巻号一覧
53 巻, 6 号
選択された号の論文の12件中1～12を表示しています
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Original Articles
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Yoshihiro TAKAHASHI, Kuniaki OGASAWARA, Yuuki MATSUMOTO, Masakazu KOBA ...2013 年 53 巻 6 号 p. 353-359
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスObjective and subjective assessments of changes in cognition after carotid endarterectomy (CEA) were compared between older patients (≥76 years old) and younger patients (<76 years old). Patients underwent subjective cognitive assessment by a neurosurgeon and the patient's next of kin, and neuropsychological testing (five parameters) before and after surgery. Of 37 older patients studied, 4 (11%), 28 (75%), and 5 (14%) patients were defined as having subjectively improved, unchanged, and impaired cognition, respectively, following surgery. Differences in test scores (postoperative test score − preoperative test score: Δ score) in all neuropsychological tests were significantly lower in the older patients than in the 213 younger patients. The Δ score was able to statistically differentiate older patients with subjectively improved, unchanged, and impaired cognition after surgery. Receiver operating characteristic analysis showed that the Δ score cut-off point for detecting subjective improvement (upper cut-off point) and impairment (lower cut-off point) in cognition after surgery in older patients was identical to the mean or the mean +0.5 standard deviation (SD) and the mean −1.5 SD or the mean −1 SD, respectively, of the control value obtained from normal subjects. The upper and lower cut-off points were lower and higher, respectively, than those in younger patients. In conclusion, although neuropsychological test scores reflect the subjective assessment of postoperative change in cognition in older patients, the optimal cut-off points for the test scores to detect subjective improvement and impairment in cognition after CEA are different in older patients compared with younger patients.
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Keita SHIBAHASHI, Akio MORITA, Toshikazu KIMURA2013 年 53 巻 6 号 p. 360-364
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスMicrovascular decompression (MVD) is effective for the relief of symptoms, but little is known about the impact of the MVD procedure on patient's quality of life (QoL) or which QoL factors are important. The surgical results of MVD and the impact of this procedure were evaluated on patient's QoL in 139 patients, 74 with hemifacial spasm (HFS) and 65 with trigeminal neuralgia (TN), who underwent MVD between 2004 and 2011 using the 36-Item Short Form Health Survey questionnaire. Symptoms had resolved in approximately 95% of patients after MVD. The QoL questionnaire was completed by 54 HFS patients and 38 TN patients. Although long-term QoL scores for both groups were comparable to the average national value, scores related to physical role, emotional role, and social function were significantly lower for patients within 12 months of receiving MVD for HFS, compared with the reference scores. Symptomatic improvements and complications were correlated with the QoL scores related to the social function domain for patients with HFS. No other significant relationships were observed between any of the factors or scores in any of the respective domains or periods. Subjective symptoms were the main self-reported causes of delayed recovery of QoL domains. Some QoL domains take a long time to recover and postoperative subjective symptoms might be major causes in addition to delayed relief of symptoms.
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Dakuan GAO, Nobuyuki KAWAI, Takehiro NAKAMURA, Feng LU, Zhou FEI, Taka ...2013 年 53 巻 6 号 p. 365-374
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスD-allose, a type of rare sugar, can produce inhibitory effects on activated leukocytes in various organs, including immunosuppressive effects and anti-inflammatory effects, as well as anti-oxyradical effects. The present experiment was performed to investigate the potential anti-inflammatory effects of D-allose in acute cerebral ischemia/reperfusion (I/R) injury. Transient middle cerebral artery occlusion model was applied in rats. D-allose was administered two times via a tail vein (300 mg/kg, 1 hour before ischemia and 10 hours after reperfusion). After 22 hours of reperfusion following 2 hours of ischemia, brain damage was evaluated by cerebral infarct volume. Myeloperoxidase (MPO) activity assay by enzyme-linked immunosorbent assay, and protein expression of MPO and cyclooxygenase-2 (COX-2) by immunohistochemistry were evaluated to investigate the potential mechanisms of D-allose. The experimental results showed that D-allose exhibited significant neuroprotective effects against acute cerebral I/R injury. The infarct volume in D-allose-treated rats (90.9 ± 13.5 mm3) was significantly smaller than that in vehicle rats (114.9 ± 15.3 mm3, p < 0.01). D-allose treatment significantly suppressed the MPO activity and the number of MPO-positive cells compared with those in the vehicle group, suggesting that treatment with D-allose can reduce the infiltration of leukocytes into the ischemic tissue. Treatment of D-allose also significantly decreased the number of COX-2-positive cells and microglial activation in the ischemic tissue. The present results demonstrate that D-allose exerts potent neuroprotective effects against acute cerebral I/R injury, and constitute the first evidence of anti-inflammatory effects of D-allose which considerably contributes to the beneficial effects. Treatment with D-allose might provide a new strategy and clinically beneficial outcome for acute ischemic stroke.
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Yoshiro ITO, Noriyuki KATO, Akira MATSUMURA, Makoto SONOBE2013 年 53 巻 6 号 p. 375-380
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスHemodynamic instability (HI) may impair the washout of debris during distal intracranial circulation and increase the risk of clinically evident cerebral ischemia. However, the interaction between HI and new ischemic brain lesions detected on diffusion-weighted imaging (DWI) has not been examined. This study evaluated whether HI was significantly associated with the incidence of new ischemic brain lesions on DWI. Data on 128 patients who underwent carotid artery stenting (CAS) with the same devices and procedures between January 2005 and May 2010 were retrospectively analyzed. HI was noted in 31 (24.2%) patients. New ischemic brain lesions were detected on DWI in 25 (19.5%) patients. Ten of 31 (32.2%) patients with HI showed new ischemic brain lesions on DWI. Fifteen of 97 (15.5%) patients without HI showed new lesions. Univariate analysis showed that patients with HI had a significantly higher incidence of new ischemic brain lesions than patients without HI (p = 0.04). A multivariable model showed that age and HI were significantly associated with the incidence of new ischemic brain lesions. In patients with carotid artery stenosis, decreased blood pressure produced no active vascular response, but reduced the cerebral blood volume and velocity due to impaired dynamic cerebral autoregulation. The results of this study suggest that HI with CAS induces impaired clearance of microembolisms and causes an increased number of new ischemic brain lesions detected on DWI.
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Risk Factors of Ischemic Lesions Related to Cerebral Angiography and Neuro-interventional ProceduresMasayuki SATO, Yasunobu NAKAI, Hideo TSURUSHIMA, Masanari SHIIGAI, Tom ...2013 年 53 巻 6 号 p. 381-387
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスEmbolic stroke is not a rare complication of cerebral angiography. The risk factors for incidental embolism after cerebral angiography were retrospectively examined using diffusion-weighted magnetic resonance imaging (DWI) in 180 patients who underwent 247 angiography procedures, consisting of 174 diagnostic angiography and 73 interventional procedures, and magnetic resonance imaging including DWI within 72 hours after angiography. The two neuroradiologists in our hospital detected embolism after cerebral angiography as high-intensity lesions (HIL) on DWI. The relationships between HIL on DWI and procedural factors were evaluated. DWI after cerebral angiography revealed HIL related to the procedure in 72 of 247 angiographies. In all procedures, age (p < 0.01), past history of cerebral infarction (p < 0.05), anti-platelet therapy (p < 0.05), neuro-intervention (p < 0.01), and total amount of contrast medium (odds ratio [OR] 2.125, 95% confidence interval [CI] 1.045-4.321) were significantly correlated with HIL. In diagnostic angiography, the performance of the procedure by a resident operator (OR 2.526, 95% CI 1.214-5.254) was significantly correlated with HIL. Age, past history of cerebral infarction, and previous anti-platelet therapy determined the risk of atherosclerotic changes in patients. The neuro-intervention and total amount of contrast medium used could predict the risk of time limitations for angiography. Resident operator is also a risk factor. This study demonstrates the importance of improving the risk of time limitations for angiography and the risk due to operator inexperience. Further training of residents may be needed to reduce the occurrence of embolic complications.
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Takato MORIOKA, Tetsuro SAYAMA, Takafumi SHIMOGAWA, Nobutaka MUKAE, Ta ...2013 年 53 巻 6 号 p. 388-395
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスLow-flow bypass, such as superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, can result in cerebral hyperperfusion syndrome (CHS). The present study evaluated the pathophysiological conditions of CHS through the use of repeated electroencephalography (EEG). Among a total of 22 patients who underwent STA-MCA anastomosis over a course of 4 years, 3 patients were diagnosed with CHS based on clinical symptoms and neuroradiological examinations, including cerebral blood flow evaluation. Case 1 and Case 2 developed CHS on postoperative day 1, when EEG demonstrated focal slow waves on the frontal region of the operated side, indicating cortical dysfunction in these areas. Although prompt recovery of these EEG findings was noted with improvement of the clinical symptoms in Case 1, Case 2 developed an intracranial hemorrhage on postoperative day 5, when EEG clearly depicted persistent nonconvulsive status epilepticus (NCSE) after control of convulsive status epilepticus. In contrast, the clinical onset in Case 3 was delayed to postoperative day 6 and EEG revealed frequent ictal discharges in the operated hemisphere, although convulsive seizures were not apparent. Administration of anticonvulsants was performed after the diagnosis of NCSE, and complete recovery from CHS was achieved. Although the pathophysiology of CHS is cortical dysfunction, ictal hyperperfusion associated with NCSE could be included. The present findings emphasize the importance of repeated EEG examinations in the differential diagnosis of the various types of pathophysiological conditions of CHS.
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Hiroyuki TOI, Noriko MATSUMOTO, Kimihiko YOKOSUKA, Shunji MATSUBARA, K ...2013 年 53 巻 6 号 p. 396-402
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスTranscranial Doppler (TCD) is widely used to monitor vasospasm after subarachnoid hemorrhage (SAH), but its ability to predict the future occurrence of the symptomatic vasospasm (SVS) remains controversial. We investigated the utility of TCD for predicting the future occurrence of SVS after SAH in 45 patients with aneurysmal SAH. TCD was performed on days 1, 3, 5, 7, 10, and 14 after SAH. The mean flow velocity (MFV) of the horizontal portion of the middle cerebral artery (M1) was recorded. SVS occurred in 24.4% of patients (n = 11). MFV of M1 increased progressively in patients with SVS, but did not increase in patients without SVS. The mean MFV values were significantly higher in patients with SVS than in patients without SVS (p = 0.031). The mean MFV value on day 3 was already significantly higher in patients with SVS than in patients without SVS (88.5 cm/sec versus 62.7 cm/sec, respectively) (p = 0.018). The receiver operating characteristic curve of MFV on day 3 showed the threshold of 72.5 cm/sec for predictive value of SVS in the future (sensitivity 71.4%, specificity 68.1%, and accuracy 82.3%). Increased MFV of M1 during the early stage of SAH may predict the future occurrence of SVS. The threshold value of 72.5 cm/sec MFV of M1 on SAH day 3 was one of the best predictor of future SVS. To prevent delayed cerebral ischemia, aggressive treatment for vasospasm is needed for patients with increased MFV in the early stages of SAH.
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Wataro TSURUTA, Yuji MATSUMARU, Yusuke HAMADA, Mikito HAYAKAWA, Yuki K ...2013 年 53 巻 6 号 p. 403-408
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスThe intracranial nitinol stent named the Enterprise Vascular Reconstruction Device has poor radiographic visibility. The characteristics of closed-cell intracranial stents were investigated and the efficacy of intraoperative stent visualization examined with the 80 kV high-resolution XperCT protocol, which is a flat detector C-arm volume acquisition functionality system integrated with the angiography equipment. We treated 39 aneurysms with stent-assisted coil embolization. The aneurysms were located on the internal carotid artery in 24 cases, the anterior communicating artery (AcomA) in three, the basilar artery (BA) in 10, and the vertebral artery in two. Intraoperative 80 kV XperCT was performed in all cases after deposition of the stent. We evaluated the coverage of the aneurysm neck, incomplete stent apposition (ISA), and shift of vessels. Accurate stent visualization was achieved in 29 of the 39 cases without coil and delivery wire artifact. Coverage of the aneurysm neck succeeded in 28 cases; there was one case of BA top Y-configuration stenting in which the stent was dislocated into the aneurysm. ISA was detected in nine cases, including seven kinks and one flattening in the carotid siphon and one kink in the BA top. We detected linearization of vessels due to stent deployment in three AcomA cases and three BA top cases. We conclude that intraoperative 80 kV XperCT is an efficient modality for the evaluation of ISA. Stent kinking in the carotid siphon and linearization in distal vessels can be detected with this protocol.
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Tomosato YAMAZAKI, Makoto SONOBE, Noriyuki KATO, Hiromichi KASUYA, Go ...2013 年 53 巻 6 号 p. 409-417
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスWe apply endovascular coiling as the first treatment option for ruptured pericallosal artery aneurysms. We conducted a retrospective analysis of the clinical and radiological outcomes of this treatment strategy and morphological factors associated with the success of endovascular coiling, to assess the safety and feasibility of our management strategy. From January 2003 to January 2012, we attempted endovascular coiling as the first-intention treatment for 30 consecutive patients with ruptured pericallosal artery aneurysms including those with intracerebral hematoma. Twenty-seven cases of ruptured pericallosal artery aneurysms were successfully embolized with coiling whereas three failures required surgery. Four patients experienced periprocedural complications including thromboembolic event in two and hematoma enlargement after coiling in two. A maximum aneurysm diameter of <3 mm was most strongly associated with failure of endovascular coiling. Of the 27 coil-treated aneurysms, immediate angiographic results showed complete aneurysm occlusion in 19 cases, neck remnant in 6, and residual aneurysm in 2. One patient had a major aneurysm recurrence that was uneventfully reembolized. Sixteen of our 30 patients had good outcomes (modified Rankin scale [mRS] 0-2), 7 had moderate disability (mRS 3), and 4 had severe disability (mRS 4-5) at 3 months after treatment. The management strategy for coiling as the first-intention treatment for ruptured pericallosal artery aneurysms has the potential to become an acceptable alternative to surgical clipping for selected cases, although a larger study population and longer follow-up periods are needed before definitive conclusions can be drawn.
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Case Report
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—Case Report—Toshiro KATSUTA, Akiko FUJIMOTO, Kumiyo OBA2013 年 53 巻 6 号 p. 418-421
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスA 64-year-old man with a long history of untreated diabetes mellitus had suffered from visual disturbance in his right eye. Neovascular glaucoma in the right eye and diabetic retinopathy in both eyes were found, and ischemic ocular syndrome was suspected for the right eye. Neuroimaging revealed severe stenosis of the right internal carotid artery. He was first treated for diabetes and glaucoma, and then, after these conditions were stabilized, right carotid endarterectomy (CEA) was carried out. Although the operation was uneventful, he suffered from headache and his right sight was blurred on the day after surgery. Right intraocular pressure was markedly increased, and corneal edema and increased iris neovascularization were also recognized. Intensive ophthalmologic care was carried out, but his right vision worsened and was eventually lost. Ocular ischemia causes not only neovascularization of the iris, which leads to insufficient resorption of the aqueous humor, but also insufficient production of the aqueous humor. After CEA, production of the humor is immediately activated, but the resorption capacity does not change, which results in an extraordinary increase in intraocular pressure. Neurosurgeons should be aware that CEA not only improves or avoids worsening of vision in patients with ischemic oculopathy, but can also rarely cause paradoxical devastating visual deterioration.
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Technical Note
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—Technical Note—Kouhei NII, Gorou ABE, Minoru IKO, Yasuyuki NOMOTO, Iwae YU, Kimiya SA ...2013 年 53 巻 6 号 p. 422-426
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスAn 87-year-old man presented with extracranial vertebral artery (VA) occlusion and progressive vertebrobasilar ischemia despite maximal medical management. Cerebral angiography showed left proximal VA occlusion, termination of the right VA at the ipsilateral posterior inferior cerebellar artery, and hypoplastic bilateral posterior communicating arteries. Although the stump of the left VA ostium was not visualized, the distal patent artery was reconstituted via muscular branches from the left subclavian artery (SCA). Endovascular angioplasty with a stent for left VA occlusion was performed. The non-visualized VA ostium was extrapolated from the computed tomography angiography findings of the distal patent VA and the partial calcification of the SCA. The occluded VA was penetrated by the guide wire and revascularized by balloon angioplasty with the stent using the support of a snare wire inserted via the left brachial artery for stabilization of the guide catheter. This treatment resulted in resolution of the severe neurological findings.
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Editorial Committee
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2013 年 53 巻 6 号 p. EC11-EC12
発行日: 2013年
公開日: 2013/06/25
ジャーナル オープンアクセスPDF形式でダウンロード (44K)
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