研究者詳細 - 西堀　正洋

論文 - 西堀　正洋

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Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads 国際誌 Open Access

Uda, K; Tanahashi, K; Mamiya, T; Kanamori, F; Yokoyama, K; Nishihori, M; Izumi, T; Araki, Y; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 2 ) 頁： 1617 - 1624 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：Neurosurgical Review

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA–SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO− and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO−, and StA. In all parameters, ApA-ZO− extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO−, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon’s anastomosis skill level.

DOI： 10.1007/s10143-021-01686-z

Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case. 国際誌 Open Access

Araki Y, Yokoyama K, Uda K, Kanamori F, Mamiya T, Takayanagi K, Ishii K, Nishihori M, Takeuchi K, Tanahashi K, Nagata Y, Tanei T, Nishimura Y, Izumi T, Saito R

Journal of neurosurgery. Case lessons 3 巻 ( 12 ) 2022年3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 Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA). OBSERVATIONS A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18. LESSONS Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.

DOI： 10.3171/CASE21704

Comparison of hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment for internal carotid artery aneurysm

Tsukada, T; Izumi, T; Isoda, H; Nishihori, M; Kropp, AE; Mizuno, T; Wakabayashi, T

JOURNAL OF NEUROSURGERY 136 巻 ( 3 ) 頁： 619 - 626 2022年3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

OBJECTIVE De novo aneurysms generally develop in healthy vessels after parent artery occlusion for large internal carotid artery (ICA) aneurysm, possibly owing to increased hemodynamic stress in the remaining vessels. In recent years, there has been a shift toward flow diverter stent treatment. However, there is a lack of direct evidence and data that prove this change in hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment. The authors compared hemodynamic stress in healthy-side vessels before and after parent artery occlusion and flow diverter treatments. METHODS The authors included patients who underwent 3D cine phase-contrast MRI before and after large ICA aneurysm treatment. Spatially and temporally averaged volume flow rates and spatially averaged systolic wall shear stress (WSS) in healthy-side ICA distal to the posterior communicating artery (C1 segment according to Fisher's classification) were measured before and after parent artery occlusion and flow diverter treatments. RESULTS Seventeen patients were included (5 patients in the parent artery occlusion group and 12 in the flow diverter group). At 1-2 months after treatment, median volume flow rate in healthy-side ICA increased from 5.36 ml/sec to 6.28 ml/sec (total increase 117%, p = 0.04) in the parent artery occlusion group and from 4.65 ml/sec to 4.93 ml/sec (total increase 106%, p = 0.02) in the flow diverter group. In the parent artery occlusion group, median WSS in the C1 segment of the healthy-side ICA increased from 3.91 Pa to 5.61 Pa (total increase 143%, p = 0.08); however, no significant increase was observed in the flow diverter group (4.29 Pa to 4.57 Pa [total increase 107%, p = 0.21]). CONCLUSIONS Postoperatively, volume flow rate and WSS in the C1 segment of the healthy-side ICA significantly increased in the parent artery occlusion group. Therefore, the parent artery occlusion group was more prone to de novo aneurysm than the flow diverter group.

DOI： 10.3171/2021.2.JNS204185

その他リンク： https://thejns.org/downloadpdf/journals/j-neurosurg/136/3/article-p619.xml

Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case. 国際誌 Open Access

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

Journal of neurosurgery. Case lessons 3 巻 ( 3 ) 2022年1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 Transient neurological deficits (TNDs) develop after cerebral revascularization in patients with moyamoya disease (MMD). The authors report a rare pediatric MMD case with extensive decreased cerebral blood flow (CBF) and prolonged TNDs after combined revascularization. OBSERVATIONS A 9-year-old boy presented with transient left upper limb weakness, and MMD was diagnosed. A right-sided combined surgery was performed. Two years after the surgery, frequent but transient facial (right-sided) and upper limb weakness appeared. The left internal carotid artery terminal stenosis had progressed. Therefore, a left combined revascularization was performed. The patient’s motor aphasia and right upper limb weakness persisted for approximately 10 days after surgery. Magnetic resonance angiography showed that the direct bypass was patent, but extensive decreases in left CBF were observed using single photon emission tomography. With adequate fluid therapy and blood pressure control, the neurological symptoms eventually disappeared, and CBF improved. LESSONS The environment of cerebral hemodynamics is heterogeneous after cerebral revascularization for MMD, and the exact mechanism of CBF decreases was not identified. TNDs are significantly associated with the onset of stroke during the early postoperative period. Therefore, appropriate treatment is desired after determining complex cerebral hemodynamics using CBF studies.

DOI： 10.3171/CASE21628

Contrast-Enhanced Magnetic Resonance Imaging Suggested a Possibility of Transvenous Embolization in the Superior Petrosal Sinus Dural Arteriovenous Fistula: A Case Report Open Access

Nishihori, M; Izumi, T; Tsukada, T; Kato, Y; Uda, K; Yokoyama, K; Araki, Y; Saito, R

JOURNAL OF NEUROENDOVASCULAR THERAPY 16 巻 ( 3 ) 頁： 163 - 169 2022年

Atypical Incomplete Detachment Following PulseRider Deployment Open Access

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

JOURNAL OF NEUROENDOVASCULAR THERAPY 16 巻 ( 8 ) 頁： 409 - 412 2022年

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease. 国際誌 Open Access

Araki Y, Yokoyama K, Uda K, Kanamori F, Mamiya T, Takayanagi K, Ishii K, Shintai K, Nishihori M, Tsukada T, Takeuchi K, Tanahashi K, Nagata Y, Nishimura Y, Tanei T, Nagashima Y, Muraoka S, Izumi T, Seki Y, Saito R

Surgical neurology international 13 巻頁： 511 - 511 2022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: The aim of this study was to investigate the association between early postoperative slow flow in bypass grafts and preoperative focal cerebral blood flow (CBF) in patients who underwent combined surgery for moyamoya disease (MMD). Methods: The subjects were 18 patients (22 surgeries) who underwent single photon emission computed tomography (SPECT) before surgery. The CBF value of the middle cerebral artery territory was extracted from the SPECT data, and the value relative to the ipsilateral cerebellar CBF (relative CBF, or RCBF) was calculated. The association between RCBF and early postoperative slow flow in the bypass graft was investigated. In addition, the correlation between the revascularization effect and preoperative RCBF was analyzed. Results: In four of 22 surgeries (18.2%), slow flow in the bypass graft was identified in the early postoperative period. Preoperative RCBF in the slow flow and patent groups was 0.86 ± 0.15 and 0.87 ± 0.15, respectively, with no significant difference (P = 0.72). The signal intensity of four slow-flowed bypasses was improved in all cases on magnetic resonance angiography images captured during the chronic phase (mean of 3.3 months postoperatively). The revascularization scores were 2 ± 0.82 and 2.1 ± 0.68 in the slow flow and patent groups, respectively, and did not differ significantly (P = 0.78). A significant correlation was not observed between preoperative RCBF and the revascularization effect. Conclusion: No significant association was observed between preoperative RCBF and early postoperative slow flow in bypass grafts in patients with MMD undergoing combined surgery. Given the high rate of improved depiction of slow-flowed bypass in the chronic postoperative phase, the conceptual significance of an opportune surgical intervention is to maintain CBF by supporting the patient's own intracranial-extracranial conversion function.

DOI： 10.25259/SNI_772_2022

Dural Arteriovenous Fistula Mimicking a Brain Tumor on Methionine-positron Emission Tomography: A Case Report.

Hanyu T, Nishihori M, Izumi T, Motomura K, Ohka F, Goto S, Araki Y, Yokoyama K, Uda K, Saito R

NMC case report journal 9 巻 ( 0 ) 頁： 289 - 294 2022年

Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series Open Access

Araki Y., Mamiya T., Fujita N., Yokoyama K., Uda K., Kanamori F., Takayanagi K., Ishii K., Nishihori M., Takeuchi K., Tanahashi K., Nagata Y., Nishimura Y., Tanei T., Muraoka S., Izumi T., Kato K., Saito R.

Journal of Neurosurgery: Case Lessons 3 巻 ( 19 ) 2022年

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

BACKGROUND Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (DRCBF) (to ipsilateral cerebellar ratio (denoted DRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the DRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke.

DOI： 10.3171/CASE2274

Postoperative stroke and neurological outcomes in the early phase after revascularization surgeries for moyamoya disease: an age-stratified comparative analysis 国際誌

Araki, Y; Yokoyama, K; Uda, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Izumi, T; Sumitomo, M; Okamoto, S; Matsui, K; Emoto, R; Wakabayashi, T; Matsui, S; Natsume, A

NEUROSURGICAL REVIEW 44 巻 ( 5 ) 頁： 2785 - 2795 2021年10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

Stroke and neurological outcomes in the early phase following revascularization for moyamoya disease (MMD) may depend on the patient’s age. In this study, an age-stratified comparative analysis was performed to clarify this issue. We reviewed 105 MMD patients who underwent 179 revascularization surgeries. The demographic characteristics were collected in four age groups (≤ 5 and 6–17 years for pediatric patients and 18–49 and ≥ 50 years for adults). Additionally, we assessed the incidence of subsequent stroke and deterioration of modified Rankin Scale (mRS) score. Then, we evaluated predictors of postoperative stroke and mRS deterioration using logistic regression. The mean patient age was 26.2 ± 18.5 years. No significant difference in the incidence of postoperative stroke was observed between age groups; however, the incidence tended to be increased among patients aged ≤ 5 years (17.9%) and patients aged ≥ 50 years (16.7%). Deterioration of mRS scores was significantly associated with ages ≤ 5 years (17.9%) and ≥ 50 years (11.1%). Logistic regression showed that posterior cerebral artery involvement (odds ratio [OR], 4.6) and postoperative transient neurological events (TNEs) (OR, 5.93) were risk factors for postoperative stroke. Age ≤ 5 years (OR, 9.73), postoperative TNEs (OR, 7.38), and postoperative stroke (OR, 49) were identified as predictors of unfavorable neurological outcomes. The novel feature of this comparative analysis by age group is that membership in the early-childhood MMD patient group (under 5 years old) was an independent risk factor for unfavorable short-term neurological outcomes and was mainly associated with the incidence of postoperative severe cerebral infarction.

DOI： 10.1007/s10143-020-01459-0

Triggering of Carotid Sinus Reflex during Deployment the Flow-diverter Device Open Access

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

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 10 ) 頁： 583 - 590 2021年10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：一般社団法人日本脳神経外科学会

The carotid sinus reflex (CSR) is a rare complication of the Pipeline Embolization Device (PED) deployment. No study has assessed the potential risk factors in a case series. The purpose of this study was to examine CSR triggering during PED deployment. Thirty-seven consecutive patients who underwent PED deployment were included. All procedures were performed under local anesthesia with mild sedation. We retrospectively analyzed patient characteristics, PED deployment time, and vital signs during the procedure. The vital signs included the pulse rate (PR) and systolic blood pressure (SBP) obtained at three timepoints (pre-deployment, during deployment, post-deployment). We examined the triggering of the CSR during PED deployment by comparing the vital signs at the three timepoints. Moreover, risk factors for CSR were analyzed with univar-iate analysis. The patients’ average age was 66.3 years. The average size of the aneurysm was 18.0 mm. Six patients (16.2%) showed a decline in the SBP or PR defined as CSR. One patient had a transient cardiac arrest and two had severe transient bradycardia. Deployment into the ophthalmic segment of the internal carotid artery (C2 segment) aneurysm (p = 0.022), prolonged PED deployment time more than 14.5 minutes (p = 0.005), and an acute angle of the anterior genu less than 51.5 degrees (p = 0.005) were risk factors in triggering CSR. CSR may be triggered during PED deployment under local anesthesia with mild sedation. Deployment to the C2 segment aneu-rysm, prolonged PED deployment time, and an acute angle of the anterior genu were associated with CSR triggering.

DOI： 10.2176/nmc.oa.2021-0049

アクセス困難な硬膜動静脈瘻症例における、対側上錐体静脈洞を経由する上錐体静脈洞へのアプローチ

鈴木啓太, 西堀正洋, 泉孝嗣, 鈴木宰, 武藤学, 荒木芳生, 宇田憲司, 横山欣也, 齋藤竜太

脳血管内治療 6 巻 ( 3 ) 頁： 161 - 168 2021年10月

記述言語：日本語出版者・発行元：(NPO)日本脳神経血管内治療学会

【目的】多発硬膜動静脈瘻(dural arteriovenous fistula:DAVF)の症例において,左上錐体静脈洞部(superior petrosal sinus:SPS)のシャントを右SPS経由で塞栓した症例を報告する.【症例】60歳女性,意識障害の精査にて深部静脈逆流を伴う多発DAVFを認めた.逆流に最も関与する左横静脈洞部DAVFに対して経静脈的塞栓術を施行した.術後症状改善が乏しく,再度DSAを行うと,左SPSへのシャントと深部静脈への逆流が明らかとなった.左横静脈洞と両側下錐体静脈洞は閉塞していたため,右SPSと両側海綿静脈洞を経由してマイクロカテーテルをシャント部へ誘導し,左SPSを塞栓し,逆流の消失を得た.【結論】対側SPSを経由したSPSへのアクセスは,同側からのアクセスが困難な症例において,有効な選択肢になり得る.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J06751&link_issn=&doc_id=20211027220008&doc_link_id=%2Fcf5nokec%2F2021%2F000603%2F008%2F0161-0168%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2021%2F000603%2F008%2F0161-0168%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Streak Metal Artifact Reduction Technique in Cone Beam Computed Tomography Images after Endovascular Neurosurgery Open Access

Otsuka, T; Nishihori, M; Izumi, T; Uemura, T; Sakai, T; Nakano, M; Kato, N; Kanamori, F; Tsukada, T; Uda, K; Yokoyama, K; Araki, Y; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 8 ) 頁： 468 - 474 2021年8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：一般社団法人日本脳神経外科学会

Cone beam computed tomography (CBCT) images are degraded by artifacts due to endovascular implants. We evaluated the use of streak metal artifact reduction technique (SMART) in non-contrast CBCT images after endovascular neurosurgery obtained from 148 patients (125 with aneurysm and 23 with dural arteriovenous fistula [dAVF]). Three neurosurgeons evaluated the cistern and brain surface visibility in CBCT images with and without SMART correction based on a 4-point scale (1, excellent; 2, good; 3, limited; and 4, insufficient). Significant improvement in visibility was achieved when the median scores improved from 4 or 3 to 2 or 1 or from 2 to 1. Metal artifact reduction in adjacent slices without metal and new artifacts after SMART correction was also examined. A significant improvement was achieved regarding the visibility of the cistern in 90 (60.8%) images and of the brain surface in 108 (73.0%) images. Metal size (cistern: odds ratio [OR], 0.91 per 1 mm increase; 95% confidence interval [CI], 0.83–0.99), irregular metal shape (cistern: OR, 0.18; 95% CI, 0.05–0.60 and brain surface: OR, 0.15; 95% CI, 0.05–0.45), and infratentorial lesions (cistern: OR, 0.37; 95% CI, 0.14–0.96 and brain surface: OR, 0.30; 95% CI, 0.11–0.80) were negatively correlated with improved visibility. Metal artifact reduction in adjacent slices without metal was obtained in 25.6% and 34.8% of images with aneurysm and dAVF, respectively. New artifacts after SMART correction were found in 4.8% and 13.0% of images with aneurysm and dAVF, respectively. SMART is especially effective for supratentorial small aneurysms.

DOI： 10.2176/nmc.oa.2021-0014

Indocyanine green emission timing of the recipient artery in revascularization surgery for moyamoya disease Open Access

Kanamori, F; Araki, Y; Yokoyama, K; Uda, K; Mamiya, T; Nishihori, M; Izumi, T; Okamoto, S; Natsume, A

NAGOYA JOURNAL OF MEDICAL SCIENCE 83 巻 ( 3 ) 頁： 523 - 534 2021年8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

In superficial temporal artery to middle cerebral artery anastomosis with indirect revascularization for patients with moyamoya disease, the optimal method for selecting the most appropriate cortical artery for the recipient in anastomosis has not been established. We investigated the relationship between the fluorescence emission timing of the recipient artery in the preanastomosis indocyanine green videoangiography and operative outcomes. This retrospective study included 51 surgical revascularization procedures for 39 moyamoya disease patients. The enrolled surgical procedures were classified into three groups based on the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography: the EARLIEST, the INTERMEDIATE, and the LATEST. Clinical characteristics and operative outcomes were also collected. The occurrence of white thrombus at the anastomosis site and symptomatic hyperperfusion showed significant differences between the groups classified by the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography (white thrombus, p = 0.001; symptomatic hyperperfusion, p = 0.026). The development of white thrombi was significantly higher in the LATEST group, and all symptomatic hyperperfusion was observed in the EARLIEST group. These results indicated that the LATEST group had a significantly higher risk for developing white thrombus, and the EARLIEST group was prone to occur symptomatic hyperperfusion. Selecting the recipient artery based on evaluating the fluorescence emission timing in preanastomosis indocyanine green videoangiography may be useful in reducing perioperative complications.

DOI： 10.18999/nagjms.83.3.523

Evaluation of the Straightening Phenomenon of Various Types of Coils Open Access

Ishida, M; Izumi, T; Araki, Y; Nishihori, M; Yokoyama, K; Uda, K; Tsukada, T; Wakabayashi, T

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 6 ) 頁： 356 - 360 2021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：一般社団法人日本脳神経外科学会

The straightening phenomenon is known as a cause of catheter kickback in the late phase of coil embolization. The mechanism is supposed to be the relative shortage of the stretch resistance (SR) line, and it occurs when a coil is folded too small. Among many SR coils available, there should be a coil-specific tendency to cause this phenomenon. Here, we conducted an in-vitro experiment to know which coil is the most resistant to the straightening phenomenon. We developed an experimental model to reproduce the straightening phenomenon. Five different coils (Axium Prime, ED Coil, Hypersoft, SMART Coil, and Target 360 nano) of the same size (3 mm × 6 cm) were investigated for five times each. Resistance to the straightening phenomenon, which is represented by the insertion length at the onset of the phenomenon, was compared among coil types. The straightening phenomenon was successfully observed in all insertions. Insertion lengths were significantly different among coil types (p = 0.013). The insertion length of ED was the longest (mean ± SD, 27.0 ± 8.3 mm), which means the most resistant to the phenomenon. Axium was second (21.6 ± 7.0 mm), followed by Target (15.8 ± 6.9 mm), Hypersoft (13.8 ± 5.8 mm), and SMART (12.4 ± 4.7 mm). Difference between ED and Hypersoft (p = 0.037) and difference between ED and Smart (p = 0.018) were significant. ED coil was the one with the most resistance to the straightening phenomenon. Selecting the optimal coil is the key to avoid the phenomenon.

DOI： 10.2176/nmc.oa.2020-0348

Effects of aspirin and heparin treatment on perioperative outcomes in patients with Moyamoya disease 査読有り国際誌

Kanamori, F; Araki, Y; Yokoyama, K; Uda, K; Mamiya, T; Nishihori, M; Izumi, T; Okamoto, S; Natsume, A

ACTA NEUROCHIRURGICA 163 巻 ( 5 ) 頁： 1485 - 1491 2021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：Acta Neurochirurgica

Background: When superficial temporal artery-middle cerebral artery bypass is combined with indirect methods (e.g., revascularization surgery) to treat Moyamoya disease (MMD), antiplatelet treatment can impact bypass patency, infarction, or hemorrhage complications. Recently, heparin has been proposed as an anticoagulant treatment against white thrombus at the anastomosis site. The study aims to evaluate the effect of aspirin on the perioperative outcomes and investigate the results of heparin treatment for white thrombus. Methods: This retrospective study included 74 procedures of combined revascularization surgery for MMD patients who either received or did not receive aspirin. Perioperative outcomes were compared between the two groups. In addition, the effects of heparin treatment for white thrombus were evaluated. Results: The rate of white thrombus at the anastomosis site was significantly higher in the non-aspirin medication group (univariate: p = 0.032, multivariate: p = 0.044) and, accordingly, initial bypass patency was lower in the non-aspirin medication group (p = 0.049). Of the 17 patients with white thrombus development, five received heparin injections, and all white thrombi disappeared; however, there was one case of epidural hematoma and another of subdural hematoma. The risk of hemorrhagic complications was significantly higher in the surgical procedures that received heparin injections (p = 0.021). Conclusions: In MMD patients who received combined revascularization surgery, aspirin medication lowered the occurrence of white thrombus. Heparin injections help to treat white thrombus but can enhance the risk of hemorrhagic complications.

DOI： 10.1007/s00701-020-04668-0

Ipsilateral late stroke after revascularization surgery for patients with Moyamoya disease 国際誌

Araki, Y; Yokoyama, K; Uda, K; Kanamori, F; Mamiya, T; Nishihori, M; Sumitomo, M; Okamoto, S; Izumi, T

ACTA NEUROCHIRURGICA 163 巻 ( 5 ) 頁： 1493 - 1502 2021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：Acta Neurochirurgica

Background: Ipsilateral late stroke events occurring after cerebral revascularization for Moyamoya disease (MMD) and their risk factors have not been fully investigated. Methods: We retrospectively analyzed 123 patients with MMD who underwent 212 revascularizations. We investigated preoperative demographic data, surgical procedures, and ipsilateral stroke events occurring more than 1 month after surgery. The effect of revascularization and the residual Moyamoya vessel (MMV) score were examined using magnetic resonance angiography (MRA). Then, predictive factors for postoperative late stroke occurrence were evaluated by logistic regression. Results: The mean age was 26 ± 18.4 years (range 1 to 66 years). Ipsilateral late stroke events were present in 11 of 123 (9%) patients. Stroke occurred in 11 out of 212 surgeries (5.2%) on a hemispheric basis. During the 1300.1 hemisphere-years of follow-up more than 1 month after surgery, the annual stroke rate was 0.84%. The postoperative MRA time-of-flight image showed a mean revascularization score of 1.82 ± 0.6 and a mean residual MMV score of 1.91 ± 0.83. Postoperative strokes occurring within 1 month after cerebral revascularization (36.4%, p = 0.0026) and lower revascularization scores (1.82 ± 0.6 vs 2.51 ± 0.59, p = 0.0006) were significant factors related to the presence of ipsilateral late stroke. Logistic regression showed that stroke events within 1 month after revascularization (odds ratio [OR], 9.79; 95% confidence interval [CI], 0.02–0.57; p = 0.0103), low revascularization score (OR, 0.15; 95% CI, 0.001–0.37; p = 0.0069), and high residual MMV score (OR, 16.2; 95% CI, 1.88–187.4; p = 0.0107) were risk factors for ipsilateral stroke more than 1 month after revascularization. Conclusions: MMD patients who have a stroke within 1 month after cerebral revascularization are at high risk for late strokes. Less effective revascularization or remarkable residual MMV are risk factors for late stroke events. Additional revascularization may be considered for patients in such situations. Clinical trial registration: This study was approved by the Bioethics Review Committee of Nagoya University Hospital for the treatment and prognosis of Moyamoya disease (2016-0327).

DOI： 10.1007/s00701-021-04773-8

破壊大型脳底動脈瘤に対するステント支援コイル塞栓術後に2度の帝王切開による分娩を経験した1例

加藤直毅, 泉孝嗣, 西堀正洋, 塚田哲也, 荒木芳生, 横山欣也, 宇田憲司, 松原功明, 纐纈直樹

脳血管内治療 6 巻 ( 1 ) 頁： 24 - 29 2021年5月

記述言語：日本語出版者・発行元：(NPO)日本脳神経血管内治療学会

【目的】ステント留置後妊娠において,抗血栓療法に関する明確な基準は認めない.われわれは破裂大型脳底動脈瘤に対してステント支援コイル塞栓術を施行し,2度の出産を経験した症例を報告する.【症例】27歳女性.脳底動脈瘤破裂によるくも膜下出血を発症し,ステント支援コイル塞栓術を施行した.33歳時に体外受精にて妊娠した.抗血小板剤は治療3年後に中止となっていたが,妊娠時の過凝固を考慮しアスピリンを開始,28週からヘパリン皮下注射へ切り替え,帝王切開で児を分娩した.母子共に合併症なく経過した.35歳時の妊娠も同内容の抗血栓療法を行い,合併症なく経過した.【結論】周産期抗血栓療法によって合併症なく2度の分娩を経験した.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J06751&link_issn=&doc_id=20210527200004&doc_link_id=%2Fcf5nokec%2F2021%2F000601%2F004%2F0024-0029%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2021%2F000601%2F004%2F0024-0029%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Development and clinical evaluation of a contactless operating interface for three-dimensional image-guided navigation for endovascular neurosurgery 査読有り国際誌 Open Access

Nishihori, M; Izumi, T; Nagano, Y; Sato, M; Tsukada, T; Kropp, AE; Wakabayashi, T

INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY 16 巻 ( 4 ) 頁： 663 - 671 2021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：International Journal of Computer Assisted Radiology and Surgery

Purpose: In endovascular neurosurgery, the operator often acquires three-dimensional (3D) images of the cerebral vessels. Although workstation reoperation is required in some situations during treatment, it leads to time loss because a sterile condition cannot be maintained and treatment must be temporarily interrupted. Therefore, a workstation reoperating system is required while maintaining the desired sterility. Methods: A contactless operating interface using Kinect to control 3D images was developed via gesture recognition for endovascular neurosurgery and was applied to a 3D volume rendering technique (VRT) image reconstructed at the workstation. The left-hand movement determines the assigned functions, whereas the right-hand movement is used like a computer mouse to pan and zoom in/out. In addition to the interface, voice commands were used and assigned to digital operations, such as image view changes and mode signal changes. Results: This system was used for the actual endovascular treatment of cerebral aneurysms and cerebral arteriovenous malformations. The operator and gesture were recognized without any problems. Using voice operation, it was possible to expeditiously set the VRT image back to the reference angle. Furthermore, it was possible to finely adjust gesture operations, including mouse operation, and treatment was completed while maintaining sterile conditions. Conclusion: A contactless operating interface was developed by combining the existing workstation system with Kinect and voice recognition software, allowing surgeons to perform a series of operations, which are normally performed in a console room, while maintaining sterile conditions.

DOI： 10.1007/s11548-021-02330-3

Short-segment Internal Trapping for Symptomatic Thrombosed Large Fusiform Vertebral Artery Aneurysms (Bird's Nest Trapping): A Technical Note Open Access

Nishihori, M; Izumi, T; Tsukada, T; Kropp, AE; Uda, K; Yokoyama, K; Araki, Y; Wakabayashi, T

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 4 ) 頁： 284 - 291 2021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：一般社団法人日本脳神経外科学会

Internal trapping with coils is an established treatment of symptomatic large non-branching thrombosed fusiform vertebral artery aneurysms (VAA). However, when perforators arise near the aneurysm neck, parent artery occlusion has a high risk of causing medullary infarction. As an alternative treatment, we performed short-segment internal trapping of the artery using n-butyl-2-cyanoacrylate (NBCA) and coils (bird’s nest trapping). Before treatment, perianeurys-mal perforators are carefully detected using high-resolution three-dimensional rotational angiog-raphy (3DRA). Double microcatheters are advanced to the distal portion of the aneurysm through a balloon guiding catheter where coils are deployed without tight packing. Then, NBCA is injected into the coil mass, taking care to preserve perforators and significant branches. The same maneu-ver is repeated in the proximal portion of the aneurysm. Coil placement is avoided within the middle of the aneurysm; however, if necessary, only a small number of coils are placed to prevent worsening of mass effect. Two quinquagenarian males presented with a large thrombosed fusi-form VAA that caused symptoms due to mass effect. In each case, perforators arose from the parent artery and short-segment internal trapping with NBCA and coils was performed. Symptoms improved after treatment and follow-up imaging confirmed aneurysm shrinkage with no long-time recurrence. In symptomatic large fusiform VAAs where the distance from the lesion to important perforators is extremely short, internal trapping using a combination of NBCA and coils can be more useful than conventional internal trapping.

DOI： 10.2176/nmc.tn.2020-0329

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