2022/12/01 更新

写真a

ハセガワ ヒトシ
長谷川 仁
HASEGAWA Hitoshi
所属
医歯学総合病院 脳神経外科 講師
職名
講師
外部リンク

学位

  • 博士(医学) ( 2005年9月   新潟大学 )

研究キーワード

  • 脳血管内治療

  • 脳神経外科

研究分野

  • ライフサイエンス / 脳神経外科学

経歴(researchmap)

  • 新潟大学医歯学総合病院   脳神経外科   講師

    2015年4月 - 現在

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  • 京都大学

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経歴

  • 新潟大学   医歯学総合病院 脳神経外科   講師

    2016年4月 - 現在

  • 新潟大学   医歯学総合病院 脳神経外科   特任助教

    2015年4月 - 2016年3月

  • 新潟大学   医歯学総合病院 高次救命災害治療センター   特任助教

    2013年11月 - 2015年3月

  • 新潟大学   医歯学総合病院 脳神経外科   特任助教

    2013年4月 - 2013年10月

  • 新潟大学   医歯学総合病院 地域保健医療推進部   特任助教

    2012年6月 - 2013年3月

 

論文

  • Non-contrast-enhanced silent magnetic resonance angiography for assessing cerebral aneurysms after PulseRider treatment.

    Tomoaki Suzuki, Hitoshi Hasegawa, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Shoji Saito, Makoto Oishi, Yukihiko Fujii

    Japanese journal of radiology   2022年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Conventional time-of-flight (TOF) magnetic resonance angiography (MRA) failed to depict clear visualization of coiled cerebral aneurysms with PulseRider due to metal-induced susceptibility artifacts. Our aim was to overcome the metal artifact using a novel imaging technique of non-contrast-enhanced ultrashort echo-time magnetic resonance angiography (UTE-MRA). MATERIALS AND METHODS: Five unruptured intracranial aneurysms were treated using PulseRider and the patients underwent silent MRA (UTE-MRA). The images were compared with TOF-MRA and digital subtraction angiography (DSA). RESULTS: Silent MRA can visualize the residual cavity of the coiled aneurysms, which was not well visualized and rather defective when using TOF-MRA. While a segment of the proximal marker composed of stainless steel was poorly visualized, the other parts of the parent artery and the arteries of bifurcation, including the aneurysmal neck, were clearly visualized, equivalent to that of DSA. CONCLUSIONS: UTE-MRA achieves better visualization of cerebral aneurysms after PulseRider treatment than TOF-MRA.

    DOI: 10.1007/s11604-022-01276-z

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  • Endovascular treatment of an infectious aneurysm using the selective provocative test and transcranial motor evoked potential monitoring under general anesthesia: a case report. 国際誌

    Kazuhiro Ando, Tetsuya Hiraishi, Makoto Oishi, Hitoshi Hasegawa, Bumpei Kikuchi, Manabu Natsumeda, Tomoaki Suzuki, Shoji Saito, Tomoyoshi Ota, Yuichi Yoshida, Yukihiko Fujii

    Acta neurochirurgica   2021年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The selective provocative test (SPT) under local anesthesia aids in protecting against ischemic complications during endovascular treatment. However, the use of this test under general anesthesia is not well described. Herein, we present a case of a 51-year-old man with a ruptured fusiform aneurysm in the middle cerebral artery M4 segment, which was thought to possibly supply the motor cortex. Internal trapping of the affected vessel and aneurysm by endovascular intervention was successfully performed after SPT using transcranial motor evoked potential (MEP) monitoring under general anesthesia. Transcranial MEP is suitable for neurological assessment during SPT under general anesthesia.

    DOI: 10.1007/s00701-021-05001-z

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  • Genetic and nongenetic factors for contralateral progression of unilateral moyamoya disease: the first report from the SUPRA Japan Study Group. 国際誌

    Yohei Mineharu, Yasushi Takagi, Akio Koizumi, Takaaki Morimoto, Takeshi Funaki, Tomohito Hishikawa, Yoshio Araki, Hitoshi Hasegawa, Jun C Takahashi, Satoshi Kuroda, Kiyohiro Houkin, Susumu Miyamoto

    Journal of neurosurgery   136 ( 4 )   1 - 10   2021年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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 63 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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  • Delayed Bleeding of Unruptured Intracranial Aneurysms After Coil Embolization: A Retrospective Case Series. 国際誌

    Kazuhiro Ando, Hitoshi Hasegawa, Tomoaki Suzuki, Shoji Saito, Kohei Shibuya, Haruhiko Takahashi, Makoto Oishi, Yukihiko Fujii

    World neurosurgery   149   e135-e145   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Delayed bleeding of unruptured intracranial aneurysms (UIAs) after coil embolization is rare; this study aimed to analyze the occurrence of delayed bleeding of UIAs after coil embolization. METHODS: We retrospectively analyzed patients with UIAs after coil embolization between January 2002 and December 2018 and assessed the features of UIAs with delayed bleeding after coil embolization. RESULTS: Analysis included 307 patients with 335 UIAs. Mean follow-up was 7.1 ± 4.9 years, and total follow-up was 2365 aneurysm-years. There were 271 (80.9%) aneurysms located in the anterior circulation and 64 (19.1%) aneurysms located in the posterior circulation. Significant differences were observed between the 2 groups in terms of maximum size of the aneurysm (P < 0.01), width of the aneurysm neck (P < 0.01), and number of retreatment cases (P < 0.01). During the follow-up period, delayed bleeding occurred in 4 aneurysms (annual bleeding rate of 0.17%); all were located in the posterior circulation. The original size was not relatively large (mean 8.6 ± 2.4 mm). All aneurysms bled within 5 years (mean 35 ± 9.6 months) after the initial treatment. Two were de novo aneurysms that developed adjacent to the coiled aneurysms and were not detected on follow-up magnetic resonance angiography. CONCLUSIONS: Cautious follow-up of UIAs with digital subtraction angiography is important, articularly within the first 5 years after the procedure. If there are changes in the anatomic outcomes, short-term reassessment or additional treatment should be actively considered, particularly for aneurysms in the posterior circulation.

    DOI: 10.1016/j.wneu.2021.02.061

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  • Unilateral oculomotor nerve palsy caused by arterial compression accompanying subarachnoid hemorrhage: a case report. 国際誌

    Shoji Saito, Hitoshi Hasegawa, Toru Takino, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Jotaro On, Tomoaki Suzuki, Makoto Oishi, Yukihiko Fujii

    Acta neurochirurgica   163 ( 3 )   813 - 816   2021年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Unilateral oculomotor nerve palsy, often caused by aneurysmal compression, is one of the decisive findings for confirming the site of a ruptured aneurysm. However, arterial compression can also cause unilateral oculomotor nerve palsy. Here, we present the case of a 59-year-old woman with a ruptured right internal carotid-posterior communicating artery aneurysm accompanied by contralateral oculomotor nerve palsy. The nerve was found to be compressed by the posterior cerebral artery and was isolated from the ruptured aneurysm. When confirming a ruptured aneurysm based on the evidence of unilateral oculomotor palsy, the arteries surrounding the nerve must be thoroughly assessed.

    DOI: 10.1007/s00701-020-04633-x

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  • Hemodynamic features of an intracranial aneurysm rupture predicted by perianeurysmal edema: A case report. 国際誌

    Tomoaki Suzuki, Hitoshi Hasegawa, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Shoji Saito, Jotaro On, Makoto Oishi, Yukihiko Fujii

    Surgical neurology international   12   49 - 49   2021年

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    記述言語:英語  

    Background: Perianeurysmal edema (PAE) has been suggested as an indicator of potential aneurysm rupture; however, the hemodynamic features of these aneurysms are still unknown. A computational fluid dynamic (CFD) analysis was performed to evaluate the hemodynamic features of a very rare case of a ruptured middle cerebral artery (MCA) aneurysm with PAE. Case Description: A 65-year-old woman presented with disturbed consciousness. A subarachnoid hemorrhage due to an azygos anterior cerebral artery (ACA) aneurysm rupture was suspected. An unruptured MCA aneurysm with PAE was identified in the left temporal lobe. Although the ACA aneurysm was clipped to prevent re-bleeding, the MCA aneurysm subsequently ruptured 6 days later. Clipping of the MCA aneurysm was performed, and hemosiderin deposits suggestive of sentinel bleeding were found on the surface of the aneurysm dome. CFD analysis revealed unstable hemodynamic stress at the expanded bleb area after rupture, localized to the rupture site. Moreover, this analysis revealed flow impingement with pressure elevation and low wall shear stress, which indicated increased inflammation and aneurysm wall thinning that likely led to rupture. Conclusion: Hemosiderin deposits at the aneurysm wall and PAE indicates leakage from a cerebral aneurysm. Hemodynamic stress at the aneurysm may promote an inflammatory response and lead to wall weakening accompanied by PAE. Based on our findings, we recommend that surgical intervention should be considered as the first line of treatment for such aneurysms to prevent rupture.

    DOI: 10.25259/SNI_780_2020

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  • Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography. 査読 国際誌

    Shoji Saito, Hitoshi Hasegawa, Tomoyoshi Ota, Toru Takino, Yuichi Yoshida, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Tomoaki Suzuki, Makoto Oishi, Yukihiko Fujii

    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences   26 ( 6 )   713 - 718   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: We aimed to evaluate the safety and feasibility of the distal transradial approach (DTRA) as a novel technique for cerebral angiography based on our institutional initial experience. METHODS: We retrospectively analyzed our institutional database of consecutive diagnostic cerebral angiographies performed with DTRA from December 2018 to August 2019. Patient demographics and clinical and procedural data were recorded. RESULTS: In total, 51 diagnostic cerebral angiographies in 51 patients (age, 15-83 years; mean age, 59.4 years, SD 13.5; 35 (69%) females) were performed or attempted with DTRA. Ultrasound evaluation showed that the mean inner distal radial artery diameter was significantly smaller than the mean inner forearm radial artery diameter (2.19 mm vs. 2.56 mm, P < 0.001). Cannulation via the distal radial artery was successful in 47 (92%) procedures. In the four procedures that failed, operators converted to the ipsilateral transradial approach without repositioning or redraping. Selective catheterization of the intended vessel was achieved in 64 (91%) of 70 vessels. In the remaining six, operators achieved the objective of the examination with angiography injecting from proximal and conversion to another approach was not required. One patient experienced temporary numbness around the puncture site after the procedure. No radial artery occlusion was identified in the patients who underwent ultrasound evaluation. CONCLUSION: Our results demonstrate that DTRA could become a standard approach for diagnostic cerebral angiography owing to the low complication rate and the high cannulation success rate.

    DOI: 10.1177/1591019920925709

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  • [Dural arteriovenous fistula causing complex visual hallucinations without an anopsia]. 査読

    Shingo Koide, Masahiro Hatakeyama, Masahiro Uemura, Bumpei Kikuchi, Hitoshi Hasegawa, Osamu Onodera

    Rinsho shinkeigaku = Clinical neurology   60 ( 6 )   425 - 428   2020年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    We report the case of a 76-year-old woman who presented with recurrent episodes of complex visual hallucinations in her right visual field without an anopsia. The electroencephalogram showed sharp transients in the left parietotemporal region with phase reversals at T5 and P3. FLAIR MRI revealed hyperintense lesions in the left temporo-occipital lobe, located mainly in the left inferior temporal lobe. Cerebral angiography revealed an arteriovenous shunt from the left occipital artery to the left transverse sinus with cortical venous reflux. The complex visual hallucinations were resolved after transarterial embolization. We therefore hypothesize that this patient's complex visual hallucinations were caused by epileptic seizures or changes in cortical blood flow caused by the cortical venous reflux from the arteriovenous fistula. In general, epileptic hallucinations expand into the bilateral visual field. We reveal that in rare cases, complex visual hallucinations can also be limited to the unilateral visual field without an anopsia. Additionally, we reveal that a dural arteriovenous fistula can cause visual hallucinations without hemianopia.

    DOI: 10.5692/clinicalneurol.60.cn-001371

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  • [Endovascular Revascularization for Acute Ischemic Stroke Related to Blunt Carotid Injury:A Case Report]. 査読

    Shoji Saito, Hitoshi Hasegawa, Daisuke Sato, Kazuhiro Ando, Kunio Motohashi, Manabu Natsumeda, Bumpei Kikuchi, Makoto Oishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   48 ( 6 )   527 - 532   2020年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Although blunt carotid artery injury is known as an important cause of ischemic stroke, the role of the endovascular treatment for acute ischemic stroke related to blunt carotid injuries remains unclear. We report the case of a patient with acute ischemic stroke secondary to blunt carotid artery injury who was treated with endovascular revascularization. A 46-year-old man suffered from sudden left-sided hemiparesis a day after a strike from a Japanese fencing staff on his right neck. 3D-CT angiography revealed tandem internal carotid artery occlusions of the cervical and C1 portions. We performed endovascular revascularization with carotid artery stenting and direct aspiration of the thrombus and achieved complete recanalization. The patient recovered almost completely. We conclude that endovascular revascularization should not be withheld from patients with acute ischemic stroke related to blunt carotid injury.

    DOI: 10.11477/mf.1436204223

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  • 顔面静脈経由による経静脈的塞栓術で治療した眼症状を有するAnterior Condylar Confluence近傍硬膜動静脈瘻の1例 査読

    河辺 啓太, 長谷川 仁, 菊池 文平, 伊藤 靖, 神保 康志, 大石 誠, 藤井 幸彦

    脳血管内治療   5 ( 2 )   86 - 92   2020年4月

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    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】Anterior condylar confluence(ACC)近傍硬膜動静脈瘻に対し,顔面静脈を経由して経静脈的塞栓術を施行した1例を経験したので報告する.【症例】52歳,男性.右眼球結膜充血,眼球突出,複視を呈し,精査でACC近傍硬膜動静脈瘻と診断した.静脈流出路として下錐体静脈洞近位側が閉塞し,患側の海綿静脈洞から上眼静脈,顔面静脈が描出された.Triple coaxial systemにより長く蛇行した顔面静脈を経由してACCに到達し,塞栓術を施行した.【結論】眼症状を有するACC近傍硬膜動静脈瘻に対し,顔面静脈経由の経静脈的塞栓術は有効な治療の選択肢になり得ると考える.(著者抄録)

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    その他リンク: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J06751&link_issn=&doc_id=20200514160003&doc_link_id=10.20626%2Fnkc.cr.2019-0004&url=https%3A%2F%2Fdoi.org%2F10.20626%2Fnkc.cr.2019-0004&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

  • Main feederをバルーンで一時遮断し、細径の標的動脈から根治的Onyx塞栓術を施行し得た小脳テント部硬膜動静脈瘻の1例(A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders) 査読

    Ogura Ryosuke, Hasegawa Hitoshi, Kumagai Shunsuke, Takahashi Haruhiko, Fujiwara Hidemoto, Yoshimura Junichi, Fujii Yukihiko

    JNET: Journal of Neuroendovascular Therapy   14 ( 3 )   112 - 117   2020年3月

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    記述言語:英語   出版者・発行元:(NPO)日本脳神経血管内治療学会  

    【目的】Multiple feedersを有する小脳テント部硬膜動静脈瘻に対する根治的Onyx塞栓術の1例を報告する。【症例】66歳、男性。Main feederは両側後頭動脈(OA)、静脈洞交会左の小脳テントにfistula pointを有し、主に上小脳虫部静脈から直静脈洞に流出していた。両側中硬膜動脈(MMA)からも、細径だが同部へshuntを認めた。両側OAをバルーンで一時遮断することで、両側MMAからOnyxをfistula pointに浸透させやすくする工夫により、根治的塞栓が行えた。【結論】Main feederをバルーンで一時遮断し、細径の標的血管からOnyx塞栓術を行う方法は有用である。(著者抄録)

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    その他リンク: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J05194&link_issn=&doc_id=20200409220007&doc_link_id=10.5797%2Fjnet.tn.2019-0053&url=https%3A%2F%2Fdoi.org%2F10.5797%2Fjnet.tn.2019-0053&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

  • pial arteriovenous fistulae(pial AVF)に伴い高心拍出性心不全をきたした1例

    小出 伸, 萱森 裕美, 柏村 健, 安藤 和弘, 長谷川 仁, 大久保 健志, 保屋野 真, 柳川 貴央, 小澤 拓也, 尾崎 和幸, 藤井 幸彦, 南野 徹

    心臓   52 ( 3 )   321 - 326   2020年3月

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    記述言語:日本語   出版者・発行元:(公財)日本心臓財団  

    症例は27歳女性。頭痛、嘔吐、意識障害のため入院し、pial arteriovenous fistulae(pial AVF;脳軟膜動静脈瘻)に伴うくも膜下出血が認められた。降圧薬使用下に経動脈的塞栓術を施行した後に肺水腫をきたし、利尿薬に加え人工呼吸管理を要した。神経原性肺水腫も考えられたが、心臓カテーテル検査を行うと心拍出量は熱希釈法で14.55L/分、平均肺動脈楔入圧は17mmHgであり、高心拍出性心不全と診断した。このとき、上大静脈ばかりでなく、下肢から下大静脈にかけても静脈血酸素飽和度が90%以上と高く、高心拍出はpial AVFによるシャント血流に加え、末梢血管拡張により全身で血流が増加しているためと考えられた。β遮断薬に続き、再度経動脈的塞栓術を行うことで心拍出量が正常化し、以後心不全の再発はみられなかった。pial AVFに起因した高心拍出性心不全の成人症例はこれまで報告がなく、病態についての考察を交えて報告する。(著者抄録)

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    その他リンク: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00679&link_issn=&doc_id=20200323220012&doc_link_id=20200323220013%2C20200323220014&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20200323220013%2C20200323220014&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

  • Vascular Hyperintensity on Fluid-Attenuated Inversion Recovery Indicates the Severity of Hypoperfusion in Acute Stroke. 査読 国際誌

    Toshiharu Nomura, Kouichirou Okamoto, Hironaka Igarashi, Masato Watanabe, Hitoshi Hasegawa, Makoto Oishi, Yukihiko Fujii

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   29 ( 2 )   104467 - 104467   2020年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: Although fluid-attenuated inversion recovery vascular hyperintensities may be frequently seen in acute large-artery ischemic stroke, reports on their prognostic utility had been conflicting due to lack of quantitative evaluation of the perfusion status based on the signal intensity. We hypothesized that greater hyperintensity represents more severe hypoperfusion. METHODS: Overall, 27 patients with acute occlusion of the proximal middle cerebral artery were divided into 2 groups, based on their signal intensity in the insular segment of middle cerebral artery on the affected side, relative to that of the insular cortex: the low signal intensity group (hypo- or isointense signals, n = 12) and the high signal intensity group (hyperintense signals, n = 15). Using dynamic susceptibility contrast magnetic resonance imaging, we assessed the time of the maximum value of the residue function and mean transit time, in the entire middle cerebral artery cortical area and diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, including the corona radiata. RESULTS: The high signal intensity group had significantly longer time of the maximum value of the residue function in all the diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, except the M3 and M6 regions, and significantly longer mean transit time in the M1 and M4 regions. CONCLUSIONS: Quantitative analysis of the perfusion parameters revealed more severely compromised and widely disturbed perfusion status in the high signal intensity group than in the low signal intensity group.

    DOI: 10.1016/j.jstrokecerebrovasdis.2019.104467

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  • Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms. 国際誌

    Tomoaki Suzuki, Hitoshi Hasegawa, Kazuhiro Ando, Kouhei Shibuya, Haruhiko Takahashi, Shoji Saito, Makoto Oishi, Yukihiko Fujii

    Frontiers in neurology   11   611124 - 611124   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery. Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated. Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery. Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

    DOI: 10.3389/fneur.2020.611124

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  • 外科的介入を受けていない症候性もやもや病の1剖検例

    齋藤 祥二, 齋藤 理恵, 中原 亜紗, 長谷川 仁, 田口 貴博, 上村 昌寛, 本多 忠幸, 伊藤 靖, 小野寺 理, 梅津 哉, 藤井 幸彦, 柿田 明美

    新潟医学会雑誌   133 ( 11-12 )   389 - 389   2019年12月

  • 専門医に求められる最新の知識 脳血管障害 急性期血栓回収療法にまつわる問題点と対策

    長谷川 仁

    脳神経外科速報   29 ( 11 )   1172 - 1177   2019年11月

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    記述言語:日本語   出版者・発行元:(株)メディカ出版  

    急性期主幹動脈閉塞(AIS)に対する血栓回収療法(MT)は、その高い有効性から最近急速に増加している治療法である。一方で、近年脳卒中に携わる医師の疲弊が指摘されており、いわゆる「燃え尽き症候群」が問題となっている。そのような状況を踏まえ、問題点の洗い出しにとどまらない脳卒中医の具体的な負担軽減策を講じておくことと並行して、現時点でMTを含めたAIS治療を組織的に運営していくシステム、すなわち脳卒中センターによる集約化を目的とした医療体制を整備しておくことが必要である。(著者抄録)

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  • Treatment Strategies for Infectious Intracranial Aneurysms: Report of Three Cases and Review of the Literature. 査読

    Kazuhiro Ando, Hitoshi Hasegawa, Bumpei Kikuchi, Shoji Saito, Jotaro On, Kohei Shibuya, Yukihiko Fujii

    Neurologia medico-chirurgica   59 ( 9 )   344 - 350   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2-50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.

    DOI: 10.2176/nmc.oa.2019-0051

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  • Malignant Hyperthermia and Cerebral Venous Sinus Thrombosis After Ventriculoperitoneal Shunt in Infant with Schizencephaly and COL4A1 Mutation. 査読 国際誌

    Jun Watanabe, Kouichirou Okamoto, Tsukasa Ohashi, Manabu Natsumeda, Hitoshi Hasegawa, Makoto Oishi, Satoko Miyatake, Naomichi Matsumoto, Yukihiko Fujii

    World neurosurgery   127   446 - 450   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Schizencephaly is a rare congenital central nervous system malformation characterized by linear, thickened clefts of the cerebral mantle. Recently, germline mutations in collagen type IV alpha 1 (COL4A1) have been reported to be a genetic cause of schizencephaly as a result of prenatal stroke. Patients with COL4A1 mutation demonstrate a variety of disease phenotypes. However, little is known about the potential complications of patients with COL4A1 mutations before and after neurologic surgery. CASE DESCRIPTION: A 9-month-old boy with schizencephaly and a congenital cataract underwent a ventriculoperitoneal shunt for progressive hydrocephalus. Postoperatively, he developed malignant hyperthermia and cerebral venous thrombosis. Early treatment with dantrolene sodium and hydration was effective. Genetic testing revealed a germline COL4A1 mutation. CONCLUSIONS: To our knowledge, malignant hyperthermia and cerebral venous thrombosis have not been reported in the literature in patients with COL4A1 mutations after surgery. Schizencephaly arising from COL4A1 mutations might be a disease prone to these adverse effects because this mutation is known to be associated with venous tortuosity, venous vulnerability, and muscle spasms due to basement membrane protein abnormalities. We need to better understand the wide spectrum of clinical phenotypes of COL4A1 mutations and potential complications in order to better manage surgery of patients with schizencephaly.

    DOI: 10.1016/j.wneu.2019.04.156

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  • 基本をマスター 脳神経外科手術のスタンダード Hybrid Neurosurgeonによる脳動静脈奇形の治療 自分でつめて自分でとることの重要性

    長谷川 仁

    脳神経外科速報   29 ( 7 )   740 - 746   2019年7月

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    記述言語:日本語   出版者・発行元:(株)メディカ出版  

    <POINT 1>脳血管内治療と直達手術双方を行う術者をHybrid Neurosurgeonと定義する。<POINT 2>Spetzler-Martin grade 3以下のAVMに対して、plug & push法による丹念なOnyx塞栓術に続いて外科的に摘出する治療成績は良好である。<POINT 3>脳動静脈奇形(AVM)の治療において、「自分でつめて自分でとる」メリットは大きく、Hybrid Neurosurgeonであることは治療成績向上に貢献できる。(著者抄録)

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  • Long-term outcomes of coil embolization of unruptured intracranial aneurysms. 査読 国際誌

    Masaomi Koyanagi, Akira Ishii, Hirotoshi Imamura, Tetsu Satow, Kazumichi Yoshida, Hitoshi Hasegawa, Takayuki Kikuchi, Yohei Takenobu, Mitsushige Ando, Jun C Takahashi, Ichiro Nakahara, Nobuyuki Sakai, Susumu Miyamoto

    Journal of neurosurgery   129 ( 6 )   1492 - 1498   2018年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11-13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

    DOI: 10.3171/2017.6.JNS17174

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  • Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. 査読 国際誌

    Rustam Al-Shahi Salman, Joseph Frantzias, Robert J Lee, Patrick D Lyden, Thomas W K Battey, Alison M Ayres, Joshua N Goldstein, Stephan A Mayer, Thorsten Steiner, Xia Wang, Hisatomi Arima, Hitoshi Hasegawa, Makoto Oishi, Daniel A Godoy, Luca Masotti, Dar Dowlatshahi, David Rodriguez-Luna, Carlos A Molina, Dong-Kyu Jang, Antonio Davalos, José Castillo, Xiaoying Yao, Jan Claassen, Bastian Volbers, Seiji Kazui, Yasushi Okada, Shigeru Fujimoto, Kazunori Toyoda, Qi Li, Jane Khoury, Pilar Delgado, José Álvarez Sabín, Mar Hernández-Guillamon, Luis Prats-Sánchez, Chunyan Cai, Mahesh P Kate, Rebecca McCourt, Chitra Venkatasubramanian, Michael N Diringer, Yukio Ikeda, Hans Worthmann, Wendy C Ziai, Christopher D d'Esterre, Richard I Aviv, Peter Raab, Yasuo Murai, Allyson R Zazulia, Kenneth S Butcher, Seyed Mohammad Seyedsaadat, James C Grotta, Joan Martí-Fàbregas, Joan Montaner, Joseph Broderick, Haruko Yamamoto, Dimitre Staykov, E Sander Connolly, Magdy Selim, Rogelio Leira, Byung Hoo Moon, Andrew M Demchuk, Mario Di Napoli, Yukihiko Fujii, Craig S Anderson, Jonathan Rosand

    The Lancet. Neurology   17 ( 10 )   885 - 894   2018年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography. METHODS: In a systematic review of OVID MEDLINE-with additional hand-searching of relevant studies' bibliographies- from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5-24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known. FINDINGS: Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56-76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36-0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46-11·60; p<0·0001), antiplatelet use (1·68, 1·06-2·66; p=0·026), and anticoagulant use (3·48, 1·96-6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75-0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95-6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03-0·07). INTERPRETATION: In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials. FUNDING: UK Medical Research Council and British Heart Foundation.

    DOI: 10.1016/S1474-4422(18)30253-9

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  • 【Hybrid Neurosurgeonのための疾患別臨床脳血管解剖テキスト】(第1章)開頭手術と血管内治療の選択 dAVF 前頭蓋底部dAVF 前頭蓋底部dAVFの開頭手術

    長谷川 仁

    脳神経外科速報   ( 2018増刊 )   122,124,126,128,130,132,134 - 122,124,126,128,130,132,134   2018年9月

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    記述言語:日本語   出版者・発行元:(株)メディカ出版  

    <開頭手術のポイント(まとめ)>(1)前頭蓋底部dAVFは比較的まれであるが、出血発症が多く、積極的な治療を考慮すべき病態である(2)外科的治療は安全かつ確実にシャントを遮断することが可能な方法である(3)シャントポイントのjust distalで流出静脈を遮断することにより根治させることが可能である(著者抄録)

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  • Unruptured medial paraclinoid internal carotid artery aneurysm embedded within symptomatic nonfunctioning pituitary giant adenoma: A high-risk comorbid pathology in transsphenoidal surgery and its countermeasures 査読

    Taiki Saito, Yuichiro Yoneoka, Jun Watanabe, Bumpei Kikuchi, Hitoshi Hasegawa, Yukihiko Fujii

    Interdisciplinary Neurosurgery: Advanced Techniques and Case Management   10   138 - 141   2017年12月

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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:Elsevier B.V.  

    Background Injury of the internal carotid artery (ICA) in the cavernous portion is one of the most critical complications of transsphenoidal surgery (TSS), especially in cases of coexistence with a pituitary adenoma (PA) and ICA aneurysm. Case description We present a rare case of unruptured medial paraclinoid ICA aneurysm (ICA-An) associated with symptomatic nonfunctioning giant PA. After endovascular coil embolization of the unruptured 4-mm saccular medial paraclinoid ICA-An, the patient underwent adenomectomy through an endoscopic endonasal TSS. During the bone resection over the right sellar floor near the right cavernous sinus, a tangle of packed coils in the treated medial paraclinoid ICA-An was observed immediately after a bite of a Kerrison rongeur. The dural layer over the coiled aneurysm had become thin to the point of transparency or complete absence. Careful inspection revealed that the bone hillock was formed by the medial paraclinoid ICA-An. Gross total resection of the adenoma was achieved without vascular injuries related to the coiled aneurysm despite postoperative transient right oculomotor paresis. Conclusions This case conveys three important lessons about TSS: 1) coil embolization will manage a medial paraclinoid ICA-An as a sufficient preoperative procedure for TSS
    2) a medial paraclinoid ICA-An can appear directly under the sellar floor as an apparent extradural aneurysm
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    3) surgeons should take great care in procedures near a coil-embolized medial paraclinoid ICA-An because the aneurysmal wall can be thin to the point of transparency.

    DOI: 10.1016/j.inat.2017.09.005

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  • Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern. 査読 国際誌

    Kazuhiko Nishino, Hitoshi Hasegawa, Kenichi Morita, Masafumi Fukuda, Yasushi Ito, Yukihiko Fujii, Mitsuya Sato

    Journal of neurosurgery   126 ( 1 )   60 - 68   2017年1月

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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:AMER ASSOC NEUROLOGICAL SURGEONS  

    OBJECTIVE Arteriovenous malformations (AVMs) in the cerebellopontine angle cistern (CPAC) are specific lesions that can cause neurovascular compression syndromes as well as intracranial hemorrhage. Although case reports describing the CPAC AVMs, especially those presenting with trigeminal neuralgia (TN), have been accumulating by degrees, the pathophysiology of CPAC AVMs remains obscure. The authors' purpose in the present study was to evaluate the clinical and radiographic features of CPAC AVMs as well as the treatment options. METHODS This study defined a CPAC AVM as a small AVM predominantly located in the CPAC with minimal extension into the pial surface of the brainstem and closely associated with cranial nerves. All patients with CPAC AVMs treated in the authors' affiliated hospitals over a 16-year period were retrospectively identified. Clinical charts, imaging studies, and treatment options were evaluated. RESULTS Ten patients (6 men and 4 women), ranging in age from 56 to 77 years (mean 65.6 years), were diagnosed with CPAC AVMs according to the authors' definition. Six patients presented with hemorrhage, 3 with TN, and the remaining patient developed a hemorrhage subsequent to TN. Seven AVMs were associated with the trigeminal nerve (Group V), and 3 with the facial-vestibulocochlear nerve complex (Group VII-VIII). All patients in Group VII-VIII presented with the hemorrhage instead of hemifacial spasm. Regarding angioarchitecture, the intrinsic pontine arteries provided the blood supply for all CPAC AVMs in Group V. In addition, 5 of 7 AVMs with hemorrhagic episodes accompanied flow-related aneurysms, although no aneurysm was detected in patients with TN alone. With respect to treatment, all patients with hemorrhagic presentation underwent Gamma Knife surgery (GKS), resulting in favorable outcomes except for 1 patient who experienced rebleeding after GKS, which was caused by the repeated rupture of a feeder aneurysm. The AVMs causing TN were managed with surgery, GKS, or a combination, according to the nidus-nerve relationship. All patients eventually obtained pain relief. CONCLUSIONS Clinical symptoms caused by CPAC AVMs occur at an older age compared with AVMs in other locations; CPAC AVMs also have distinctive angioarchitectures according to their location in the CPAC. Although GKS is likely to be an effective treatment option for the CPAC AVMs with hemorrhagic presentations, it seems ideal to obliterate the flow-related aneurysms before performing GKS, although this is frequently challenging. For CPAC AVMs with TN, it is important to evaluate the nidus-nerve relationship before treatment, and GKS is especially useful for patients who do not require urgent pain relief.

    DOI: 10.3171/2015.12.JNS152190

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  • Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion. 査読 国際誌

    Kazuhiko Nishino, Hitoshi Hasegawa, Yasushi Ito, Yukihiko Fujii

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   24 ( 8 )   1865 - 72   2015年8月

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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:ELSEVIER SCIENCE BV  

    BACKGROUND: Although the introduction of flow-diverter stents has been recognized as a major revolution in the treatment of cavernous carotid aneurysms (CCAs), therapeutic internal carotid artery occlusion (TICAO) remains a reliable procedure for alleviating symptoms caused by CCAs. However, TICAO has the potential risk of the enlargement of coexisting aneurysms that are frequently detected in CCA patients. The purpose of this study is to assess the occurrence of the enlargement of aneurysms coexisting with CCAs after TICAO. METHODS: We reviewed medical charts of CCA patients who were managed using unilateral TICAO. Coexisting aneurysms were identified using angiograms obtained before TICAO, and imaging data in long follow-up periods were retrospectively examined to determine the extent of the enlargement after TICAO. RESULTS: Of 12 patients with CCAs, 10 had 12 coexisting aneurysms; 5 of the coexisting aneurysms (41.7%) showed enlargement during a mean follow-up period of 8.1 years, and all enlarged aneurysms were smaller of the bilateral CCAs; the larger CCA had been managed by TICAO. Five of 6 (83.3%) patients with bilateral CCAs showed enlargement of the contralateral aneurysm after TICAO. Two contralateral CCAs showed marked enlargement after TICAO and were subsequently treated with stent-assisted coil embolization. CONCLUSIONS: Contralateral, smaller aneurysms frequently enlarge after unilateral TICAO in patients with bilateral CCAs. The findings emphasize the importance of long-term observation after TICAO and appropriate interventions against enlarging contralateral aneurysms.

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.025

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  • Onyx embolization後の脳動静脈奇形摘出術の要点 査読

    西野 和彦, 長谷川 仁, 伊藤 靖, 藤井 幸彦

    脳卒中の外科   43 ( 4 )   283 - 288   2015年7月

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    記述言語:日本語   出版者・発行元:(一社)日本脳卒中の外科学会  

    2010年1月〜2014年6月に著者らの施設へ紹介された脳動静脈奇形(AVM)において、治療を受けた34例のうち、ONYX液体塞栓システム(Onyx)を施行した11例(男性3例、女性8例、年齢12〜62歳、平均年齢35.3歳)の手術成績を検討した。その結果、1)対象の初発症状は出血が6例、てんかんが2例で、Spetzler-Martin gradeはgrade 2が7例、grade 1が2例、grade 3とgrade 4が各1例であった。2)11例に対し13回のOnyx塞栓術が施行され、10例で50%以上のnidusの閉塞が得られ、うち6例では80%以上の閉塞が得られた。3)手技に伴う合併症は3例にみられ、1例のみが一時的に新たな神経症状を呈したが最終的には消失した。また、摘出術によるmodified Rankin Scale低下を1例で認められたが、これは無症候例で術後に軽度の視野障害が遺残したものあった。一方、nidusが残存した1例があったが、ガンマナイフの施行により3年後には消失が確認された。4)AVM摘出術は塞栓によりnidusが完全遮断の場合以外は可能な限り残存feederを遮断し、次いでnidus周囲のくも膜を全周性に剥離後、Onyx充填のfeederを切断、最後にmain drainer切断後にnidusを摘出、周囲の白質に残存nidusがないことが確認された。

    DOI: 10.2335/scs.43.283

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  • Successful removal of a huge hypervascular tentorial cavernous angioma after preoperative endovascular embolization. 査読 国際誌

    Junichi Yoshimura, Yoshihiro Tsukamoto, Masakazu Sano, Hitoshi Hasegawa, Kazuhiko Nishino, Akihiko Saito, Masafumi Fukuda, Kouichirou Okamoto, Yukihiko Fujii

    Journal of neurosurgery. Pediatrics   14 ( 1 )   43 - 7   2014年7月

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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:AMER ASSOC NEUROLOGICAL SURGEONS  

    The authors report a rare case of a huge hypervascular tentorial cavernous angioma treated with preoperative endovascular embolization, followed by successful gross-total removal. A 15-year-old girl presented with scintillation, diplopia, and papilledema. Computed tomography and MRI studies revealed a huge irregularly shaped tumor located in the right occipital and suboccipital regions. The tumor, which had both intra- and extradural components, showed marked enhancement and invasion of the overlying occipital bone. Angiography revealed marked tumor stain, with blood supply mainly from a large branch of the left posterior meningeal artery. Therefore, this lesion was diagnosed as a tentorium-based extraaxial tumor. For differential diagnosis, meningioma, hemangiopericytoma, and malignant skull tumor were considered. Tumor feeders were endovascularly embolized with particles of polyvinyl alcohol. On the following day, the tumor was safely gross totally removed with minimum blood loss. Histopathological examination confirmed the diagnosis of cavernous angioma. To date, there have been no reports of tentorium-based cavernous angiomas endovascularly embolized preoperatively. A tentorial cavernous angioma is most likely to show massive intraoperative bleeding. Therefore, preoperative embolization appears to be quite useful for safe maximum resection. Hence, the authors assert that the differential diagnosis of tentorium-based tumors should include tentorial cavernous angioma, for which preoperative endovascular embolization should be considered.

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  • 高齢者に対する頸動脈ステント留置術は本当に安全か? 査読

    長谷川 仁, 西野 和彦, 本間 順平, 中里 真二, 伊藤 靖, 藤井 幸彦

    Geriatric neurosurgery : 日本老年脳神経外科学会記録集   26   17 - 22   2013年3月

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  • 直接穿刺による腫瘍内塞栓術中にglueのmigrationを認めた頸動脈小体腫瘍の1例 症例報告 査読

    長谷川 仁, 伊藤 靖, 本道 洋昭, 反町 隆俊, 藤井 幸彦

    JNET: Journal of Neuroendovascular Therapy   5 ( 1 )   43 - 49   2011年7月

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    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】摘出術前の直接穿刺による腫瘍塞栓術中に外頸動脈へのNBCA(n-butyl-2-cyanoacrylate)のmigrationを認めた頸動脈小体腫瘍の1例を報告する.【症例】42歳,女性.徐々に増大し,圧痛を伴う左頸部腫瘤を自覚.頸動脈小体腫瘍と診断し,摘出術に先行して腫瘍塞栓術を行った.経皮的に腫瘍を直接穿刺しロードマップガイド下に20%NBCAによる塞栓術を行い,完全な腫瘍濃染の消失を認めた.塞栓術終了直前にNBCAが外頸動脈の分枝に逆流し,外頸動脈分枝閉塞をきたしたが,症状は出現しなかった.塞栓術翌日に腫瘍摘出術が施行され,約200mlと少ない出血量で全摘出が行われた.【結論】NBCAを用いた直接穿刺による塞栓術は頸動脈小体腫瘍の術前塞栓術として有用であると思われる.しかし,周辺血管への塞栓物質迷入に充分な注意が必要である.(著者抄録)

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  • 頭部外傷7年後に頭蓋内出血を発症した外傷性内頸動脈海綿静脈洞瘻の1例 査読

    長谷川 仁, 伊藤 靖, 反町 隆俊, 藤井 幸彦

    脳神経外科速報   21 ( 7 )   782 - 786   2011年7月

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    記述言語:日本語   出版者・発行元:(株)メディカ出版  

    28歳男。7年前の転落事故により左眼球突出および視力低下が残存していた。突然意識消失を来たし救急搬送され、CTで左側頭葉内出血、脳室内出血、造影剤で増強される拡張した左海綿静脈洞およびシルビウス裂の静脈を認めた。脳血管造影では左内頸動脈海綿静脈洞瘻(CCF)を認め、C3部の瘻孔から拡張した左海綿静脈洞と中大脳静脈への造影剤逆流があり、逆流により左上眼静脈が造影された。両側下錐体静脈洞への流出も認めた。Traumatic CCFに伴う脳静脈圧上昇を原因とする頭蓋内出血と診断し、血管内治療を行った。全身麻酔下に右大腿動脈経由でアプローチして左内頸動脈に9Frガイディングカテーテルを留置し、detachable balloonをマウントした2Fr/3Fr同軸カテーテルを左内頸動脈C3部の瘻孔部に進めた。造影剤を用いてballoonをinflationすると、静脈へのshuntは消失して頭蓋内内頸動脈が描出され、強い狭窄がないことを確認後に同部位でballoonをdetachした。直後の血管造影ではCCFの完全消失を確認できた。症状は徐々に改善し術後2ヵ月で消失し、左視力障害が残存したものの社会復帰した。

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  • 海綿静脈洞部硬膜動静脈瘻に対する経静脈的塞栓術におけるアクセス困難な海綿静脈洞部へのグースネックスネアを用いたマイクロカテーテル・プルアップ法 査読

    長谷川 仁, 伊藤 靖, 本道 洋昭, 反町 隆俊, 藤井 幸彦

    JNET: Journal of Neuroendovascular Therapy   5 ( 1 )   68 - 73   2011年7月

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    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】海綿静脈洞部硬膜動静脈瘻(CS dAVF)に対する経静脈的塞栓術で,マイクロカテーテル(MC)プルアップ法が有用だった1例を報告する.【症例】76歳,女性.CS dAVFによる右眼症状を認めた.通常の方法では右CSへ到達できなかった.ガイドワイヤー(GW)を左下錐体静脈洞(IPS)からposterior intercavernous sinusと右IPSを介し右内頸静脈(IJV)へ誘導,右IJVの近位から誘導したグースネックスネアで捕捉した.GWと共にグースネックスネアとMCを右IPSへ引き上げ,さらに右CS内へ誘導しコイル塞栓を施行,症状は消失した.【結論】MCプルアップ法は,CSへ到達困難な症例に有効な場合がある.(著者抄録)

    DOI: 10.5797/jnet.5.68

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  • Development of cranial nerve palsy shortly after endosaccular embolization for asymptomatic cerebral aneurysm: report of two cases and literature review. 査読 国際誌

    Kazuhiko Nishino, Yasushi Ito, Hitoshi Hasegawa, Junsuke Shimbo, Bumpei Kikuchi, Yukihiko Fujii

    Acta neurochirurgica   151 ( 4 )   379 - 83   2009年4月

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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:SPRINGER WIEN  

    CLINICAL DESCRIPTION: We report two cases of asymptomatic cerebral aneurysm in which cranial nerve palsy (CNP) developed shortly after symbolization. The CNP occurred immediately in case 1, but case 2 showed the CNP 30 h after symbolization. Although both aneurysms had increased in size on follow-up angiography, case 2 who showed dome re canalization resulted in progressive CNP deterioration. CONCLUSION: These findings suggest that the CNP may result not only from mechanical compression by coils but also from inflammation induced by perpendicular thrombosis, and that the prognosis of the CNP may be influenced by dome re canalization. This complication should be kept in mind in treatment for asymptomatic aneurysms adjacent to the cranial nerves.

    DOI: 10.1007/s00701-009-0234-4

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  • Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils. 査読 国際誌

    Kazuhiko Nishino, Yasushi Ito, Hitoshi Hasegawa, Bumpei Kikuchi, Junsuke Shimbo, Keiko Kitazawa, Yukihiko Fujii

    Journal of neurosurgery   109 ( 2 )   208 - 14   2008年8月

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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:AMER ASSOC NEUROLOGICAL SURGEONS  

    OBJECT: Transvenous embolization (TVE) for the treatment of a cavernous sinus (CS) dural arteriovenous fistula (DAVF) occasionally causes cranial nerve palsy (CNP). Overpacking of coils is considered to result in CNP. The purpose of this study was to analyze the association of TVE-induced CNP with the volume and location of coils activated in the CS. METHODS: Thirty-one patients with CS DAVFs (33 lesions) underwent TVE. RESULTS: Cranial nerve palsy occurred or was aggravated in 13 cases (39.4%; CNP group). The cumulative volume of activated coils was significantly greater in the CNP group (0.241 +/- 0.172 cm3) than in the non-CNP group (0.119 +/- 0.075 cm3; p < 0.05). Of those lesions with > 0.2 cm3 of coil volume, 77.8% showed immediate aggravation or a new occurrence of CNP after TVE. Five lesions treated with a smaller volume of coils showed a delayed worsening or occurrence of CNP. In cases with induced oculomotor nerve palsy, coils had been densely packed in the superolateral part of the anterior CS. Dense packing in the lateral portion of the posterior CS frequently induced abducent nerve palsy. Although patients harboring lesions with a greater coil volume required a longer recovery time, newly developed or aggravated CNP, related to 84.6% of the lesions, resolved completely. CONCLUSIONS: The cumulative volume and specific locations of coils in the CS correlated with TVE-induced CNP. Overpacking appeared to be the predominant cause of CNP; however, for CNP in cases involving smaller coil volumes, an alternative mechanism may be involved.

    DOI: 10.3171/JNS/2008/109/8/0208

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  • Modified buddy wire technique for coil embolization of posterior circulation aneurysms. 査読 国際誌

    Kazuhiko Nishino, Yasushi Ito, Hitoshi Hasegawa, Bunpei Kikuchi, Yukihiko Fujii, Ryuichi Tanaka

    Neuroradiology   49 ( 1 )   49 - 55   2007年1月

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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:SPRINGER  

    INTRODUCTION: In coil embolization of a posterior circulation aneurysm, tortuosity or a small vessel caliber frequently prevents placement of a guiding catheter in the vertebral artery. Even in such difficult situations, however, coil embolization is the only treatment option when the patient's clinical condition is very poor, or the aneurysm is inaccessible by microsurgery. METHODS: Three patients with a posterior circulation aneurysm were treated by coil embolization with the use of a modified buddy wire technique to stabilize a guiding catheter that could not be placed into the vertebral artery. RESULTS: The guiding catheter was stabilized in the subclavian artery and the microcatheter was firmly supported. As a result, coil embolization was performed safely in all patients. There were no procedural complications. CONCLUSION: The modified buddy wire technique could provide patients with a chance to undergo endovascular surgery despite having a tortuous or narrow vertebral artery.

    DOI: 10.1007/s00234-006-0154-4

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  • 電位依存性カルシウムチャネルγ-8遺伝子欠失誘導型マウスの作製 査読

    長谷川 仁

    新潟医学会雑誌   120 ( 4 )   203 - 213   2006年4月

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    記述言語:日本語   出版者・発行元:新潟医学会  

    小脳運動失調と欠神てんかんを特徴とする変異マウスStargazerの解析により,その原因遺伝子であるstargazin(VDCCγ-2)がAMPA型受容体と機能的に密接な関係にあることが示された.この分子と相同性が高い電位依存性カルシウムチャネル(VDCC)γ-3,4,7,8も,AMPA型受容体の機能発現に重要な補助的サブユニットであることが示唆されているが,個体レベルでの解析に乏しく,その機能や役割分担については未解明の部分が多い.本研究では海馬で高い発現を示すγ-8サブユニットに着目し,海馬CA3特異的にこの分子を欠失させ,AMPA型受容体を介した脳の分子機構の解明を計画した.そのためにCre/loxPシステムにより,部位・時期特異的にVDCCγ-8を欠失できるマウスγ8-flox系統を樹立した.そしてこのマウスと全身でCreリコンビネースを発現するマウスとを交配することによりVDCCγ-8がCre活性依存的に欠失することを確認した.さらに,VDCCγ-8の欠失は,AMPA型受容体のタンパク発現に選択的に影響を及ぼすことも示唆された.本研究で樹立したVDCCγ-8KOマウスは,特にAMPA型受容体の関与する神経分子機構の個体レベルでの解析において有用なツールとなると考えられる(著者抄録)

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  • Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm. Case report. 査読 国際誌

    Hiroatsu Murakami, Tadashi Kawaguchi, Masafumi Fukuda, Yasushi Ito, Hitoshi Hasegawa, Ryuichi Tanaka

    Journal of neurosurgery   101 ( 5 )   861 - 3   2004年11月

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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:American Association of Neurological Surgeons  

    The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm. A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively. This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.

    DOI: 10.3171/jns.2004.101.5.0861

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  • 小児モヤモヤ病の長期予後に関与する因子の検討

    小澤 常徳, 竹内 茂和, 伊藤 靖, 西野 和彦, 森田 健一, 長谷川 仁, 藤井 幸彦, 田中 隆一

    小児の脳神経   29 ( 4 )   290 - 297   2004年8月

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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  

    小児モヤモヤ病の外科的治療後の長期予後について,1979年〜2001年の23年間に経験した60例を対象に,ロジスティック回帰分析による多変量解析を用いて予後不良因子の相対危険率を求めた.予後不良はmRS=1とした.検討した因子の中で,PCAへの病変の進展は予後不良と弱い関与があり,間接的血行再建術のみが予後不良と強い関与があった.血管支配領域別の検討では,MCA領域中心の障害である麻痺の残存のみでは,全ての症例がmSR=1で日常生活に障害はなかった.ACA領域,或いは脳全般の血流低下を反映する知能低下を示す症例では86%がmRS 2以上で発症前の活動が遂行できなくなり,PCA領域の虚血により失明した症例では全例がmRS 3〜4で日常生活に介助を要した.再手術の検討では,MCA領域のみに対する間接的血行再建術を基本方針とした症例のうち17%が追加手術を必要とした.MCA領域とACA/PCA領域に同時に複合式血行再建を施行した症例には追加手術は必要なかった

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  • Induction of an antitumor immunological response by an intratumoral injection of dendritic cells pulsed with genetically engineered Semliki Forest virus to produce interleukin-18 combined with the systemic administration of interleukin-12. 査読 国際誌

    Ryuya Yamanaka, Naoto Tsuchiya, Naoki Yajima, Junpei Honma, Hitoshi Hasegawa, Ryuichi Tanaka, Jay Ramsey, R Michael Blaese, Kleanthis G Xanthopoulos

    Journal of neurosurgery   99 ( 4 )   746 - 53   2003年10月

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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:AMER ASSOC NEUROLOGICAL SURGEONS  

    OBJECT: The aim of this study was to investigate further immunogene treatment of malignant brain tumor to improve its therapeutic efficacy. METHODS: Intratumoral dendritic cells pulsed with Semliki Forest virus (SFV)-interleukin-18 (IL-18) and/or systemic IL-12 were injected into mice bearing the B16 brain tumor. To study the immune mechanisms involved in tumor regression, we monitored the growth of implanted B16 brain tumor cells in T cell-depleted mice and IFNgamma-neutralized mice. To analyze the protective immunity created by tumor inoculation, B16 cells were injected into the left thighs of mice that had received an inoculation, and tumor growth was monitored. The local delivery of dendritic cells pulsed with IL-18 bound by SFV combined with the systemic administration of IL-12 enhanced the induction of the T helper type 1 response from tumor-specific CD4+ and CD8+ T cells and natural killer cells as well as antitumor immunity. Interferon-gamma is partly responsible for this IL-18-mediated antitumor immunity. Furthermore, the protective immunity is mediated mainly by CD8+ T cells. CONCLUSIONS: Immunogene therapy that combines the local administration of dendritic cells pulsed with IL-18 bound by SFV and the systemic administration of IL-12 may be an excellent candidate for the development of a new treatment protocol. A self-replicating SFV system may therefore open a novel approach for the treatment of malignant brain tumor.

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  • EC-IC bypass 術後の血行評価 : Microvascular Doppler を用いた donor STA の経皮的血流評価法 査読

    小澤 常徳, 森田 健一, 長谷川 仁, 伊藤 靖, 田中 隆一, Tsunenori OZAWA, Kenichi MORITA, Hitoshi HASEGAWA, Yasushi ITO, Ryuichi TANAKA, 新潟大学脳研究所脳神経外科, 新潟大学脳研究所脳神経外科, 新潟大学脳研究所脳神経外科, 新潟大学脳研究所脳神経外科, 新潟大学脳研究所脳神経外科, Department of Neurosurgery, Brain Research Institute Niigata University, Department of Neurosurgery, Brain Research Institute Niigata University, Department of Neurosurgery, Brain Research Institute Niigata University, Department of Neurosurgery, Brain Research Institute Niigata University, Department of Neurosurgery, Brain Research Institute Niigata University

    脳卒中の外科 = Surgery for cerebral stroke   31 ( 5 )   355 - 360   2003年9月

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    記述言語:日本語   出版者・発行元:The Japanese Society on Surgery for Cerebral Stroke  

    To examine flowdynamic change after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery, we measured the pulsatility index (PI) and end-diastolic blood flow velocity (Vd) of the donor STA by percutaneous direct microvascular Doppler sonography. In 63 patients (5-76 y/o) who had received STA-MCA bypass surgery for either ischemic stroke (11 cases), supportive therapy before parent artery occlusion in the treatment of internal carotid giant aneurysm (3 cases), or moyamoya disease (49 cases) (total 96 sides of STA), PI was 1.01±0.41 and Vd was 18.9±8.4 cm/sec. When compared to normal volunteers (6-76 y/o, 70 sides of STA) (PI: 1.96±0.63 and Vd: 5.6±2.5 cm/sec), PI decreased and Vd increased after STA-MCA bypass with high statistical significance (p&lt;0.0001 and p&lt;0.0001, respectively). Low PI and high Vd indicate that STA flow has changed from extracranial flow to intracranial flow. STA flowdynamics can be quantitatively assessed by measuring PI and Vd of the donor STA. This new bedside method is easy, noninvasive and useful to identify functional patency of the STA-MCA bypass.

    DOI: 10.2335/scs.31.355

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  • Histological evaluation of endothelial reactions after endovascular coil embolization for intracranial aneurysm: Clinical and experimental studies and review of the literature 査読

    Tsunenori Ozawa, S. Tamatani, T. Koike, H. Abe, Y. Ito, Y. Soga, H. Hasegawa, K. Morita, R. Tanaka

    Interventional Neuroradiology   9   69 - 82   2003年5月

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    The purpose of this study was to evaluate the role of the endothelial cell reaction after endovascular coil embolization for the treatment of intracranial aneurysms. A scanning electron microscopic (SEM) study of the platinum coil, embolized into a middle cerebral aneurysm in a 35-year-old woman and subsequently removed surgically eight months later, revealed no endothelial coverage on the coil. This finding prompted us to perform experimental studies. In the first in vitro study, endothelial cells from gerbil brain microvessels and canine carotid arteries were co-cultured with either bare-form platinum coils or type-1 collagen-coated coils for up to three weeks, and the endothelial cell population on the coils was ascertained. In the second in vivo study, platinum coils coated with type-1 collagen were delivered endovascularly into canine carotid arteries, while the contralateral side was treated with bare-form coils, and endothelialization over the coil was investigated. SEM studies revealed that no endothelial cells, either from gerbil brain microvessels or from canine carotid artery, were found on the uncoated coils, whereas gerbil endothelial cells began to proliferate on the collagen-coated coils in three days, covering extensively in one week and reaching confluence in two weeks in vitro. The in vivo canine study demonstrated that bare-form platinum coils did not show endothelial coverage until two weeks, but endothelial cells proliferated directly on the collagen-coated coils in three days, and coils were completely covered in two weeks. These results supported the SEM study of our case and several human histopathological reports in the literature in that endothelial cell coverage in the orifice of the intracranial aneurysm is exceptional after endovascular treatment. But if some extracellular matrix, like collagen in our study, is prepared, coverage could be possible, as is seen in a few human cases. Biological modification of the platinum coils, such as collagen coating, is awaited for the better long-term results of endovascular coil embolization without recanalization of the treated intracranial aneurysms.

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