著者

内山 拓 岡本 浩昌 田島 裕 香畑 智彦 鈴山 堅志

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.43, no.6, pp.459-464, 2015 (Released:2016-01-07)

参考文献数

7

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Cerebral venous thrombosis is a rare and uncommon type of stroke, and the deep venous system is affected in approximately 10% of cases of cerebral venous thrombosis. The clinical presentation of deep cerebral venous thrombosis is variable and nonspecific, and hence, it is difficult to diagnose this condition. In this report, we describe three cases of deep cerebral venous thrombosis. All the cases presented with mild decreased consciousness, and two cases also experienced quadriparesis. Magnetic resonance (MR) images demonstrated vasogenic edema in the thalamus/thalami, and T2* -weighted MR images indicated a thrombus in the deep venous system in all the cases. Hence, T2* -weighted MR images and magnetic resonance venography is useful for the early diagnosis of deep cerebral venous thrombosis, which can be followed by prompt treatment.

著者

小宮山 雅樹 石黒 友也 中島 英樹

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.232-233, 2015 (Released:2015-06-18)

参考文献数

11

著者

金谷 春之 湯川 英機 伊藤 善太郎 加川 瑞夫 神野 哲夫 桑原 武夫 水上 公宏

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科研究会講演集 (ISSN:03878031)

巻号頁・発行日

vol.7, pp.265-273, 1978

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In regard to hypertnsive intracerebral hemorrhage, different neurological gradings for clinical evaluation of the patient and different classifications for hematoma location on computed tomography have been used up to the present. To compare one clinical data to others, however, a standard neurological grading and a classification are required. For this reason, the authors tried to make a standard neurological grading and a classification on computed tomography based on 410 patients who had been treated in 6 different neurosurgical facilities in Japan.<BR>In the course of this study, it was found that the factors such as patient's age, level of consciousness, abnormal size and reaction to light of the pupils, and decerebrate or decorticate rigidity are directly influential to operative results. As to evaluation of the postoperative patient, the activities of daily living (ADL) was described as follows: full work, minimal disability and vegetative state.

著者

新川 修司

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.35, no.2, pp.130-135, 2007 (Released:2008-08-26)

参考文献数

10

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I encountered 4 cases of blood blister-like aneurysm (3 ruptured and 1 unruptured) during the past 7 years. The unruptured one was accompanied by a ruptured internal carotid-ophthalmic aneurysm. These aneurysms constitute 3.4% of the total of 117 aneurysms managed by open or endovascular surgery during the same period. In these 4 cases, the lesion arose at the nonbranching site on internal carotid artery. The 4 aneurysms were operated upon via a transsylvian approach. A combination of both wrapping and clipping was done in 3 cases, and for the remaining 1 (ruptured) clipping only. The aneurysm managed by clipping only suffered postoperative massive bleeding because of an inappropriate obliteration of the proximal aneurysmal neck. The other 2 ruptured aneurysms that underwent both wrapping and clipping did not suffer any bleeding postoperatively, and 1 patient with an unruptured aneurysm has been in good condition. I detail the course of these 4 cases and problems concerning management for blood blister-like aneurysm.

著者

田中 雄一郎 大塩 恒太郎 伊藤 英道 佐瀬 泰玄 池田 哲也 川口 公悠樹 梶 友紘 久代 裕一郎

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.48, no.1, pp.1-6, 2020 (Released:2020-03-27)

参考文献数

12

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For many years, neck clipping of large internal carotid artery paraclinoid aneurysms has been challenging. However, recent technical developments in coil embolization and flow diverters have been associated with great advancements. Indeed, reducing surgical complications related to neck clipping in the era of interventional radiology is essential. The basic techniques include 1) preparation of the cervical carotid artery, 2) cannulation of the carotid artery, 3) craniotomy, 4) sectioning of the falciform ligament, 5) removal of the anterior clinoid process, 6) preparation of the ophthalmic artery, 7) temporary arterial occlusion, and 8) intraoperative angiography or indocyanine green videoangiography. Key points of the surgical techniques include appropriate preparation of the parent artery and selection of the aneurysm clips. Here, some technical details, including the removal of the anterior clinoid process, the separation of the distal dural ring and the transposition of the sphenoparietal sinus, are described to both avoid surgical complications and improve the visual outcome.

著者

中川 忠 小股 整 鎌田 健一

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.38, no.3, pp.186-190, 2010 (Released:2010-10-27)

参考文献数

19

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We report a rare case of a 15-year-old male with multiple saccular aneurysms. He experiences dizziness while riding a bicycle and fell. On admission, he was drowsy but had no other neurological deficits. A brain CT scan demonstrated diffuse subarachnoid hemorrhage. A cerebral angiogram revealed a left internal carotid artery-anterior choroidal artery (IC-Ac) aneurysm (AN) with a bleb, a left basilar artery-superior cerebellar artery (BA-SCA) AN, a small left anterior cerebral artery (A1A2) AN and a right M1M2 portion of middle cerebral artery (M1M2) AN. The left IC-Ac AN seemed to be ruptured. The left ruptured IC-Ac and left unruptured BA-SCA ANs were clipped on Day 1. About 1 year later the right M1M2 AN was clipped, but the left A1A2 AN could not be clipped via a trans-sylvian approach because of its high position at 1 stage operation. The small left A1A2 AN was periodically followed up with MRA for 3 years. Since it increased in size, it was clipped via an inter-hemispheric approach. All 4 ANs were completely clipped on postoperative angiogram. Adolescents and adults display different clinical features in ANs. The biggest treatment difficulty is the higher incidence of giant ANs of the IC bifurcation and vertebro-basilar ANs in adolescents than in adults, and thus therapeutic strategy should be considered on a case-by-case basis.

著者

井川 房夫 日高 敏和 黒川 泰玄 米澤 潮 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.43, no.4, pp.262-266, 2015 (Released:2015-09-29)

参考文献数

15

被引用文献数

5 4

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The incidences of subarachnoid hemorrhage (SAH) in Finland and Japan are the highest in the world, with about 20-23 cases per 100,000 persons per year. Since the report of the International Subarachnoid Aneurysm Trial (ISAT) was published, the use of intravascular coil embolization (CE) for cerebral aneurysm has become more frequent worldwide. In this paper, we discuss the current situation of therapy for cerebral aneurysm in Japan according to the data of our institute, the Japan Standard Stroke Registry Study, and the Japan Neurosurgical Society.From 1999 to 2013, 543 cases of ruptured saccular cerebral aneurysms were treated in Shimane Prefectural Central Hospital. According to data, most cases occurred in men in their fifties and in women in their seventies. The mean sizes of ruptured cerebral aneurysm according to site were 7.4 ± 4.1, 7.0 ± 5.4, and 5.5 ± 2.5 mm in the internal carotid artery posterior communicating artery, middle cerebral artery, and anterior communicating artery, respectively. Aneurysms smaller than 5 mm account for 187 (34.4%) of the cases.According to the Japan Standard Stroke Registry Study, the poor outcome rates (modified Rankin scale score, 3-6) according to the ISAT criteria were 18.3% and 24.2% in the surgical clipping (SC) and CE groups, respectively. These rates were superior to the ISAT data (36.4% for SC and 25.4% for EC). According to the survey of the Japan Neurosurgical Society from 2001 to 2011, the prevalence of cerebral aneurysm cases treated with clipping decreased from 88.2% in 2001 to 71.2% in 2011. The number of ruptured cerebral aneurysms treated with clipping also decreased. However, the frequency of clipping for unruptured cerebral aneurysm was increasing.

著者

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

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

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

参考文献数

4

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

著者

久門 良明 渡邉 英昭 松本 洋明 井上 明宏 岩田 真治 大上 史朗 大西 丘倫

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.18-25, 2009 (Released:2009-09-29)

参考文献数

22

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We evaluated the effectiveness of assist-systems such as endoscopy, navigation, and motor evoked potential (MEP) monitoring in terms of improving the safety and accuracy of surgery for cerebrovascular diseases. Since January 2000, the following devices have been used at our institution to assist in surgical procedures: an endoscope (diameter, 2.7 or 4.0 mm; tip angle, 30° or 70°) in 69 surgical procedures to treat cerebral aneurysms, a navigation system (Stealth Station) in 22 operations for cerebral aneurysms and arteriovenous or cavernous malformations, and MEP monitoring (bipolar or mono-polar electrical stimulation of the motor cortex and EMG recording of the face, trunk and upper extremity contralateral to the stimulated side) in 11 operations for cerebral aneurysms or arteriovenous malformations. Endoscopy allowed visualization of the anatomical relationship between the aneurysm neck and the parent or perforated artery before clipping, and the location of the clip tip, occlusion of the perforated artery, or stenosis of the parent artery could be evaluated after clipping. Postoperative MR and/or CT images revealed an asymptomatic infarction of perforated artery in 4 patients. Navigation allowed prediction of the sites of aneurysms, cavernous malformations, or of the feeding arteries of arteriovenous malformations. This resulted in accurate approaches to these structures, although a brain shift in some patients was recognized by ultrasound imaging linked to the navigation system. Although MEP monitoring should have predicted postoperative motor function, MEP findings after clipping the neck of aneurysms or obliterating the arteriovenous malformation of a feeding artery were normal in all of the analyzed patients. Postoperative convulsive seizures developed in patients as a result of 20 mA of bipolar electrical stimulation. Endoscopy, navigation, and MEP monitoring are considered helpful for safe and accurate surgical treatment of cerebrovascular diseases, although the disadvantages of these systems should also be considered.

著者

松崎 粛統 須磨 健 渋谷 肇 中村 真 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 = Surgery for cerebral stroke (ISSN:09145508)

巻号頁・発行日

vol.38, no.5, pp.353-357, 2010-09-30

参考文献数

18

被引用文献数

1 1

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A 57-year-old man was referred to our hospital for detailed investigation and therapy of right exophthalmos and chemosis. Cerebral angiography demonstrated a dural arteriovenous fistula (DAVF) involving an anterior part of the right cavernous sinus (CS). The main feeders of the CS-DAVF consisted of the right inferolateral trunk and right middle meningeal artery. The predominant drainage route was the right superior ophthalmic vein (SOV), extending to the right facial vein. The right inferior petrosal sinus (IPS) was not visualized in the arterial phase, but was visualized in the venous phase, indicating that it contributes normal venous drainage. Transvenous embolization (TVE) was performed under general anesthesia through the right facial vein. We advanced a guiding catheter in the right angular vein and passed a microcatheter system through the tortuous vessel to the shunting point under single plane road mapping. The affected anterior part of the CS was occluded with Micrus coils (UltiPaq and Cashmere) (Micrus Endovascular, San Jose, CA, USA). Post-treatment angiography revealed disappearance of the fistula. <br> In general, CS-DAVFs are treated with TVE through the IPS. However, in the present case, IPS was not used for the approach based on the angiographic appearance. Large drainage volume of the right facial vein enabled us to advance the guiding catheter to the angular vein with facility, and to pass the microcatheter system through the tortuous vessel with sufficient support of the guiding catheter. Cashmere, which is a 14 system infinity loop-shaped coil and relatively soft as a framing coil, had a tendency to attach to the anterior part of the CS wall. <br> Because of good packing efficiency, transvenous Micrus coil embolization through the facial vein is an efficient treatment of DAVF involving the anterior part of the CS.<br>

著者

周藤 高 松永 成生 末永 潤 猪森 茂雄 藤野 英世

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.38, no.4, pp.228-234, 2010 (Released:2011-04-29)

参考文献数

23

被引用文献数

3 3

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We retrospectively studied 15 patients, 9 men and 6 women aged 17 to 52 years (mean 28.1 years), who developed cyst formation following gamma knife radiosurgery (GKS) at our hospital for cerebral arteriovenous malformation (AVM). The mean nidus volume was 11 cm3 (0.1-26.7 cm3), and the mean prescription dose at the nidus margin was 20.0 Gy (18-28 Gy). Nidus obliteration was obtained in 9 patients, partial obliteration in 5, and no change in 1. Cyst formation was detected from 2.5 to 13.5 years (mean 6.4 years) after GKS. Three patients underwent craniotomy, and 2 received placement of an Ommaya reservoir. Spontaneous regression of cyst was observed in 2 patients. The outcome of the cyst was unknown in 2 patients, because of no response from the neurosurgeon the patients were referred to. Serial magnetic resonance imaging was performed in the other 6 patients because the cyst size was stable or asymptomatic. These findings suggest that cyst formation following GKS is not a “late complication.” Placement of an Ommaya reservoir or cyst-peritoneal shunt is recommended for cysts with obliterated nidus. Craniotomy should be considered if the nidus is not completely obliterated or the cyst is associated with an expanding hematoma. Serial follow-up imaging is recommended for asymptomatic patients.

著者

府川 修 相原 坦道 石井 完治 菊池 淳 増山 祥二 片山 正文 小暮 哲夫

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科研究会講演集 (ISSN:03878031)

巻号頁・発行日

vol.10, pp.36-41, 1981 (Released:2012-10-29)

参考文献数

5

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10 cases having abnormal angiographical findings which showed the stenosis or occlusion of middle cerebral artery with moyamoya phenomenon were reported. The characteristics of these cases were summarized as follows. 1) It showed high incidence in female (3 males and 7 females). 2) These patients involved two young cases ranged in age from 4 years to 62 years. 3) Intracranial hemorrhage was cofirmed in 4 cases and onset of symptom in other 6 cases was similar to that of cerebral infarction. 4) 5 cases showed a unilateral occlusion of middle cerebral artery at its origin and 2 cases showed a unilateral stenosis of M1 portion, with moyamoya vessels in this region. 5) Two cases demonstrated bilateral occlusion of middle cerebral artery, and one showed a right stenosis and left occlusion of middle cerebral artery, with moyamoya vessels. 6) On the other hand, we could not find a stenosis on the intracranial internal carotid artery in these cases. 7) These findings suggested that such cases may be different from the so-called“Moyamoya disease”.

著者

小野 純一 樋口 佳則 町田 利生 松田 信二 石毛 聡 永野 修 田島 洋佑

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.2, pp.118-124, 2015 (Released:2015-05-27)

参考文献数

19

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The natural history of intracranial arterial dissection is not well known. This study was conducted to elucidate the serial changes of radiographic findings and the long-term outcomes in both hemorrhagic and non-hemorrhagic patients who underwent intracranial vertebrobasilar artery dissection.Among 200 patients who underwent intracranial arterial dissection of the vertebrobasilar system, 99 (49.5%) were conservatively managed. These patients were divided into two groups: the hemorrhagic group (H, subarachnoid hemorrhage; n = 24 patients) and non-hemorrhagic group (NH, ischemia or headache; n = 75). Age, site of dissection, initial radiological findings and serial changes, follow-up period, and long-term outcome were analyzed. Outcomes were evaluated using the Glasgow Outcome Scale.Results: The median ages were 54 and 52 years in the H and NH groups, respectively. In both groups, the vertebral artery was most commonly affected, followed by the basilar artery. Regarding radiographic findings, the pearl-and-string sign was the most common initial finding in the H group. Conversely, tapering, narrowing, or occlusion was the most common finding in the NH group. As for serial changes in radiographic findings, no change was most frequent in both groups, followed by improvement. These changes mostly occurred within a few months in the H group but over several years in the NH group. The mean follow-up periods were 7.2 and 5.7 years in the H and NH groups, respectively. Regarding long-term outcomes, in the H group, 15 patients (62.5%) had a good recovery, and 7 (29.2%) died. In the NH group, 58 patients (77.5%) recovered, and 7 (9.3%) died. The cause of poor outcome was initial hemorrhage or subsequent rupture in the H group. Poor outcomes in the NH group were primarily due to systemic problems.These results demonstrate the long-term radiological changes and outcomes associated with the intracranial arterial dissection of the vertebrobasilar system. However, these findings are insufficient to argue the natural history of this disease because patients who received surgical treatment were excluded from this study.

著者

山浦 晶 小野 純一 興村 義孝 福田 和正 宮田 昭宏

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.21, no.5, pp.341-346, 1993-09-30 (Released:2012-10-29)

参考文献数

14

被引用文献数

12 7

著者

高橋 立夫 服部 和良 小林 由充子 井上 繁雄 今川 健司 浅井 昭 桑山 明夫

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.21, no.2, pp.153-160, 1993-03-25 (Released:2012-10-29)

参考文献数

13

被引用文献数

1 1

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Six adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, 2 patients presented with subarachnoid hemorrhage and 4 with brain-stem ischemia. In all patients, angiography demonstrated fusiform dilatation and constrictions of the involved vessel, which were called “pearl and string”sign. Among these, 2 patients of subarachnoid hemorrhage and one patient with definite dissecting aneurysm that did not improve in spite of angiographic monitoring were surgically treated. Three other patients were treated conservatively with rather good clinical results. Ischemic type of vertebrobasilar dissection must be angiographically monitored, because of spontaneous healing of dissection. In dealing with dissection of vertebrobasilar arteries, because only severe headache develops before ischemic symptoms appear, great care must be taken for these patients. MRI is one of the most reliable neuroimaging methods for detecting dissection.

著者

吉浦 徹 綾部 純一 前田 昌宏 三島 弘之 川崎 泰輔 鈴木 幸二 土屋 雄介 関口 徳朗 田中 良英

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.2, pp.127-131, 2018 (Released:2018-04-20)

参考文献数

15

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A 33-year-old man presented with subarachnoid hemorrhage (Hunt and Kosnik grade II, World Federation of Neurological Surgeons [WFNS] grade I, Fisher group 3). Cerebral angiography revealed two anterior choroidal arteries and an aneurysm in a distal branch, in addition to an occlusion at the beginning of the right middle cerebral artery (MCA) and ipsilateral moyamoya vessels (unilateral moyamoya disease). On day 5, proximal ligation and bypass (superficial temporal artery [STA]-MCA anastomosis and encephalo-myo-synangiosis [EMS]) was performed. After surgery, neither symptomatic cerebral vasospasm nor hydrocephalus occurred. The patient was discharged without any neurological deficits. According to several reports, in cases of ruptured aneurysms associated with main trunk artery occlusion, it is important to operate both the aneurysm and STA-MCA anastomosis simultaneously in the acute phase to prevent re-rupture of the aneurysm and improve the cerebral blood flow. Thus, combination surgery consisting of proximal ligation and direct/indirect bypass in the acute phase is considered useful for hemorrhagic moyamoya disease.

著者

大熊 洋揮 棟方 聡 嶋村 則人 中野 高広 漆舘 聡志 畑山 徹

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.39, no.2, pp.75-83, 2011 (Released:2011-07-26)

参考文献数

23

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Aesthetics must be considered in surgery for unruptured cerebral aneurysms, since it is a prophylactic treatment and a good-quality postoperative life should be maintained. We introduce several of our attempts to this end. To prevent postoperative alopecia, scalp clips are not used, and a skin incision is made perpendicular to the hairline and parallel to the hair-growing angle. Prevention of postoperative atrophy of the temporal muscle is attempted by not using keyholes, not using incision in the anterior part of the muscle, and preserving deep temporal arteries and veins. Any craniotomy lines and burr holes should be covered by artificial devices or autologous bone powder obtained during craniotomy and tightly covered by subgaleal connective tissue or temporal muscle with periosteum. In bald-headed patients, keyhole surgery is effective to make the scar ambiguous. Otherwise, a craniotomy under a skin incision on a wrinkle of the forehead, which can offer a larger operative field than keyhole surgery, effectively obscures the skin incision postoperatively. These attempts have resulted in satisfactory aesthetic effects both subjectively and statistically.

著者

波多野 武人 塚原 徹也 荻野 英治 中久木 卓也 青山 貴子 辻 芳仁 大谷 良

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.3, pp.178-184, 2006 (Released:2008-08-08)

参考文献数

14

被引用文献数

2 2 2

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Patients who have symptomatic, medically refractory, vertebrobasilar artery stenosis have a high risk of stroke. The benefits of vascular reconstruction surgery and balloon angioplasty for these lesions are limited, and these treatments are associated with considerable complications. Recently stent placement in the intracranial arteries became available and is expected to improve the results of endovascular treatments. We review our experience with endovascular treatment for symptomatic intracranial vertebrobasilar artery stenosis. Forty patients with intracranial vertebrobasilar artery stenosis were treated with endovascular surgery. Indication of the endovascular surgery was medically refractory symptomatic patients with over 60% angiographical stenosis. Balloon angioplasty was firstly performed in all patients. Stenting was performed only in cases with insufficient dilatation, dissection or restenosis after balloon angioplasty. Successful dilatation was obtained in all cases. Twelve patients underwent stenting in initial treatments. The stenosis rate reduced to 25.2% after balloon angioplasty and 16.1% after stenting. No neurological complications occurred after procedure. The restenosis rates after treatments were 25.9% after balloon angioplasty and 23.5% after stenting. During the follow-up period, only 1 patient developed stroke of posterior circulation. Endovascular surgery for symptomatic vertebrobasilar artery stenosis has become more feasible and safer after the introduction of stenting. Prevention of restenosis is the next problem to be solved.

著者

小林 繁樹 古口 徳雄 大石 博通 和田 政則 宮田 昭宏 中村 弘 八木下 敏志行

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.2, pp.79-85, 2006 (Released:2008-08-08)

参考文献数

17

被引用文献数

4 3

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We evaluate the effect of introduction of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of aged patients (>=70 years old) with subarachnoid hemorrhage (SAH). Between 1990 and 2003, 92 aged patients with SAH underwent angiography as candidates for early aggressive treatment in our hospital. In 1990-96 (Group 1), treatment options were early craniotomy surgery, intensively delayed craniotomy surgery and conservative management (n=38), while GDC embolization at an acute stage was added to those 3 treatment options in 1997-2003 (Group 2, n=54). We compared clinical courses and outcomes assessed by Glasgow Outcome Scale (GOS) at discharge between the 2 groups. The percentage of the patients in whom the aneurysm was occluded at an acute stage (early-treated cases) significantly increased from 47% in Group 1 to 76% in Group 2. In the early-treated cases in Group 2, GDC embolization was chosen as the treatment option in 69% of all cases (Grade I-V) and 78% of poor-graded cases (Grade IV-V). The percentage of favorable outcomes (good recovery and moderately disabled in GOS at discharge) significantly increased from 34% in Group 1 to 63% in Group 2 for all cases, and from 53% to 78% for early-treated cases. None of the poor-graded patients had a favorable outcome in Group 1, while 24% did in Group 2. In the early-treated cases in Group 2, the percentage of favorable outcomes did not differ significantly between the aged (>=70 y) and younger patients ( The introduction of GDC embolization expanded the indication of early treatment for aged patients with poor grade and, as a consequence, improved the outcome of those patients.

著者

大岩 美嗣 奥村 浩隆 廣鰭 洋子 田中 亮平 山家 弘雄 照井 慶太 高山 東春

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.2, pp.130-136, 2013 (Released:2013-07-27)

参考文献数

24

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Recent advancement of three-dimensional computed tomographic angiography (3D-CTA) allows high-spatial-resolution images for the diagnosis of cerebral aneurysms. Prior to operative intervention, the best possible strategy can be developed with the precise knowledge of the shape and location of the lesions in relation to the bone structure and the vascular arrangement, using 3D-CTA. However, replacing conventional digital subtraction angiography (DSA) in order to develop the best treatment strategy remains controversial. In 47 patients with symptomatic cerebral aneurysms, such as subarachnoid hemorrhage or cranial nerve palsy, between April, 2008 and December, 2011, we developed the treatment strategy with computer simulation using only 3D-CTA images of 64- or 320-detector row CT. Thirty-four of the 47 underwent neck clipping of the aneurysms, 3D-CTA clearly showed not only the exact locations of the aneurysms, but also neighboring bone structure such as the anterior clinoid process. Venous arrangements were more clearly shown with 320-detector row CT. In the seven other patients, subsequent DSA was done prior to neck clipping. Coil embolization was employed for the three other patients following the use of 3D-CTA. Two patients underwent parent artery occlusion with EC-IC bypass after DSA. In most cases of the cerebral aneurysms, 3D-CTA seems to be a reliable and less invasive method to develop the operative strategy. The 320-detector row CT can show more precise venous arrangements. If patients have cerebral vasospasm, conventional DSA is still necessary.