Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
65 巻, 1 号
選択された号の論文の7件中1~7を表示しています
Original Articles
  • Takao HASHIMOTO, Yusuke ARAI, Hirofumi OKADA, Muneaki KIKUNO, Hiroki S ...
    2025 年 65 巻 1 号 p. 1-8
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/06
    ジャーナル オープンアクセス

    The widespread adoption of preoperative embolization in highly vascularized brain tumors often involves the frequent use of Embosphere (Merit Medical Systems, South Jordan, Utah, USA). Nevertheless, inconsistency in size selection and dilution rates across different institutions requires comprehensive examination. This study explored the appropriate size and dilution rate of Embosphere microspheres. To assess catheter occlusion and Embosphere breakage, various dilutions (4-, 10-, 20-, 30-, and 60-fold) of Embosphere 300-500 and 500-700 μm were injected into the catheter in vitro. Results indicated that 20-fold or higher dilutions of Embosphere 300-500 μm and 30-fold or higher dilutions of Embosphere 500-700 μm showed no occlusion of the Excelsior SL-10 microcatheter (Stryker, Fremont, CA, USA) or Embosphere breakage. For embolization, to reduce the risk of Excelsior SL-10 occlusion further, a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm were employed. For 195 blood vessels in 107 patients (84 with meningioma and 23 with schwannoma), embolization was carried out using a 30-fold dilution of Embosphere 300-500 μm when the provocative test was negative and a 60-fold dilution of Embosphere 500-700 μm when the test was positive or when there was a risk of migration into neurotrophic vessels. Contrast-enhanced magnetic resonance imaging after embolization revealed a reduced enhancement effect in 69.1% of cases. Embolization using a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm with an Excelsior SL-10 catheter is safe and satisfactory, which minimizes microcatheter occlusion.

  • Yutaka MORISHIMA, Masahito KAWABORI, Yoichi M. ITO, Masayuki GEKKA, Ko ...
    2025 年 65 巻 1 号 p. 9-14
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/25
    ジャーナル オープンアクセス

    Carotid endarterectomy (CEA) is conducted to reduce the risk of cerebral infarction; therefore, a low complication rate is highly required. To predict long-term morbidity and mortality, various scoring systems have been considered; nonetheless, a model that can be utilized to estimate nonmajor temporary complications and minor complications is currently lacking. To evaluate the occurrence rate of perioperative complications in various surgical domains, the E-PASS (Estimation of Physiological Ability and Surgical Stress) score is employed. This study was carried out to investigate the utility of the E-PASS score as a predictive factor for the risk of minor complications in patients undergoing CEA. The retrospective analysis was performed for 104 consecutive series of CEA procedures carried out at Otaru Municipal Hospital. The correlation between E-PASS and the rate of minor complications was examined. Sensitivity and specificity were used to construct a receiver operating characteristic curve, and the area under the curve (AUC) was calculated for accuracy. Postoperative minor complications occurred in eight cases (7.7%), including six vagal nerve injuries and two pneumonia cases. Three categorical data-preoperative risk score, surgical stress scores, and comprehensive risk score (CRS) -showed a good relationship with the postoperative minor complication. Among them, CRS presented the highest sensitivity and specificity, as indicated by an AUC of 0.68. The CRS cutoff value was calculated as −0.068, with a 1.7% postoperative minor complication rate for those lower than −0.068 and 14.0% for those higher than −0.068. The E-PASS score was effective for evaluating and predicting postoperative minor complications in patients with CEA procedures.

  • Hiroshi OHMAE, Taku MATSUDA, Maki FUJIMOTO, Yuka NAKANOWATARI, Megumi ...
    2025 年 65 巻 1 号 p. 15-21
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/25
    ジャーナル オープンアクセス
    電子付録

    Robotic rehabilitation is a high-intensity intervention for upper limb paralysis after a stroke. This study explored the safety and feasibility of using a single-joint hybrid assistive limb (HAL-SJ) exoskeletal device for upper limb paralysis in patients with acute stroke. In total, 11 patients with stroke (6 with moderate paralysis and 5 with severe paralysis) were enrolled between October 2021 and October 2023 in a stroke care unit. The patients underwent HAL training 3 times a week for 6 sessions. No serious adverse events related to HAL-SJ occurred, and participants demonstrated significant improvements in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) (pre- vs. post-intervention; p < 0.05). The minimal clinically important difference (MCID) for FMA-UE was surpassed in 5 patients (83.3%) with moderate paralysis and 2 (40.0%) with severe paralysis. Regarding ARAT, 4 patients (66.7%) with moderate paralysis exceeded the MCID, whereas none (0.0%) with severe paralysis did. These findings suggest that HAL-SJ is both safe and feasible, particularly for individuals with moderate paralysis.

  • Fumiaki OKA, Takayuki OKU, Akiko KAWANO, Koki OKAZAKI, Takuma NISHIMOT ...
    2025 年 65 巻 1 号 p. 22-28
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/25
    ジャーナル オープンアクセス

    Staged angioplasty (SAP) is used as an alternative to preventing cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS), particularly among patients with compromised cerebral haemodynamics. Although SAP is presumed to prevent CHS by gradually restoring cerebral blood flow (CBF), few studies have examined haemodynamic changes, and none have evaluated CBF during the chronic phase of SAP. In the present study, in addition to the clinical outcome of SAP, we measured both resting CBF and cerebrovascular reactivity (CVR) throughout all stages of SAP, including the chronic phase, using quantitative N-isopropyl-p-[I-123] iodoamphetamine (123I-IMP) single-photon emission computed tomography (SPECT) and evaluated the effects of SAP on cerebral haemodynamics. In total, 28 patients underwent SAP. Among them, 19 had a successful procedure. Nine received stenting at the first stage of the procedure because of inadequate dilatation. Patients who underwent SAP had a lower incidence of hyperperfusion than those who underwent stenting at the first stage (5.3% vs. 33.3%). Nevertheless, the results did not significantly differ (p = 0.08). In an analysis limited to the patients who underwent successful SAP, the resting CBF was unchanged except for immediately after the first stage, on the other hand, the CVR increased at each stage. After the first stage, 14 (74%) patients recovered from the steal phenomenon. After the second stage, the CVR normalised. SAP may help to improve cerebral haemodynamics gradually. Consequently, it has the potential to prevent CHS or hyperperfusion among patients with severely impaired CVR, which is a significant risk factor for CHS.

  • Sosho KAJIWARA, Takayuki KAWANO, Yu HASEGAWA, Yukihiko NAKAMURA, Kiyoh ...
    2025 年 65 巻 1 号 p. 29-36
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/25
    ジャーナル オープンアクセス

    In every hospital in Japan, until 2022, the primary treatment for preventing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) involved a combination of ozagrel sodium (Oz), fasudil hydrochloride (Fs), cilostazol, and statins. However, with the approval of clazosentan in January 2022, it has been used as a first-choice drug more frequently. Despite this shift, limited evidence exists regarding the use of clazosentan as the first choice for DCI prevention. In this study, we analyzed the efficacy and outcomes of these two treatments in aSAH patients. Patients treated with Oz+Fs were enrolled between January 2014 and March 2022. In April 2022, clazosentan was prescribed to prevent DCI. Clinical data were collected, and propensity-score matching was conducted based on the clazosentan group. The primary endpoint was the functional outcome at discharge and 6-12 months after admission; the secondary endpoints were the incidence of cerebral vasospasm (CV) and DCI. In this study, 221 patients were included, and 27 were selected from both groups after matching. The incidence of CV was significantly lower in the clazosentan group (11.1% vs. 55.6%, p<0.01), and the incidence of DCI tended to be lower in the clazosentan group (3.7% vs. 25.9%, p=0.05). No significant difference was observed in the primary endpoint of functional outcome at discharge; however, a significant improvement in functional outcome was observed in the clazosentan group at 6 months (96.3% vs. 70.4%, p<0.05). Clazosentan significantly reduced the incidence of CV and improved functional outcomes in patients with aSAH compared to Oz+Fs.

  • Shuki OKUHARA, Tomoaki MURAKAMI, Shingo TOYOTA, Kosei OKOCHI, Koichi N ...
    2025 年 65 巻 1 号 p. 37-44
    発行日: 2025/01/15
    公開日: 2025/01/15
    [早期公開] 公開日: 2024/11/25
    ジャーナル オープンアクセス

    Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.

    We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.

    During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.

    CAS in hemodialysis patients may be safe and effective.

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