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54 巻, 10 号
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The 72nd Annual Meeting Special Topic: Neurosurgery in Update
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Kyousuke KAMADA, Hiroshi OGAWA, Masato SAITO, Yukie TAMURA, Ryogo ANEI ...2014 年 54 巻 10 号 p. 775-785
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/09/29ジャーナル オープンアクセスThere are two main approaches to intraoperative monitoring in neurosurgery. One approach is related to fluorescent phenomena and the other is related to oscillatory neuronal activity. We developed novel techniques to visualize blood flow (BF) conditions in real time, based on indocyanine green videography (ICG-VG) and the electrophysiological phenomenon of high gamma activity (HGA). We investigated the use of ICG-VG in four patients with moyamoya disease and two with arteriovenous malformation (AVM), and we investigated the use of real-time HGA mapping in four patients with brain tumors who underwent lesion resection with awake craniotomy. Real-time data processing of ICG-VG was based on perfusion imaging, which generated parameters including arrival time (AT), mean transit time (MTT), and BF of brain surface vessels. During awake craniotomy, we analyzed the frequency components of brain oscillation and performed real-time HGA mapping to identify functional areas. Processed results were projected on a wireless monitor linked to the operating microscope. After revascularization for moyamoya disease, AT and BF were significantly shortened and increased, respectively, suggesting hyperperfusion. Real-time fusion images on the wireless monitor provided anatomical, BF, and functional information simultaneously, and allowed the resection of AVMs under the microscope. Real-time HGA mapping during awake craniotomy rapidly indicated the eloquent areas of motor and language function and significantly shortened the operation time. These novel techniques, which we introduced might improve the reliability of intraoperative monitoring and enable the development of rational and objective surgical strategies.抄録全体を表示PDF形式でダウンロード (7536K)
Original Articles
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Keita SHIBAHASHI, Akio MORITA, Toshikazu KIMURA2014 年 54 巻 10 号 p. 786-793
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/07/14ジャーナル オープンアクセスThe surgical procedure used to treat an unruptured intracranial aneurysm (UIA) has controversial effects on cognitive function. From January 2010 through December 2012, we enrolled patients who underwent surgical clipping for a UIA. Patients were tested within one week prior to surgery and again postoperatively (6.8 ± 2.3 days) using a neuropsychological battery comprising the Mini-Mental State Examination, the Trail Making Test (TMT), the Frontal Assessment Battery (FAB), and Raven’s colored progressive matrices (RCPM). Differences between preoperative and postoperative test scores for each examination were analyzed across individuals. In an additional subgroup analysis, patients were grouped according to age (< 65 or ≥ 65 years), the largest dimension of the aneurysm, the location of the aneurysm (i.e., anterior communicating artery, internal carotid artery, or middle cerebral artery) and operation duration. Paired student’s t-tests were used to examine potential differences between groups. Two-tailed P-values < 0.05 were considered significant. Seventy-one patients were included in the analysis. The surgical procedure used to correct a UIA resulted in significant changes in neuropsychological scores. After the procedure, the TMT-A score declined significantly, whereas the FAB and RCPM scores were significantly improved. In the subgroup analysis, a significant deterioration in TMT-A score was observed in older patients and those with larger aneurysms, anterior communicating artery aneurysms and longer surgeries. Our findings, therefore, indicate that the surgical procedure to correct a UIA affects cognitive function. Older patients and those with large aneurysms, anterior communicating aneurysms, and long operations represent the high-risk groups.抄録全体を表示PDF形式でダウンロード (111K) -
Ryo MOMOSAKI, Masahiro ABO, Shu WATANABE, Wataru KAKUDA, Naoki YAMADA, ...2014 年 54 巻 10 号 p. 794-798
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/09/29ジャーナル オープンアクセスThe effects of testosterone on functional recovery in stroke patients have not previously been studied. The purpose of the study was to determine the effects of pre-rehabilitation serum testosterone levels on functional recovery in male stroke patients. In total, 111 male stroke patients admitted to our department were enrolled in the study (age: 74 ± 10 years, days from stroke onset: 36 ± 14 days). Serum concentration of free testosterone (Free-T) was measured upon admission. Patients were also evaluated using the Functional Independence Measure (FIM) at admission and discharge. The main outcome variable was FIM at discharge. Correlations between Free-T and FIM were evaluated using Spearman’s rank-order correlation coefficients. We performed multivariate linear regression analysis to assess the effects of testosterone on functional outcome with adjustment for patient background variables. In addition, we added a subgroup analysis based on age. The average Free-T serum concentration was 4.7 ± 1.7 pg/ml. There was a significant positive correlation between Free-T and discharge FIM. The multivariate linear regression model showed that Free-T concentration was significantly associated with FIM at discharge (β = 0.09; P = 0.01). In the subgroup analysis, Free-T had significant association with discharge FIM only in patients under 76 years old (β = 0.24; P < 0.001). Our data suggest that serum Free-T levels have a positive effect for discharge FIM in male stroke patients.抄録全体を表示PDF形式でダウンロード (1340K) -
Shigeo MATSUNAGA, Takashi SHUTO2014 年 54 巻 10 号 p. 799-805
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/01/10ジャーナル オープンアクセスThe long-term outcomes of gamma knife surgery (GKS) in patients with posterior fossa arteriovenous malformations (AVMs) were retrospectively analyzed in 82 patients followed up for more than 5 years to evaluate the efficacy and safety. The median AVM volume at GKS was 0.95 cm3. The prescribed dose to the AVM margin was median 18 Gy with 1–18 isocenters. The actual complete AVM obliteration rate was 58.5% at 3 years and 78.0% at 5 years. The significant factors for higher complete obliteration rate were younger patient age and smaller maximum/minimum nidus diameter ratio. Two patients experienced hemorrhage caused by residual AVM rupture at 4 and 49 months. Twenty patients developed peri-nidal edema as an adverse radiation-induced reaction at median 13 months. One patient developed radiationinduced necrosis at 6.8 years. Neurological complication was observed in 12 patients and 6 patients remained with neurological dysfunction permanently. Larger nidus volume and location adjacent to an eloquent area significantly increased the risk of neurological complication. Pittsburgh radiosurgery-based AVM grading scale was significantly correlated with the outcome of neurological symptoms after GKS. GKS achieved acceptable and complete obliteration rate for posterior fossa AVM with relatively low risk of morbidity on neuroimaging and neurological symptoms for the long-term period after treatment. We recommend conformable and selective treatment planning to achieve both obliteration of the AVM nidus and preservation of neurological function.抄録全体を表示PDF形式でダウンロード (192K) -
Hiroyuki KATANO, Kazuo YAMADA2014 年 54 巻 10 号 p. 806-811
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2013/12/05ジャーナル オープンアクセスWe compared patients who underwent carotid endarterectomy (CEA) using two-way and three-way internal shunts and discussed which shunt was more appropriate and effective for surgeons. Eighty-two patients (mean 69.5 ± 6.1 years old, mean degrees of stenosis 79.6 ± 10.4%) who had undergone CEA by our routine shunting policy were examined concerning the difference of Sundt and Pruitt-Inahara (P-I) shunts in clinical use. Carotid clamping time for the P-I shunt was over 2 minutes longer than that by Sundt in either split or conventional continuous arteriotomy (p < 0.001). The proportions of cases with multiple trials of either arteriotomy or insertion of a shunt tube, cases detected more than one high-intensity spot on diffusion-weighted images of magnetic resonance imaging after CEA, and cases detected postoperative intimal flaps detected by multi-detector CT angiography showed no significant differences between the two shunt groups. The two-way Sundt shunt was quicker than the three-way P-I shunt in placement with no remarkable problems. Split arteriotomy was not useful in shortening the placement time for either Sundt or P-I shunt tubes, compared with continuous arteriotomy. A simple two-way shunt with easy handling like the Sundt shunt would be also appropriate to choose in selective shunting under the unfamiliarity of treating shunts.抄録全体を表示PDF形式でダウンロード (181K)
Technical Notes
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Kuniyasu NIIZUMA, Hiroaki SHIMIZU, Takashi INOUE, Mika WATANABE, Teiji ...2014 年 54 巻 10 号 p. 812-818
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/09/29ジャーナル オープンアクセスCarotid endarterectomy (CEA) is intended to remove atheromatous plaque by dissecting a plane between the intima and the media (circular medial fibers), but this may not be the optimal dissection plane. The present technique is based on identifying the plane that divides the media from the plaque, so preserving the media on the adventitia as much as possible. This plane is more difficult to find and follow than the easy-to-dissect plane usually located between the media and the adventitia, because the plaque invades the media and so the dividing plane is located within the media. In this prospective observational study, CEA was performed in 22 patients to histologically examine the excised plaques and small samples of the whole arterial wall, and evaluate the clinical outcomes. Plaque had invaded the luminal part of the media in the whole arterial wall sample of 80% of cases. Thin medial layers covering > 80% of the surface of the plaque were found in 16 of 22 plaques (73%). Some atheromatous component was sometimes left in the preserved media, rather than completely removed with the media. No morbidity or mortality had occurred by discharge. Only 1 small ipsilateral infarction (4.5%) and no restenosis of greater than 50% were detected during the mean follow-up period of 7 years. Since the plaque usually invades the media, the optimum dissection plane may be located within the media, dividing it into two layers. The presence of some remnant atheromatous components in the preserved media was not associated with surgical complications or restenosis.抄録全体を表示PDF形式でダウンロード (2757K) -
Kenji FUKUDA, Jun MASUOKA, Shigeki TAKADA, Shinji KATSURAGI, Tomoaki I ...2014 年 54 巻 10 号 p. 819-823
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/04/23ジャーナル オープンアクセスWe report two methods of intraoperative fetal heart rate (FHR) monitoring in cases of cerebral arteriovenous malformation surgery during pregnancy. In one case in her third trimester, cardiotocography was used. In another case in her second trimester, ultrasound sonography was used, with a transesophageal echo probe attached to her lower abdomen. Especially, the transesophageal echo probe was useful because of the advantages of being flexible and easy to attach to the mother’s lower abdomen comparing with the usual doppler ultrasound probe. In both cases, the surgery was successfully performed and FHR was monitored safely and stably. The use of intraoperative FHR monitoring provides information about the influence of induced maternal hypotension and unexpected bleeding on fetus during surgery. These monitoring techniques would be especially emphasized in cerebrovascular surgery for the safe management of both mother and fetus.抄録全体を表示PDF形式でダウンロード (482K)
Case Reports
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Yosuke AKAMATSU, Miki FUJIMURA, Hiroshi UENOHARA, Hiroaki SHIMIZU, Tei ...2014 年 54 巻 10 号 p. 824-826
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/09/29ジャーナル オープンアクセスProgressive moyamoya disease in pregnancy and puerperium has not been reported previously. Here, we present a 39-year-old woman who had been found to have moderate stenosis of right middle cerebral artery (MCA) 4 years prior to her pregnancy, finally suffering minor completed stroke due to progressive moyamoya disease at the early postpartum period. Three days after cesarean section without any complication, she developed cerebral infraction at right hemisphere, when magnetic resonance angiography indicated apparent progression of the proximal MCA stenosis. Catheter angiography demonstrated nearly occlusion of the right terminal internal carotid artery (ICA) and the development of an abnormal vascular network at the base of the brain as well as MCA stenosis, indicating a definitive diagnosis of moyamoya disease with unilateral involvement. The patient underwent superficial temporal artery-middle cerebral artery anastomosis 1 month after the onset of stroke, and she did not manifest as further neurological events during the follow-up period of 2 years. Moyamoya disease could newly develop in pregnancy and puerperium, which should be noted as a pitfall of the management of moyamoya disease with pregnancy.抄録全体を表示PDF形式でダウンロード (429K) -
Toshio MACHIDA, Junichi ONO, Ryota NOMURA, Atsushi FUJIKAWA, Osamu NAG ...2014 年 54 巻 10 号 p. 827-831
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/03/27ジャーナル オープンアクセスHere we report a case of moyamoya disease in which cortical veins reddened after superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis, following postoperative hyperperfusion. A 37-year-old man with moyamoya disease suffered cerebral infarction in his right hemisphere. Single photon emission computed tomography (SPECT) showed impaired cerebral blood flow (CBF) in both cerebral hemispheres. The patient underwent STA-MCA anastomosis in the right cerebral hemisphere. During operation, soon after declamping the STA, cortical veins near the anastomosis site changed its color from blue to red. This change was repeatable by clamping and declamping of the STA. Postoperative SPECT and computed tomography (CT) demonstrated increased CBF and subarachnoid hemorrhage at the anastomosis site, suggesting the occurrence of postoperative hyperperfusion. By strictly controlling the patient’s blood pressure, the syndrome resolved 1 week after the operation. We propose that the venous reddening after STA-MCA anastomosis may be a sign of postoperative hyperperfusion.抄録全体を表示PDF形式でダウンロード (2124K) -
Yoshiro ITO, Yasunobu NAKAI, Hiroyoshi KINO, Takao KOISO, Kazuhiro NAK ...2014 年 54 巻 10 号 p. 832-835
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/09/29ジャーナル オープンアクセスThe natural history of aneurysms of the major arteries after revascularization in moyamoya disease has yet to be documented. At our institute, we treated two patients with moyamoya disease-associated aneurysms involving major arteries of the posterior cerebral circulation. The aneurysms became enlarged at an early stage after revascularization, necessitating coil embolization. Although cerebral blood flow was improved in the anterior circulation, revascularization for these patients did not decrease hemodynamic stress in the posterior circulation and was not able to attenuate aneurysmal growth. Therefore, patients with moyamoya disease-associated aneurysms of the major arteries should be carefully monitored after revascularization.抄録全体を表示PDF形式でダウンロード (1162K) -
Michiko YOKOSAWA, Toshiaki HAYASHI, Reizo SHIRANE, Teiji TOMINAGA2014 年 54 巻 10 号 p. 836-840
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/02/28ジャーナル オープンアクセスMoyamoya disease can be associated with a rapidly progressive course in young patients. This report describes a patient with moyamoya disease who experienced rapid disease progression, resulting in cerebral infarction and a wide area of diminished cerebral perfusion. Double superficial temporal artery (STA)-middle cerebral artery (MCA) anastomoses were utilized to immediately increase cerebral perfusion in the affected area. This case involved a 5-year-old girl who had been diagnosed with moyamoya disease and had undergone STA-MCA anastomosis with indirect bypass in the right hemisphere at the age of 3. At the time of presentation, magnetic resonance (MR) imaging showed cerebral infarction at the left frontal lobe, and MR angiography showed rapidly progressive narrowing of the left MCA that had not been present 3 months prior. N-isopropyl-p-[I123] iodoamphetamine single-photon emission computed tomography (IMP-SPECT) showed markedly decreased uptake in the left hemisphere. She underwent emergent STA-MCA double anastomoses with indirect bypass on the left side. IMP-SPECT showed marked increase in uptake in the left hemisphere. The anterior cerebral artery (ACA) territory adjacent to the cerebral infarction also showed increased uptake on the SPECT. Postoperatively, there were no clinical or radiographic indications of ischemic or hemorrhagic complications. Double anastomoses are effective in quickly and significantly increasing blood flow. The postoperative course in this case was uneventful. Double anastomoses are a surgical option for patients with moyamoya disease who show rapid disease progression, even in those in the acute phase of cerebral infarction.抄録全体を表示PDF形式でダウンロード (1502K) -
Joji TOKUGAWA, Yasuaki NAKAO, Kentaro KUDO, Koji IIMURA, Takanori ESAK ...2014 年 54 巻 10 号 p. 841-844
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2013/10/21ジャーナル オープンアクセスThe posterior auricular artery (PAA) is one of the branches of the external carotid artery, but is usually too small for use as a donor artery for middle cerebral artery (MCA) territory revascularization. An extremely unusual case of PAA-MCA anastomosis was performed in a patient requiring MCA territory revascularization because the superficial temporal artery (STA) parietal branch was absent and the PAA was large enough. A 65-year-old man developed mild motor weakness in the right extremities caused by multiple small infarctions. Single photon emission computed tomography (CT) revealed deterioration of the vascular reserve capacity in the left MCA area. Cerebral angiography showed severe stenosis in the C2 portion of the left internal carotid artery, absence of the parietal branch of the left STA, and a well-developed PAA extending to the parietal area. The patient underwent STA (frontal branch)-MCA and PAA-MCA double anastomosis, and has suffered no stroke or transient ischemic attack. The STA with no bifurcation is known as a rare variation. The PAA also occurs with size variations but well-developed PAA is thought to be extremely rare. PAA can be used as a donor artery for MCA territory revascularization if the vessel size is suitable. Preoperative evaluation of the anatomy is mandatory for harvesting the arteries.抄録全体を表示PDF形式でダウンロード (879K) -
Hidemichi ITO, Yuichiro TANAKA, Taigen SASE, Masashi UCHIDA, Yasuyuki ...2014 年 54 巻 10 号 p. 845-850
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2013/11/20ジャーナル オープンアクセスThe authors report a rare case of cerebral hyperperfusion syndrome (HPS) following the excision of a mycotic aneurysm with superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass. A 74-year-old woman with infective endocarditis presented with progressive cerebral infarction and subarachnoid hemorrhage due to a mycotic aneurysm, which was excised with a STA-MCA bypass. Postoperatively, the patient developed HPS that was considered to be exacerbated by a previous ischemic event. Therefore, cerebral hemodynamics should be evaluated before bypass surgery to prevent subsequent hyperperfusion.抄録全体を表示PDF形式でダウンロード (1981K) -
Naoki OTANI, Kojiro WADA, Fumihiro SAKAKIBARA, Kimihiro NAGATANI, Sato ...2014 年 54 巻 10 号 p. 851-853
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2014/03/27ジャーナル オープンアクセスWe herein describe a patient with symptomatic common carotid artery occlusion who underwent a reverse superficial temporal artery (STA)-middle cerebral artery (MCA) single bypass using a naturally formed “bonnet” STA. The surgical procedure was performed without difficulty, and no further neurological deterioration was observed after surgery. In practice, this case highlights that the reverse STA-MCA bypass can be achieved safely and less invasively using a naturally formed “bonnet” STA.抄録全体を表示PDF形式でダウンロード (1767K) -
Hiroshi KAWAI, Tadashi HAMASAKI, Junnichi IMAMURA, Norio TOMONORI, Tak ...2014 年 54 巻 10 号 p. 854-860
発行日: 2014年
公開日: 2014/10/15
[早期公開] 公開日: 2013/12/05ジャーナル オープンアクセスSpontaneous, nontraumatic, superficial temporal artery (STA) aneurysms have been rarely reported. We herewith report three cases of spontaneous and true STA aneurysms. All patients, a 65-year-old male, a 76-year-old female, and a 47-year-old female, had no history of head trauma that requires medical attention. Painless, pulsatile, and slowly growing calvarial lump was the symptom leading to image studies. All the lumps were preoperatively diagnosed as STA aneurysms by magnetic resonance angiography and/or three-dimensional computed tomographic angiography. One case was accompanied by anterior communicating aneurysm. And another case was associated with two more scalp aneurysms arising from occipital artery and contralateral STA. Pathologic studies showed that all three were true aneurysms, with intact media and adventitia but without organized hematoma. Literature review showed that 8% of all STA aneurysms comprised spontaneous STA aneurysms. We found 32 cases (19 males and 13 females) of well-described spontaneous STA aneurysms including ours. Twenty-eight cases (87.5%) were true aneurysms. Seven cases (21.9%) had coexisting vascular lesions. Five (15.6%) of these seven cases were diagnosed with cerebral or abdominal aneurysm. Multiple scalp aneurysms are quite rare; only two cases including ours have been reported. It seems important to know that spontaneous STA aneurysms may coexist with other vascular lesions including intracranial aneurysm.抄録全体を表示PDF形式でダウンロード (2310K)
Editorial Committee
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2014 年 54 巻 10 号 p. EC19-EC20
発行日: 2014年
公開日: 2014/10/15
ジャーナル オープンアクセスPDF形式でダウンロード (480K)
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