研究者詳細 - 西堀　正洋

The usefulness of three-dimensional fusion imaging of spinal arteriovenous malformation by a workstation connected to angiography systems Open Access

Nagashima, Y; Izumi, T; Nishimura, Y; Nishihori, M; Oyama, T; Matsuo, M; Ito, H; Nishii, T; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 1 ) 頁： 127 - 133 2023年2月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Digital subtraction angiography (DSA) is the most useful technique for diagnosing spinal arteriovenous malformations (AVM). In recent years, with the improvement of imaging capabilities, the usefulness of three-dimensional (3D) imaging by fusing various modalities has been recognized. The use of 3D fusion imaging with a workstation connected to an angiography system has been reported in many cases of intracranial disease, but less frequently for spinal AVM. In this article, we describe two illustrative cases of spinal AVM in which 3D fusion imaging was useful for treatment. Although 3D fusion images using the system have the disadvantage that only a maximum of two images can be fused, it provides spinal surgeons with useful information for preoperative evaluation in a small amount of time.

DOI： 10.18999/nagjms.85.1.127

Rare Dilated Collateral Circulation from Accessory Meningeal Artery to Inferolateral Trunk: A Case Report.

Ikezawa M, Maeda K, Takasu S, Takemoto M, Nishihori M, Choo J, Sago F, Somiya D, Doba K, Ikeda A

NMC case report journal 10 巻 ( 0 ) 頁： 47 - 50 2023年

Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review.

Yokoyama H, Nishihori M, Izumi T, Goto S, Kurimoto M, Kato M, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 177 - 183 2023年

Usefulness of Stanch Belt Plus in Postoperative Management after Endovascular Neurosurgery Open Access

Nishihori, M; Kawase, R; Izumi, T; Nakase, H; Onishi, E; Saito, R

JOURNAL OF NEUROENDOVASCULAR THERAPY 17 巻 ( 12 ) 頁： 281 - 285 2023年

Simultaneous Aneurysmal Subarachnoid Hemorrhage and Epistaxis in an Untreated Prolactinoma: A Case Report and Literature Review.

Nishihori M, Izumi T, Takeuchi K, Goto S, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 163 - 168 2023年

Sacral arteriovenous fistula with lower thoracic cord edema without perimedullary vein enlargement. Open Access

Ishii M, Nishimura Y, Nagashima Y, Tanei T, Nishihori M, Izumi T, Saito R

Surgical neurology international 14 巻頁： 295 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Surgical Neurology International

Background: Sacral dural arteriovenous fistulas (AVFs) are often undiagnosed at the initial presentation due to their rarity. Case Description: For 1 year, a 71-year-old man developed progressive motor and sensory disturbances in both legs. Magnetic resonance imaging showed spinal cord edema with mild contrast enhancement at the T9–10 and T12 levels. Although mild venous dilatation was observed only at the cauda equina level, it was not initially recognized as abnormal. Blood and cerebrospinal fluid tests and spinal angiography of the lower thoracic to upper lumbar levels were nonspecific. The patient was unsuccessfully treated with three courses of high-dose intravenous methylprednisolone. Ultimately, following repeat spinal angiography (i.e., including the bilateral internal iliac arteries) that revealed a low-flow sacral dural AVF supplied by the right lateral sacral artery, the patient underwent successful surgical venous AVF occlusion/transection. Conclusion: In cases of spinal cord edema without perimedullary abnormal flow voids, careful spinal angiography including the sacral spine is necessary even if only minimal venous dilation is initially observed at the cauda equina level.

DOI： 10.25259/SNI_606_2023

Open Access

イスラム教徒の診療において脳神経外科医が注意すべき薬剤および医療材料

大野貴都, 岡田健, 遠藤乙音, 藤井健太郎, 西堀正洋, 川㟢裕一

脳神経外科ジャーナル 32 巻 ( 5 ) 頁： 318 - 323 2023年

記述言語：日本語出版者・発行元：一般社団法人日本脳神経外科コングレス

症例はヨルダン人の11歳男児. 突然の意識障害を発症し, 精査にて小脳脳動静脈奇形からの出血と診断し, 緊急で開頭血腫除去術および外減圧術を施行した. 症状は徐々に改善し, 頭蓋形成術を行ったのち自宅退院となった. 患者および父親はイスラム教徒であった. イスラム教では豚肉やアルコールなどの摂取が禁じられているが, ゼリーや醤油などそれらを材料として含み得る飲食物も忌避されるため, 提供する病院食にも難渋した. また, 脳神経外科で使用する薬剤, 医療材料にも, ヘパリンなど動物由来の成分を含むものが多くあり, 使用に配慮する必要があった. 脳神経外科で扱う動物由来成分を含む医療材料, 薬剤についてまとめ, 報告する.

DOI： 10.7887/jcns.32.318

CiNii Research

Efficacy of comparing coil behavior and distribution using the silicone aneurysm model: difference of coil distribution in the early filling stage Open Access

Goto, S; Izumi, T; Nishihori, M; Araki, Y; Yokoyama, K; Uda, K; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 4 ) 頁： 762 - 771 2022年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

This study sought to establish an experimental aneurysm model of visualizing coil insertion using radiolucent nylon coils. Moreover, this study aimed to clarify the characteristics and differences of each coil and use them clinically as indices of coil selection. The coil insertion test was performed on the 10 mm spherical silicone aneurysm model filled to a nylon coil volume embolization ratio of 11.8%. Five types of coil were randomly tested six times, and the distribution of the coils was analyzed by fluoroscopy imaging. Indices of “Area (mm2),” “Feret’s diameter (mm),” and “Circularity” were calculated from the fluoroscopic images. Among the indices, only “Area” showed a significant difference between coils (p = 0.002). On multivariate analysis, “Area” of the ED Infini was larger than those of Target XL soft and Galaxy G3 (p = 0.018 and 0.026, respectively). Furthermore, the area of the 360 soft was larger than that of G3 (p = 0.049). Analysis of the correlation between these values and the coil configuration showed that “Area” was negatively correlated with the stock-wire diameter (r = −0.50; p = 0.004) and primary coil configuration (r = −0.65; p < 0.001). When inserting the coils in the early stage, although the difference between each coil is relatively difficult to obtain, knowledge on the proper use of the coils with differences in characteristics can help in selecting the coil most appropriate for the conditions.

DOI： 10.18999/nagjms.84.4.762

Abnormal foreshortening of a Flow Re-Direction Endoluminal Device caused by in-stent thrombosis immediately after deployment br Open Access

Otsuka, T; Izumi, T; Nishihori, M; Tsukada, T; Goto, S; Ikezawa, M; Kato, N; Nakano, M; Uda, K; Yokoyama, K; Araki, Y; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 4 ) 頁： 884 - 889 2022年11月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Thromboembolic complications are a concern in the treatment of cerebral aneurysms using a flow diverter. In this study, we report a case of abnormal foreshortening of a Flow Re-Direction Endoluminal Device (FRED) caused by in-stent thrombosis immediately after its deployment. A 72-year-old woman had a large cavernous carotid aneurysm, which caused ptosis and diplopia. FRED deployment was planned, and dual antiplatelet therapy was initiated 2 weeks before the procedure. Under systemic heparinization, FRED was deployed with local compaction over the aneurysm orifice. Cone-beam computed tomography subsequently revealed slightly poor wall apposition at the proximal side. While the balloon catheter was prepared for angioplasty, the stent became abnormally foreshortened, the proximal side slipped into the aneurysm, and the internal carotid artery became occluded. FRED was removed using a snare wire, and recanalization was obtained. The lumen of the removed FRED was filled with thrombus. The antiplatelet therapy was changed to triple regimen, and a Pipeline Flex embolization device was placed 1 month later. At that time, no thromboembolic complications were noted. It was considered that thrombotic occlusion was followed by foreshortening of FRED on the distal side because of antegrade blood flow. Multiple factors, such as increased mesh density by locally compacted stent deployment, slightly poor wall apposition, clopidogrel resistance, and the dual-layer structure of FRED, may have been involved in thrombus formation.

DOI： 10.18999/nagjms.84.4.884

開頭術後に硬膜動静脈瘻を生じOnyx TAEを施行した2例

横山欣也, 西堀正洋, 今岡永喜, 羽生健人, 松野宏樹, 石原晃司郎, 横山勇人, 金森史哲, 宇田憲司, 荒木芳生, 泉孝嗣, 齋藤竜太

脳血管内治療 7 巻 ( Suppl. ) 頁： S233 - S233 2022年11月

The usefulness and safety of dexmedetomidine for postoperative sedation in pediatric patients with moyamoya disease 国際誌

Kanamori, F; Araki, Y; Yokoyama, K; Uda, K; Kurimoto, M; Shiba, Y; Mamiya, T; Takayanagi, K; Ishii, K; Nishihori, M; Izumi, T; Okamoto, S; Saito, R

JOURNAL OF NEUROSURGERY-PEDIATRICS 30 巻 ( 3 ) 頁： 301 - 307 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery: Pediatrics

OBJECTIVE After revascularization surgery in pediatric patients with moyamoya disease (MMD), resting and avoiding crying is important. However, this inaction is often difficult because of pain or anxiety. Dexmedetomidine (DEX), which has sedative and analgesic properties, may be useful in reducing those uncomfortable conditions; however, its common side effects include bradycardia and hypotension, which have a risk of decreasing the cerebral blood flow. The aim of this study was to investigate the efficacy and safety of using DEX for pediatric patients with MMD in the acute period after revascularization surgery. METHODS This retrospective study included pediatric patients with MMD who underwent revascularization surgery. Based on whether DEX was used for light sedation during postoperative days (PODs) 0–1 after extubation, the patients were divided into DEX or control groups. For neurological outcomes, the incidence of symptomatic cerebral infarction and transient neurological events (TNEs) during PODs 0–1 and the entire hospitalization were investigated. In addition, the Richmond Agitation-Sedation Scale (RASS) was used to assess the effect of DEX, and bradycardia and hypotension were evaluated as side effects. RESULTS A total of 84 surgical procedures were included in this study (27 in the DEX group and 57 in the control group). During PODs 0–1, symptomatic infarction was not observed in either group. The incidence of TNEs was almost the same in both groups: 2 (7.4%) of the 27 procedures in the DEX group and 4 (7.0%) of the 57 procedures in the control group (p > 0.99). Moreover, the incidences of symptomatic infarction and TNEs during the entire hospitalization did not differ significantly (symptomatic infarction, p > 0.99; TNEs, p = 0.20). Regarding the DEX effect, the median RASS scores during PODs 0–1 were −1.0 (drowsy) in the DEX group and +1.0 (restless) in the control group, showing a significant difference (p < 0.01). Regarding side effects, bradycardia was observed only in 3 (11.1%) of the 27 procedures in the DEX group (p = 0.03), and hypotension was not observed in any of the cases. CONCLUSIONS In pediatric patients with MMD who are extubated after revascularization surgery, DEX produced appropriate light sedation and analgesia. The risk for symptomatic infarction is almost the same in cases in which DEX is used and those in which it is not; however, neurosurgeons should be cautious of bradycardia and TNEs as potential side effects.

DOI： 10.3171/2022.6.PEDS2241

Medical Management of a Mural Thrombus Inducing Repeated Ischemic Strokes in a Patient with Congenital Afibrinogenemia 国際誌

Nishihori, M; Araki, Y; Suzuki, N; Tamura, S; Hattori, M; Izumi, T; Goto, S; Yokoyama, K; Uda, K; Matsushita, T; Saito, R

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 31 巻 ( 7 ) 頁： 106526 - 106526 2022年7月

記述言語：英語出版者・発行元：Journal of Stroke and Cerebrovascular Diseases

Objectives: Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment. Case description: A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events. Conclusion: This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106526

Changes in cerebral blood flow in the postoperative chronic phase after combined cerebral revascularization for moyamoya disease with ischaemic onset 国際誌

Araki, Y; Mamiya, T; Fujita, N; Uda, K; Yokoyama, K; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Takeuch, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Tanei, T; Sumitomo, M; Okamoto, S; Izumi, T; Kato, K; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 3 ) 頁： 2471 - 2480 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Neurosurgical Review

The purpose of this study was to examine the effects of combined revascularization for ischaemic-onset moyamoya disease (MMD) on cerebral haemodynamics by comparing cerebral blood flow (CBF) during the postoperative chronic phase with preoperative CBF. A retrospective cohort of 24 MMD patients (representing 31 surgeries) who received single photon emission computed tomography (SPECT) before and more than 6 months after surgery was investigated. The CBF value of each vascular territory was extracted from SPECT data, and the value relative to the ipsilateral cerebellar value (relative CBF, or RCBF) was calculated. The correlation between the revascularization effect and the proportional change in RCBF before and after surgery (calculated as post-RCBF/pre-RCBF (“post/pre-RCBF”)) was analysed. Furthermore, the relationships between changes in neurological symptoms and post/pre-RCBF were investigated. Preoperative and postoperative mean RCBF values were 0.92 ± 0.15 and 0.96 ± 0.13 (p = 0.619) in the anterior cerebral artery territory, 0.99 ± 0.17 and 1.01 ± 0.17 (p = 0.598) in the middle cerebral artery territory and 1.15 ± 0.22 and 1.14 ± 0.19 (p = 0.062) in the posterior cerebral artery territory, respectively. No significant correlation was found between the revascularization score and post/pre-RCBF. The revascularization score and post/pre-RCBF were not significant predictors of worsening neurological symptoms postoperatively. No significant change in RCBF was observed in any vascular territory in the chronic phase after revascularization. Combined revascularization may assist in the redirection of blood flow from the internal to the external carotid system and contribute to CBF maintenance.

DOI： 10.1007/s10143-022-01774-8

Evaluation of the differences in pressure applied to the vessel wall by different types of balloon remodeling microcatheters in an experimental model 国際誌 Open Access

Ikezawa, M; Izumi, T; Nishihori, M; Tsukada, T; Tamari, Y; Araki, Y; Yokoyama, K; Uda, K; Goto, S; Kropp, AE; Otsuka, T; Kato, N; Nakano, M; Saito, R

INTERVENTIONAL NEURORADIOLOGY 28 巻 ( 3 ) 頁： 323 - 331 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Interventional Neuroradiology

Background: We examined compliance differences among balloon remodeling microcatheters, which have not been established previously. Methods: Straight and 120° angulated vascular models were created in a 3 mm diameter tube with 3 mm hole (vascular model A), a tube with a 4 mm hole (vascular model B), and a 4 mm diameter tube (vascular model C). We compared the pressure exerted when each balloon was herniated 1 or 2 mm between three compliant balloons (SHOURYU SR, TransForm C, and Scepter C) and four super-compliant balloons (HyperForm, SHOURYU HR, TransForm SC, and Scepter XC). Results: In vascular model A, there was a significant difference in the pressure exerted by compliant balloons and super-compliant balloons in both the straight and angulated models. In the straight model (1 and 2 mm), the lowest pressure was exerted by HyperForm (super-compliant balloons group) and SHOURYU SR (compliant balloons group). The lowest pressure was exerted in the angulated model by HyperForm (super-compliant balloons group) and Scepter C (compliant balloons group). The Scepter balloon exerted higher pressure in the straight model than other balloon remodeling microcatheters but less in the angulated model. In vascular model B, the pressure decreased in all balloons compared with model A. In vascular model C, the pressure increased in all balloons compared with model A. Conclusions: Pressure differed across balloon remodeling microcatheters. In addition, vessel shape and diameter, and hole size, affected the results. Our findings can help select balloon remodeling microcatheters.

DOI： 10.1177/15910199211031765

Blood flow stagnation after treatment of a giant internal carotid artery aneurysm: a computed fluid dynamics analysis 査読有り国際誌 Open Access

Muraoka, S; Takagi, R; Araki, Y; Uda, K; Sumitomo, M; Okamoto, S; Nishihori, M; Izumi, T; Nakamura, M; Saito, R

SCIENTIFIC REPORTS 12 巻 ( 1 ) 頁： 7283 - 7283 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Scientific Reports

Balloon test occlusion (BTO) is an angiographic test to evaluate ischemic tolerance after permanent occlusion of an internal carotid artery (ICA). BTO can simulate ischemia caused by parent artery occlusion and can be used to select a suitable bypass surgery using specific criteria. On the other hand, a postoperative thrombus can form despite proper case selection, optimal radiological evaluation, and an appropriate surgical strategy. Postoperative ischemic complications related to perforating branches are clinically significant. This simulation study aimed to analyze postoperative flow characteristics and elucidate the cause of ischemic complications related to the perforating branch using computational fluid dynamics (CFD). An unexpected postoperative thrombus formation related to the perforating branch occurred after treating a giant aneurysm in the cavernous portion of the ICA in a patient. Three-dimensional digital subtraction angiography was used to acquire flow data and set up the CFD simulation. The flow simulations were performed at various bypass flow rates. The CFD analysis indicated flow stagnation in the ICA only when surgical treatment using a low-flow bypass graft was performed. Thrombus formation may lead to ischemic complications related to the perforating branch, such as the anterior choroidal artery. BTO did not reflect the influence of bypass blood flow. Therefore, recognizing that blood flow stagnation may occur and comprehensively deciding on the surgical strategy by CFD analysis can be helpful to prevent ischemic complications in patients with giant aneurysms.

DOI： 10.1038/s41598-022-11321-6

Angiographic characteristics of improper watershed shift after STA-MCA bypass in a patient with moyamoya disease: illustrative case 国際誌 Open Access

Kanamori F., Araki Y., Yokoyama K., Uda K., Mamiya T., Nohira S., Takayanagi K., Ishii K., Nishihori M., Izumi T., Saito R.

Journal of Neurosurgery: Case Lessons 3 巻 ( 16 ) 2022年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery: Case Lessons

BACKGROUND In patients with moyamoya disease (MMD) who receive superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, hypoperfusion remote from the anastomosis site rarely occurs. Watershed shift due to direct bypass has been proposed as the mechanism; however, no report has confirmed this phenomenon using angiography. OBSERVATIONS A 48-year-old man presented with transient weakness in his left arm. Angiography revealed severe bilateral stenosis of the MCAs and moyamoya vessels. The right anterior cerebral artery (ACA) had short stenosis at A2 but ample blood supply to the cortical area of the right ACA and MCA regions. The patient was diagnosed with MMD and received a single STA-MCA bypass. The next day, he had difficulty communicating, and a cerebral infarction away from the anastomosis site was identified. Perfusion examination revealed hyperperfusion around the direct bypass and hypoperfusion away from the anastomosis site. Angiography revealed bypass patency; however, the original anterograde flow of the right ACA decreased significantly at the stenosed point, indicating an improper watershed shift. LESSONS STA-MCA bypass for patients with MMD can cause an improper watershed shift decreasing cerebral flow. Donor flow should be prepared based on each angiographic characteristic, and the risk of the improper watershed shift should be considered.

DOI： 10.3171/CASE22104

Risk Factors for Cerebral Infarction Early After Revascularization in Children Younger than 5 Years with Moyamoya Disease 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

WORLD NEUROSURGERY 160 巻頁： E220 - E226 2022年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：World Neurosurgery

Objective: Cerebral revascularization is necessary for pediatric patients younger than 5 years with moyamoya disease (MMD). However, they have a high risk of developing cerebral infarction early after surgery. This study aimed to analyze the risk factors for developing cerebral infarction among these patients. Methods: The charts of 21 consecutive patients with MMD (39 surgeries) younger than 5 years who had undergone revascularization at our hospital were retrospectively analyzed. Because cerebral infarction occurring within 1 month after surgery was the primary end point, other clinical information was evaluated, including each surgical procedure. Multivariate analysis of the risk factors for postoperative cerebral infarction was performed. Results: Cerebral infarction occurred after 7 of 39 surgeries (17.9%). Of the 39 surgeries, 23 (59%) included direct and indirect combined revascularization. The incidence of cerebral infarction did not differ significantly between the combined (21.7%) and indirect (12.5%) groups (P = 0.46). Logistic regression showed no association between the revascularization procedure and the occurrence of cerebral infarction after surgery (P = 0.3). However, younger age at surgery was correlated with a higher risk of developing cerebral infarction in the early postoperative period (P = 0.05). Conclusions: No differences were found in the risk of developing cerebral infarction early after surgery as a result of surgical procedures. However, younger patients had higher postoperative risk. Further multicenter research should examine this issue for young pediatric patients with moyamoya at high risk of developing cerebral infarction.

DOI： 10.1016/j.wneu.2021.12.115