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

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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.

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

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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

前田 拓真 大井川 秀聡 小野寺 康暉 佐藤 大樹 鈴木 海馬 栗田 浩樹

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.51, no.5, pp.397-404, 2023 (Released:2023-10-04)

参考文献数

12

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神経外視鏡手術が脳神経外科臨床にも導入され,その有用性が報告されている.当科では2021年から脳血管外科手術を神経外視鏡化するプロジェクトに取り組み,2022年は大部分の手術を神経外視鏡下で行っている.今回,顕微鏡手術からの移行期における脳動脈瘤手術の治療成績を検討した.対象は2021年1月から2022年8月までに当院で開頭手術を行った未破裂脳動脈瘤連続134例のうち,開頭クリッピング術を行った132例とした.神経外視鏡と顕微鏡の両群間で患者背景,セットアップ時間,手術時間,周術期合併症の有無,退院時予後について後方視的に検討を行った.神経外視鏡は75例(55.1%)で選択された.両群間で年齢・性別などの患者背景に有意差を認めなかった.両群で専攻医の執刀率が最も高く(65.3% vs. 59.0%),セットアップ時間(63分 vs. 62分),手術時間(295分 vs. 304分),周術期合併症(5.3% vs. 3.3%),退院時予後良好(97.3% vs. 95.1%)は両群間で有意差を認めなかった.アンケート調査では,画質(78.9%),明るさ(84.2%),操作性(73.7%),教育(57.9%)などにおいて,神経外視鏡がより高い評価を得た.一方で,助手の操作性については課題も明らかとなった.神経外視鏡は高画質,デジタルズームによる従来以上の強拡大,head-up surgeryによる疲労軽減,接眼レンズをもたない小型なカメラで視軸の自由度が大きいなどのメリットを有する.神経外視鏡は開頭クリッピング術においても有用であり,trainer,traineeの経験がともに少ない初期経験においても,許容可能な治療成績であった.

著者

宮田 悠 中原 一郎 太田 剛史 松本 省二 定政 信猛 石橋 良太 五味 正憲 坂 真人 岡田 卓也 西 秀久 園田 和隆 高下 純平 渡邉 定克 永田 泉

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.145-150, 2016 (Released:2016-06-07)

参考文献数

13

被引用文献数

11 10

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We report a case of repeated cerebral infarction caused by internal carotid artery (ICA) dissection triggered by an elongated styloid process, a form of Eagle syndrome. A 41-year-old man presented with sudden, mild left hemidysesthesia. Magnetic resonance imaging (MRI) revealed a small acute cerebral infarction in the right parietal cortex and insular cortex. Magnetic resonance angiography and digital subtraction angiography (DSA) revealed a right-sided ICA dissection distal to the carotid bifurcation. Idiopathic carotid artery dissection was suspected, and the patient was prescribed aspirin and observed. However, 5 months after the initial cerebral infarction, he had a second episode of left hemiparesis and confusion accompanied by occlusion of the right ICA. Because the area of impaired perfusion in the right hemisphere was greater than that suggested by the diffusion-weighted images of head MRI and clinical status was worse than expected, we performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis of cerebral infarction (TICI)-grade IIB was achieved. Computed tomographic (CT) angiography combined with analysis of bony structures revealed close proximity of the right ICA and an elongated styloid process with its tip directed toward the dissection. In an angiographic suite, a dynamic cone beam CT was performed with the head of the patient variedly rotated and tilted; the carotid artery dissection appeared to be triggered by the elongated styloid process. Resection of this process was performed to prevent recurrence of the cerebral infarction. Under the guidance of a navigation system, the elongated styloid process, which was located ventral to the anterior belly of the digastric muscle, was cut 3 cm from the tip. The patient was discharged on postoperative day 8 without medical problems, and no recurrence was observed for 12 months after the surgery.

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

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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

小畑 仁司 荻田 誠司 川上 真樹子 二村 元 杉江 亮

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.445-450, 2017 (Released:2017-12-22)

参考文献数

23

被引用文献数

2 1

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Fever in subarachnoid hemorrhage (SAH) is associated with vasospasm and poor outcome. To mitigate early brain damage in SAH, we have been treating World Federation of Neurological Surgeons (WFNS) Grade 5 patients with rapid induction of therapeutic hypothermia (TH) initiated immediately following onset of SAH and continued for approximately 7 days. Management after rewarming has been problematic. Rebound fever, especially during the period of post-SAH vasospasm, may increase the risk of cerebral infarction. We prospectively studied the feasibility and safety of endovascular cooling for maintaining prophylactic normothermia following initial TH in patients with severe SAH.TH (core body temperature 34.0°C) using surface cooling was initiated immediately after a diagnosis of WFNS Grade 5 SAH was made. All ruptured aneurysms were surgically clipped as soon as possible within 6 hours after arrival. At approximately postoperative day 7, after rewarming to 36°C, an endo- vascular catheter with 2 cooling balloons (Cool Line® Catheter, Asahi Kasei ZOLL Medical Corp., Tokyo, Japan) was inserted into the left internal jugular vein and connected to the Thermogard XP® Temperature Management System (Asahi Kasei ZOLL Medical Corp.) for the following 7 days. Temperature recordings in 11 SAH patients immediately before the period of endovascular cooling served as the control.Eleven patients (6 women; mean age of 63.8 ± 6.4 years [range, 50-73 years]) were enrolled in the study. Endovascular cooling was initiated at 7.9 ± 1.4 days (range, 6-11 days) after admission and continued for 6.7 ± 0.9 days (range 4-7 days). Unfavorable outcomes were associated with minimal shivering and good temperature control, whereas favorable outcomes were associated with vigorous shivering and increased temperature. Nine patients manifested shivering with increased temperature and were treated with acetaminophen, dexmedetomidine, and/or propofol. During the study period, two patients developed fevers above 38°C, and 8 of 11 patients without endovascular cooling developed fevers (p=0.03, two-tailed Fisher's exact test). There was no evidence of cerebral infarction related to vasospasm during endovascular cooling, and no catheter-related sepsis or thromboembolic events. In one patient, fasudil hydrochloride was administered intra-arterially for angiographic vasospasm, resulting in no cerebral infarction. In another patient, intensive treatment was withdrawn because of massive brain swelling; however, slight but extensive early ischemic change was retrospectively confirmed on computed tomography prior to endovascular cooling. Vasospasm-related cerebral infarction occurred in one patient 2 days after removal of the cooling catheter. In one patient, fatal bacterial meningitis related to spinal drainage occurred on Day 29. Three-month outcomes showed good recovery in 2, moderate disability in 4, severe disability in 2, vegetative state in 1, and death in 2. Amelioration of fever burden during the first 14 days after onset of SAH was safe and feasible with combined surface and endovascular cooling in patients with WFNS Grade 5 SAH.

著者

坂本 誠 宇野 哲史 中島 定男 細谷 朋央 桑本 雄平 末吉 駿太郎 神部 敦司 黒崎 雅道

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.50, no.6, pp.482-491, 2022 (Released:2022-12-28)

参考文献数

31

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内頚動脈および中大脳動脈M1部の緊急大血管閉塞(emergency large vessel occlusion:ELVO)に対する機械的血栓除去術(mechanical thrombectomy:MT)は,内科的治療単独よりも患者の予後を改善することが示されている.ステントリトリーバー(stent retriever:SR)や吸引カテーテル(aspiration catheter:AC)を用いたMTでは,90%前後の高い再開通率が報告されているが,実臨床では,解剖学的な要因や病変の複雑さから通常のMTでは再開通が困難な複雑な症例を経験することがある.本稿では,臨床で遭遇する可能性が高い以下の6つの典型的な複雑な条件下でのMT症例を提示し,治療戦略と手技を文献的に考察した.①蛇行した血管走行による病変部へのアクセス困難症例,②頚動脈と頭蓋内のタンデム病変,③中大脳動脈 M2 セグメントより遠位部の病変,④椎骨脳底動脈閉塞,⑤頭蓋内動脈硬化性狭窄症(intracranial atherosclerotic stenosis:ICAS),⑥脳動脈解離.当院では,MT手技は主にSRとACのcombined technique を第一選択としている.combined techniqueの利点は以下の点である.①SRとACの両方で血栓を強固に把持することで,遠位塞栓(embolization in new territory:ENT)を減少させる.②遠位にSRを留置して,ACをSR内の血栓部位まで先進させることでSR展開長が短縮しかつSRとACの長軸方向が一致することで,SRの牽引時の血管直線化が減少し穿通枝引き抜き損傷が減少する.③SRを展開し遠位固定することで,SRに追従させてのACの遠位誘導が容易になる.予後を改善するためには,状況に応じてさまざまな治療戦略や技術を駆使し,常に1回のデバイス通過での完全な再開通(first pass effect:FPE)を目指すべきである.

著者

出井 勝 村岡 賢一郎 寺田 欣矢 目黒 俊成 廣常 信之 西野 繁樹

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.41, no.1, pp.60-64, 2013 (Released:2013-06-22)

参考文献数

9

被引用文献数

2 1

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We report two cases of pregnant females presenting with intracerebral hematoma caused by ruptured arteriovenous malformation (AVM). A 21-year-old woman suddenly presented with severe headache, motor aphasia and right hemiparesis at 30 weeks of pregnancy because of a hematoma in the left frontal lobe. A cerebral angiogram showed AVM in the frontal lobe. We performed an emergency operation to remove the hematoma and AVM. The postoperative course was uneventful without neonatal complications. In the other case, a 32-year-old woman complained of headache and vomiting at 11 weeks of pregnancy. A CT scan indicated a right cerebellar hematoma. A cerebral angiogram revealed cerebellar AVM. An emergency surgical evacuation of the hematoma and AVM was performed. A complete cure was achieved after operation without complications. Intracerebral hematoma in a pregnant woman can lead to the death of the mother and fetus. Appropriate diagnosis and treatment should be immediately undertaken to save maternal and neonatal life.

著者

佐野 公俊 加藤 庸子 安部 雅人 笠間 睦 神野 哲夫

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.19, no.4, pp.595-597, 1991-12-20 (Released:2012-10-29)

参考文献数

8

被引用文献数

3 2

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In cases of difficult aneurysms the temporary occlusion of blood flow makes the operation easy; however, ischemic damage of the brain must always be considered. Temporary clipping of the parent artery is easy, but ischemic damage may be severe.On the other hand, a tentative clip which is put on the aneurysm either partially or totally, has the following merits:1) Preparation of the aneurysm is easy and safe.2) There is less ischemic damage.But there are the following demerits:1) The part of the aneurysm on which a tentative clip is put should be prepared.2) At the time of tentative clipping the back side of the aneurysm cannot be seen.Temporary clipping and tentative clipping, each has its own merits and demerits.We have to approach aneurysms on the base of sufficient knowledge.

著者

恩田 英明 谷川 達也 竹下 幹彦 荒井 孝司 川俣 貴一 氏家 弘 井沢 正博 加川 瑞夫 高倉 公朋

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.22, no.4, pp.293-299, 1994-07-30 (Released:2012-10-29)

参考文献数

20

被引用文献数

20 16

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The authors present 33 patients with dissecting aneurysm of the intracranial vertebral artery, of whom subarachnoid hemorrhage developed in 26 patients and cerebral ischemia in 7 patients. Sixteen patients were surgically treated and 17 were conservatively treated. In this series, recurrent hemorrhage occured in 9 (35%) of 26 patients who presented with subarachnoid hemorrhage within 2 weeks after the initial ictus. The outcome of the cases with recurrent hemorrhage was very poor-7 of these 9 patients died. Therefore, surgical intervention during the acute stage is required to avoid the early rerupture. Comparative study with surgical and conservative treatment for dissecting aneurysms of the vertebral artery indicated that the outcome of patients with surgical treatment was much better than with conservative treatment. In surgical procedures, proximal clip-occlusion of the vertebral artery at the site distal to the PICA (DTP) was performed in 5 cases, at proximal to the PICA (PTP) in 4, trapping of the vertebral artery with dissecting aneurysm in 2, coating in 3, and proximal occlusion of the vertebral artery with detachable balloon in 2 patients. Postoperatively, transient lower cranial nerve palsy or cerebellar signs developed in 2 cases with trapping, in 1 with PTP and permanent hemiparesis due to thromboembolism at the top of the basilar artery in 1 with balloon-occlusion of the vertebral artery. In spite of surgical intervention, rerupture occured postoperatively in 1 case with coating and in 1 with DTP. Trapping procedure is most reliable to prevent rerupture of dissecting aneurysm, but it is difficult to expose the distal part of the vertebral artery beyond the aneurysm for trapping. Although proximal clip-occlusion is not completely satisfactory for prevention of rebleeding, it is simple as a method and useful for dissecting aneurysm of the vertebral artery.

著者

林 健太郎 堀江 信貴 陶山 一彦 永田 泉

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.40, no.3, pp.179-182, 2012 (Released:2013-03-09)

参考文献数

21

被引用文献数

2 1

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Moyamoya disease (MMD) is characterized by progressive occlusion of the internal carotid artery or its terminal branches, associated with formation of extensive collateral vessels (moyamoya vessels) at the base of the brain. Whether unilateral moyamoya disease, confirmed by typical angiographic evidence of moyamoya disease unilaterally and normal or equivocal findings contralaterally, is an early form of definite (bilateral) moyamoya disease remains controversial. Inherited or acquired disorders and conditions may present in conjunction with moyamoya disease. This condition is known as quasi-moyamoya disease (quasi-MMD). We attempted to determine the incidence and total patient number of moyamoya disease, unilateral MMD and quasi-MMD, who were treated during 2005 in Japan. Questionnaires were sent to 2,998 departments, which are listed in resident training programs of neurosurgery, neurology and pediatrics. Totally, 1,183 departments replied, and the response rate was 39.5%. The number of annual first-visit patients of MMD, unilateral MMD and quasi-MMD is 571, 118, and 53, respectively. Thus, the number of annual revisit patients of MMD, unilateral MMD and quasi-MMD is 2,064, 214, and 117 respectively. It is estimated that 6,670.9 MMD patient exists in Japan. The incidence rate of MMD, unilateral MMD and quasi-MMD is 1.13, 0.23 and 0.11/100,000, respectively, and the prevalence is 5.22, 0.66 and 0.34/100,000, respectively. This nationwide study revealed the present epidemic status of MMD, unilateral MMD and quasi-MMD.

著者

吉田 和道 宮本 享

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.48, no.6, pp.414-419, 2020 (Released:2021-01-07)

参考文献数

30

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Summary: Atherosclerotic carotid stenosis (CS) comprises about 20% of all cerebral infarctions in Western countries, and the number of patients with CS is also likely to increase in Japan due to changes in dietary habits and the unprecedented rate of the aging population. Therefore, the significance of appropriate management of CS will also concomitantly increase. The risk of future ischemic events in patients with CS has long been assessed mainly by luminal morphology as angiographically determined stenosis and ulceration. However, recent remarkable advances in vessel wall visualization using ultrasound and magnetic resonance imaging (MRI) combined with a deeper understanding of vascular biology have shown that vessel wall characteristics also have considerable influence on the onset of ischemic events. Assessments of plaque characteristics are now important in the management of CS. Several features of a vulnerable plaque such as intraplaque hemorrhage, large lipid-rich necrotic cores, and ruptured fibrous caps have been precisely demonstrated using MRI. The current status of carotid plaque characterization using MRI will be briefly outlined in this review. Thereafter, the potential clinical implications and future challenges of analyzing plaque using MRI will be discussed.

著者

山口 慎也 魏 秀復 宇野 淳二 伊飼 美明 古賀 広道 伊野波 諭 甲斐 康稔 藤本 基秋 前田 一史 長岡 慎太郎 西尾 俊嗣

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.1, pp.30-34, 2009 (Released:2009-09-29)

参考文献数

13

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We report 5 cases of remote cerebellar hemorrhage (RCH), which occurs rarely after supratentorial aneurysmal clipping. Among 501 consecutive cases, who were operated on for their supratentorial cerebral aneurysms (unruptured 174 cases; ruptured 327 cases) in our facility between 2002 and 2007, 5 (unruptured 4; ruptured 1) were found to have RCH. RCH was not found on the first CT scan taken within an hour after surgery but was detected between 4 hours and 8 days after surgery. Postoperative epidural drainage in RCH cases amounted to more than 200 ml per 4 hours. While several risk factors for this hemorrhage have been reported, hemorrhage along the cerebellar folia and delayed occurrence suggested that the disturbed cerebellar venous drainage caused by excessive CSF drainage during the perioperative period was the cause of this hemorrhage. While the pathogenesis of RCH has not fully been elucidated, excessive CSF drainage should be avoided during supratentorial aneurysm surgery.

著者

安藤 大祐 豊田 一則

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.48, no.2, pp.87-90, 2020 (Released:2020-09-15)

参考文献数

16

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With the development of medical treatment in recent years, the incidence of stroke associated with carotid stenosis has continued to decrease. Treatment for carotid artery stenosis is intended to reduce the risk of thrombotic events and atherosclerotic changes to prevent future cardiovascular events. Antiplatelet therapy is routinely used for secondary prevention of ischemic stroke and is effective for the prevention of microembolism from the rupture or erosion of a carotid plaque. It is common to perform dual antiplatelet therapy in the acute to subacute stages of ischemic stroke. Lipid modification with statins is an essential element in the treatment of carotid artery stenosis. Statins are used to reduce the progression of carotid intima-media complex thickening and for plaque stabilization. Management of diabetes mellitus, lifestyle changes (including smoking cessation), physical activity, and weight management are also important for the prevention of carotid artery stenosis.

著者

豊田 真吾 藤田 祐也 菅野 皓文 後藤 哲 熊谷 哲也 森 鑑二 瀧 琢有

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.6, pp.431-438, 2016 (Released:2016-12-27)

参考文献数

38

被引用文献数

1

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Considering the excellent results of coil embolization in several clinical studies for cerebral aneurysms, endovascular treatment has often been selected as the first-choice treatment of cerebral aneurysms, even in Japan. However, recurrence, which occurs at a certain probability after coil embolization, is a crucial problem. As a result of the increased use of endovascular treatment, we have experienced increased frequency of recurrent aneurysms after coil embolization.Many authors have reported that re-coil embolization is safe and efficient for the treatment of recurrent aneurysms after coil embolization. On the other hand, surgical clipping is an alternative option for retreatment, especially in cases unsuitable for coil embolization. Surgical clipping for recurrent aneurysms after coil embolization is performed with or without removal of embolized coils. However, removal of embolized coils entails management of some uncertain elements during the procedure. Therefore, when technically feasible, clipping without removal of embolized coils is preferred.We present our experience with retreatment of 24 cerebral aneurysms after coiling between 2009 and 2015. Among the 24 aneurysms, 12 were retreated with coiling, and 12 were retreated with clipping. Among the 12 cases with clipping, 10 involved neck clipping and two involved partial clipping of the non-thrombosed portion. In all the cases, clipping was accomplished without coil removal. No neurological complications occurred in any of the cases retreated with surgical clipping.The management of recurrent lesions of embolized aneurysms requires appropriate choice of treatment that involves using coiling as well as clipping. In these cases, surgical clipping, especially without coil removal, plays an important role in ensuring safe treatment.

著者

宮原 宏輔 市川 輝夫 向原 茂雄 岡田 富 郭 樟吾 谷野 慎 瓜生 康浩 坂本 雄大 畑岡 峻介 藤津 和彦

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.41, no.6, pp.416-421, 2013 (Released:2014-01-29)

参考文献数

33

被引用文献数

1 1

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The surgical procedure for a brainstem lesion must be carefully considered because of the critical neurological functions of the brainstem. We have surgically treated brainstem cavernous angioma after bleeding without significant postoperative morbidity, because the boundary between the angioma and normal brain tissue is generally well demarcated by preceding hemorrhages. However, because the angioma tissues are often destroyed by hemorrhage, care must be taken not to leave any pieces of the angioma tissue. To reduce the risk of morbidity, surgeons must investigate carefully when performing the operation. We analyze the surgical results and pathological findings of nine cases of symptomatic brainstem cavernous angiomas, and discuss the various surgical strategies especially based on the timing of surgery.

著者

原 淑恵 山下 晴央 山本 浩隆 井上 悟志 松本 優

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.40, no.2, pp.112-116, 2012 (Released:2013-03-09)

参考文献数

9

被引用文献数

1 2

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We report three cases with endocarditis-related mycotic intracranial aneurysms. Two presented with hemorrhage and one with cerebral infarction followed by aneurysm formation in the same territory. All three suffered bacteremia and infectious endocarditis. Two had multiple aneurysms. Ruptured and/or enlarging aneurysms were treated with endovascular coil embolization. For unruptured, asymptomatic aneurysms that were stable in size, systemic antibiotic therapy and a serial follow-up with angiography was done. Embolization was successful in all cases. Two had cardiac surgery uneventfully. Two had untreated unruptured aneurysms that disappeared on the follow-up angiography after long-term systemic antibiotic therapy. There was no reassurance of treated aneurysms.

著者

上野 俊昭 内藤 雄一郎 中込 忠好

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.40, no.1, pp.19-23, 2012 (Released:2012-07-11)

参考文献数

6

被引用文献数

1

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We sought to compare medical costs of coiling and clipping for treatment of cerebral aneurysms. Data of total medical costs for coiling and clipping from 2006 to 2009 were retrieved from the medical reimbursement database at Teikyo University Hospital. There were 32 and 29 cases, respectively, for coiling and clipping of ruptured aneurysm who presented with subarachnoid hemorrhage, and 41 cases each with unruptured aneurysms for coiling and clipping. In patients with ruptured aneurysms, basic hospitalization costs were lower in the coiling group even with higher device-related costs. As a result, total medical costs during hospitalization were equivalent between the coiling and clipping groups. In patients with unruptured aneurysms, however, total medical costs during hospitalization were much higher in the coiling group than those in the clipping group. The difference in an amount of basic hospital costs was not enough to absorb the higher device-related costs in the coiling groups due to relatively shorter length of hospital stays in patients with unruptured aneurysms. Medical costs for treatment of cerebral aneurysms are well balanced between coiling and clipping in patients with subarachnoid hemorrhage. Coiling of unruptured aneurysms, however, pushes up the total amount of medical costs significantly due to higher device-related costs compared with clipping.

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

被引用文献数

42

著者

津田 恭治 高野 晋吾 今井 資 松原 鉄平 阿久津 博義 松村 明

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.40, no.3, pp.149-153, 2012 (Released:2013-03-09)

参考文献数

26

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We reviewed three cases of mid-brain cavernous angioma treated in our hospital. Here we describe the case summary and discuss therapeutic strategy for this lesion. Case 1 was a 56-year-old man who had dorsal mid-brain cavernous angioma and presented with Parinaud syndrome and right abducent nerve palsy. He had been observed conservatively, because removal of the lesion might be difficult or nearly impossible without producing a postoperative neurological deficit. The lesion increased gradually, and the patient suffered from walk disturbance due to Parkinsonism, and from memory disturbance. After six years of follow-up, he was admitted to a nursing home because of dependence (mRS 4). Case 2 was a 52-year-old woman who had ventral mid-brain cavernous angioma and presented with right hemiparesis. She underwent stereo-tactic radiation therapy (SRT). However, the lesion gradually progressed. Two years after SRT, she became disabled due to right-side hemiplegia and disuse of legs and was admitted to a nursing home (mRS 5). Case 3 was a 37-year-old woman who had dorsal mid-brain cavernous angioma and presented with right-mild hemiparesis, right extremities involuntary movement, right oculomotor nerve palsy, and Parinaud syndrome. The lesion was completely removed surgically via the occipital inter-hemispheric trans-callosal approach with intraoperative neurophysiological monitoring. One year after operation, right hemiparesis and voluntary movement improved gradually and she became able to walk independently, although Parinaud syndrome remained (mRS 3). Only Case 3 showed neurological recovery and an uneventful course. Cavernous angioma with re-hemorrhagic episode and located in a superficial region should be removed aggressively via the proper approach and with intra-operative neurophysiological monitoring.