著者

Shinichi YOSHIMURA Kazutaka UCHIDA Nobuyuki SAKAI Hiroshi YAMAGAMI Manabu INOUE Kazunori TOYODA Yuji MATSUMARU Yasushi MATSUMOTO Kazumi KIMURA Reiichi ISHIKURA Takeshi MORIMOTO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.rc.2021-0311, (Released:2021-12-24)

参考文献数

19

被引用文献数

13

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Endovascular therapy is strongly recommended for acute cerebral large vessel occlusion (LVO) with an Alberta stroke program early computed tomography score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of endovascular therapy for patients with a large ischemic core with an ASPECTS ≤5 (0–5) was not established. A multicenter, randomized, open-label, parallel-group trial was conducted to investigate the superiority of endovascular therapy over medical therapy without endovascular therapy for a large ischemic core with ASPECTS (3–5). Patients were randomly assigned to receive endovascular therapy or without endovascular therapy at a ratio of 1:1. The primary outcome was a moderate functional outcome, defined as a modified Rankin scale (mRS; scores ranging from 0 [no symptoms] to 6 [death]) ≤3 after 90 days. The secondary outcomes were defined as ordinal mRS, good functional outcome (mRS ≤2), excellent functional outcome (mRS ≤1), mRS shift analysis after 90 days, and early improvement of neurological findings at 48 hours. A total sample size of 200 was estimated to provide a power of 0.9 with a two-sided alpha of 0.05, for the primary outcome, considering a 15% dropout rate. This randomized clinical trial reported the applicability of endovascular therapy in patients with acute cerebral LVO with a large ischemic core.

著者

Ryohei Ono Masayuki Sato Sho Okune Tenyu Hino Taisuke Akimoto Yoshiro Ito Aiki Marushima Mikito Hayakawa Eiichi Ishikawa Yuji Matsumaru

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2022-0029, (Released:2022-12-15)

参考文献数

15

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Objective: To report a case of symptomatic large cerebral aneurysm of the internal carotid artery (ICA), associated with a primitive trigeminal artery variant (PTAv), which was treated with a balloon occlusion test (BOT) to evaluate ischemic tolerance.Case Presentation: A 79-year-old woman was diagnosed with a symptomatic large cerebral aneurysm of the ICA bifurcating the PTAv due to diplopia. After confirming the ischemic tolerance of the perfusion area and PTAv by BOT, we performed ICA parent artery occlusion with selective embolization of the PTAv. Postoperative MRI showed no ischemic lesion and the diplopia was resolved.Conclusion: ICA parent artery occlusion with PTAv selective embolization after evaluation by BOT is useful in the treatment of large aneurysms.

著者

Satoshi MIYAMOTO Hisayuki HOSOO Eiichi ISHIKAWA Yuji MATSUMARU

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.81-85, 2023-12-31 (Released:2023-03-24)

参考文献数

14

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Middle meningeal arteriovenous fistula (MMAVF) is a shunt between the middle meningeal artery and the vein surrounding the artery. We report an extremely rare case of spontaneous MMAVF; then, we evaluated the effectiveness of trans-arterial embolization for spontaneous MMAVF and the possible cause of spontaneous MMAVF.A 42-year-old man with tinnitus, a left temporal headache, and pain surrounding the left mandibular joint was diagnosed with MMAVF on digital subtraction angiography. Trans-arterial embolization with detachable coils was conducted, which resulted in a fistula closure and symptoms' diminishment. The cause of MMAVF was thought to be the rupture of the middle meningeal artery aneurysm.A middle meningeal artery aneurysm can be a cause of spontaneous MMAVF, and trans-arterial embolization might be an optimal treatment.

著者

Toshitsugu TERAKADO Akibumi OMI Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.93-98, 2023-12-31 (Released:2023-04-10)

参考文献数

19

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Both chronic subdural hematoma (CSDH) and spontaneous intracranial hypotension (SIH) cause headaches. However, the etiologies are different: SIH headache is caused by decreased intracranial pressure (ICP), whereas CSDH headache results from increased ICP. Moreover, CSDH is treated by hematoma drainage, while SIH is treated by epidural blood patch (EBP). Treatment for the cases of combined SIH and CSDH is not well-established. Herein, we report two cases wherein ICP was monitored and safely controlled by EBP after hematoma drainage. Case 1: A 55-year-old man with progressive consciousness disturbance was diagnosed with bilateral CSDH. He underwent bilateral hematoma drainage; however, the headache became apparent during standing. We diagnosed SIH by diffuse pachymeningeal enhancement on brain MRI and epidural contrast medium leakage on CT myelography. Due to the re-enlargement of bilateral CSDH, we performed EBP after hematoma drainage and ICP monitor insertion. Finally, the headache and bilateral CSDH were resolved. Case 2: A 54-year-old man with persistent headache was diagnosed with bilateral CSDH. He underwent multiple hematoma drainage sessions. However, headache on standing persisted. We diagnosed SIH by diffuse pachymeningeal enhancement on brain MRI and epidural contrast medium leakage on CT myelography. Due to the re-enlargement of the left CSDH, we performed EBP after left hematoma drainage and ICP monitor insertion. Finally, the headache and bilateral CSDH were resolved. EBP after hematoma drainage and ICP monitoring was useful for SIH with bilateral CSDH. By monitoring ICP before EBP, the ICP was safely controlled and CSDH was resolved.

著者

Noriyuki WATANABE Masashi MIZUMOTO Taishi AMANO Hisayuki HOSOO Akinari YAMANO Alexander ZABORONOK Masahide MATSUDA Shingo TAKANO Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.10, pp.337-342, 2023-12-31 (Released:2023-11-29)

参考文献数

17

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Cavernous sinus hemangioma (CSH) is a rare vascular malformation, arising from the cavernous sinus. Because of its anatomically complex location, a large lesion can cause a variety of symptoms due to cranial nerve compression. A 69-year-old woman with an unsteady gait was admitted to our hospital, and magnetic resonance imaging revealed an extra-axial giant tumor in the cavernous sinus and enlarged ventricles. A radiographic diagnosis of CSH was made. As the risk of surgical removal was considered high, the patient underwent intensity-modulated radiation therapy of 50.4 Gy in 28 fractions. The size of the tumor decreased markedly over time, and the symptoms improved soon after treatment. A 61.8% reduction in tumor size was confirmed immediately after irradiation, and a 75.9% reduction was revealed at a follow-up visit one year later. We reported a case of a giant CSH with hydrocephalus, where tumor shrinkage was confirmed immediately after radiation therapy, and the symptoms of hydrocephalus improved without surgical intervention.

著者

Mikito Hayakawa Yuji Matsumaru Nobuyuki Sakai Hiroshi Yamagami Koji Iihara Kuniaki Ogasawara Hidenori Oishi Yasushi Ito Kenji Sugiu Shinichi Yoshimura for the STrategy of Optimal carotid revascularization for high-risk Patients of Cerebral Hyperperfusion Syndrome (STOP CHS) study group

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2017-0009, (Released:2017-03-27)

参考文献数

30

被引用文献数

5

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Objective: Cerebral hyperperfusion syndrome (CHS) including intracranial hemorrhage (ICH) is a serious complication after carotid artery stenting (CAS). Therefore, neurointerventionalists in Japan commonly stratify the risk for CHS preprocedurally in CAS candidates using various imaging tests that are available, and sometimes performed preventive methods against CHS, such as staged angioplasty (SAP), undersized-balloon angioplasty followed by delayed CAS. In the current study, we used a nationwide questionnaire survey to clarify the current status of the periprocedural management against CHS and the 30-day outcomes of patients with a high risk of CHS after undergoing CAS or endovascular carotid revascularization procedures, such as SAP or stand-alone angioplasty. This study specifically analyzed the data for the periprocedural management against CHS.Materials and Methods: Between June and August 2014, questionnaires were emailed to all of the neurointerventional specialists certified by the Japanese Society for Neuroendovascular Therapy (JSNET). If two or more specialist physicians belonged to an institute, a representative physician of the institute answered the questionnaire. This study focused on 14 items of the questionnaire that were directed at examining the preprocedural imaging tests done to evaluate the risk of CHS, the periprocedural management strategies used to prevent CHS, and the postprocedural imaging tests to detect hyperperfusion phenomenon, among others.Results: Replies were obtained from 154 institutes which represented 336 JSNET-certified neurointerventional specialists. Preprocedural imaging tests done to evaluate the risk of CHS were performed in 144 institutes (93.5%), with single-photon emission CT (SPECT) the most used modality in 88.2% of the institutes. Acetazolamide challenge was performed in 114 (89.8%) of 127 institutes that used preprocedural SPECT evaluation. Of the institutes performing preprocedural CHS-risk evaluation, general anesthesia was administered during the procedure in 44.4%, periprocedural edaravone (a free radical scavenging agent) was used in 52.1%, and periprocedural strict blood pressure control was performed in 91.7%. Postprocedural intravenous anticoagulation therapy was not used for patients with a high risk of CHS in 63.2%. Postprocedural imaging tests to detect hyperperfusion phenomenon were undertaken in 99.3% of the institutes performing preprocedural CHS-risk evaluation. The leading imaging modality, SPECT, was used in 78.3%. SAP was attempted or performed in 27.1% of the institutes.Conclusion: The present study demonstrated that Japanese practitioners attempt to prevent CHS after carotid endovascular revascularization procedures. Most Japanese neurointerventionalists preprocedurally evaluated the risk of CHS in CAS candidates primarily using SPECT with acetazolamide challenge. The penetration rate for SAP was 27.1% of the institutes.

著者

Yoshiro ITO Hisayuki HOSOO Masayuki SATO Aiki MARUSHIMA Mikito HAYAKAWA Yuji MATSUMARU Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0361, (Released:2023-09-23)

参考文献数

25

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In the transsylvian (TS) approach, as characterized by clipping surgery, the presurgical visualization of the superficial middle cerebral vein (SMCV) can help change the surgical approach to ensure safe microsurgery. Nevertheless, identifying preoperatively the venous structures that are involved in this approach is difficult. In this study, we investigated the venous structures that are involved in the TS approach using three-dimensional (3D) rotational venography (3D-RV) and evaluated the effectiveness of this method for presurgical simulation. Patients who underwent 3D-RV between August 2018 and June 2020 were involved in this retrospective study. The 3D-RV and partial maximum intensity projection images with a thickness of 5 mm were computationally reconstructed. The venous structures were subdivided into the following three portions according to the anatomic location: superficial, intermediate, and basal portions. In the superficial portion, predominant frontosylvian veins were observed on 31 (41%) sides, predominant temporosylvian veins on seven (9%) sides, and equivalent fronto- and temporosylvian veins on 28 (37%) sides. The veins in the intermediate (deep middle cerebral and uncal veins) and basal portions (frontobasal bridging veins) emptied into the SMCV on 57 (75%) and 34 (45%) sides, respectively. The 3D-RV images were highly representative of the venous structures observed during microsurgery. In this study, 3D-RV was utilized to capture the details of the venous structures from the superficial to the deep portions. Presurgical simulation of the venous structures that are involved in the TS approach using 3D-RV may increase the safety of microsurgical approaches.

著者

Satoshi Miyamoto Mikito Hayakawa Sho Okune Ryosuke Shintoku Akinari Yamano Takato Hiramine Toshihide Takahashi Hisayuki Hosoo Yoshiro Ito Aiki Marushima Masao Koda Eiichi Ishikawa Yuji Matsumaru

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1386-22, (Released:2023-06-07)

参考文献数

9

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Hidden bow hunter's syndrome (HBHS) is a rare disease in which the vertebral artery (VA) occludes in a neutral position but recanalizes in a particular neck position. We herein report an HBHS case and assess its characteristics through a literature review. A 69-year-old man had repeated posterior-circulation infarcts with right VA occlusion. Cerebral angiography showed that the right VA was recanalized only with neck tilt. Decompression of the VA successfully prevented stroke recurrence. HBHS should be considered in patients with posterior circulation infarction with an occluded VA at its lower vertebral level. Diagnosing this syndrome correctly is important for preventing stroke recurrence.

著者

Takanari Kitazono Masahiro Kamouchi Yuji Matsumaru Masato Nakamura Kazuo Umemura Hajime Matsuo Nobuyuki Koyama Junko Tsutsumi Kazumi Kimura

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

pp.63473, (Released:2022-05-21)

参考文献数

12

被引用文献数

8

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Aim: To examine the efficacy and safety of prasugrel vs clopidogrel in thrombotic stroke patients at risk of ischemic stroke. Methods: This multicenter, active-controlled, randomized, double-blind, double-dummy, parallel group study enrolled thrombotic stroke patients aged ≥ 50 years at risk of ischemic stroke. Patients received prasugrel (3.75 mg/day) or clopidogrel (75 or 50 mg/day) for 24–48 weeks; other antiplatelet drugs were prohibited. The primary efficacy endpoint was the composite incidence of ischemic stroke, myocardial infarction (MI), and death from other vascular causes from the start to 1 day after treatment completion or discontinuation. Secondary efficacy endpoints included the incidences of ischemic stroke, MI, death from other vascular causes, ischemic stroke and transient ischemic attack, and stroke. Safety endpoints included bleeding events and adverse events (AEs). Results: In the prasugrel (N=118) and clopidogrel (N=112; all received 75 mg) groups, the primary efficacy endpoint composite incidence (95% confidence interval) was 6.8% (3.0%–12.9%) and 7.1% (3.1%–13.6%), respectively. The risk ratio (prasugrel/clopidogrel) was 0.949 (0.369–2.443). Secondary efficacy endpoints followed a similar trend. The combined incidences of life-threatening, major, and clinically relevant bleeding were 5.0% and 3.5% in the prasugrel and clopidogrel groups, respectively. The incidences of all bleeding events and AEs were 19.2% and 24.6% and 76.7% and 82.5% in the prasugrel and clopidogrel groups, respectively. No serious AEs were causally related to prasugrel. Conclusions: We observed a risk reduction of 5% with prasugrel vs clopidogrel, indicating comparable efficacy. There were no major safety issues for prasugrel.

著者

Sho Okune Mikito Hayakawa Tenyu Hino Takato Hiramine Taisuke Akimoto Masayuki Sato Yoshiro Ito Aiki Marushima Tomoya Takada Eiichi Ishikawa Akira Tamaoka Yuji Matsumaru

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0633-22, (Released:2023-07-05)

参考文献数

17

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Hemichorea-hemiballism (HCHB) due to transient ischemic attacks (TIAs) is rare. An 83-year-old woman had repeated episodes of right-sided HCHB for 3 months. Magnetic resonance (MR) angiography demonstrated occlusion of the left carotid and middle cerebral arteries and severe stenosis of the innominate artery, and 24-h ambulatory blood pressure monitoring showed a blood pressure decrease of >20 mmHg after each meal. We speculated that HCHB developed as TIAs due to hemodynamic failure in the left cerebral hemisphere, caused by a combination of severe stenosis of the innominate artery concomitant with occlusion of the left carotid and middle cerebral arteries as well as postprandial hypotension.

著者

Takao KOISO Yoji KOMATSU Daisuke WATANABE Go IKEDA Hisayuki HOSOO Masayuki SATO Yoshiro ITO Tomoji TAKIGAWA Mikito HAYAKAWA Aiki MARUSHIMA Wataro TSURUTA Noriyuki KATO Kazuya UEMURA Kensuke SUZUKI Akio HYODO Eichi ISHIKAWA Yuji MATSUMARU

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0253, (Released:2023-01-05)

参考文献数

15

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The influence of aneurysm size on the outcomes of endovascular management (EM) for aneurysmal subarachnoid hemorrhages (aSAH) is poorly understood. To evaluate the outcomes of EM for ruptured large cerebral aneurysms, we retrospectively analyzed the medical records of patients with aSAH that were treated with coiling between 2013 and 2020 and compared the differences in outcomes depending on aneurysm size. A total of 469 patients with aSAH were included; 73 patients had aneurysms measuring ≥10 mm in diameter (group L), and 396 had aneurysms measuring <10 mm in diameter (group S). The median age; the percentage of patients that were classified as World Federation of Neurological Surgeons grade 1, 2, or 3; and the frequency of intracerebral hemorrhages differed significantly between group L and group S (p = 0.0105, p = 0.0075, and p = 0.0458, respectively). There were no significant differences in the frequencies of periprocedural hemorrhagic or ischemic events. Conversely, rebleeding after the initial treatment was significantly more common in group L than in group S (6.8% vs. 2.0%; p = 0.0372). The frequency of a modified Rankin Scale score of 0-2 at discharge was significantly lower (p = 0.0012) and the mortality rate was significantly higher (p = 0.0023) in group L than in group S. After propensity-score matching, there were no significant differences in complications and outcomes between the two groups. Rebleeding was more common in large aneurysm cases. However, propensity-score matching indicated that the outcomes of EM for aSAH may not be affected markedly by aneurysm size.

著者

Satoru Kawauchi Koichi Chida Takashi Moritake Yusuke Hamada Shogo Yoda Hideyuki Sakuma Wataro Tsuruta Yuji Matsumaru

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0024, (Released:2022-07-14)

参考文献数

30

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Objective: In interventional neuroradiology (INR), the evaluation of the peak skin dose (PSD) and lens dose is important because the patient radiation dose increases in cases in which the procedure is more difficult and complex. This study evaluated the radiation doses during INR procedures using a direct measurement system.Methods: Radiation dose measurements during INR were performed in 332 patients with unruptured aneurysm (URAN), dural arteriovenous fistula (DAVF), and arteriovenous malformation (AVM). The PSD and bilateral lens doses were analyzed for each disease. The Pearson correlation test was used to determine whether the PSD and lens doses were linearly related to the reference air kerma (Ka,r).Results: In all cases, the PSD and right and left lens doses were 2.36 ± 1.28 Gy, 114.2 ± 54.6 mGy, and 189.8 ± 160.3 mGy, respectively. The PSD and lens doses of the DAVF and AVM cases were significantly higher than those of the URAN case. The Pearson correlation test revealed statistically significant positive correlations between Ka,r and PSD, Ka,r and right lens dose, and Ka,r and left lens dose.Conclusion: The characteristics of radiation dose in INR were clarified. Owing to the concern of increased radiation doses exceeding the threshold values in DAVF and AVM cases, protection from radiation is required. Simple regression analysis revealed the possibility of precisely predicting PSD using Ka,r.

著者

Koji Hirata Yoshiro Ito Go Ikeda Kazuya Uemura Masayuki Sato Aiki Marushima Mikito Hayakawa Yuji Tomono Yuji Matsumaru Akira Matsumura

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.15, no.12, pp.787-792, 2021 (Released:2021-12-20)

参考文献数

17

被引用文献数

2

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Objective: Asymptomatic intracranial dural arteriovenous fistula (DAVF) is a rare disease that is often undiagnosed before symptom onset. The present study aimed to examine the detection rate and radiological features of asymptomatic intracranial DAVF using brain MRI data obtained from the Japanese brain check-up system.Methods: We retrospectively identified 11745 individuals who underwent brain MRI between January 2010 and December 2014. After a routine brain MRI screening, a definite diagnosis was made based on DSA. Data regarding sex, age, disease location, classification type, and treatment method were extracted from the system database and patients’ medical records.Results: Six individuals (0.05%; mean age, 61.0 ± 9.7 years) were diagnosed with definite intracranial DAVF. The intracranial DAVFs were located in the transverse sinus, confluence, and tentorial sinus in 2, 1, and 3 case(s), respectively. Cortical venous reflux was confirmed in four cases (66.7%), and none of the cases had intracranial hemorrhage or venous congestion. All cases had infratentorial lesions and two-thirds were Borden type II/III.Conclusion: The detection rate of asymptomatic intracranial DAVF was 0.05% based on the analysis of MRI data from the brain check-up system. Low-flow shunt and tiny cortical venous reflux were likely missed on MRI.