著者

谷川 緑野 安榮 良悟 泉 直人 橋爪 明 藤田 力 橋本 政明 上山 博康

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.27, no.6, pp.433-438, 1999-11-30 (Released:2012-10-29)

参考文献数

26

被引用文献数

15 18

---

Spontaneous dissection of the anterior cerebral artery (ACA) is an unusual condition, and the natural history of the intracranial arterial dissection is not well known. We report our surgical strategy for the dissection of ACA. In our series of ACA dissections, 5 cases presented an ischemia and 1 showed an SAH. Case 1 showed the dissection of the A2 portion of the ACA presenting weakness of the right lower extremity. According to Yonas et al., the dissection between the internal elastica and the media causes a cerebral ischemia and the dissection between the media and the adventitia causes an SAH. In Case 1, the pathological study revealed a dissection between the media and the adventitia in spite of a cerebral ischemia. Case 3 after initial headache showed a mild paresis of the right leg and the dissection of A2, A3 portion of ACA in the repeated angiography. The pericallosal-pericallosal side-to-side anastomosis and callosomarginal artery-callosomarginal artery side-to-side anastomosis with the ligation of the proximal A2 portion was performed. The pseudo lumen was detected in the anterior internal frontal artery after the arteriostomy. Preoperative left CAG did not reveal a double lumen sign but mild stenosis of the anterior internal frontal artery. This is the first report of intraoperative detection of intracranial arterial dissecting pseudo lumen. Obliteration of the dissecting entry in the surgical treatment of arterial dissection is essential. Therefore, it is considered that the trapping of the dissection and the revascularization of the ACA is necessary to prevent postoperative infarction and future rupture of the dissection. The pressure in the true lumen of the dissecting vessels is elevated by producing A3-A3 anastomosis, and the increasing pressure of the true lumen will compress the pseudo lumen after the blocking of the entry. We conclude that the occlusion of the entry and revascularization for the dissecting arteries might be the first choice in the surgical treatment for the patients of ACA dissection.

著者

高倉 祐樹 大槻 美佳 中川 賀嗣 大澤 朋史 谷川 緑野

出版者

一般社団法人 日本高次脳機能障害学会

雑誌

高次脳機能研究 (旧 失語症研究) (ISSN:13484818)

巻号頁・発行日

vol.31, no.4, pp.411-421, 2011-12-31 (Released:2013-01-04)

参考文献数

31

被引用文献数

1

---

発症時から失語症を認めず, 言語性短期記憶 (Short-Term Memory : STM) に選択的な障害を呈した 1 例を報告した。本例の知見から, 言語性 STM の解剖学的基盤は優位半球の側頭弁蓋~横側頭回近傍と示唆された。本例は数唱に比べ, 明確な意味を伴い, かつ同じ音韻系列を持つ文の復唱が良好 (例 : “8-2-3-1”の数唱は困難だが, “蜂に刺されて散々な一日だ”という文の復唱は可能) , 桁数付き数字の復唱が良好 (例 : “7-2-3”の数唱は困難だが, “ななひゃくにじゅうさん”の復唱は可能) , 無意味語系列に比べ有意味語系列の再生が良好であった。以上から言語性 STM における「容量」は必ずしも音韻情報量に依存せず, 意味の付与や情報のチャンク化の効率により決定されると考えられ, 既報告を支持した。さらに, 刺激提示の時間間隔や素材の変化により把持成績には差異が生じており, 援用されるストラテジーもそれぞれ異なる可能性が示唆された。

著者

谷川 緑野 上山 博康 小林 延光 高村 春雄

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.24, no.2, pp.129-135, 1996-03-30 (Released:2012-10-29)

参考文献数

4

被引用文献数

7 6

---

Casting hematoma and subarachnoid hemorrhage in acute subarachnoid hemorrhage causes serious consciousness disturbance and can be fatal. Severe subarachnoid hemorrhage with Fisher Group 3 or more causes symptomatic cerebral vasospasm, which greatly affects the prognosis in such serious cases. Here we report our procedure to remove intraventricular casting hematoma and subarachnoid clots to improve the prognosis in such serious cases.Intraventricular casting hematoma: Intraventricular casting hematoma is often found in ruptured anterior communicating artery aneurysm, and anterior interhemispheric approach (AIH) is used to clip the aneurysm. Intraventricular casting hematoma complicated with anterior communicating artery aneurysm, in many cases, ranges from the anterior horn of the lateral ventricle, to the body, posterior horn, inferior horn, and third ventricle. Removal of casting hematoma is possible from the anterior horn of the lateral ventricle by frontal corticotomy after AIH. The contralateral intraventricular casting hematoma can be treated by breaking the septum pellucidum, and the third ventricle can be treated via the foramen of Monro. After removal of the hematoma, drainage tubes are placed in the trigone and third ventricle to control the intracranial pressure.Subarachnoid clot: For subarachnoid hemorrhage in the acute stage, the irrigation suction system is applied with irrigation water, that is 500ml of saline mixed with 60,000 units of urokinase compressed to 400mmHg, to remove the subarachnoid clots as much as possible. In severe subarachnoid hemorrhage with Fisher Group 3 or more, the sylvian fissure is opened widely from the distal part to remove clots. In addition, clots are removed from the carotid cistern and prechiasmatic cistern, then the liequist membrane is opened, and clots are removed from the ambient cistern, interpeduncular cistern, and prepontine cistern not only in case of internal carotid aneurysm but also in case of middle cerebral aneurysm. Finally, the tip of the drainage tube should be placed in the opposite inlet of the ambient cistern. In case of anterior communicating aneurysm, removal of subarachnoid clots is basically limited to those in the anterior interhemispheric fissure and prechiasmatic cistern because the approach is made by AIH. Therefore, the frontal base should be opened with the bifrontobasal approach first, to allow the sylvian fissure to be easily opened by the frontobasal approach. Subarachnoid clots in the sylvian fissure can be removed by the frontobasal approach, and also from the interpeduncular cistern and prepontine cistern.By this method, consciousness disturbance was improved in early postoperative stages in intraventricular casting hematoma cases. In addition, extensive removal of subarachnoid clots significantly reduced the occurrences of symptomatic vasospasm.

著者

太田 仲郎 谷川 緑野 坪井 俊之 野田 公寿茂 宮崎 貴則 木下 由宇 松川 東俊 榊原 史啓 齊藤 寛浩 上山 博康 徳田 禎久

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.45, no.6, pp.425-431, 2017 (Released:2017-12-22)

参考文献数

14

被引用文献数

1 1

---

Introduction: Although improvements in endovascular treatment have decreased the frequency of bypass surgery, cerebral vascular reconstructions are still important. Many critical points are required to achieve a reliable bypass patency. We describe our experience and techniques for bypass surgery, especially focusing on the superficial temporal artery to middle cerebral artery (STA-MCA) bypass.Materials and methods: Over a period of 5 years, STA-MCA bypass was performed for 42 patients with atherosclerotic internal carotid artery or middle cerebral artery occlusion, or hemodynamic ischemia; 35 patients with moyamoya disease; and 97 patients with complex cerebral aneurysms. Mean occlusion time, bypass patency, hyperperfusion, ischemic complication, and postoperative delayed wound healing were assessed.Results: Within 42 ischemic cases, the mean occlusion time of the STA-MCA procedure was 20 minutes 16 seconds. No ischemic complications due to temporal occlusion occurred. Acute bypass occlusion (occlusion within 2 weeks after operation) occurred in 1 case of STA-MCA for moyamoya disease and 1 case of STA-MCA bypass for a patient with ischemic occlusion. Perioperative ischemic stroke was observed in 4 patients with ischemic occlusion and 1 patient with moyamoya disease.Conclusion: To perform a safe and reliable vascular reconstruction, off-the-job training, a bloodless operative field, selection of an appropriate donor and recipient artery, use of the “fish mouth” method for trimming the donor artery, and an intima-to-intima everting suture are necessary.

著者

野田 公寿茂 谷川 緑野 太田 仲郎 小田 淳平 原口 健一 木下 由宇 宮崎 貴則 近藤 智正 渡邉 定克 上山 博康

出版者

一般社団法人日本脳神経外科コングレス

雑誌

脳神経外科ジャーナル (ISSN:0917950X)

巻号頁・発行日

vol.30, no.1, pp.65-68, 2021 (Released:2021-01-25)

参考文献数

1

---

脳神経外科疾患に対する治療手段の多様化などにより, 開頭術者は限られた症例で効率的に手術手技を学ぶ必要性が高まっている. さらに, “働き方改革” など社会情勢が変化する中, 外科医にとっても時間生産性向上が求められている. デジタルイラストレーションの特徴を踏まえ, 筆者らが行ってきた時間生産性, 教育効率性向上を目指した手術イラストを用いた手術教育について報告する.

著者

高倉 祐樹 大槻 美佳 中川 賀嗣 大澤 朋史 谷川 緑野

出版者

一般社団法人 日本高次脳機能障害学会

雑誌

高次脳機能研究 : 日本高次脳機能障害学会誌 = Higher brain function research (ISSN:13484818)

巻号頁・発行日

vol.31, no.4, pp.411-421, 2011-12-31

参考文献数

30

---

発症時から失語症を認めず, 言語性短期記憶 (Short-Term Memory : STM) に選択的な障害を呈した 1 例を報告した。本例の知見から, 言語性 STM の解剖学的基盤は優位半球の側頭弁蓋~横側頭回近傍と示唆された。本例は数唱に比べ, 明確な意味を伴い, かつ同じ音韻系列を持つ文の復唱が良好 (例 : "8-2-3-1"の数唱は困難だが, "蜂に刺されて散々な一日だ"という文の復唱は可能) , 桁数付き数字の復唱が良好 (例 : "7-2-3"の数唱は困難だが, "ななひゃくにじゅうさん"の復唱は可能) , 無意味語系列に比べ有意味語系列の再生が良好であった。以上から言語性 STM における「容量」は必ずしも音韻情報量に依存せず, 意味の付与や情報のチャンク化の効率により決定されると考えられ, 既報告を支持した。さらに, 刺激提示の時間間隔や素材の変化により把持成績には差異が生じており, 援用されるストラテジーもそれぞれ異なる可能性が示唆された。