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

Objectives: Vascular Eagle syndrome (ES) is a rare condition involving vessel compression by an elongated styloid process, leading to neurologic symptoms. Here, we present the case of a patient with a complication of carotid artery stenting for vascular ES and discuss the implications of treatment of this rare condition. Case description: A 35-year-old previously healthy male patient presented with transient aphasia and right-sided hemiparesis following ischemic stroke in left frontal lobe. Digital subtraction angiography revealed a large aneurysm with stenosis of the left cervical internal carotid artery, and computed tomography (CT) demonstrated elongated ipsilateral styloid process. Progressive aneurysm enlargement required coil embolization and carotid artery stenting (CAS). Cervical X-ray obtained 1 year later revealed the fracture and fragmentation of the carotid stent. Imaging studies identified multiple stent fragments dispersed in distal arteries and a dissecting aneurysm with an irregular wall at the site of the stent site. Dynamic cone-beam CT scan without contrast performed during neck movement, revealed that the styloid process tip was adjacent to the stent fracture line, confirming vascular ES. The symptomatic left styloid process was resected, followed by repeat CAS. The dissecting aneurysm was thrombosed post-CAS, and the patient remained asymptomatic without complications at 6-month follow-up. Conclusion: In patients with vascular ES, diagnostic imaging should include dynamic evaluations to assess cervical dynamics and the resection of styloid process is essential to prevent chronic stent fracture.

DOI： 10.1016/j.jstrokecerebrovasdis.2024.108202

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7759/cureus.74971

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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: Transient neurological deficits (TNDs) are known to develop after direct bypass for Moyamoya disease and may be risk factors for subsequent stroke. However, the factors involved in the development of TNDs and stroke after indirect revascularization alone, including their association with subsequent stroke, remain unclear. The purpose of this study was to investigate this issue. Methods: The subjects of the study were 30 patients with Moyamoya disease who underwent a total of 40 indirect revascularization procedures at our institution. Clinical and radiological data were collected retrospectively. To examine factors associated with the development of postoperative TND/stroke/asymptomatic disease, the clinical characteristics of each group were statistically compared. Results: The mean age at surgery was 7 years (range 1–63). TNDs developed after surgery in 9 out of 40 patients (22.5%). Stroke in the acute postoperative period occurred in 3 patients (7.5%), all of whom experienced cerebral infarctions. Demographic data and preoperative clinical information were not different between the groups. However, posterior cerebral artery involvement on preoperative imaging was significantly associated with the development of TNDs and stroke (P = 0.006). Furthermore, postoperative stroke was associated with unfavorable outcomes (P = 0.025). Conclusions: Posterior cerebral artery involvement is significantly associated with the occurrence of TNDs. In contrast, TNDs after indirect revascularization have little relationship with the subsequent development of stroke. TNDs usually resolve without new strokes, and a better understanding of this particular pathology could help establish an optimal treatment regimen.

DOI： 10.1016/j.wneu.2024.04.135

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuroradiology  

This report examines delayed leukoencephalopathy as a postoperative complication after the use of flow diverter (FD) devices for endovascular cerebral aneurysm treatment. A case involving a 78-year-old female treated with a pipeline embolization device for a left internal carotid artery aneurysm is presented. Despite adherence to dual anti-platelet therapy, the patient developed intermittent headaches and memory issues 3 months post-operation. MRI revealed T1-enhancing foci and T2 hyperintense signal abnormalities in the left cerebral hemisphere, without new ischemic lesions, indicating potential embolic events or foreign body reactions. Following aphasia, a change from clopidogrel to prasugrel and the initiation of steroid pulse therapy led to the resolution of symptoms and MRI abnormalities over 6 months. This case underscores the reversibility of delayed leukoencephalopathy with appropriate intervention.

DOI： 10.1007/s00234-024-03281-7

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

Objective: This study aimed to analyze whether the development of donor vessels after combined revascularization surgery for moyamoya disease (MMD) is related to cerebral blood flow (CBF) changes. Methods: We retrospectively reviewed the charts of 11 adult (12 hemispheres) and 13 pediatric (19 hemispheres) patients who underwent combined revascularization in our department. The total vessel cross-sectional area (TVA) was the sum of the cross-sectional areas of the superficial temporal, middle meningeal, and deep temporal arteries imaged using time-of-flight magnetic resonance angiography. The ipsilateral relative CBF (RCBF) on the brain surface in the craniotomy area was calculated by single-photon emission computed tomography. ΔTVA and ΔRCBF were defined as the preoperative and postoperative ratios of TVA and RCBF, and their correlations were analyzed in adult and pediatric patients. Results: The TVA and RCBF showed a significant increase after surgery, regardless of the age group. However, there was no significant correlation between ΔTVA and ΔRCBF in either the adult or pediatric groups. While the adult group exhibited significantly higher ΔRCBF values compared to the pediatric group (p < 0.01, r = −0.44), the ΔTVA values were higher in the pediatric group compared to the adult group (p = 0.06). Conclusions: In the chronic phase after combined revascularization surgery for MMD, the development of measurable TVA of donor vessels does not necessarily correlate with an increase in CBF around the craniotomy area.

DOI： 10.1016/j.clineuro.2023.108110

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

<p>クラゾセンタンはくも膜下出血後のスパズムに伴う遅発性脳虚血（delayed cerebral ischemia：DCI）および新規脳梗塞の発症を抑制するために使用される新規薬剤である．この研究ではクラゾセンタンを使用した当科での約 1 年間の初期治療経験について調査した．評価項目は患者背景，臨床的特徴，画像上スパズム，DCI/新規脳梗塞，体液貯留に伴う合併症，その他の合併症とした．対象は 32 例で 25 例にクラゾセンタンが使用された．クラゾセンタン使用群では 10 例（31％）に画像上スパズムが認められ，1 例（4％）に DCI，4 例（16％）に新規脳梗塞を認めた．体液貯留合併症は 13例（52％）で発生した．患者背景，臨床的特徴，クラゾセンタン以外の併用薬などで第III相試験と差はあるものの，結果は DCI や新規脳梗塞の予防におけるクラゾセンタンの有効性が示されるものであった．体液貯留合併症を回避するための理想的な体液管理プロトコルを確立するには，より多くの症例を蓄積する必要があると考えられた．</p>

DOI： 10.2335/scs.52.258

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担当区分：筆頭著者,　責任著者   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  

Cerebrovascular complications of central nervous system tuberculosis (TB) are predictors of poor prognosis and adverse outcomes. These complications are mainly intracranial arterial involvement, with occasional venous involvement. Here, we present a 67-year-old woman with concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated by miliary tuberculosis. Mycobacterium tuberculosis was observed on the luminal side of the carotid plaques in pathological specimens. Treatment with anti-TB drugs alone would likely not cure the patient, as M. tuberculosis would continue to disseminate. Endarterectomy could directly remove the embolic source, and a complete cure was achieved.

DOI： 10.1007/s00701-023-05489-7

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その他リンク： https://link.springer.com/article/10.1007/s00701-023-05489-7/fulltext.html

担当区分：筆頭著者,　責任著者   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  

Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5–6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.

DOI： 10.1007/s10143-022-01820-5

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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

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出版者・発行元：Journal of Neurosurgery  

OBJECTIVE Although many studies have analyzed risk factors for contralateral progression in unilateral moyamoya disease, they have not been fully elucidated. The aim of this study was to examine whether genetic factors as well as nongenetic factors are involved in the contralateral progression. METHODS The authors performed a multicenter cohort study in which 93 cases with unilateral moyamoya disease were retrospectively reviewed. The demographic features, RNF213 R4810K mutation, lifestyle factors such as smoking and drinking, past medical history, and angiographic findings were analyzed. A Cox proportional hazards model was used to find risk factors for contralateral progression. RESULTS Contralateral progression was observed in 24.7% of cases during a mean follow-up period of 72.2 months. Clinical characteristics were not significantly different between 67 patients with the R4810K mutation and those without it. Cox regression analysis showed that the R4810K mutation (hazard ratio [HR] 4.64, p = 0.044), childhood onset (HR 7.21, p < 0.001), male sex (HR 2.85, p = 0.023), and daily alcohol drinking (HR 4.25, p = 0.034) were independent risk factors for contralateral progression. CONCLUSIONS These results indicate that both genetic and nongenetic factors are associated with contralateral progression of unilateral moyamoya disease. The findings would serve to help us better understand the pathophysiology of moyamoya disease and to manage patients more appropriately.

DOI： 10.3171/2021.3.JNS203913

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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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PLoS ONE  

A percutaneous coronary intervention (PCI) is widely performed for acute coronary syndromes or chronic coronary syndromes. Periprocedural stroke is a clinically significant complication during PCI. The incidence of cerebrovascular events (CVEs) after PCI in the chronic phase is obscure. This study aimed to investigate the prevalence of CVEs after PCI in the chronic phase and evaluate the usefulness of a simple coronary artery calcification (CAC) evaluation method. This prospective observational study included 179 patients who underwent PCI between January 2016 and December 2018. The incidence of cerebral infarction was examined from one month after PCI to December 2019. In total, 171 individuals (134 men; mean age, 69.8 ± 9.8 years) were recruited. During a median follow-up period of 33 months, the onset of cerebral infarction was observed in 20 individuals (11.7%). More CAC sites (p = 0.009) and post-PCI for the chronic coronary syndrome (p = 0.049) showed a significant association with future CVEs. There was no significant cervical internal carotid artery stenosis for patients who occurred CVEs. The cutoff value for the number of CAC sites for predicting future CVEs was 4.5. The new and easy method accurately reflected future CVEs risk and may be clinically applicable. Copyright:

DOI： 10.1371/journal.pone.0251253

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担当区分：筆頭著者,　責任著者   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  

Moyamoya disease (MMD) causes intracranial arterial stenosis progression. The progression of intracranial arterial stenosis will increase the risk of ischemic cerebrovascular events. This study aims to investigate the relationship between intracranial arterial stenosis progression, vessel wall enhancement (VWE), and the recent neurological symptoms. A total of 39 MMD patients (12 male 37.6 ± 18.0 years old) were registered in this study analysis between April 2016 and July 2018. All patients received MRI at registration and 6, 12, and 24 months post-registration. The incidence of ischemic cerebrovascular events (transit ischemic attacks or cerebral infarction) was checked until December 2018. We evaluated the relationship between the intensity of VWE, intracranial arterial stenosis, and the recent neurological symptoms. During the mean follow-up period of 13.8 ± 5.5 months, the changes in VWE were observed in 33 hemispheres (42.3%), stenosis progression was observed in 21 hemispheres (26.9%), and recent neurological symptoms occurred in 10 hemispheres (12.8%). Stenosis progression was observed in 11 hemispheres (33.3%) in the VWE(+) group and ten hemispheres (22.2%) in the VWE(-) group (p = 0.310). The recent neurological symptoms were observed in eight hemispheres (21.2%) in the VWE(+) group and two hemispheres (4.44%) in the VWE(-) group (odds ratio 6.88, 95% confidence interval 1.35-34.98, p = 0.015). The intensity of VWE sometimes changes. The changes in VWE were significantly associated with the recent neurological symptoms but not with stenosis progression.

DOI： 10.2176/nmc.oa.2021-0058

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

<p> 突然の頭痛を契機とする急速な意識障害で発症したSLE罹患中の43歳女性. 急性硬膜下血腫を認め, 術中所見から右後大脳動脈末梢性脳動脈瘤が出血源と判断した. 術後精査でもう1箇所の末梢性動脈瘤と右内頚動脈終末部狭窄を認め, 類もやもや病と判断した. 経過中, 残存動脈瘤も破裂したため開頭で摘出した. 2箇所の動脈瘤病理検査では, perivascular infiltrationと血管拡張傾向を認め, 典型的な血管炎はなかった.</p><p> SLE合併脳動脈瘤の病理学的な報告はきわめてまれで, 血管炎が原因とするものが多いが, 本症例では, 典型的血管炎以外の複合的要因により, 動脈瘤の発生破裂に至ったと考えられた.</p>

DOI： 10.7887/jcns.29.375

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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  

Background: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a well-described subset of subarachnoid hemorrhage with an excellent prognosis in adults. However, its characteristics in the pediatric population have not yet been fully understood. We present a case of acute hydrocephalus requiring external ventricular drainage following pediatric PNSAH. Case Description: A previously healthy 10-year-old girl was admitted to our neurosurgical department after sudden onset of severe headache with vomiting during exercise. Cerebral non-contrast computed tomography detected subarachnoid hemorrhage filling all perimesencephalic cisterns. However, digital subtraction angiography could not locate the hemorrhage source. Her consciousness deteriorated within 7 hours of onset, and a computed tomography scan revealed acute hydrocephalus. We subjected the patient to external ventricular drainage for 10 days. She was discharged after 38 days of hospitalization, when she was physically and neuropsychologically healthy. Repeated digital subtraction angiography performed at the 6-month follow-up did not show any obvious source of hemorrhage except for a variant drainage pattern of the basal vein of Rosenthal. Based on the observations, we diagnosed the patient with PNSAH of a venous origin. Conclusions: We propose that acute hydrocephalus be suspected in pediatric patients with nonaneurysmal subarachnoid hemorrhage filling all perimesencephalic cisterns, as in adults. We also propose that one of the possible causes of pediatric PNSAH as of venous origin and related to the abnormal drainage pattern of basal vein of Rosenthal and elevation of venous pressure with exercise. Immediate surgical drainage could obtain a good outcome in a symptomatic case.

DOI： 10.1016/j.wneu.2019.06.090

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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  

Background: Posterior cerebral artery (PCA) aneurysms are relatively rare, and neck clipping is often difficult due to their fusiform shape. We report a case of a thrombosed aneurysm of the distal PCA for which curative trapping and parent artery reconstruction by in situ bypass were performed through an occipital transtentorial approach (OTA). Case Description: A 67-year-old woman had been suffering from numbness in the right face and limbs for 4 months. Radiologic imaging demonstrated a thrombosed aneurysm on a distal portion of the left PCA. Curative trapping of the aneurysm and in-situ bypass between the distal PCA and superior cerebellar artery were performed through the OTA. Before surgery, we had evaluated access to the PCA and feasibility of the bypass in a cadaveric simulation. The PCA was well exposed in the posterior half of the ambient cistern, and the proximity of the distal PCA to the superior cerebellar artery through a tentorial incision was confirmed. Conclusions: This OTA could represent a useful option for definitive treatment of distal PCA aneurysms.

DOI： 10.1016/j.wneu.2019.02.127

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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 Transient neurological events (TNEs) occur frequently in the acute phase after direct bypass surgery for moyamoya disease (MMD), but there is currently no way to predict them. FlowInsight is a specialized software for analyzing indocyanine green (ICG) videoangiography taken with a surgical microscope. The purpose of this study was to investigate whether intraoperative evaluation of local hemodynamic changes around anastomotic sites using FlowInsight could predict the incidence and duration of TNEs. METHODS From patients who were diagnosed with MMD in our hospital between August 2014 and March 2017 and who underwent superficial temporal artery–middle cerebral artery bypass surgery, we investigated 25 hemispheres (in 22 patients) in which intraoperative ICG analysis was performed using FlowInsight. To evaluate the local cerebral hemodynamics before and after anastomosis, regions of interest were set at 3 locations on the brain surface around the anastomotic site, and the mean cerebral blood flow (CBF), mean gradation (Grad), mean transit time (MTT), and mean time to peak (TTP) were calculated from the 3 regions of interest. Furthermore, the change rate in CBF (DCBF [%]) was calculated using the formula (postanastomosis mean CBF - preanastomosis mean CBF)/preanastomosis mean CBF. DGrad (%), DMTT (%), and DTTP (%) were similarly calculated. RESULTS Postoperative stroke without TNE occurred in 2 of the 25 hemispheres. These 2 hemispheres (in 2 patients) were excluded from the study, and data from the remaining 23 hemispheres (in 20 patients) were analyzed. For each parameter (DCBF, DGrad, DMTT, and DTTP) calculated by FlowInsight, the difference between the groups with and without TNEs was significant. The median values for DCBF and DGrad were significantly higher in the TNE group than in the no-TNE group (DCBF 30.13 vs 3.54, p = 0.0106; DGrad 62.05 vs 10.78, p = 0.00435), whereas the median values for DMTT and DTTP were significantly lower in the TNE group (DMTT -16.90 vs -7.393, p = 0.023; DTTP -29.07 vs -7.02, p = 0.00342). Comparison of the area under the curve (AUC) for each parameter showed that DTTP had the highest AUC and was the parameter with the highest diagnostic accuracy (AUC 0.857). The Youden index revealed that the optimal cutoff value of DTTP was -11.61 (sensitivity 77.8%, specificity 71.4%) as a predictor of TNEs. In addition, Spearman’s rank correlation coefficients were calculated, and DCBF, DGrad, DMTT, and DTTP each showed a strong correlation with the duration of TNEs. The larger the change in each parameter, the longer the TNEs persisted. CONCLUSIONS Intraoperative ICG videoangiography findings were correlated with the occurrence and duration of TNEs after direct bypass surgery for MMD. Screening for cases at high risk of TNEs can be achieved by ICG analysis using FlowInsight.

DOI： 10.3171/2017.10.JNS171523

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記述言語：英語   出版者・発行元：一般社団法人 日本脳神経外科学会  

DOI： 10.2176/nmccrj.cr.2017-0014

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

DOI： 10.2335/scs.46.439

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

名古屋大学脳神経外科関連施設46施設を対象に、杉田クリップの使用率をクリップ出荷率ベースで調査した。その結果、使用率は80%で、使用ラインナップは単純な形状のstraightとbayonetが43%を占めた。また、同門脳外科医60名に対し、6種類の特殊形状のクリップに対するアンケート調査を行った。その結果、経験年数に関わらず網羅的な杉田クリップに対する知識と使用経験が乏しかった。更に、杉田クリップ開発スケッチや杉田の手術記事を調査した。その結果、杉田クリップの形状は様々で、single clipping用としてクリップ固有の使用方法を想定しているものと、multiple clipping用として複数のクリップを組み合わせることで複雑な形状の瘤頸部を完全閉塞させるものと大別された。また、母血管の温存のため、瘤頸部の完全閉塞のみでなく親血管を狭窄・閉塞させないように変形を最小限に抑える工夫もされていた。

DOI： 10.2335/scs.45.83

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02079&link_issn=&doc_id=20170410320001&doc_link_id=%2Fcp4strok%2F2017%2F004502%2F001%2F0083-0088%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2017%2F004502%2F001%2F0083-0088%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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  

Aneurysms arising from the distal anterior inferior cerebellar artery (AICA) are very rare. When the parent artery is an AICA-posterior inferior cerebellar artery (PICA) variant, occlusion of the artery, even distal to the meatal loop, leads to a significant area of cerebellar infarction. We report two cases of ruptured partially thrombosed distal AICA aneurysms. In both cases, the parent artery was an AICA-PICA variant. The aneurysms were clipped in one case and trapped following occipital artery (OA)-AICA anastomosis in another case. It is important to keep the OA as a donor artery for revascularization in the treatment of the AICA-PICA variant aneurysms, especially when the absence of intra-aneurysmal thrombus is not comfirmed preoperatively.

DOI： 10.18999/nagjms.78.4.517

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担当区分：筆頭著者,　責任著者   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  

Background The mortality rate of central nervous system (CNS) Aspergillus infection is >90%. Most cases with ruptured aneurysmal formation resulting from CNS aspergilloma invasion into the arterial wall are difficult to treat with surgical therapy, antifungal drugs, or steroid administration. There is no established therapy for ruptured Aspergillus aneurysms. Both a standardized examination for the diagnosis of CNS aspergillosis and effective treatment of ruptured Aspergillus aneurysms are needed. Case Description A 56-year-old man developed prolonged fever and headache. Magnetic resonance imaging showed a mass lesion around the brainstem. No laboratory data were suspicious for inflammatory diseases or autoimmune diseases. Considering the invasiveness of a surgical approach, we initiated steroid pulse therapy to confirm whether the mass would shrink before biopsy or resection for definitive pathologic diagnosis. Cerebral infarction and subarachnoid hemorrhage occurred almost concurrently just after steroid therapy. We first performed decompression surgery to treat the elevated intracranial hypertension. The specimen taken from the mass lesion at the time of surgery showed CNS Aspergillus fungal forms. Endovascular treatment of the ruptured aneurysm was performed, and medical therapy with an antifungal drug was started. After the Aspergillus infection was well controlled, the patient was discharged. Glasgow Outcome Scale score at discharge was 3. Conclusions Although most patients with ruptured Aspergillus aneurysm have poor outcomes as reported in the literature, this patient's clinical course and outcome were good. Early recognition of CNS aspergillosis and timely surgical intervention to control the vascular event can improve the prognosis for these patients.

DOI： 10.1016/j.wneu.2016.03.021

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PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

J-GLOBAL

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

J-GLOBAL

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1436203266

CiNii Research

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

Disrupted-in-schizophrenia 1 (DISC1) is a susceptibility gene for major psychiatric disorders, including schizophrenia. DISC1 has been implicated in neurodevelopment in relation to scaffolding signal complexes. Here we used proteomic analysis to screen for DISC1 interactors and identified several RNA-binding proteins, such as hematopoietic zinc finger (HZF), that act as components of RNA-transporting granules. HZF participates in the mRNA localization of inositol-1,4,5-trisphosphate receptor type 1 (ITPR1), which plays a key role in synaptic plasticity. DISC1 colocalizes with HZF and ITPR1 mRNA in hippocampal dendrites and directly associates with neuronal mRNAs, including ITPR1 mRNA. The binding potential of DISC1 for ITPR1 mRNA is facilitated by HZF. Studies of Disc1-knockout mice have revealed that DISC1 regulates the dendritic transport of Itpr1 mRNA by directly interacting with its mRNA. The DISC1-mediated mRNA regulation is involved in synaptic plasticity. We show that DISC1 binds ITPR1 mRNA with HZF, thereby regulating its dendritic transport for synaptic plasticity.

DOI： 10.1038/nn.3984

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PubMed

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

もやもや病に対する浅側頭動脈(STA)-中大脳動脈(MCA)バイパス術では、術後急性期に一過性神経脱落症状を呈することがあり、脳血流をリアルタイムに測定するシステムが望まれている。インドシアニングリーンビデオ血管造影のデータと、超音波血流計の測定値を、専用のソフトウエアを用いて解析し、任意の局所脳血流を仮想的に定量化する方法を開発し、バイパス術の前と後の局所脳血流の変化と一過性神経脱落症状との関連を検討した。症例は8歳男児で、右上肢脱力発作で発症し、脳循環不全が認められ、STA-MCAバイパス術を施行した。本法により、バイパス術後の局所脳血流量の増加が示されたが、術後の一過性神経脱落症状は見られなかった。

DOI： 10.2335/scs.43.207

CiNii Research

J-GLOBAL

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02079&link_issn=&doc_id=20150612260008&doc_link_id=%2Fcp4strok%2F2015%2F004303%2F008%2F0207-0211%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2015%2F004303%2F008%2F0207-0211%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

小児もやもや病に対する血行再建術の周術期脳梗塞のリスク因子について、2005年7月から2015年11月までに当院で経験した15歳以下の小児もやもや病29例51側について臨床経過および画像診断結果を中心に検討した。周術期脳梗塞は、症候性無症候性にかかわらず術後1週間以内に生じたものとした。結果、周術期脳梗塞の危険因子として、脳梗塞発症であることや後方循環の血管狭窄も呈していることや鈴木分類で進行していることが挙げられた。小児もやもや病患者のうち、これらの危険因子をもつ患者は脳循環動態が不安定な状態であることが予想されるため、厳格な周術期管理が必要である。当院では、深鎮静を用いた周術期管理を開始し始めたが、いつまで鎮静するのかというこに関しては今後の課題である。また、症状が急速に進行する例に対する手術介入時期も今後の課題であるが、緊急血管吻合も1つの選択肢となる可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

小児閉塞性脳血管障害のうち、画像所見がもやもや病に類似しながらも診断基準を満たさず臨床経過も異なった疾患群が存在し「非もやもや病小児閉塞性脳血管障害」に分類される。我々は本疾患群を疑う3例を経験し、RNF213遺伝子多型なども検討した。3例とも併存疾患なく生来健康で外傷歴なし、直近1年VZV感染なし。症例1のSTA病理所見正常。RNF213遺伝子多型はいずれも野生型であった。これらの特徴はfocal cerebral arteriopathyに分類される疾患群に類似している。(著者抄録)

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)にゅーろん社  

脳動脈瘤治療におけるclipping術に焦点を当てた際に中堅が術者としての技術、手技の経験があるのかを明らかにするため、アンケートを実施した。中堅55名中47名(85.4%)、指導医9名中9名(100%)から回答を得た。中堅は術者として医師3年目後半にはClipping術を執刀する機会を得ており、初めての未破裂脳動脈瘤の執刀時期は平均して4年目前半であった。脳動脈瘤手術を初めて行う部位はMCA、ICPCからが多かった。中堅での経験数は、平均すると破裂脳動脈瘤30例前後、未破裂脳動脈瘤が10例前後で、指導医では破裂脳動脈瘤100〜450例、未破裂脳動脈瘤で37〜350例であった。後方循環系の脳動脈瘤の治療は血管内治療が選択されることが多く、術者、助手を含めても約40%がclipping術による治療の経験がなかった。指導医のアンケートで、自身が執刀医でレジデントを第一助手に手術を任されるようになった年次は平均すると医師8.8年目、自身が指導的助手でレジデントを執刀医として手術をさせるようになったのは医師10.7年目であった。

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   会議種別：口頭発表（一般）  

記述言語：日本語   会議種別：口頭発表（一般）  

記述言語：英語   会議種別：口頭発表（一般）  

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記述言語：英語   会議種別：口頭発表（一般）  

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記述言語：英語   会議種別：口頭発表（一般）  

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