著者

和田 健太郎 野田 智之 槇 英樹 雄山 博文 鬼頭 晃

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.41, no.6, pp.452-457, 2013 (Released:2014-01-29)

参考文献数

17

被引用文献数

1

---

A 49-year-old woman presented with a sudden onset of right hemiparesis and motor aphasia. Computed tomography (CT) and magnetic resonance imaging (MRI) showed subarachnoid hemorrhage (SAH) localized in the interhemispheric fissure and cerebral infarction in the territory of the left anterior cerebral artery (ACA). Digital subtraction angiography (DSA) demonstrated segmental narrowing and dilatation at the left A2 segment, leading to a diagnosis of ACA dissection. The day after the onset, we planed trapping of the dissecting portion and A3–A3 side-to-side anastomosis. As a result, we performed only the wrapping of the dissection portion, because the dissection was longer than we expected. Neither aneurysmal dilatation nor narrowing progressed almost six months after the operation. This case indicates wrapping is also effective as a treatment of dissecting aneurysms, and it is important to consider longer-than-expected ACA dissections.

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

鐙谷 武雄 七戸 秀夫 黒田 敏 石川 達哉 岩崎 喜信 小林 祥泰

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.34, no.1, pp.49-53, 2006 (Released:2008-08-08)

参考文献数

9

被引用文献数

7 7

---

We explored national and regional characteristics based on age, gender, and prognosis of subarachnoid hemorrhage by using the Japanese Stroke Data Bank, a data bank of acute stroke patients established to provide evidence for standardization of Japanese stroke management. We analyzed data from 1,183 patients with subarachnoid hemorrhage in the Japanese Stroke Data Bank. For regional investigation, we divided the patients into 3 groups according to their place of residence: Hokkaido, Tohoku, and the area west of Kanto. The total male-to-female ratio was 1:1.88. The female proportion was dominant in older patients: 1:2.27 in the 60s, 1:4.48 in the 70s, and 1:4.63 in the 80s. The age distribution of the patients was apparently different between male and female. Female patients (mean age: 64.5) were older than male patients (mean age: 56.1)(p In total, favorable outcome (mRS of 0-2), extremely poor outcome (mRS of 5-6), and death (mRS of 6) were 58.0%, 28.3%, and 19.8%, respectively. In a regional analysis, the outcome of the patients of the area west of Kanto was poorer than that of Hokkaido and Tohoku (p

著者

山木 哲 近藤 礼 佐藤 慎治 毛利 渉 齊藤 元太 齋藤 伸二郎 園田 順彦

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.46, no.1, pp.25-30, 2018 (Released:2018-02-14)

参考文献数

15

被引用文献数

1

---

In subarachnoid hemorrhage cases with multiple cerebral arterial aneurysms, it is important to identify the ruptured aneurysms. We previously reported the usefulness of the contrast-enhanced motion-sensitized driven equilibrium three-dimensional turbo spin echo (MSDE-3D-TSE) sequence method, which allows vessel wall imaging by visualizing enhancement of ruptured aneurysms at a high rate. The present study examined the usefulness of this method in cases with multiple ruptured cerebral arterial aneurysms. Between September 2011 and September 2014, magnetic resonance imaging (MRI) using the contrast-enhanced MSDE-3D-TSE sequence method was performed before surgery in 22 patients with acute-phase subarachnoid hemorrhage and a total of 53 cerebral arterial aneurysms. Among the 53 aneurysms, 30 (56.6%) showed enhancement of the aneurysmal wall. All 22 ruptured aneurysms showed enhancement. However, 8 unruptured aneurysms also showed enhancement (sensitivity: 100%, specificity: 73.3%). Ruptured aneurysms showed greater enhancement than unruptured aneurysms, and ruptured aneurysms were identified at a high rate. In cases with multiple cerebral arterial aneurysms in which ruptured aneurysms were difficult to identify with conventional methods, the contrast-enhanced MSDE-3D-TSE sequence method was extremely useful.

著者

波出石 弘 鈴木 明文 師井 淳太

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.34, no.5, pp.340-346, 2006 (Released:2008-08-08)

参考文献数

11

被引用文献数

9 8

---

In surgical procedures to dissect the sylvian fissure, the fissure is commonly unfolded by the attachment of all sylvian veins to the temporal lobe. During this procedure, cerebral edema and contusion in the frontal lobe are often caused by sacrificing bridging veins from the frontal lobe and excessive retraction on the frontal lobe. In this procedure, some sylvian veins must be kept on the side of the frontal lobe to preserve the bridging vein. In many cases, detachment of the sylvian vein from the surface of the temporal lobe is required. The sylvian vein can be detached from the temporal lobe using the space around the temporal artery right under the sylvian vein. For detachment of adhesions between the frontal and temporal lobes, a “paper knife technique” is available in which a surgical site is generated by cutting upwards from the subarachnoid space around M1. In a “denude technique,” a wide surgical field can be obtained with less retraction of the frontal lobe by detaching the arachnoid membrane from the sylvian vein and thus allowing venous extension. During dissection of the sylvian fissure, arteries and veins belonging to the temporal lobe spread while adhering to the frontal lobe. In this case, the site to dissect is the frontal-lobe side where the vessels are located, even if the sylvian fissure is widely unfolded. Conversely, when cerebral vessels belonging to the frontal lobe are attached to the temporal lobe, the site to dissect is on the temporal lobe side, where the vessels are located. Thus the concept of a “microvascular sylvian fissure” in which detailed vessel structures are captured at a microscopic level is important in terms of preventing damage to blood vessels, pia matter and brain tissue. It is crucial to obtain a large surgical field and confirm where blood vessels belong. To detach an aneurysm attached to arteries such as M2, A2 or perforating arteries and deep veins, without causing damage, using the tip of micro-forceps for microvascular anastomosis as a raspatory is useful. Other detailed technical ideas are introduced. These include: pulling the aneurysm into the surgical site by transposing the artery and aneurysm using brain spatulas, silk threads, and Aron alpha to confirm adjacent vascular structures such as perforating arteries; using a “double-clip technique” to confirm complete clipping with 2 clips; and deliberately shifting the bayonet clip to preserve perforating arteries.

著者

入佐 剛 大田 元 山﨑 浩司 内之倉 俊朗 竹島 秀雄

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.46, no.3, pp.210-215, 2018 (Released:2018-07-06)

参考文献数

14

被引用文献数

1 1

---

Eagle's syndrome presents with a series of symptoms caused by an elongated styloid process and/or the ossification of part of the entire stylohyoid ligament. Symptoms of the classic type are caused by factors such as irritation and compression of the lower cranial nerve, sore throat and dysphagia, facial pain, and neck pain. The other rare type is caused by compression or dissection of the carotid artery, causing a transient ischemic attack or stroke. This report describes a case of Eagle's syndrome with cerebral infarction caused by internal carotid artery (ICA) dissection, treated with endovascular revascularization of the ICA and surgical resection of the styloid process. A 51-year-old woman presented with sudden onset of right hemiparesis and aphasia. Magnetic resonance imaging revealed left ICA occlusion. Endovascular recanalization therapy for the ICA occlusion was initiated, and recanalization with thrombolysis of the cerebral infarction (TICI) grade IIb was achieved. Carotid artery dissection with intraluminal thrombus was observed at the extracranial portion. Computed tomographic angiography on day 6 revealed the dissected ICA compressed by the elongated styloid process. On day 24, the elongated styloid process was resected extraorally, and successful decompression of the ICA was achieved. ICA dissection caused by an elongated styloid process has been reported frequently. Eagle's syndrome is rare but is one of the important diseases to consider in the differential diagnosis of extracranial carotid artery dissection.

著者

堤 一生

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.35, no.5, pp.361-363, 2007 (Released:2008-08-26)

参考文献数

6

被引用文献数

16 7

---

Recently, better direct surgery for cerebrovascular disease has come to be required, while less invasive treatment (gamma knife and intravascular surgery) has played an alternative role. To improve the quality of surgery, one of the most important issues is the surgical education of young neurosurgeons. They must learn traditional surgical skills and achieve more sophisticated techniques than those of their seniors. In this paper, I present my experience and discuss the education of neurosurgeons. My teaching method was based on suturing training with 10-0 nylon using a microscope and hands-on practice under my supervision. This training was useful to improve dexterity and maneuverability with a limited number of clinical cases. The hands-on practice of microsurgery was inevitable to learn surgical skills and judgment. Moreover, the experience of real surgery was an incentive to train harder. My residents trained in suturing for 1 to 3 years with a total of 10,000 to 20,000 stitches each. During the same period, they operated on 150-250 cases, including aneurysmal clipping (20-50 cases), STA-MCA anastomosis (5-20) and carotid endarterectomy (5-30). Surgical complication was 1-2% of all, although the time of surgery was prolonged in the early stage. Differences of resident's grades at the start of training were not related to the results. Satisfactory results were not achieved in less than 2 years. In my subjective judgment, the result of education depended on the individual passion for surgery, the continuous training and a positive attitude about learning from others. Even young neurosurgeons should be given a chance to perform microsurgery if they continue the training. Under a senior's supervision, the results of surgery can be acceptable. Early experience and education may be promising for improving microsurgery for cerebrovascular disease.

著者

森 健太郎

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.44, no.2, pp.102-112, 2016 (Released:2016-06-07)

参考文献数

110

被引用文献数

1

---

Endothelin-A receptor inhibitor (clazosentan) treatment after aneurysmal subarachnoid hemorrhage has failed to show any beneficial effects on neurological outcome, despite resolution in angiographic vasospasm, challenging the central dogma that angiographic vasospasm is the main cause of delayed ischemic neurological deficit (DIND). Many putative mechanisms have been proposed, such as microvascular disturbance, spreading cortical ischemia, early brain injury, and inflammation, to explain the cause of DIND. Consequently, recent research findings pertaining to treatment of cerebral vasospasm and DIND have been confusing and contradictory. In this review, we summarize the latest research concerning this issue and discuss the future trends in treatment strategy.

著者

菅原 貴志 高里 良男 正岡 博幸 太田 禎久 早川 隆宣 八ツ繁 寛 今江 省吾 山本 崇裕 武川 麻紀

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.34, no.4, pp.294-298, 2006 (Released:2008-08-08)

参考文献数

7

---

Generally vitreous hemorrhage (VH) is detected in 2.2% to 13% of subarachnoid hemorrhage (SAH) patients. VH with SAH (Terson's syndrome) is known to occur frequently in patients with severe SAH or re-ruptured aneurysms. We retrospectively analyzed 20 patients diagnosed with Terson's syndrome out of a total of 881 patients treated for SAH in our department from July 1995 to October 2004. Our study group comprised 15 male and 5 female patients ranging in age from 38 to 77 years (mean 51.2 years). Each patient was classified in Hunt & Kosnik (H&K) grades on admission. One patient was classified in Grade 2, 3 patients in Grade 3, 7 patients in Grade 4 and 9 patients in Grade 5. Each patient was further classified in a Fisher group: 1 patient was in Group 2, 9 patients in Group 3, and 10 patients in Group 4. Regarding the aneurysmal location, 4 cases had ICA aneurysms, 6 had AcomA aneurysms, 4 had MCA aneurysms, 4 had VA or BA aneurysms, and 2 had ACA aneurysms. Re-rupture of aneurysm occurred in 4 cases. Two patients underwent external ventricular drainage because of acute hydrocephalus immediately after CT on admission. Seventeen aneurysms were treated by surgical neck clipping, and 3 aneurysms were treated by intra-aneurysmal coil embolization as the final treatment. Seven patients underwent external decompression because of severe brain swelling, and 6 patients underwent V-P shunt for chronic hydrocephalus. Symptomatic vasospasm occurred in 1 case. Glasgow Outcome Scale (GOS) at discharge showed that 8 patients were GR, 10 were MD, and 2 were SD. VH occurred in only 1 patient on the contralateral side to the ruptured aneurysm among those who had obvious hemilateral VH. Vitrectomy was performed for the 17 VH of 10 patients, and the duration from VH onset to treatment was 8-24 weeks (mean 16.4 weeks). Conservative therapy was done for 15 VH of 10 patients, and the follow-up duration was 12-102 weeks (mean 27.0 weeks). Comparing these 20 VH patients with 311 favorable-outcome (GR or MD) patients who were not considered to have VH, H&K grade or Fisher group scales were significantly higher in VH patients. No significant difference existed between the groups with regard to the number of ruptures or the location of the ruptured aneurysms.

著者

冨永 悌二 鈴木 則宏 宮本 享 小泉 昭夫 黒田 敏 高橋 淳 藤村 幹 寶金 清博

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.46, no.1, pp.1-24, 2018 (Released:2018-02-14)

参考文献数

230

被引用文献数

44

著者

宮本 享 永田 泉 唐澤 淳 菊池 晴彦 秋山 義典 野崎 和彦 橋本 信夫

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.28, no.2, pp.111-114, 2000-03-31 (Released:2012-10-29)

参考文献数

20

被引用文献数

9 7

---

We assessed the posttreatment clinical course of 113 patients with moyamoya disease. All of them were treated with superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis with or without encephalo-myo-synangiosis. The mean follow-up duration was 14.4 years. Complete disappearance of the ischemic episodes was obtained in 110 patients (97.3%). Independent daily life activities were possible for 100 patients. Fifteen patients were incapable of social lives because of their mental retardation, although they can take care of themselves in their daily life. All of them suffered from preoperative completed stroke. Therepeutic time lag should be minimized to prevent these preoperative strokes.

著者

加納 恒男 平山 晃康 片山 容一

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.31, no.5, pp.344-348, 2003 (Released:2008-03-18)

参考文献数

18

被引用文献数

8 9

---

Thrombosed giant aneurysm (TGA) possesses a high growth potential. In patients with TGAs, clinical symptoms evolve most commonly from its mass effect. Surgical interventions are therefore required to prevent TGA growth. We analyze the clinical characteristics and histopathological findings of TGAs, and discuss possible mechanisms underlying their growth. We have treated 30 cases of TGA during the last 10 years. Of these, 10 underwent direct surgery and 20 were treated by endovascular surgery. Endovascular obliteration of TGAs frequently fails to terminate their growth when contrast-enhancement of the aneurysmal wall is demonstrated on CT or MRI. Incomplete endovascular obliteration of TGAs does not appear to reduce their growth potential. Complete thrombosis of TGAs, induced either spontaneously or by surgical modification of the blood flow, does not necessarily indicate termination of their growth. The growth of TGAs can be terminated when both the aneurysmal lumen and vascular channels of the aneurysmal wall are physically isolated from the blood flow through direct surgery: neck clipping or trapping. Together with the histopathological findings of TGAs, the above-mentioned characteristics suggest that 2 mechanisms may underlie their growth: intraluminal thrombus accumulation, and proliferation of vascular channels of the aneurysmal wall. Radical surgery to isolate TGAs from the blood flow, before they become too large to be operated on safely, may be advisable.

著者

小宮山 雅樹

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.43, no.3, pp.193-200, 2015 (Released:2015-06-18)

参考文献数

55

被引用文献数

5 4

---

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Rendu-Weber disease, is an autosomal dominant disorder that results from multi-system vascular dysplasia. It is not a rare condition, but is under-recognized, and is characterized by the presence of mucocutaneous telangiectases and arteriovenous malformations (AVMs) of the brain, lung, liver, and spinal cord. Neurological manifestations may develop due to paradoxical embolisms from a pulmonary AVM or hemorrhage of AVMs of the brain and spinal cord. This article summarizes the clinical features of HHT as well as its treatment, and also emphasizes the need for a high index of suspicion for this disease in patients with characteristic clinical manifestations.

著者

鈴木 一郎 清水 弘之 高橋 宏 石島 武一

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.19, no.2, pp.295-300, 1991-07-15 (Released:2012-10-29)

参考文献数

18

被引用文献数

8 5

---

We have originated cisternal irrigation combined with head shaking in order to remove subarachnoid clots rapidly and extensively. Eighteen patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms of the anterior part of the circle of Willis were studied. The degree of SAH as shown by CT was Group 3 on the Fisher's grading scale. Clipping was performed within 72 hours after the last bleeding. Continuous ventriculo-cisternal irrigation was carried out from 12 hours after the surgery, using solution with or without urokinase. The head was intermittently shaken (amplitude 4 cm, frequency 1.0-2.0 c/s) by a head-shaking device of our own making. The effect of head shaking on clot removal was evaluated by neurological examination, CT, and the volume of sedimentary clots in the draining fluid. Postoperative angiography was usually performed about 10 days after SAH.Although the number of patients was small for statistical analysis, the effect of head shaking on clot removal as shown by CT was remarkable. The subarachnoid clots with CT attenuation values of more than 60 in the basal and sylvian cisterns were usually washed out to the range (10-15) of normal cerebrospinal fluid within 48 hours. No delayed ischemic neurological deficits (DIND) occurred, and no low-density areas due to vasospasm were observed on computed tomography. Angiographic vasospasms were observed in only 2 cases, in which the diameter of the artery was less than 75% of that in the acute phase. But these vasospasms were limited to the area adjacent to the ruptured aneurysm.

著者

中島 義和 山田 和雄 甲村 英二 藤中 俊之 吉峰 俊樹

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.32, no.6, pp.443-447, 2004 (Released:2007-06-12)

参考文献数

16

---

We present 2 cases of arteriovenous malformation (AVM) in children that recurred 5 and 16 years, respectively, after initial total extirpation confirmed by cerebral angiography. In the first case, a parasplenial AVM that presented initially as a hemorrhage in a 5-year-old patient was completely resolved. Sixteen years later, it reappeared posterior to its initial location in the nidus and then ruptured. The second case also presented initially with AVM-related hemorrhage. Five years following extirpation of the diffuse paracallosal AVM in the right frontal lobe, the defect reappeared surrounding the location of the initial lesion and continued to grow. These cases demonstrate that even in cases where cerebral angiography and operative findings confirm total extirpation of an AVM, the AVM may recur after 10 years or longer. Thus, long-term follow-up is recommended in such cases, especially for children.

著者

吉岡 裕樹 井川 鋭史 渡辺 高志

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.35, no.6, pp.432-436, 2007 (Released:2008-08-26)

参考文献数

23

---

We analyzed the outcome of 25 SAH patients who were over 80 years old. We performed early operations on SAH patients between the ages of 80 and 85, and intentionally delayed operations on patients over 85 years of age (7 cases with neck clipping and 3 cases with endovascular coil embolization). Four of 10 patients in the operative group (40%) had favorable outcomes. The risk factors that worsened the outcome were cerebral vasospasm and general complications. All in the non-operative group had a poor outcome. In elderly SAH patients, an acceptable treatment plan must be made from a social and economic viewpoint.

著者

田中 貴大 周藤 高 末永 潤 高瀬 創 佐藤 充 大竹 誠 立石 健祐 上野 龍 宮崎 良平 村田 英俊

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.46, no.1, pp.58-64, 2018 (Released:2018-02-14)

参考文献数

17

---

We report herein five cases of symptomatic brainstem cavernous malformations (CM). Specific surgical approaches were designed to directly access each lesion. Neuronavigation and intraoperative monitoring were used. Four lesions underwent gross total resection, and one was subtotally partially removed. None of the patients developed new neurological deficits and all cases showed an improvement based on the modified Rankin Scale and the Karnofsky Performance Status. Although brainstem CM have a relatively high rate of re-bleeding, thus adversely affecting the neurological status of the patient, recent reports have demonstrated favorable outcomes after their resection. Hence, surgical removal can be recommended for cases of symptomatic brainstem CM, particularly those with re-bleeding. An optimal surgical approach, providing direct access to the lesion, is critical for successfully resecting brainstem CM.

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

---

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

平松 亮 田辺 英紀 近藤 明悳 村尾 健一 中澤 和智 島野 裕史 安田 宗一郎 井上 洋人 柴田 真帆 高畠 望 國枝 武伸 三木 義仁 黒岩 敏彦

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.4, pp.264-268, 2009 (Released:2010-03-20)

参考文献数

14

---

Terson's syndrome (TS) is a vitreous hemorrhage that develops in patients with subarachnoid hemorrhage (SAH) most frequently due to ruptured aneurysm. The reported incidence of TS has varied between 1.4 and 16.7%. Of 36 consecutive SAH patients that we treated, TS was diagnosed in 12 patients (33%). The reason that the incidence of TS in our patients series was much higher than previously reported was due to the use of a mydriatic agent to accurately diagnose TS and the examination of all 36 consecutive patients, including those with a high Hunt and Kosnik grade. In our study, the incidence of TS was significantly greater among patients with a higher grade of SAH according to a H & K classification, as noted in past reports (P-value=0.0047<0.05). Additionally, the incidence of TS was greater in patients with a higher SAH grade according to the classification proposed by Fisher (P-value=0.088>0.05). In this connection, we speculated that the mechanism of TS was the reflux of an abundance of blood drained into the orbital cavity via the Virchow-Robin space. Long-term retention of blood in the vitreous body may cause cell damage and delay the start of rehabilitation. Therefore, early treatment is preferable.

著者

遠山 義浩 杉山 拓 伊東 雅基 村井 宏 馬渕 正二

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.35, no.3, pp.174-180, 2007 (Released:2008-08-26)

参考文献数

21

---

We investigated the effect of sustained administration of intrathecal nicardipine, calcium antagonist, in 16 cases to prevent post-subarachnoid hemorrhage (SAH) vasospasm. Patients with SAH of Fisher CT Group 3 (15 cases) or Group 4 (1 case) underwent direct clipping surgery and the placement of the cisternal catheter. From 1-4 days after SAH onset, the nicardipine solution (0.09 mg/ml) was continuously injected through the cisternal catheter at the rate of 2 ml/h for 4-16 days. The vasospasm was evaluated from postoperative angiography performed 1 week after SAH onset. The ratios of diameter at internal carotid arteries (ICA) C1 portion, middle cerebral arteries (MCA) M1 portion and anterior cerebral arteries A1 portion were obtained from preoperative and post-operative angiograms. Mild localized vasospasm was observed in 5 cases. The ratios of diameter at C1, M1 and A1 were 1.15±0.19, 1.13±0.23 and 1.17±0.26, respectively. No symptomatic vasospasm was observed in any of the cases. These findings demonstrated that the vaso-dilative effect of nicardipine prevented the post SAH vasospasm of intracranial arteries at C1, M1 and A1. The mild angiographical vasospasm in the 5 cases was probably due to the insufficient delivery of nicardipine solution. Following the operative manipulation of the exposure of ICA and MCA with radical clot removal, administration of nicardipine solution through the catheter in the contralateral carotid cistern and draining from the catheter in ipsilateral sylvian cistern brought the widespread nicardipine delivery to peripheral arteries. Though further improvement of this method is required, sustained intrathecal administration of nicardipine effectively prevents vasospasm following SAH.