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50 巻, 11 号
選択された号の論文の21件中1～21を表示しています
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Original Articles
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Nobuyuki SAKAI, Waro TAKI, Shinichi YOSHIMURA, Toshio HYOGO, Masayuki ...原稿種別: Original Article
2010 年 50 巻 11 号 p. 961-965
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスAnnual retrospective surveys of 20 to 31 medical centers performing endovascular treatment of cerebral aneurysms in Japan from 1997 to 2008 were performed to analyze technical and clinical outcomes of endovascular treatment for ruptured cerebral aneurysm. Patients treated with dome embolization using bare platinum coils within 14 days after onset were retrospectively selected, and clinical features, and technical and clinical outcomes at discharge were studied. Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) 1 covers patients treated from 1997, when the Guglielmi detachable coil was introduced, to 2002, just after International Subarachnoid Aneurysm Trial was reported. RESAT 2 to RESAT 7 were conducted annually between 2003 and 2008. Among 5,624 patients with ruptured aneurysms treated within 14 days after onset, 4,782 patients were treated by dome embolization using platinum detachable coils. The patients in this large retrospective survey included 35.8% aged over 70 years, 36.6% with posterior circulation aneurysms, and 29.3% with poor grades (Hunt and Kosnik grades IV and V). The proportion of patients aged over 70 years tended to increase each year from 33.4% in RESAT 1 to 39.8% in RESAT 7, and the proportion of those with posterior circulation aneurysms decreased from 44.2% in RESAT 1 to 23.8% in RESAT 7 (p<0.001). Overall technical success was obtained in 4,666 patients (97.6%), and favorable clinical outcome (good recovery and moderate disability) at discharge was obtained in 88.0% of grade I-III cases and 73.6% of grade I-V cases. Procedure-related morbidity was 2.9% and mortality was 0.8%. Despite this survey involving high proportions of aged, posterior circulation, and poor-grade patients, the technical success rate and immediate clinical results were relatively favorable. The patient prognosis and aneurysm changes must be investigated over a longer period, together with the effects of the introduction of new endovascular devices for cerebral aneurysms.
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Tomofumi NISHIKAWA, Tetsuya UEBA, Motohiro KAJIWARA, Ryoichi IWATA, Na ...原稿種別: Original Article
2010 年 50 巻 11 号 p. 966-971
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスThe preventive effect of aggressive blood pressure lowering on hematoma enlargement was investigated in patients with ultra-acute spontaneous intracerebral hemorrhage (ICH). Retrospective review of 248 patients (145 males, 103 females) with spontaneous ICH treated in our hospital between 2005 and 2008 identified patients with ultra-acute ICH who were directly taken to our institute by ambulance within 3 hours after onset. Patients who could not be assessed twice by computed tomography (CT) within 24 hours after arrival were excluded. Systolic blood pressure (SBP) was aggressively controlled in all patients using intravenous nicardipine to below 140 mmHg as soon as possible after diagnosis of ICH with CT. Hematoma enlargement was defined as increase in volume of more than 33% or more than 12.5 ml in the first 24 hours. Hematoma enlargement was observed in 11 of the 73 patients (15.0%). The time course of SBP change was not significantly different in patients with and without hematoma enlargement. The incidence of hematoma enlargement in patients with ultra-acute ICH in this study was 15.0%, which was lower than that in other series in which blood pressure was not reduced aggressively. This finding suggests that aggressive SBP lowering to below 140 mmHg has a preventive effect on hematoma enlargement in patients with ultra-acute ICH.
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Fuminari KOMATSU, Mika KOMATSU, Naoki WAKUTA, Shinaya OSHIRO, Hitoshi ...原稿種別: Original Article
2010 年 50 巻 11 号 p. 972-976
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスThe efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre- and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation.
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Hidenori ENDO, Miki FUJIMURA, Kuniyasu NIIZUMA, Hiroaki SHIMIZU, Teiji ...原稿種別: Original Article
2010 年 50 巻 11 号 p. 977-983
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスAppropriate management of moyamoya syndrome associated with Graves' disease is undetermined because of the rarity of this combination. Patients tend to present with cerebrovascular events such as transient ischemic attack (TIA) in a thyrotoxic state, which is relieved by proper antithyroid therapy. Four patients with moyamoya syndrome associated with Graves' disease were successfully treated with revascularization surgery on 5 hemispheres among 58 consecutive patients (2-62 years old, mean 34.4 years) with moyamoya disease in 80 hemispheres treated from March 2004 to May 2007. Three patients presented with TIA, and one patient presented with intracerebral hemorrhage. Three patients were thyrotoxic at the onset of the cerebrovascular events. All patients underwent revascularization surgery after normalization of thyroid function. Euthyroid state was strictly maintained perioperatively. One patient developed symptomatic cerebral hyperperfusion, which was resolved by blood pressure control. Postoperative courses of the other patients were uneventful, and all 4 patients have remained neurologically stable after discharge. Cerebrovascular reconstruction surgery is a successful treatment option for moyamoya syndrome associated with Graves' disease. Timing of surgery during the euthyroid state and perioperative management considering the thyroid function and the cerebral hemodynamic change are the keys to successful surgical treatment.
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Case Reports
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—Case Report—Yoshinori AKIYAMA, Tsutomu OKADA, Naoki HAYASHI, Toshihiro YOKOI原稿種別: Case Report
2010 年 50 巻 11 号 p. 984-987
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 63-year-old woman presented with infraoptic course of the anterior cerebral artery (ACA) originating from the extradural internal carotid artery (ICA) associated with contralateral ICA agenesis and multiple intracerebral aneurysms. The extradural origin of the infraoptic course of ACA was identified with constructive interference in steady state magnetic resonance (MR) imaging, and confirmed at surgery. The aneurysms were successfully clipped and embolized with coils. The anomalous artery of this rare anomaly almost always arises from the intradural ICA. MR imaging is useful for evaluating the anatomical details of this anomaly.
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—Case Report—Ryoichi IWATA, Kohsuke YAMASHITA, Tomofumi NISHIKAWA, Motohiro KAJIWAR ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 987-989
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 67-year-old woman presented with symptomatic infarction in the territory of the anterior inferior cerebellar artery manifesting as vertigo, vomiting, and right facial weakness. Basiparallel anatomic scanning (BPAS) magnetic resonance (MR) imaging combined with MR angiography demonstrated the occluded anterior inferior cerebellar artery. Common anatomic variations and limited detection of the smaller branches on MR angiography sometimes hinder evaluation of the occluded artery. BPAS-MR imaging may have a supplementary role to MR angiography in the diagnosis of cerebellar artery occlusions.
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—Case Report—Ruth PRIETO, José M. PASCUAL, Issa SUBHI-ISSA, Miguel YUS原稿種別: Case Report
2010 年 50 巻 11 号 p. 990-994
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスWe report the exceptional case of an encapsulated solid non-organized chronic subdural hematoma (SDH) in a 67-year-old woman that was admitted with acute hemiplegia followed by rapid deterioration in consciousness 5 months after a minor head trauma. Computed tomography (CT) showed an extracerebral biconvex shaped hyperdense mass that led to the misdiagnosis of an acute epidural hematoma. Urgent craniotomy revealed an encapsulated mass filled with solid fresh clot in the subdural space. Complete evacuation of this SDH, including both its inner and outer membranes, was achieved, and the patient recovered successfully. Histological analysis confirmed that the content of the hematoma corresponded to a newly formed clot that was enclosed between an inner membrane, composed of two collagen layers, and an outer membrane with a three layered structure. Chronic SDH may seldom present as an encapsulated solid non-organized lesion that consists of a fibrous capsule enclosing a fresh clot and lacking the thick fibrous septations that typically connect the inner and outer membranes of organized chronic SDH. This entity mimics the clinical course and radiological appearance of acute epidural hematomas and should be considered in the differential diagnosis of extracerebral hyperdense biconvex shaped lesions.
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—Case Report—Hideaki ISHIHARA, Shoichiro ISHIHARA, Hiroaki NEKI, Mai OKAWARA, Ryuza ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 995-997
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 71-year-old male presented with a rare case of dural arteriovenous fistula (AVF) of the anterior cranial fossa associated with carotid artery stenosis manifesting as a transient visual disorder. The therapeutic strategy was complicated because the collateral network to the ischemic brain from the external carotid artery was associated with the dural AVF. Transarterial embolization of the shunt was performed simultaneously with carotid artery stent placement. The patient showed good recovery despite a tiny skin ulcer around his nose.
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—Case Report—Toshinori TAKAGI, Shinichi YOSHIMURA, Kiyofumi YAMADA, Yukiko ENOMOTO, ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 998-1000
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 64-year-old man with chronic occlusion of common carotid artery (CCA) underwent successful recanalization with angioplasty and stenting. Patients with symptomatic CCA occlusion with hemodynamic impairment are at increased risk of subsequent stroke. Percutaneous transluminal angioplasty and stenting could be an option for chronic occluded CCA with hemodynamic impairment.
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—Case Report—Toru YAMAGATA, Yutaka MITSUHASHI, Akimasa NISHIO, Taichiro KAWAKAMI, M ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1001-1005
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 61-year-old man presented with a severe external carotid artery (ECA) stenosis with concomitant ipsilateral internal carotid artery (ICA) occlusion manifesting as amaurosis fugax. The left ophthalmic artery was supplied from the left ECA. The left intracranial ICA was supplied by the collateral flow from the contralateral ICA and ipsilateral ECA through the ophthalmic artery. The left vertebral artery also participated in the latter collateral pathway through the left occipital artery and ascending pharyngeal artery. Percutaneous revascularization of the ECA was performed using a nitinol self-expanding stent. To prevent embolic complications through the ophthalmic or vertebral arteries, distal protection was performed using a balloon. During a 22-month follow-up period, the patient was completely free from any ocular or neurological symptoms. The present case of severe ECA stenosis with ipsilateral ICA occlusion showed that percutaneous balloon angioplasty with stenting is feasible and effective. This intervention requires cautious evaluation of the anastomotic pathways connecting the ECA to the cerebral circulation to avoid embolic complications.
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—Two Case Reports—Yoshiteru TADA, Masaaki UNO, Shunji MATSUBARA, Atsuhiko SUZUE, Kenji S ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1006-1011
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスVascular ischemic signs, i.e. multiple hypointense vessels in the ischemic territory, were identified by gradient echo-type 3-T T2*-weighted magnetic resonance (MR) imaging in 3 patients with acute ischemia due to major vessel occlusion. Emergency superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 2 patients with progressive stroke caused by bleeding-type moyamoya disease or severe MCA stenosis. Both patients were initially treated conservatively, but their neurological signs deteriorated. 3-T T2*-weighted MR imaging detected funicular low signals in both patients indicating enhancement of cortical vessels or medullary veins. The area of the vascular ischemic signs was almost the same or smaller than the hypoperfusion area on perfusion-weighted MR imaging or single-photon emission computed tomography. Postoperatively, the vascular ischemic signs disappeared in both patients, suggesting a relationship with severe ischemia due to high-risk misery perfusion. Their postoperative course was uneventful, and MR imaging revealed no new cerebral ischemic lesions or cerebral hyperperfusion. The patient without surgery developed cerebral infarction in the area of the vascular ischemic signs. Vascular ischemic signs detected by 3-T T2*-weighted MR imaging may represent a new predictor of high-risk misery perfusion, and may disappear after STA-MCA anastomosis performed in the subacute stage.
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—Case Report—Masaaki HOKARI, Hiroshi YASUDA, Motoyuki IWASAKI, Masahito KAWABORI, S ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1012-1014
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 77-year-old female presented with a very rare case of intracerebral hemorrhage (ICH) from a ruptured aneurysm at the site of the anastomosis 27 years after superficial temporal artery-middle cerebral artery (STA-MCA) bypass manifesting as sudden onset of unconsciousness and right hemiparesis. Computed tomography (CT) on admission demonstrated massive ICH in the left frontoparietal region. Magnetic resonance angiography showed good patency of the anastomosis and no obvious aneurysm, but three-dimensional CT (3D-CT) angiography revealed a small aneurysm at the site of the left STA-MCA anastomosis. Emergency evacuation of the hematoma was performed, and the aneurysm was trapped and resected after ligation. After the operation, she continued to exhibit deep consciousness disturbance. Unfortunately, her general condition grew steadily worse and she died 3 months later. Patients who undergo STA-MCA anastomosis should be carefully followed up by periodical imaging examinations. 3D-CT angiography is very useful to detect aneurysm formation at the anastomosis site.
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—Case Report—Jun KARAKAMA, Kazuhiko NAKAGAWA, Taketoshi MAEHARA, Kikuo OHNO原稿種別: Case Report
2010 年 50 巻 11 号 p. 1015-1019
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral angiography studies on admission and on the 4th day demonstrated no definite abnormality as a bleeding source. A ventricular catheter was inserted to treat the acute hydrocephalus, and conservative management was continued during the acute period. Third angiography on the 18th day demonstrated an anterior spinal artery aneurysm at the C1 level which was considered to be the bleeding site. After conservative treatment, the patient was discharged without neurological deficits. Fourth angiography on the 108th day disclosed spontaneous disappearance of the aneurysm, which was confirmed by the fifth angiography on the 269th day. If subarachnoid hemorrhage of unknown etiology is encountered, spinal artery aneurysm should be considered as the bleeding source. Despite the controversy concerning the treatment strategy, ruptured spinal artery aneurysms can be treated conservatively because of the possibility of spontaneous regression. Follow-up angiography is required to evaluate the natural course of the lesion.
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—Case Report—Yousuke AKAMATSU, Akihiro UTSUNOMIYA, Shinsuke SUZUKI, Toshiki ENDO, I ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1020-1023
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 32-year-old man presented with subependymoma in the lateral ventricle causing intraventricular hemorrhage and manifesting as severe headache and disturbance of consciousness. Computed tomography on admission showed a massive intraventricular hemorrhage and acute obstructive hydrocephalus. Cerebral angiography revealed no abnormal findings. Emergency external ventricular drainage was performed, and his neurological deficits gradually improved. Magnetic resonance imaging at 5 weeks after admission showed a tumor arising from the septum pellucidum or the floor of the right lateral ventricle, appearing as a mixed-intensity solid tumor, which was partially enhanced following gadolinium administration. The tumor had arisen from the septum pellucidum and was totally removed via an interhemispheric anterior transcallosal approach. Histological examination found typical subependymoma, with little vascularity. Intraventricular hemorrhage from cerebral neoplasms is usually due to highly vascular tumors. Since subependymomas are quite benign and show poor vascularity, intraventricular or subarachnoid hemorrhages are very rare, but do occasionally occur.
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—Case Report—Yuriz BAKHTIAR, Kazunori ARITA, Hirofumi HIRANO, Mika HABU, Shingo FUJ ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1023-1026
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 53-year-old male presented with a case of prolactin-producing pituitary adenoma with abundant spherical amyloid depositions masquerading as extensive calcification and manifesting as visual disturbance. Computed tomography revealed a large high density mass suggesting calcified tumor in the intra- and supra-sellar regions. Magnetic resonance imaging revealed a heterogeneously enhanced large pituitary tumor reaching lateral ventricle. Blood prolactin level was elevated to 5971 ng/ml. Cabergoline treatment for 3 months provided considerable shrinkage of the tumor but failed to improve the visual symptoms. Transcranial surgery revealed that the tumor was fibrous and included abundant grayish translucent spherical granules with diameter of 0.5-1.5 mm. Immunohistochemically, the tumor was strongly positive for prolactin. Congo red stain and polarized light showed that these spherical bodies were amyloid depositions. No calcification was noted.
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—Case Report—Tatsuya ISHIKAWA, Hiroshi WANIFUCHI, Keiichi ABE, Koichi KATO, Atsushi ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1027-1030
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 51-year-old man presented with a rare case of brain metastasis of malignant pleural mesothelioma (MPM) manifesting as intratumoral hemorrhage. He had undergone several treatments such as left pneumonectomy, pleurectomy, chemotherapy with cis-diamminedichloroplatinum and gemcitabine hydrochloride, and irradiation. Five years later, computed tomography revealed right parietal metastasis with intratumoral hemorrhage and the patient was treated by surgery and irradiation. Six months after the surgery, recurrent intratumoral hemorrhage occurred and a second surgery was performed. MPM has a poor prognosis and brain metastasis is rare, but long-term survival has recently improved through the application of multi-modality approaches. Therefore, the number of opportunities for treating MPM metastasis will increase in the near future. Intratumoral hemorrhage may occur in patients with solitary brain metastasis of MPM, so surgery should be considered as a general candidate treatment for metastatic tumors.
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—Case Report—Satoshi TSUTSUMI, Yasuomi NONAKA, Yusuke ABE, Yukimasa YASUMOTO, Yoich ...原稿種別: Case Report
2010 年 50 巻 11 号 p. 1031-1035
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 39-year-old male presented with gait disturbances with rapid deterioration for 2 weeks. Neurological examination found paraparesis, sensory loss in the L1-S5 dermatomes, and vesicorectal dysfunction. Magnetic resonance (MR) imaging revealed a fusiform intramedullary tumor at T12-L1 levels with heterogeneous enhancement. The patient underwent microsurgical tumor resection. A myelotomy exposed a highly vascular tumor that was subtotally resected. Histological examination demonstrated hypercellular tumor accompanied by significant cell atypism and mitotic figures. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100 protein, synaptophysin, and INI-1, consistent with primitive neuroectodermal tumor (PNET). Postoperatively, the patient underwent irradiation to the whole craniospinal axis. He experienced local recurrence 7 months after surgery. MR imaging performed at 10 months revealed holocord progression and intracranial dissemination. The patient died 13 months after the onset of the disease. PNET should be considered in the differential diagnosis of an intramedullary spinal cord tumor.
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—Case Report—Jung-Hoon LEE, Tag-Geun JUNG, Hyung-Suk KIM, Jee-Soo JANG, Sang-Ho LEE原稿種別: Case Report
2010 年 50 巻 11 号 p. 1035-1038
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスA 72-year-old man presented with an extremely rare case of symptomatic isolated lumbosacral interdural arachnoid cyst manifesting as pain and weakness in the right buttock and lower extremity that had aggravated for 2 weeks. Although the surgical strategy for the interdural cyst was not complicated, the origination of the cyst was not clearly understood. Surgery found an isolated membrane of the cyst inside double-layered dura without communication with the intact arachnoid membrane. Cerebrospinal fluid with hemorrhage accumulated within the interdural cyst indicated recent bleeding into the cyst. Our experience suggests that this cyst was congenital based on the surgical results and imaging studies.
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Technical Notes
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—Technical Note—Yuko MIHARA, Kenji DOHI, Shunsuke NAKAMURA, Yasufumi MIYAKE, Tohru ARU ...原稿種別: Technical Note
2010 年 50 巻 11 号 p. 1039-1044
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスAcute subdural hematoma (ASDH) is a critical condition following the onset of traumatic brain injury, and it is essential to immediately reduce elevated intracranial pressure (ICP). Single burr hole surgery/twist drill craniostomy is commonly performed in patients with ASDH as an emergency surgical intervention, usually preceding decompressive craniotomy. A novel method using a cerebrospinal fluid (CSF) drainage catheter kit for rapid drainage of ASDH is described. Percutaneous twist drill craniostomy using a CAMINO® micro ventricular bolt pressure-temperature monitoring kit was performed in the emergency room in 12 patients with severe ASDH. The kit contained a closed-system CSF drainage and pressure-temperature monitoring catheter, which allowed aspiration of the hematoma and monitoring of the ICP. The tip of the catheter was inserted into the hematoma from the forehead. The mean initial ICP was 61 mmHg, with a range of 31 to 120 mmHg. The liquid hematoma was aspirated, and the ICP was temporarily controlled to the normal range. Pupil dilation recovered immediately after aspiration of the hematoma in 3 patients. No complications occurred either during or after the operation. This new method for craniostomy is easy, safe, and effective to monitor and rapidly control ICP in the emergency room. This technique also offers the possibility of evaluating the patient's prognosis and determining indications for further decompressive craniectomy by the continuation of ICP control under ICP monitoring and evaluation of the reversibility of pupillary findings in ASDH patients.
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—Technical Note—Toshihiro TAKAMI, Toru YAMAGATA, Isao CHOKYU, Hidetoshi IKEDA, Naohiro ...原稿種別: Technical Note
2010 年 50 巻 11 号 p. 1044-1049
発行日: 2010年
公開日: 2010/11/25
ジャーナル オープンアクセスSpinal nerve sheath tumors (NSTs) originating from the C1 or C2 level are unique from both anatomical and clinical perspectives. Surgical technique to accomplish radical but safe resection of these tumors is described in 8 cases treated during the past 5 years. Surgical measures included positioning the patient in the lateral oblique position, unilateral posterior approach, exposure of the tumor along the surgical plane of the dural or perineural boundary, and proximal and distal amputation of the tumor with resection of dural penetration. Excessive bone resection and soft tissue manipulation were unnecessary. Microscopic complete removal of the tumor was accomplished in seven of eight cases. Subtotal resection was done in one case where the tumor extended beyond the vertebral artery. Functional assessment demonstrated satisfactory improvement after surgery in all cases. Surgery-related complications were not encountered in any case.
Exposure of the tumor along the surgical plane of the dural or perineural boundary may be the key procedure required to accomplish radical but safe resection of spinal NSTs originating from the C1 or C2 level.
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Editorial Committee
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2010 年 50 巻 11 号 p. EC21-EC22
発行日: 2010年
公開日: 2013/03/08
ジャーナル オープンアクセスPDF形式でダウンロード (53K)
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