巻号一覧
54 巻, 6 号
選択された号の論文の14件中1～14を表示しています
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Contribution
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James I. AUSMAN, Tadashi SHIBUYA, Kazuhiro HONGO, Nobutaka KAWAHARA, T ...2014 年 54 巻 6 号 p. 429-434
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/05/20ジャーナル オープンアクセスPDF形式でダウンロード (131K)
Original Articles
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Shunsaku TAKAYANAGI, Takashi OCHI, Shunya HANAKITA, Yasutaka SUZUKI, K ...2014 年 54 巻 6 号 p. 435-440
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/03/27ジャーナル オープンアクセスThere are still few studies of low-dose recombinant tissue plasminogen activator (rtPA) therapy (0.6 mg/kg) for acute ischemic stroke (AIS) patients ≥ 80 years old, though most strokes occur in elderly people. The safety and effectiveness of this form of thrombolysis without endovascular therapy were evaluated in AIS patients ≥ 80 years old at our hospital. The data were collected from August 2006 to April 2010, before approval of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever in Japan. Intravenous rtPA was administered to patients within 3 hours of stroke onset. The incidence of intracerebral hemorrhage (ICH), the recanalization rate of the occluded artery, and the modified Rankin Scale (mRS) score 3 months after stroke were examined. The patients who received rtPA therapy were stratified into two age groups: a younger group (< 80 years) and an older group (≥ 80 years). Of the 87 patients who received rtPA therapy, 17 (19.5%) were ≥ 80 years old. The incidence of symptomatic ICH was not significantly different between the younger (4.3%) and older (0%) groups (p = 0.61). The recanalization rate of the occluded artery was not significantly different between the younger (54%) and older (50%) groups (p = 0.78). The rate of an mRS score of 0–2, 3 months after stroke was significantly higher in the younger (44.3%) than in the older group (11.8%) (p = 0.013). Low-dose rtPA therapy appears to be as safe and feasible for AIS patients ≥ 80 years old as it is for younger people. This therapy should not be withheld because of age.抄録全体を表示PDF形式でダウンロード (144K) -
Atsushi SHINDO, Masahiko KAWANISHI, Kenya KAWAKITA, Masanobu OKAUCHI, ...2014 年 54 巻 6 号 p. 441-449
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/04/23ジャーナル オープンアクセスIntravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pretreatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications.抄録全体を表示PDF形式でダウンロード (863K) -
Kentaro HAYASHI, Nobutaka HORIE, Minoru MORIKAWA, Izumi NAGATA2014 年 54 巻 6 号 p. 450-456
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/01/28ジャーナル オープンアクセスC-stopper coil (CSC) which are available for 0.018-inch inner diameter microcenter have been used for neurointervention such as transarterial embolization (TAE) of feeding artery. Although various shapes of pushable microcoils have been developed, microcoils are usually short to embolize the lesion and require lots of coils. The most specific feature of CSC is the extended length of 18 cm. To evaluate the usefulness of CSC, we reviewed our experience of CSC. Neurointervention using CSC was performed for 28 patients (31 treatments). Intervention procedures were TAE for dural arteriovenous fistula (AVF)(n = 15), transvenous embolization for dural AVF (n = 4), parent artery occlusion for cerebral aneurysm, dissection and carotid-cavernous fistula (n = 8), TAE for epistaxis (n = 2), and preoperative embolization for tumor (n = 2). CSCs were deployed with push technique through microcatheter. CSCs were successfully placed into the lesion namely feeding artery, venous sinus, parent artery of aneurysm, or dissection. There were no major technical complications resulting in morbidity. Postoperative course was uneventful. No recanalization of the occluded vessel occurred during follow-up. Use of CSCs was safe and feasible for embolization of cerebrovascular lesion.抄録全体を表示PDF形式でダウンロード (932K) -
Yong JI, Qin-Hu MENG, Zhi-Gang WANG2014 年 54 巻 6 号 p. 457-464
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/12/05ジャーナル オープンアクセスThe aim of this study was to investigate the dynamic changes in the coagulation and fibrinolytic system with subarachnoid hemorrhage. The blood coagulation enzyme-AT complex (TAT), anticoagulant enzyme (AT), tissue plasminogen activator (tPA), plasminogen activin inhibitor (PAI-1), and mean blood flow velocity were measured. The TAT level was significantly higher 6 h after subarachnoid hemorrhage (SAH), whereas AT was significantly lower. These changes were maintained at 12 h to 1 d after SAH, returned to normal at 3 d, significantly changed again at 7 d to 14 d. The tPA level gradually increased after SAH and peaked at 14 d, and then returned to normal at 21 d. The PAI-1 levels were significantly lower than those in the control group 1 d after SAH gradually increased, and returned to normal at 21 d. In the cerebral vasospasm (CVS) groups, the levels of TAT, and AT significantly changed compared to the non-CVS groups after SAH. The PAI-1 levels were higher at 7 d and 14 d, but the changes were not significant. In groups Fisher III and IV as well as Hunt III to V, the TAT, AT, tPA, and PAI-1 levels were significantly higher than those in both Fisher and Hunt I and II 6 h, 12 h, 1 d, 7 d, and 14 d after SAH. The changes in the coagulation and fibrinolytic system of patients with SAH are correlated with the progress and symptoms of SAH as well as the blood content and CVS.抄録全体を表示PDF形式でダウンロード (540K) -
Tetsuji INAGAWA, Kaita YAHARA, Naohiko OHBAYASHI2014 年 54 巻 6 号 p. 465-473
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/03/27ジャーナル オープンアクセスWe studied the risk factors associated with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). The subjects were 370 patients with ruptured aneurysms who fulfilled all of the following criteria: admission by day 2 after onset, operation performed by day 3 by the same surgeon (T.I.), Hunt-Hess grade I–IV, availability of bilateral carotid angiograms acquired by day 2 and repeated between days 7 and 9. The demographic, clinical, radiographic, surgical, laboratory, and electrocardiographic data were analyzed for angiographic vasospasm (AV), symptomatic vasospasm (SV), and cerebral infarction on computed tomography (CT) scan. Both CT-evident SAH and AV were graded as 0–IV. Among the 370 patients, AV grade III–IV, SV, and cerebral infarction occurred in 26%, 24%, and 20%, respectively. Univariate analysis showed that Hunt-Hess grade III–IV, SAH grade III–IV, intracerebral or/and intraventricular hemorrhage, rebleeding, cigarette smoking, hypertension, alcohol intake, leukocytosis, hyperglycemia, and electrocardiographic QTc prolongation, left ventricular hypertrophy (LVH), and ST depression were significantly related to at least one of AV grade III–IV, SV, or cerebral infarction. Multivariate analysis showed that SAH grade III–IV was the most important risk factor for vasospasm followed by LVH on electrocardiogram, cigarette smoking, and hypertension. AV grade III–IV, SV, and cerebral infarction occurred in 57%, 54%, and 39% of the 46 smokers with LVH, and in 43%, 49%, and 35% of the 68 patients who had both LVH and hypertension, respectively. CT-evident SAH, LVH, cigarette smoking, and hypertension are associated with vasospasm. In smokers or hypertensive patients, premorbid LVH appears to predict much more severe vasospasm.抄録全体を表示PDF形式でダウンロード (657K) -
Hana TOBISHIMA, Toru HATAYAMA, Hiroki OHKUMA2014 年 54 巻 6 号 p. 474-482
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/12/05ジャーナル オープンアクセスMentalis muscle responses to electrical stimulation of the zygomatic branch of the facial nerve are considered abnormal muscle responses (AMRs) and can be used to monitor the success of decompression in microvascular decompression (MVD) surgery. The aim of this study was to compare the long-term outcome of MVD surgery in which the AMR disappeared to the outcome of surgery in which the AMR persisted. From 2005 to 2009, 131 patients with hemifacial spasm received MVD surgery with intraoperative monitoring of AMR. At 1 week postsurgery, spasms had resolved in 82% of cases in the AMR-disappearance group and 46% of cases in the persistent-AMR group, mild spasms were present in 10% of cases in the AMR-disappearance group and 31% of cases in the persistent-AMR group, and moderate were present spasms in 8% of cases in the AMR-disappearance group and 23% of cases in the persistent-AMR group (P < 0.05). At 1 year postsurgery, spasms had resolved in 92% of cases in the AMR-disappearance group and 84% of cases in the persistent-AMR group, mild spasms were present in 6% of cases in the AMR-disappearance group and 8% of cases in the persistent-AMR group, and moderate spasms were present in 3% of cases in the AMR-disappearance group and 8% of the cases in the persistent-AMR group (P = 0.56). These results indicate that the long-term outcome of MVD surgery in which the AMR persisted was no different to that of MVD surgery in which the AMR disappeared.抄録全体を表示PDF形式でダウンロード (1246K)
Technical Reports
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Yuichiro TANAKA, Masashi UCHIDA, Hidetaka ONODERA, Jun HIRAMOTO, Yasuy ...2014 年 54 巻 6 号 p. 483-485
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/10/07ジャーナル オープンアクセスMicrovascular decompression (MVD) is a standard surgical procedure for treating vascular compression syndromes. There are two basic ways to perform MVD: interposition using a prosthesis and transposition. With the transposition technique, adhesions and granuloma around the decompression site are avoided, but the required operation is more complex than that for the interposition method. We describe a simple, quick MVD transposition procedure that uses a small “belt” cut from a sheet of 0.3-mm-thick expanded polytetrafluoroethylene membrane. The belt has a hole at the wide end and the other end tapered to a point. The belt is encircled around offending vessels by inserting the pointed end into the hole. The pointed end is then passed through a dural tunnel over the posterior wall of the petrous bone and is tied two or three times. This method avoids the risks involved in handling a surgical needle close to the cranial nerves and vessels.抄録全体を表示PDF形式でダウンロード (713K) -
Kyojiro NAMBU, Yoshihiro MURAGAKI, Yasuo SAKURAI, Hiroshi ISEKI2014 年 54 巻 6 号 p. 486-489
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/11/21ジャーナル オープンアクセスFor improvement of surgical performance and safety, we record surgeries by video cameras. However, analysis of the video records is time consuming. To help this task, we are developing methods to automatically mark up significant time points in the surgery. As a possible mean for the marking, we focused on the surgeon’s heart rate. During a craniotomy of an intracranial glioma, we recorded the surgeon’s electrocardiogram using a telemeter and measured the R-to-R interval (RRI). We detected the stable state of heart rate as a peak-to-peak RRI of less than 5% of the mean of RRI data from 15 consecutive heartbeats. We also quantified the frequency of brain touches by the surgeon under the surgical microscope. We examined the association between the stability of surgeon’s heart rate and the brain touches using a chi-square test. As the result, the stable state of surgeon’s heart rate was associated with the brain touches (p < 0.05, odds ratio 5.1). We edited a one-minute digest video of the surgery based on only the heart rate data, and it was sufficient to understand how the surgery was preceded.抄録全体を表示PDF形式でダウンロード (358K) -
Tsuyoshi ICHIKAWA, Kyouichi SUZUKI, Yoichi WATANABE2014 年 54 巻 6 号 p. 490-496
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2014/01/28ジャーナル オープンアクセスIntra-arterial fluorescence angiography from a catheter inserted into the external carotid artery (ECA) via the superficial temporal artery (STA) allowed us to satisfactorily evaluate cerebral arterial and venous blood flow. We report this novel method that allowed for repeated angiography within minutes with a low risk of complications due to catheter placement from the STA. The STA was secured at the edge of the standard skin incision during cerebral aneurysm surgery. A 3 Fr catheter was inserted approximately 5 cm to 10 cm into the STA. After manual injection of 5 ml of 20 times diluted 10% fluorescein sodium (fluorescein), fluorescein reached the intracranial internal carotid artery (ICA) through the common carotid artery or anastomoses between the ECA and ICA. Fluorescence emission from the cerebral arteries, capillaries, and veins was clearly observed through the microscope and results were recorded. Quick dye clearance makes it possible to reexamine within 1 minute. In addition, we made a graph of the fluorescence emission intensity in the arteries, capillaries, and veins using fluorescence analysis software. With intravenous fluorescence angiography, dye remains in the vessels for a long time. When repeated examinations are necessary, intervals of approximately 10 minutes are required. There were some cases we could not correctly evaluate with intravenous injection due to weak fluorescence emission. Fluorescence angiography with intra-arterial injection from a catheter inserted into the carotid artery or another major vessel, like conventional angiography, has a risk of procedurerelated complications. We report our new method since it solved these problems and is useful.抄録全体を表示PDF形式でダウンロード (2787K) -
Nobuhisa MATSUMURA, Takashi SHIBATA, Emiko HORI, Hironaga KAMIYAMA, Ma ...2014 年 54 巻 6 号 p. 497-501
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/10/07ジャーナル オープンアクセスWe describe a higher magnifying power operating microscope system to improve one method of high-quality microsurgical clipping for cerebral aneurysm in some cases. This higher magnification is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnifications (distinctiveness of 7 μm). This higher-resolution operating microscope system provides the surgeon with higher-magnified images (at the maximum of more than 30× magnifications as each working distance) in the operating field. The magnifications can be changed from low power (2.9×) to high power (62.0×) depending on the circumstances in a given procedure. We have used this operating microscope system on 11 patients with microsurgical clipping for cerebral aneurysms. Microsurgical treatment could be performed safely and precisely. All aneurysms were treated without any technical complications. We think that the use of this microscope would have potential benefits for microsurgical treatment for cerebral aneurysms because of better visualization.抄録全体を表示PDF形式でダウンロード (1095K) -
Naoki OTANI, Miya ISHIHARA, Kanji NAKAI, Masanori FUJITA, Kojiro WADA, ...2014 年 54 巻 6 号 p. 502-506
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/11/08ジャーナル オープンアクセスWe herein present our experience to assess intraoperative confirmation of vascular patency with an uncooled infrared camera in extracranial–intracranial (EC-IC) bypass surgery. This camera had distinguishing characteristics, including its small size, light weight, and adequate temperature resolution (< 0.022 degrees). We used a simplified zoom germanium lens as a preliminary study to verify the potential of using this camera to assess the vascular flow of the end-to-side anastomosis model in rats. In addition, we evaluated the vascular flow in continuous clinical series using this infrared camera during EC-IC bypass in 14 patients (17 sides). This infrared camera offers real-time information on the vascular patency of end-to-side anastomosis vessels of all relevant diameters. The spatial resolution and image quality are satisfactory, and the procedure can be safely repeatable. We have shown that the infrared camera could be a new and feasible technology for intraoperative imaging of the vascular flow and is considered to be clinically useful during cerebrovascular surgery.抄録全体を表示PDF形式でダウンロード (1464K) -
Jun HIRAMOTO, Yuichiro TANAKA2014 年 54 巻 6 号 p. 507-509
発行日: 2014年
公開日: 2014/06/17
[早期公開] 公開日: 2013/10/11ジャーナル オープンアクセスKamiyama introduced a unique method of temporary cerebral revascularization using a radial artery graft (RAG) in his technical review. We tried original method with Sugita frame, and pointed out some disadvantages that include to avoid taking instruments or hands in and out, stability of hands, and unrestricted usage of brain retractors during temporary bypass between radial artery and M2 potion of middle cerebral artery (RA-M2 bypass). To solve those disadvantages, especially for Sugita head frame users, we here present a modified Kamiyama’s method of temporary cerebral revascularization with the forearm elevated over the face like as hand-eyeshade posture.抄録全体を表示PDF形式でダウンロード (765K)
Editorial Committee
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2014 年 54 巻 6 号 p. EC11-EC12
発行日: 2014年
公開日: 2014/06/17
ジャーナル オープンアクセスPDF形式でダウンロード (77K)
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