著者

山下 正文 橋本 隆寿 平川 俊彦 福島 武雄 朝長 正道 原 泰寛 河野 彬 田中 睦子

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.25, no.8, pp.613-619, 1985-08-15 (Released:2006-09-21)

参考文献数

17

被引用文献数

1 2

---

To evaluate the usefulness of 5'-deoxy-5-fluorouridine (5'-DFUR) therapy for brain tumor, the pharmacokinetics of 5'-DFUR and 5-fluorouracil (5-FU) in the tumor, in the white matter surrounding the tumor and in the serum were investigated, and the thymidine phosphorylase, the main activating enzyme of 5'-DFUR in human tissues, was also studied. Materials were obtained from 24 cases of primary brain tumors and from 4 cases of metastatic carcinoma. During the operation 500 or 1, 000 mg of 5'-DFUR was administrated intravenously, and blood, tumor tissue and white matter were taken mainly within 60 minutes and partly within 180 minutes after intravenous administration of 5'-DFUR. In some cases samplings were performed serially. Concentrations of 5'-DFUR and 5-FU were measured by high performance liquid chromatography, and thymidine phosphorylase activity in tissue extracts was obtained against d-thymidine and/or 5'-DFUR as substrates. The concentrations of 5'-DFUR and 5-FU in serum decreased immediately in an exponential mode after intravenous administration of 1, 000 or 500 mg of 5'-DFUR. High concentrations of 5'-DFUR and 5-FU in the tumor tissues were noticed in malignant tumors, such as glioblastoma, ependymoma and chondrosarcoma, and 5-FU concentrations in the tumor in two cases of glioblastoma and one of ependymoma were higher than that in their sera. An important characteristic of 5'-DFUR was that it was converted to 5-FU in various tissues predominantly in malignant neoplasms. Thymidine phosphorylase activity was more prominent in glioblastoma, metastatic carcinoma and chordoma. Although the 5'-DFUR concentration in white matter was considerable, the 5-FU concentration was negligible suggesting low enzyme activity. An effect of 5'-DFUR therapy on malignant brain tumor should be expected from the high concentration of 5' DFUR and 5-FU in the tumor tissue. However, these high concentrations rapidly decreased, therefore, the appropriate mode of prescription of 5'-DFUR should be considered in clinical practice.

著者

高山 秀一 戸谷 重雄 河瀬 斌 飯坂 陽一 村上 秀樹

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.27, no.2, pp.78-82, 1987 (Released:2006-09-21)

参考文献数

19

---

The effect of stable xenon on the regional cerebral blood flow (rCBF) was studied in 12 adult cats. Xenon in concentrations 17%, 33%, 50%, and 60% was mixed with oxygen, and inhaled by a semi-closed rebreathing system. Cortical rCBF was continuously measured by a heat clearance probe which had been calibrated using the hydrogen clearance method. Cortical rCBF decreased to 96%, 92%, 88%, and 88% of the control after inhalation of 17%, 33%, 50%, and 60% xenon, respectively, and these decreases in rCBFs were statistically significant (p<0.01, Student's paired t-test) under the high concentrations of xenon of 33% or more. No significant changes were seen in arterial carbon dioxide tension and the mean arterial blood pressure during xenon inhalation, whereas diffuse electroencephalographic slowing was observed during 50% xenon inhalation. The mechanism of the decrease of rCBF by xenon gas remains to be solved. The direct effect of xenon on rCBF should be considered when high concentrations of xenon are used for stable xenon-enhanced computed tomography.

著者

山内 康雄 高原 街彦 河村 悌夫 松村 浩

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.25, no.2, pp.136-142, 1985

被引用文献数

2 4

---

A 69-year-old male was admitted complaining of gait disturbances and diplopia, 2.5 years after an episode of serous meningitis. Neurological examination on admission disclosed Parinaud's sign, unsteady gait and dysdiadochokinesis on the left side. A striking finding on the computerized tomography (CT) was the left to right shift of the posterior portion of the third ventricle without visualization of the quadrigeminal and ambient cisterns, which were almost completely occupied by an isodense mass accompanied by high dense flecks and a low dense part. Enhanced CT showed positive enhancement in the vicinity of the pineal calcification. By the suboccipital supracerebellar approach, an encapsulated mass containing brownish yellow fluid was subtotally removed and a histological examination of it revealed epidermoid tissue and hemosiderin deposits in the solid portion. Few reports of isodense epidermoid cysts have so far been found in the literature giving a full explanation for this unusual CT attenuation value. Based on the clinical course and histology of this case, the pathogenesis of the unusual density is discussed along the following lines: The mixture of the low dense factor due to cholesterin and the high dense factor due to prior bleeding is believed to result in the isodense attenuation value in the liquid portion. Also, in the solid part, a microscopically mixed texture of deposited hemosiderin and cholesterin clefts in the inflammatory granulomatous tissue could explain its density on the CT scan.

著者

渋井 壮一郎

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.24, no.2, pp.65-72, 1984

被引用文献数

1

---

The antitumor effect of 5'-deoxy-5-fluorouridine (5'-DFUR) against experimental glioma cells was investigated in vitro and in vivo. 5'-DFUR is a newly synthesized masked compound of 5-FU, which is activated only in the presence of pyrimidine nucleoside phosphorylase. This enzyme has been reported to exist much more in malignant tumors, such as Sarcoma 180 and Ehrlich ascites carcinoma, than in normal tissues. The activities analysed in 9L, RG12, and 203GL cells were 24.3, 75.1, and 8.1% respectively of the activity in Sarcoma 180. Normal rat brain showed 22.8% of the activity. Growth curves of cultured 9L and RG12 cells showed a dose-dependent 5'-DFUR antitumor effect when it was used at a concentration of over 10 &mu;gml. The colony forming rate of 9L cells treated with 20 &mu;gml of 5'-DFUR decreased to 10%. The inhibition rate of 203GL cells transplanted subcutaneously into C57BL mice was 52.3% in weight, and that of human glioblastoma cells transplanted subcutaneously into nude mice was 20.9% in size after treatment with 5'-DFUR, 400 mgkgday for ten consecutive days. When 9L cells were transplanted intracranially into CD Fisher rats, their median survival time became four days longer than that of non-treated rats. Flowcytometric analysis of in vitro 9L cells and in vivo 203GL cells showed an accumulation in the cells between the 2C and 4C components after treatment of 5'-DFUR. It seems that a delay in DNA synthesis occurred in the presence of this drug. This newly synthesized antitumor drug is expected to be effective for the treatment of malignant brain tumors.

著者

Takayoshi MATSUI Kunio II Shuntaro HOJO Keiji SANO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.2, pp.75-80, 2012 (Released:2012-02-24)

参考文献数

7

被引用文献数

10

---

Our previous study of whiplash injury found that abnormalities in the cervical muscles cause autonomic dystonia. Further research has found that abnormalities in the cervical muscles cause headache, chronic fatigue syndrome, vertigo, and dizziness. We named this group of diseases cervical neuro-muscular syndrome. Patients treated within a 2-year period from April 1, 2002 to March 31, 2004 reported good outcomes in 83.8% for headache, 88.4% for vertigo and dizziness, 84.5% for chronic fatigue syndrome, 88.0% for autonomic dystonia, and 83.7% for whiplash-associated disorder. A large number of outpatients present with general malaise, including many general physical complaints without identifiable cause. We propose that treatment of the cervical muscle is effective for general malaise.

著者

Takamasa KAYAMA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.3, pp.119-141, 2012 (Released:2012-03-16)

参考文献数

86

被引用文献数

17 78

著者

Kevin E LIANG Ilia BERNSTEIN Yoko KATO Takeshi KAWASE Mojgan HODAIE

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.56, no.11, pp.709-715, 2016 (Released:2016-11-15)

参考文献数

27

被引用文献数

24

---

Low- and middle-income countries (LMICs) face a critical shortage of basic surgical services. Adequate neurosurgical services can have a far-reaching positive impact on society’s health care and, consequently, the economic development in LMICs. Yet surgery, and specifically neurosurgery has been a long neglected sector of global health. This article reviews the current efforts to enhance neurosurgery education in LMICs and outlines ongoing approaches for improvement. In addition, we introduce the concept of a sustainable and cost-effective model to enhance neurosurgical resources in LMICs and describe the process and methods of online curriculum development.

著者

INAMASU Joji KIM Daniel H. KLUGH Arnett

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.45, no.9, pp.439-447, 2005-09-15

被引用文献数

3 13

---

The surgical treatment of craniocervical junction (CCJ) instability has recently undergone significant development and change. Posterior instrumentation surgery has been the mainstay of treatment of CCJ instability, and is the focus of this review. For the treatment of atlantoaxial instability, C1-2 transarticular screw fixation has shown good stability, and has been regarded as the "gold standard" procedure. Because of potentially hazardous complications including vertebral artery injury, however, C-1 lateral mass-C-2 pedicle screw fixation is gaining popularity. For treatment of atlantooccipital instability, occipitocervical fixation using screw constructs (combined with either rods or plates) has shown more stability than sublaminar wiring techniques, and has been utilized more frequently. Both innovation in material engineering and in vitro biomechanical studies have contributed significantly to the development of more rigid internal fixation devices, and as a result, many patients who would have been treated conservatively with external orthosis are treated nowadays with instrumentation surgery, resulting in earlier ambulation, shortened hospital stay, and earlier recovery into social activities. New surgical techniques and instruments, however, need to stand the test of time to see whether they are free from long-term adverse events. The rapid turnover of new surgical techniques and hardware has made it difficult for less experienced surgeons to keep up with the latest developments. Conventional techniques can be safer and less technically demanding than newer techniques for those who are not familiar with them.

著者

Mitsunori MATSUMAE Osamu SATO Akihiro HIRAYAMA Naokazu HAYASHI Ken TAKIZAWA Hideki ATSUMI Takatoshi SORIMACHI

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.ra.2016-0020, (Released:2016-05-27)

参考文献数

310

被引用文献数

2 56

---

Cerebrospinal fluid (CSF) plays an essential role in maintaining the homeostasis of the central nervous system. The functions of CSF include: (1) buoyancy of the brain, spinal cord, and nerves; (2) volume adjustment in the cranial cavity; (3) nutrient transport; (4) protein or peptide transport; (5) brain volume regulation through osmoregulation; (6) buffering effect against external forces; (7) signal transduction; (8) drug transport; (9) immune system control; (10) elimination of metabolites and unnecessary substances; and finally (11) cooling of heat generated by neural activity. For CSF to fully mediate these functions, fluid-like movement in the ventricles and subarachnoid space is necessary. Furthermore, the relationship between the behaviors of CSF and interstitial fluid in the brain and spinal cord is important. In this review, we will present classical studies on CSF circulation from its discovery over 2,000 years ago, and will subsequently introduce functions that were recently discovered such as CSF production and absorption, water molecule movement in the interstitial space, exchange between interstitial fluid and CSF, and drainage of CSF and interstitial fluid into both the venous and the lymphatic systems. Finally, we will summarize future challenges in research. This review includes articles published up to February 2016.

著者

Masahide MATSUDA Tetsuya YAMAMOTO Eiichi ISHIKAWA Kei NAKAI Hiroyoshi AKUTSU Kuniyuki ONUMA Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.9, pp.749-755, 2015 (Released:2015-09-15)

参考文献数

21

被引用文献数

2 5

---

Temozolomide (TMZ) as a concomitant and adjuvant chemotherapy to radiotherapy following maximal surgical resection is the established standard therapy for patients with newly diagnosed high-grade glioma. However, detailed analysis of chemotherapy-induced nausea and vomiting (CINV) associated with concomitant TMZ has not been sufficiently described. We prospectively analyzed the profile of CINV associated with concomitant TMZ. Eighteen consecutive patients with newly diagnosed high-grade glioma treated with concomitant chemoradiotherapy including TMZ were enrolled. CINV was recorded using a daily diary including nausea assessment, emetic episodes, degree of appetite suppression, and antiemetic medication use. The observed incidence rates of all grade nausea, moderate/severe (CTC grade 2, 3) nausea, emetic episodes, and appetite suppression for the overall period were 89%, 39%, 39%, and 83%, respectively. Moderate/severe nausea and severe (CTC grade 3) appetite suppression were frequently observed during the delayed phase of the treatment. Emetic episodes and moderate/severe nausea were significantly correlated with female gender. Moderate/severe nausea and severe appetite suppression were significantly correlated with low lymphocyte counts before chemoradiotherapy. For CINV associated with concomitant TMZ, enhanced antiemetic therapy focused on the delayed phase of the treatment will likely be beneficial, especially in female patients with a low lymphocyte count before chemoradiotherapy.

著者

Hiroji MIYAKE

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.ra.2015-0282, (Released:2016-04-04)

参考文献数

20

被引用文献数

43

---

Various types of shunt valves have been developed during the past 50 years, most of which can be classified into the following categories: (1) fixed differential pressure valves; (2) fixed differential pressure (DP) valves with an antisiphon mechanism; (3) programmable DP valves; (4) programmable DP valves with an antisiphon mechanism; and (5) programmable antisiphon valves. When considering the myriad of possible postoperative condition changes, such as the onset of accidental non-related diseases or trauma in adults, and changes in normal physiological development or anticipation of future shunt removal in children, it has become standard to use the programmable valve as a first choice for cerebrospinal fluid shunting. However, it is still unclear what type of shunt valve is suitable for each individual case. Based on the results of SINPHONI and more recently SINPHONI 2 trials, the programmable DP valve is recommended as the first line shunt valve. The programmable DP valve with an antisiphon mechanism is thought to be beneficial for tall, slender patients, who have a tendency for easily developing complications of overdrainage, however, this type of valve must be used cautiously in obese patients because of the increased risk of underdrainage. Although the current evidence is still insufficient, the programmable antisiphon valve, which costs the same as the programmable DP valve, is also thought to be the first line shunt valve. The quick reference table is applicable for most shunt valves, and for patients with either the ventriculoperitoneal or the lumboperitoneal shunt.

著者

Tsuyoshi ICHIKAWA Kyouichi SUZUKI Yoichi WATANABE Taku SATO Jun SAKUMA Kiyoshi SAITO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.tn.2015-0188, (Released:2015-11-24)

参考文献数

24

被引用文献数

1 16

---

To perform intraoperative fluorescence angiography (FAG) under a microscope without an integrated FAG function with reasonable cost and sufficient quality for evaluation, we made a small and easy to use device for fluorescein FAG (FAG filter). We investigated the practical use of this FAG filter during aneurysm surgery, revascularization surgery, and brain tumor surgery. The FAG filter consists of two types of filters: an excitatory filter and a barrier filter. The excitatory filter excludes all wavelengths except for blue light and the barrier filter passes long waves except for blue light. By adding this FAG filter to a microscope without an integrated FAG function, light from the microscope illuminating the surgical field becomes blue, which is blocked by the barrier filter. We put the FAG filter on the objective lens of the operating microscope correctly and fluorescein sodium was injected intravenously or intra-arterially. Fluorescence (green light) from vessels in the surgical field and the dyed tumor were clearly observed through the microscope and recorded by a memory device. This method was easy and could be performed in a short time (about 10 seconds). Blood flow of small vessels deep in the surgical field could be observed. Blood flow stagnation could be evaluated. However, images from this method were inferior to those obtained by currently commercially available microscopes with an integrated FAG function. In brain tumor surgery, a stained tumor on the brain surface could be observed using this method. FAG could be performed with a microscope without an integrated FAG function easily with only this FAG filter.

著者

Satoshi KOIZUMI Masaaki SHOJIMA Akira IIJIMA Soichi OYA Toru MATSUI Gakushi YOSHIKAWA Kazuo TSUTSUMI Hirofumi NAKATOMI Nobuhito SAITO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.cr.2015-0233, (Released:2015-12-11)

参考文献数

16

被引用文献数

1 8

---

No treatment strategy has been established for subarachnoid hemorrhages due to basilar artery (BA) trunk dissecting aneurysms. Our aim was to report our initial experience performing stent-assisted coiling (SAC) for ruptured BA dissecting aneurysms to validate the effectiveness of this treatment. We experienced four consecutive cases of ruptured dissecting BA trunk aneurysm treated with SAC between 2008 and 2014 at three institutions. Aneurysm rebleeding was prevented without causing severe brainstem ischemia in all cases. In our opinion, both the blockage of the inflow to aneurysms and the preservation of the antegrade flow of the BA can be achieved by SAC, although controversies regarding long-term stability and appropriate antiplatelet therapy remain.

著者

Satoru OSUKA Hironori IMAI Eiichi ISHIKAWA Akira MATSUSHITA Tetsuya YAMAMOTO Hiroki NOZUE Tatsuyuki OHTO Kousaku SAOTOME Yoji KOMATSU Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.50, no.12, pp.1118-1122, 2010 (Released:2010-12-25)

参考文献数

13

被引用文献数

9 23

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Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome with a very particular clinical course. Three patients with MERS were evaluated by various sequences of magnetic resonance imaging with diffusion tensor imaging. Initial diffusion-weighted imaging showed reduction in the apparent diffusion coefficient values in the lesions, which completely resolved with the elimination of symptoms. However, diffusion anisotropy of the lesions showed no remarkable abnormalities in the early or delayed phases. These results may indicate that white matter architecture is preserved in both early and delayed phases in MERS.

著者

Koichi TAKAHASHI Tatsuo MIMA Yoichi AKIBA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2015-0032, (Released:2015-10-21)

参考文献数

40

被引用文献数

3 43

---

Spontaneous intracranial hypotension (SIH) has increasingly been recognized, and it is well known that SIH is sometimes complicated by chronic subdural hematoma (SDH). In this study, 55 cases of SIH with SDH were retrospectively analyzed, focusing on therapeutic strategies and outcomes. Of 169 SIH cases (75 males, 84 females), 55 (36 males, 19 females) were complicated by SDH. SIH was diagnosed based on clinical symptoms, neuroimaging, and/or low cerebrospinal fluid pressure. Presence of orthostatic headache and diffuse meningeal enhancement on magnetic resonance imaging were regarded as the most important criteria. Among 55 SIH with SDH cases, 13 improved with conservative treatment, 25 initially received an epidural blood patch (EBP), and 17 initially underwent irrigation of the hematomas. Of the 25 initially treated with EBP, 7 (28.0%) needed SDH surgery and 18 (72.0%) recovered fully without surgery. Of 17 SDH cases initially treated with surgery, 6 (35.7%) required no EBP therapy and the other 11 (64.3%) needed EBP and/or additional SDH operations. In the latter group, 2 cases had transient severe complications during and after the procedures. One of these 2 cases developed a hoarse voice complication. Despite this single, non-severe complication, all enrolled in this study achieved good outcomes. The present study suggests that patients initially receiving SDH surgery may need additional treatments and may occasionally have complications. If conservative treatment is insufficient, EBP should be performed prior to hematoma irrigation.

著者

Masanori YOSHINO Toki SAITO Taichi KIN Daichi NAKAGAWA Hirofumi NAKATOMI Hiroshi OYAMA Nobuhito SAITO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.tn.2014-0278, (Released:2015-07-28)

参考文献数

28

被引用文献数

9

---

Three-dimensional (3D) computer graphics (CG) are useful for preoperative planning of neurosurgical operations. However, application of 3D CG to intraoperative navigation is not widespread because existing commercial operative navigation systems do not show 3D CG in sufficient detail. We have developed a microscopic optically tracking navigation system that uses high-resolution 3D CG. This article presents the technical details of our microscopic optically tracking navigation system. Our navigation system consists of three components: the operative microscope, registration, and the image display system. An optical tracker was attached to the microscope to monitor the position and attitude of the microscope in real time; point-pair registration was used to register the operation room coordinate system, and the image coordinate system; and the image display system showed the 3D CG image in the field-of-view of the microscope. Ten neurosurgeons (seven males, two females; mean age 32.9 years) participated in an experiment to assess the accuracy of this system using a phantom model. Accuracy of our system was compared with the commercial system. The 3D CG provided by the navigation system coincided well with the operative scene under the microscope. Target registration error for our system was 2.9 ± 1.9 mm. Our navigation system provides a clear image of the operation position and the surrounding structures. Systems like this may reduce intraoperative complications.

著者

Masahito HARA Yusuke NISHIMURA Yasuhiro NAKAJIMA Daisuke UMEBAYASHI Masaya TAKEMOTO Yuu YAMAMOTO Shoichi HAIMOTO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.7, pp.547-556, 2015 (Released:2015-07-15)

参考文献数

32

被引用文献数

2 7

---

Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies.

著者

Hiroharu KATAOKA Susumu MIYAMOTO Kuniaki OGASAWARA Koji IIHARA Jun C. TAKAHASHI Jyoji NAKAGAWARA Tooru INOUE Etsuro MORI Akira OGAWA On Behalf of the JET-2 Investigators

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.6, pp.460-468, 2015 (Released:2015-06-15)

参考文献数

19

被引用文献数

3 49

---

The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.

著者

貫井 英明 長屋 孝雄 宮城 修 玉田 潤平 金子 的実 佐々木 秀夫 三塚 繁 川渕 純一 河野 徳雄 苅野 忠雄

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.22, no.6, pp.437-445, 1982-06-15

被引用文献数

8 13

---

The authors reported 7 cases that showed development of new aneurysms or enlargement of small aneurysms originally less than 3mm in diameter. New aneurysms of the anterior communicating artery and the right pericallosal artery were found in one case. In this patient with a 5 year history of hypertensiovn, cerebral angiography performed 8 years before following a head trauma had revealed marked arteriosclerosis and a hypoplasia of A1_1, but no aneurysm. Development of an aneurysm from a dilatation at the origin of the right embryonal posterior cerebral artery was found 3 years after the clipping of an aneurysm of the left internal carotid artery in the other case. In 3 cases, a small unruptured aneurysm all originally less than 3mm in diameter previously noted in conjunction with a ruptured aneurysm were found to have enlarged 3 to 13 years after the clipping of the ruptured aneurysm. In these 3 cases, anomalies of the circle of Willis, such as hypoplasia of unilateral A_1, infundibular dilatation at the origin of the posterior communicating artery and the embryonal posterior cerebral artery were revealed. Arteriosclerosis and hypertension were noted in 2 cases. In 2 cases, a small ruptured aneurysm, which had not been recognized at the first subarachnoid hemorrhage, was noted to have enlarged 5 and10 years after the first bleeding. Changes of the arterial wall due to hypertension, arteriosclerosis, etc., and hemodynamic stress caused by anomalies of the circle of Willis seemed to be responsible for the new development of aneurysm and the enlargernent of aneurysm. A small aneurysm less than 3mm in diameter, including an unruptured aneurysm that is found in association with the ruptured aneurysm, have a high incidence of progressive enlargement and rupture. Therefore, even a small aneurysm should be diagnosed and treated precisely.

著者

Toshio MATSUSHIMA Masatou KAWASHIMA Ken MATSUSHIMA Masahiko WANIBUCHI

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.ra.2014-0408, (Released:2015-03-23)

参考文献数

109

被引用文献数

1 6

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Research in microneurosurgical anatomy has contributed to great advances in neurosurgery in the last 40 years. Many Japanese neurosurgeons have traveled abroad to study microsurgical anatomy and played major roles in advancing and spreading the knowledge of anatomy, overcoming their disadvantage that the cadaver study has been strictly limited inside Japan. In Japan, they initiated an educational system for surgical anatomy that has contributed to the development and standardization of Japanese neurosurgery. For example, the Japanese Society for Microsurgical Anatomy started an annual educational meeting in the middle of 1980s and published its proceedings in Japanese every year for approximately 20 years. These are some of the achievements that bring worldwide credit to Japanese neurosurgeons. Not only should Japanese neurosurgeons improve their educational system but they should also contribute to the international education in this field, particularly in Asia.