著者

森 健太郎 和田 孝次郎 大谷 直樹 長田 秀夫 戸村 哲 山本 拓史 中尾 保秋

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.42, no.2, pp.116-121, 2014 (Released:2014-06-26)

参考文献数

13

被引用文献数

1

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Basilar artery and internal carotid paraclinoid aneurysms are still surgically challenging. We performed 31 clipping surgeries (basilar tip aneurysm 6, basilar artery-superior cerebellar artery aneurysm 8, and internal carotid aneurysm 17) via the extradural temporopolar approach. After the frontotemporal craniotomy, the meningo-orbital band was incised and the dura propria of the temporal lobe was peeled from the lateral wall of the cavernous sinus. The anterior clinoid process was removed extradurally. The distal dural ring and falciform ligament were incised for mobilization of the internal carotid artery and optic nerve. The temporal lobe was retracted posteriorly with the dura mater. The aneurysm clipping was performed through the relatively wide operative trajectory over the opened cavernous sinus. Postoperative outcome was modified Rankin Scale (mRS) 0 in 28 patients and mRS in three patients with visual deficits. No temporal lobe contusion occurred. The extradural temporopolar approach is a useful skull base technique for deeply situated aneurysms.

著者

苗代 弘 魚住 洋一 佐藤 俊一 川内 聡子 小林 弘明 長田 秀夫 大谷 直樹 和田 孝次郎 都築 伸介 島 克司

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.32, no.6, pp.559-562, 2010-11-26 (Released:2010-12-03)

参考文献数

15

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Objectives: It has been reported that near-infrared (NIR) laser irradiation is effective in cerebral ischemia. We examined the effect of 808 nm laser diode irradiation on CBF in mice. The potential of NIR laser irradiation in the treatment of cerebral ischemia was also investigated.Methods: Male C57BL/6J mice were used. An 808 nm CW diode laser was applied to the hemisphere transcranially. CBF was measured with a non-contact laser Doppler blood perfusion imager. We measured directly nitric oxide in the brain tissue during NIR laser irradiation. To confirm the effect of pretreatment by NIR laser irradiation, we conducted the 1.6 W/cm2 NIR laser irradiation to the hemisphere transcranially for 30 minutes before bilateral common carotid artery occlusion (BCCAO). The control mice were also subjected to BCCAO without pretreatment by NIR laser irradiation.Results: Transcranial NIR laser irradiation increased local CBF by 30% compared to control value in mice. NIR laser irradiation also provoked a significant increase in cerebral NO concentration. Pretreatment by NIR laser irradiation improved residual CBF following bilateral carotid occlusion in mice.Conclusions: Our data suggest that targeted increase of CBF is available by NIR laser irradiation and it is concerned in NOS activity and NO concentration. Besides, NIR laser irradiation may have a protective effect for transient ischemia.

著者

都築 伸介 大井川 秀聡 豊岡 輝繁 魚住 洋一 長田 秀夫 鈴木 隆元 宮澤 隆仁 苗代 弘 島 克司

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.37, no.5, pp.375-378, 2009 (Released:2010-04-16)

参考文献数

4

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A 74-year-old man presented with subarachnoid hemorrhage (SAH) and underwent neck clipping of a left middle cerebral artery (MCA) aneurysm 10 years ago. This patient presented with SAH again due to rupture of a de novo aneurysm of the anterior communicating artery (A-com. aneurysm). The A-com. aneurysm was clipped successfully. The “old” left MCA aneurysm was then inspected. A collapsed “old” aneurysmal dome and a previously applied clip were identified. The “old” aneurysmal dome was resected for histopathological examination. The wall of this aneurysmal dome varied in thickness and consisted of a thin layer of fibrous connective tissue. Fibroblasts were scattered in the aneurysmal wall and either the muscular layer or internal elastic lamina was absent. The aneurysmal dome collapsed to a certain degree, but the lumen of the dome was completely intact. In addition, neovascularization of microcapillaries was observed both inside and outside the aneurysmal dome. Some of these microcapillaries were filled with fresh erythrocytes. Thus the aneurysmal wall was apparently “vigorous.” The previous orifice of the aneurysm did not fuse together at all and could be opened widely with ease during preparation for histopathologic examination. We speculated that the clipped aneurysmal dome survived for 10 years for the following reasons: 1) Although the mechanism of neovascularization of the microcapillaries is unclear, the clipped aneurysmal dome may have obtained nourishment from the microcapillaries. 2) The cerebrospinal fluid may have incubated the dome and provided optimal circumstances for its survival. Considering the radical cure for ruptured cerebral aneurysms by neck clipping or coil embolization, the findings described in this report will be valuable for neurosurgeons and neurointerventionists. Regardless of the time since treatment, ruptured aneurysms treated by either neck clipping and/or coil embolization are at risk of recurrent subarachnoid hemorrhage when the blood re-enters the aneurysms in cases such as clip slip-off or coil compaction.

著者

堤 直行 長田 秀夫 荒井 伸彦 小島 正三 氏家 新生

出版者

公益社団法人 日本薬理学会

雑誌

日本薬理学雑誌 (ISSN:00155691)

巻号頁・発行日

vol.101, no.6, pp.385-391, 1993

被引用文献数

1

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ラット胎仔大腿骨を用いてタンパク質分解酵素阻害剤あるいはタンパク質合成阻害剤の骨吸収におよぼす作用を検討した.システインプロテアーゼ,アスパルティックプロテアーゼ,金属プロテアーゼの代表的な阻害剤であるE-64(10<SUP>-6</SUP>~10<SUP>-4</SUP>M),ペプスタチンA(10<SUP>-7</SUP>~10<SUP>-5</SUP>M),ホスホラミドン(10<SUP>-6</SUP>~10<SUP>-4</SUP>M),アマスタチン(10<SUP>-6</SUP>~10<SUP>-4</SUP>M),ベスタチン(10<SUP>-6</SUP>~10<SUP>-4</SUP>M),foroxymithine(10<SUP>-6</SUP>~10<SUP>-4</SUP>M)は明らかな骨吸収におよぼす作用を示さなかった.しかし,セリンプロテアーゼの阻害剤であるフェニルメチルスルホニルフルオリド(PMSF),1-クロロ-3-トシルアミノ-7-アミノ-2-ヘプタン(TLCK),L-1-トシルアミノ-2-フェニルエチルクロロメチルケトン(TPCK),エラスタチナールは10<SUP>-5</SUP>~10<SUP>-4</SUP>Mで骨吸収を抑制した.TPCK(10<SUP>-4</SUP>M)を添加してラット胎仔大腿骨の軟骨組織を培養し,そこからTPCKを除去した培養上清は骨吸収促進作用を示した.タンパク質合成阻害剤のシクロヘキシミド(0.1~10μg/ml),ピュロマイシン(0.3~30μg/ml)は軟骨組織による骨吸収の促進現象を濃度依存的に抑制した.シクロヘキシミド(3μg/ml)による骨吸収の抑制作用は薬物が存在しないと次第に消失した.また,シクロヘキシミド(3μg/ml)を添加して軟骨組織を培養し,そこからシクロヘキシミドを除去した培養上清は骨吸収の促進作用を示さなかった.これらの結果から,ラット胎仔大腿骨の軟骨組織はタンパク質を一成分とする骨吸収促進物質を産生しているが,この物質は,(1)骨吸収促進作用を有するセリンプロテアーゼの一種である,あるいは,(2)始めは生理的に不活性な物質として産生され,更にある種のセリンプロテアーゼによって骨吸収促進作用を有する物質に変換されてその生理作用を示している可能性が示唆された.