 2004.3

Language：English Publisher：EDIZIONI CENTAURO

We introduce our training tools and system of neurovascular intervention. An in vitro cerebral vascular model was used for the young residents to understand the basic interventional techniques and devices.
The model included several vascular lesions such as cerebral aneurysm, dural arterio-venous fistula, or carotid artery stenosis. Endovascular procedures in the model were performed under fluoroscopic or direct visual control, and consecutive haemodynamic changes were visualized by using digital subtraction angiography and direct observation. Thus, traineess could have an easy understanding of clinical conditions. New medical devices, such as platinum coils, were successfully implanted in the model under stable conditions.
After the initial training using vascular model, the residents had started clinical experiences under the control of senior surgeons. Although it is difficult to describe usefulness of our clinical training, we believe that we provide enough good quality and quantity of clinical cases to the residents. Because our endovascular team has recently had150-200 interventional procedures every year, one resident can have experienced more than 100 cases per year The qualification of a Board Certified Specialist of the Japanese Society of Intravascular Neurosurgery (JSIN) requires that, the applicant must have experienced more than 100 cases for four years. So our residents can have enough case materials to qualify the board examination.

くも膜下出血患者髄液におけるMCP-1、MIP-1α濃度の経時的変化について.

小野成紀, 小川智之, 菱川朋人, 西口充久, 徳永浩司, 杉生憲志, 伊達勲

脳卒中の外科 2004

3次元MR脳槽画像による未破裂脳動脈瘤外壁形態と瘤周囲環境の画像評価.

佐藤透, 浴野千菜美, 大迫知香, 勝間田篤, 小野田恵介, 土本正治, 柚木正敏, 徳永浩司, 杉生憲志, 伊達勲

脳神経外科 2004

ラット慢性低灌流モデルにおける血管内皮増殖因子(VEGF)およびAngiopoietin-1遺伝子の血管新生効果.

渡邊恭一, 日下昇, 勝間田篤, 佐々原渉, 徳永浩司, 杉生憲志, 西尾晋作, 小野成紀, 濱田洋文, 伊達勲

脳循環代謝 2004

DeferoxamineによるHypoxia inducible factor-1を介したラットくも膜下出血後脳血管攣縮時における脳保護効果の検討.

菱川朋人, 小野成紀, 小川智之, 西口充久, 徳永浩司, 杉生憲志, 伊達勲

脳卒中の外科 2004

Complication of temporary balloon test occlusion of the internal carotid artery: Experience in 119 cases

Atsushi Katsumata, Kenji Sugiu, Wataru Sasahara, Kyoichi Watanabe, Ayumi Nishida, Noboru Kusaka, Koji Tokunaga, Isao Date

Japanese Journal of Neurosurgery 13 ( 8 ) 572 - 577 2004

Language：Japanese Publisher：Japanese Congress of Neurological Surgeons

Currently, temporary balloon test occlusion (BTO) of the internal carotid artery (ICA) has become a well accepted procedure in the preoperative evaluation of patients with large aneurysm or tumor involving the neck or skull base in whom arterial sacrifice or prolonged temporary occlusion is considered. In this paper we review our experience with 119 cases of BTO and evaluate the associated techniques and complications. BTO of the ICA was accomplished endovascularly using triple-lumen balloon catheter. After ICA occlusion using the balloon, the patient's neurological status was assessed and monitored continuously throughout 30 minutes. When the patient showed neurological changes, BTO was immediately stopped. Complication related to this procedure occurred in 5 (4.2%) patients. Two (1.7%) patients had symptomatic and three (2.5%) had asymptomatic complications. One (0.8%) of these was a permanent neurological deficit due to ICA dissection caused by the balloon catheter. The other (0.8 %)was embolic M2 occlusion resulted in transient neurological deficit. There were no death related this procedure. BTO of the ICA can be performed with an acceptable low complication rate, however, it should be performed by the experienced hand and under strict indication.

DOI： 10.7887/jcns.13.572

Role of Inflammation in Cerebral Vasospasm after Subarachnoid Hemorrhage: Expression of iNOS, NF-kappaB, IKK in the Major Cerebral Arteries and CSF Samples in Humans

ONO Shigeki, NISHIO Shinsaku, TOKUNAGA Koji, SUGIU Kenji, DATE Isao

Nosotchu no Geka Kenkyukai koenshu 32 ( 5 ) 315 - 319 2004

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

We had an autopsy case who had suffered from severe subarachnoid hemorrhage (SAH). The case was a 74 year-old man who was in Fisher Group 3 and Hunt & Kosnik Grade 3 on admission. He was treated by intraarterial coil embolization to the anterior communicating artery aneurysm on Day 0, but the aneurysm reruptured on Day 8. Angiograms on Day 8 showed mild to moderate vasospasm in the right anterior and middle cerebral arteries. Although recoiling to the resting neck was performed immediately, the patient died on Day 11.<br> We were able to harvest the major cerebral arteries just 2 hours after death. RNA was extracted from each artery and then reverse transcription-polymerase chain reaction (RT-PCR) was carried out using human inducible nitric oxide synthase (iNOS) primers. Histological and immunocytochemical examination was done for iNOS, NF-kappaB, and I-kappaB kinase (IKK). Enzyme-Linked Immunosorbent Assay (ELISA) was performed using the cerebrospinal fluid of SAH patients who suffered from vasospasm for detecting iNOS protein. iNOS messenger RNA was up-regulated in the vasospastic arteries compared to the non-spastic one. Hematoxylin-eosin staining revealed that there were many white blood cells in both sides of the vascular wall. iNOS has been detected in some patients who suffered from SAH and was remarkably higher than that in patients showing no vasospasm but has not been detected in normal cerebrospinal fluid. On Day 5, iNOS protein in the CSF was highest during the course after SAH.<br> These results suggest that inflammation, especially, vascular injury by iNOS, may be important to understand the pathogenesis of cerebral vasospasm.<br>

DOI： 10.2335/scs.32.315

脳血管攣縮に対する塩酸ファスジル動注療法中に痙攣を起こした1例.

佐々原渉, 小野成紀, 徳永浩司, 杉生憲志, 中嶋裕之, 伊達勲, 大本堯史

脳神経外科 2004

解離性椎骨動脈瘤に対する血管内動脈瘤コイル塞栓術.

佐藤元美, 槌田昌平, 徳永浩司, 杉生憲志

西宮市医師会医学雑誌 2004

破裂急性期椎骨動脈解離性動脈瘤に対する血管内治療.

杉生憲志, 徳永浩司, 伊達勲

脳神経外科 32,1229-1238 2004

Spiral versus J-shaped coils for neurovascular embolisation - an in-vitro study

K Sugiu, K Tokunaga, S Mandai, JB Martin, B Jean, DA Rufenacht

NEURORADIOLOGY 45 ( 7 ) 417 - 422 2003.7

Language：English Publisher：SPRINGER-VERLAG

Our purpose was to compare the characteristics of J-shaped detachable platinum coils with those of spiral coils in in-vitro vascular models. J-shaped coils consist of distal semicircular and proximal straight segments, the latter extending for most of the length of the coil. Spiral coils have a helical shape memory and are thus limited in expansion. In in-vitro silicone vascular models simulating intracranial aneurysms and dural arteriovenous fistulae, we compared J-shaped and spiral coils with regard to ease of delivery, anchoring and folding patterns, and stability in various types of vascular lumen. Delivery and retrieval were comparable. In large and irregular aneurysms and venous sinuses, J-shaped coils could form a more complex basket which conformed to the shape of the vascular cavity. The J-shaped coil was always in contact with the vessel wall. In wide-necked aneurysms, coil protrusion was more frequent with J-shaped coils, while spiral coils tended to stay compact and circular. Arteries were occluded in a shorter segment with spiral coils. J-shaped coils were safe and superior for large and irregular aneurysms or sinuses. Spiral coils were preferable for spherical aneurysms and segmental occlusion of arteries.

DOI： 10.1007/s00234-003-1012-2

Angioplasty and coiling of ruptured aneurysm with symptomatic vasospasm: Technical case report International journal

K Sugiu, A Katsumata, Y Ono, T Tamiya, T Ohmoto

SURGICAL NEUROLOGY 59 ( 5 ) 413 - 417 2003.5

Language：English Publisher：ELSEVIER SCIENCE INC

BACKGROUND Treating a ruptured cerebral aneurysm during symptomatic vasospasm is very difficult. We describe the successful endovascular treatment of such a case and discuss its efficacy.
CASE PRESENTATION A 34-year-old man had a sudden onset of severe headache. One week later, he was referred to our institute with gradually progressing right hemiparesis and global aphasia. Cerebral angiography demonstrated severe vasospasm of the left internal carotid artery system and an anterior communicating artery aneurysm. With the patient under general anesthesia, 90% occlusion of the aneurysm was achieved with detachable coils after successful dilatation of the spastic vessels. The patient had an uneventful postoperative course and his neurologic symptoms were improved. Seven months after the endovascular treatment, the enlarged neck remnant of the aneurysm was successfully clipped without difficulty.
CONCLUSION The simultaneous treatment of a ruptured aneurysm and vasospasm with percutaneous transluminal angioplasty and coils can produce a better outcome for the patient. (C) 2003 Elsevier Inc. All rights reserved.

DOI： 10.1016/S0090-3019(03)00071-5

De novo aneurysms [2] (multiple letters)

Biodun Ogungbo, Takao Yasuhara, Takashi Tamiya, Kenji Sugiu, Satoshi Inoue, Takashi Ohmoto

Journal of Neurosurgery 98 ( 4 ) 933 - 934 2003.4

Artificial cerebral aneurysm model for medical testing, training, and research

K Sugiu, JB Martin, B Jean, P Gailloud, S Mandai, DA Rufenacht

NEUROLOGIA MEDICO-CHIRURGICA 43 ( 2 ) 69 - 72 2003.2

Language：English Publisher：JAPAN NEUROSURGICAL SOC

Artificial models of cerebral aneurysms for medical training and testing of medical devices were constructed from corrosion casts of the main cerebral arteries of a human specimen. Three aneurysms with a variety of shapes were simulated at typical locations. Rigid and soft models were made of silicone using the "lost wax" technique. The transparent silicone models were anatomically accurate and reproducible copies of human vascular casts. These models could be connected in a closed circuit that used an electric pump to simulate pulsatile flow. Endovascular procedures and surgical clip application were performed under fluoroscopic or direct visual control. Surgical clipping, endoluminal coil manipulation, and consecutive hemodynamic changes were visualized by digital subtraction angiography and direct observation. The model provides trainee surgeons with an understanding of clinical conditions. New medical devices, such as platinum coils, would be experimentally implanted in the model under stable conditions. These anatomically accurate and reproducible models of cerebral vasculature and aneurysms are valuable for medical testing, training, and research.

DOI： 10.2176/nmc.43.69

自然血栓化した後大脳動脈末梢部紡錘状動脈瘤の1例

近藤聡彦, 安原隆雄, 杉生憲志, 大本堯史

脳神経外科 2003

新しい塞栓物質と今後の塞栓術の展開.

杉生憲志, 渡邊恭一, 佐々原渉

脳神経外科速報 13,1067-1073 2003

骨粗鬆症性椎体圧迫骨折に対する経皮的椎体形成術(percutaneous vertebroplasty)の手術手技.

徳永浩司, 杉生憲志, 三好康之, 小野恭裕, 伊達勲

脳神経外科速報 13,985-991 2003

経皮的椎体形成術─適応と手技─.

徳永浩司, 杉生憲志, 中嶋裕之, 伊達勲, 大本堯史, Martin JB, Ruefenacht DA

脳神経外科 31,7-14 2003

虚血性脳卒中に対する血管内治療―急性期〜慢性期―

杉生憲志

最新医学 58,886-892 2003

くも膜下出血後脳血管攣縮に対する当科の治療戦略─ウロキナーゼ脳室内bolus injectionおよび血管内治療（PTAと塩酸ファスジル動注）の効果─.

小野成紀, 伊達勲, 徳永浩司, 杉生憲志, 大本堯史

脳卒中の外科 2003

カタクロット（オザグレルナトリウム）と経皮的血管形成術(PTA)による治療が奏功した脳底動脈狭窄症の1例

小坂章, 渡邊恭一, 為佐信雄, 杉生憲志, 大本堯史

新薬と臨床 2003

De Novo Aneurysm

Yasuhara T, Tamiya T, Sugiu K, Inoue S, Ohmoto T

J. Neurosurg 2003

De novo formation and rupture of an aneurysm - Case report International journal

T Yasuhara, T Tamiya, K Sugiu, S Inoue, T Ohmoto

JOURNAL OF NEUROSURGERY 97 ( 3 ) 697 - 700 2002.9

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

The authors describe a case of de novo fori-nation and rupture of an aneurysm located at the junction of the left internal carotid artery and the superior hypophyseal artery in a middle-aged woman 2 months after another aneurysm, located on the anterior communicating artery, had been clipped. This case is rare because of the short interval between the last angiographic study performed at the first operation and the diagnosis of the de novo aneurysm; in this case the interval was only 47 days, compared with other cases in the literature in which the intervals were 3 to 34 years. Aneurysms can enlarge considerably in 2 to 4 weeks and can rupture at or soon after their formation. This case provides insight into aneurysm formation and rupture.

Performance of long J-shaped coils in large and giant intracranial aneurysms: an in vitro study

K Tokunaga, N Tanaka, K Sugiu, O Levrier, JB Martin, DA Rufenacht

NEURORADIOLOGY 44 ( 3 ) 261 - 267 2002.3

Language：English Publisher：SPRINGER-VERLAG

We evaluated the performance of long straight coils (Detach-18(R) J-shaped coils) in large and giant in-vitro aneurysms. The coils consisted of a distal semicircular part 7 or 15 mm in diameter and a proximal 70 em straight part having three types of stiffness: soft, standard, and stiff. We first investigated the ease of passage through a microcatheter in a realistic cerebral vessel model. Second, vie made silicone models simulating lateral-type aneurysms of various spherical dome diameters (12, 15, 20 and 30 mm) and neck sizes (3-10 mm; dome-to-neck ratio approximately 3:1) and connected them to a pulsating circulatory pump. We evaluated the anchoring and folding patterns of the coils, stability of the microcatheter and coils in the aneurysm, and smoothness of delivery and retrieval of coils. Third, we compared the conformability of a coil in a large, irregular aneurysm with that of a spiral coil. The long J-shaped coils were easily advanced and retrieved through a microcatheter in a tortuous vessel model. In 12, mm spherical aneurysms, each coil made a complex framework, and knot formation or damage to the coil during withdrawal was often observed. In 15 mm aneurysms, the coils were all easily delivered and retrieved; standard-stiffness coils adapted best to this size. In 20 mm aneurysms, frameworks were less complex but still good with a standard or stiff coil, but those with soft coil were unstable and changed significantly within 3 min of detachment due to gravity and pulsatile flow. In 30 mm aneurysms, soft coils filled only the lower part during introduction, whereas a stiff coil still made a favourable framework. Conformability of a long J-shaped coil was superior to that of a spiral coil in a large, irregular aneurysm. Long J-shaped coils conform well to various configurations of large and giant aneurysms and can shorten procedures since a. larger implant volume can be delivered with a single coil. Their principle of action may promote more favourable occlusion of irregular and large aneurysms by improved conformability and stability.

DOI： 10.1007/s00234-001-0712-8

Rescue balloon procedure for an emergency situation during coil embolization for cerebral aneurysms International journal

K Sugiu, JB Martin, B Jean, DA Rufenacht

JOURNAL OF NEUROSURGERY 96 ( 2 ) 373 - 376 2002.2

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

In this article the authors describe a rescue balloon procedure for coil implantation in three cases. In each patient, the coil seemed likely to unravel. The coils stretched when attempts were made to remove the partially implanted but trapped device. The inflation of a nondetachable microballoon in front of the aneurysm orifice allowed the surgeons to complete implantation of the coil and to avoid a more forceful and potentially harmful retrieval. This rescue balloon method may be useful for emergency situations, such as coil stretching, with or without migration.

Guglielmi detachable coilを用いて治療した破裂fenestrated aneurysm of vertebral artery unionの1例.

西口充久, 杉生憲志, 大本堯史, 西条寿一, 藤沢洋之

脳神経外科 2002

出血を来しやすい硬膜動静脈瘻について.

西田あゆみ, 杉生憲志, 勝間田篤, 日下昇, 中嶋裕之, 大本堯史

脳神経外科 2002

脳血管性疾患に対するcerebral parenchymographyの有用性.

杉生憲志, 西田あゆみ, 勝間田篤, 日下昇, 中嶋裕之, 大本堯史

脳神経外科 2002

Is the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?

DS Ruiz, K Tokunaga, AR Dehdashti, K Sugiu, J Delavelle, DA Rufenacht

NEW TRENDS IN CEREBRAL ANEURYSM MANAGEMENT 82 31 - 34 2002

Language：English Publisher：SPRINGER-VERLAG WIEN

Purpose. To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture.
Materials and Methods. In a series of 76 consecutive patients, pre- and post-contrast CT images of 87 aneurysms were evaluated. Aneurysm locations were identified and aneurysms were divided into two different groups depending on whether they had ruptured or not. Contact between aneurysms and the perianeurysmal environment was studied when present, and considered to be balanced or unbalanced according to symmetry of contact and type of contact interface, i.e. with bone, dura, etc.
Results. Rupture occurred in 47 aneurysms at an average maximum dome size of 7.4 mm. There was contact with elements of the perianeurysmal environment in 38 (81%) of ruptured cases and no evidence of contact in 7 (15%). The nature of contact was unclear in 2 (4%) ruptured aneurysms. In the aneurysms with contact, the nature of contact was unbalanced in 34 (72%) and balanced in 4 (9%). Unbalanced aneurysms ruptured at significantly smaller sizes (average: 7.7 mm) than balanced aneurysms (average: 11.4 mm). Seven aneurysms of small size (3.3-6.9 mm, average: 4.8 mm) were found to have ruptured, despite the fact that they were too small to exhibit contact with the perianeurysmal environment. In 40 unruptured aneurysms (average size: 6.3 mm), contact with the perianeurysmal environment was found in 15 aneurysms, for which balanced contact was found in 11 (27.5%) and unbalanced contact in 4 (10%), and no contact in 25 (62.5%). The average size of the aneurysms without contact (3.7 mm) was significantly smaller than that with balanced contact (10.3 mm) or with unbalanced contact (11.3 mm).
Conclusion. Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.

脳血管内治療のトレーニングについて.

杉生憲志, 徳永浩司, 伊達勲, 大本堯史

脳神経外科 30,1231-1237 2002

岡山県におけるウィリス動脈輪閉塞症の実態調査と長期予後調査

大本堯史, 西田あゆみ, 勝間田篤, 日下昇, 杉生憲志, 中嶋裕之

厚生労働省特定疾患ウィリス動脈輪閉塞症の病因・病態に関する研究班平成13年度総括・分担研究報告書 2002

The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis

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

NEURORADIOLOGY 43 ( 11 ) 980 - 984 2001.11

Language：English Publisher：SPRINGER-VERLAG

Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs.

DOI： 10.1007/s002340100596

MRI of Kernohan's Notch in a Ruptured Distal Anterior Cerebral Artery Aneurysm : A Case Report

SAKAI Kyoji, NISHIGUCHI Mitsuhisa, TANIMOTO Takaho, TERASAKA Kaoru, SUGATANI Hiroshi, HIGASHI Toru, SUGIU Kenji

Japanese journal of neurosurgery 10 ( 8 ) 537 - 540 2001.8

Language：Japanese Publisher：The Japanese Congress of Neurological Surgeons

A 60-year-old female presented with a massive left subdural hematoma caused by the rupture of a distal anterior cerebral artery aneurysm. On admission, she was comatose with fixed and dilated pupils, showing a decerebrate posture. She underwent an emergency operation. The subdural hematoma was removed and an external decompression was also undertaked. Her level of consiousness gradually improved and a left hemiplegia became evident. A T2-weighted MRI revealed a lesion in the right cerebral peduncle on the extending line of the tentorium. Such hyperintense lesions may represent the myelin desruction around Kernohan's notch.

In vitro evaluation of the effectiveness of distal protection in the prevention of cerebral thromboembolism during carotid stent placement

JB Martin, KJ Murphy, P Gailloud, K Sugiu, MM Treggiari, M Muster, L Guimaraens, JG Theron, DA Rufenacht

ACADEMIC RADIOLOGY 8 ( 7 ) 623 - 628 2001.7

Language：English Publisher：ASSOC UNIV RADIOLOGISTS

Rationale and Objectives. The purpose of this in vitro study was to evaluate and quantify the benefit of the balloon protection device, to identify the most: effective sequence of irrigation or flushing, and to determine the most effective catheter position to remove the maximum number of emboli or debris beneath the flow-arrest balloon.
Materials and Methods. Silicone models of the neurovasculature were attached to a systodiastolic pump. Stents were placed in carotid stenoses by using the distal flow protection technique. Embolic material was released within the stent. The effectiveness of different irrigation techniques was evaluated.
Results. Aspiration under the balloon through the guiding catheter with a 60-mL syringe followed by one power injection at 40 mL injected at 2 mL/sec will result in removal of about 98% of potential emboli from the inferior vena cava.
Conclusion. In vitro evaluation of the distal flow protection technique indicates that it should reduce stroke risk during carotid stent placement.

DOI： 10.1016/S1076-6332(03)80687-6

Role of the distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement

JB Martin, JC Pache, M Treggiari-Venzi, KJ Murphy, P Gailloud, E Puget, G Pizzolato, K Sugiu, L Guimaraens, J Theron, DA Rufenacht

STROKE 32 ( 2 ) 479 - 484 2001.2

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background and Purpose-We sought to quantitatively and qualitatively evaluate the release of atheromatous plaque debris induced by carotid stenting procedures.
Methods-Eight patients with severe carotid atheromatous stenoses were treated by stent implantation under distal balloon protection, Blood samplings were obtained after stent deployment in the blood pooled below the inflated protection balloon. The samples were centrifuged and evaluated for plaque debris with the use of light microscopy. The debris release was quantitatively estimated by dividing the total volume of debris obtained by the mean debris size. Five patients without endovascular procedure were used as a control group.
Results-The 2 main debris types found were nonrefringent cholesterol crystals (4 to 389 mum; 115 to 8697 in number) and lipoid masses (7 to 600 mum; 341 to 34 000 in number). There was a statistically significant difference compared with the samples obtained in the control group (P = 0,017).
Conclusions-Blood samples collected during stent implantation procedures contain a large quantity of atheromatous plaque debris. This emphasizes the role of distal protection techniques in avoiding migration of this plaque material into the cerebral circulation.

A report of the clinical use of the Detach-18 mechanical detachable platinum coil in 41 patients

KJ Murphy, E Houdart, KT Szopinski, O Levrier, L Guimaraens, D Kuhne, L Solymosi, NJ Bartholdy, K Sugiu, DA Rufenacht

AMERICAN JOURNAL OF NEURORADIOLOGY 22 ( 2 ) 341 - 344 2001.2

Language：English Publisher：AMER SOC NEURORADIOLOGY

BACKGROUND AND PURPOSE: The purpose of this study was to determine the safety and reliability of the mechanical detachment system of a new platinum coil, Detach-18, when used as a vascular occlusive device for neurovascular disease.
METHODS: Forty-one patients (nine male and 32 female patients; age range, 26-75 years; mean age, 54.4 years) underwent treatment at seven centers. Twenty-two patients had dural arteriovenous fistulae of the transverse sinus treated by a transvenous route. Fourteen patients underwent internal carotid artery occlusion in the treatment of aneurysms, meningioma, facial tumor, or carotid injury. One patient underwent occlusion of the basilar artery and one patient underwent occlusion of the vertebral artery for treatment of aneurysms. In two patients, coils were used as part of the treatment of their arteriovenous malformations. In all cases, the Detach-18 coils were delivered through a microcatheter with two distal markers, Two types of coils, a 0.015-inch-diameter "regular" coil and a 0.014-inch-diameter "soft" coil, were used,
RESULTS: A total of 569 coils were used, 541 of which were detached. The number of coils in ranged from four to 53 (average number of coils, 14), The coils passed easily through the microcatheter. The detachment maneuver occurred within 10 to 25 s with 20 turns of the introducing wire. No premature coil detachment occurred. Complete occlusion of the vessel lumen was achieved in 35 cases. In three cases, 80% to 90% occlusion was achieved. In two cases, 70% to 80% occlusion was achieved, There were no device-related complications.
CONCLUSION: The detachment system was safe, reliable, consistent, and fast. This is a useful system for coil embolization in neurovascular applications.

Endovascular treatment of cerebral aneurysms: An in vitro study with detachable platinum coils and tricellulose acetate polymer

M Piotin, S Mandai, K Sugiu, P Gailloud, DA Rufenacht

AMERICAN JOURNAL OF ROENTGENOLOGY 176 ( 1 ) 235 - 239 2001.1

Language：English Publisher：AMER ROENTGEN RAY SOC

OBJECTIVE. The purpose of our experimental study was to determine the effectiveness of filling the cavity of in vitro aneurysms with detachable platinum coils and the combination of detachable platinum coils and liquid embolic agent.
MATERIALS AND METHODS. Silicone aneurysm models were connected to a circulatory system to simulate arterial flow. A microcatheter was used to introduce detachable coils into the aneurysm cavities. First, platinum coils were introduced until the point of minimal dense packing, indicated by aneurysmal circulatory exclusion. Packing was continued up to maximal dense packing, indicated by protrusion of the coil into the parent artery. Volumetric ratios (coil volume-aneurysm volume) were calculated for minimal and maximal dense packing. Then, after purposeful undercoiling of aneurysm models, a micropump system was used to fill the aneurysm by stepwise injection of tricellulose acetate polymer through the coil mesh until angiographic aneurysm exclusion was completed. The volumetric ratios of maximal packing with coils and tricellulose acetate polymer in relation to the aneurysm volume were calculated.
RESULTS. Maximal dense packing ratios with coils (mean, 32.5%; standard deviation [SD], 3%) were slightly higher than those with the minimal dense packing (mean, 28.2%; SD, 3%) but were always less than 37%. The ratios of packing with the combined use of coils and tricellulose acetate polymer were greater than 100% (mean, 124.4%; SD, 15%).
CONCLUSION. Knowledge of the volumetric ratio of maximal dense packing was useful for effective filling with coils and tricellulose acetate polymer. The combined use of coils and liquid polymer appeared more effective than the use of coils alone for the complete occlusion of the aneurysm lumen.

脳神経外科学─臨床医学の展望─

大本堯史, 松本健五, 田宮隆, 中嶋裕之, 伊達勲, 富田享, 山本良裕, 小野恭裕, 杉生憲志, 相原寛

日本医事新報 4007,14-24 2001

新しいバルーン付きガイディングカテーテルの使用経験

勝間田篤, 杉生憲志, 西田あゆみ, 日下昇, 中嶋裕之, 大本堯史

脳神経外科速報 2001

GDCを用いて腫瘍栄養血管である内頚動脈小分枝の塞栓術を行った錐体斜台部髄膜腫の1例

勝間田篤, 日下昇, 杉生憲志, 中嶋裕之, 伊達勲, 大本堯史

脳神経外科 2001

新しいmechanical detachable coilの脳血管内手術における有用性

杉生憲志, 勝間田篤, 日下昇, 中嶋裕之, 大本堯史, Daniel A Rufenacht

脳神経外科 2001

脳動脈瘤の診断と治療─どんな動脈瘤が破れるのか─

杉生憲志, Rufenacht DA

NEURO・IMAGING CONFERENCE 筑後・佐賀症例集2000 ,4-4 2001

Curative treatment of cerebral arteriovenous malformations by embolisation using cellulose acetate polymer followed by surgical resection

K Tokunaga, K Kinugasa, T Meguro, K Sugiu, H Nakashima, S Mandai, T Ohmoto

JOURNAL OF CLINICAL NEUROSCIENCE 7 1 - 5 2000.9

Language：English Publisher：CHURCHILL LIVINGSTONE

To investigate the usefulness of embolising cerebral arteriovenous malformations (AVMs) with a cellulose acetate polymer solution before surgical resection.
Methods: The cases of 12 patients with AVMs treated by embolisation before surgical resection were renewed. Two types of cellulose acetate polymer solutions were used to occlude 40 feeding vessels. All patients underwent surgical resection 1-51 days after embolisation.
Results: Reduction of the nidus volume after embolisation ranged from 20% to nearly 100%. Transient neurological deficits occurred in three patients, persistent deficits occurred in one and there were no haemorrhagic complications. All but one arteriovenous malformation were completely resected, Embolisation helped to identify feeding vessels and ease dissection. Histopathological examination of resected specimens disclosed mild inflammatory reactions in the acute stage and no unfavourable granulomatous changes in the chronic stage.
Conclusion: Embolisation with cellulose acetate polymer solutions followed by surgical resection is safe and efficacious for treating cerebral AVMs. (C) 2000 Harcourt Publishers Ltd.

Dense packing of cerebral aneurysms: An in vitro study with detachable platinum coils

M Piotin, S Mandai, KJ Murphy, K Sugiu, P Gailloud, JB Martin, DA Rufenacht

AMERICAN JOURNAL OF NEURORADIOLOGY 21 ( 4 ) 757 - 760 2000.4

Language：English Publisher：AMER SOC NEURORADIOLOGY

Aneurysm models were used to study the density of packing after coil embolization, Platinum coils were introduced until the point of minimally dense packing, indicated by aneurysmal circulatory exclusion, Packing was continued up to the point of maximal density, indicated by protrusion into the parent artery. Volumetric ratios (coil volume/aneurysmal volume) were calculated for minimally and maximally dense packing. Maximally dense packing ratios were a little higher than the minimally dense ratios, but less than 37%.

Endovascular occlusion and percutaneous treatment of vasospasm

Jean B, Sugiu K, Muster M, Rufenacht DA

Rev Med Suisse Romande 2000

ウィリス動脈輪閉塞症（もやもや病）の岡山県実態調査長期追跡調査の中間報告

大本堯史, 勝間田篤, 日下昇, 難波克成, 杉生憲志, 中嶋裕之

厚生省特定疾患・ウィリス動脈輪閉塞症の病因・病態に関する研究班平成11年度研究報告書 2000

Curative treatment of cerebral arteriovenous malformations by embolisation using cellulose acetate polymer followed by surgical resection

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

Journal of Clinical Neuroscience 7 ( 1 ) 1 - 5 2000

Language：English Publisher：Churchill Livingstone

Aim: To investigate the usefulness of embolising cerebral arteriovenous malformations (AVMs) with a cellulose acetate polymer solution before surgical resection. Methods: The cases of 12 patients with AVMs treated by embolisation before surgical resection were renewed. Two types of cellulose acetate polymer solutions were used to occlude 40 feeding vessels. All patients underwent surgical resection 1-51 days after embolisation. Results: Reduction of the nidus volume after embolisation ranged from 20% to nearly 100%. Transient neurological deficits occurred in three patients, persistent deficits occurred in one and there were no haemorrhagic complications. All but one arteriovenous malformation were completely resected. Embolisation helped to identify feeding vessels and ease dissection. Histopathological examination of resected specimens disclosed mild inflammatory reactions in the acute stage and no unfavourable granulomatous changes in the chronic stage. Conclusion: Embolisation with cellulose acetate polymer solutions followed by surgical resection is safe and efficacious for treating cerebral AVMs. (C) 2000 Harcourt Publishers Ltd.

DOI： 10.1054/jocn.2000.0700

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

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

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

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

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

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

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

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

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

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

　 PREV - NEXT 　

1