Faculty Profiles - HASEGAWA Hitoshi

Papers - HASEGAWA Hitoshi

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Hemodynamic features of an intracranial aneurysm rupture predicted by perianeurysmal edema: A case report. International journal

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

Language：English

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

Retrograde T-Stent Technique for Large, Wide-Necked Internal Carotid-Posterior Communicating Artery Aneurysm.

Kohei Shibuya, Hitoshi Hasegawa, Tomoaki Suzuki, Shoji Saito, Kazuhiro Ando, Haruhiko Takahashi, Toru Takino, Ryota Ohkura, Yukihiko Fujii

Journal of neuroendovascular therapy 15 ( 6 ) 396 - 403 2021

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: We report a case of a wide-necked internal carotid-posterior communicating (IC-Pcom) artery aneurysm treated by the retrograde T-stent technique in which a stent was also placed in the Pcom artery via the posterior circulation. CASE PRESENTATION: A 35-year-old woman was diagnosed with an unruptured right IC-Pcom artery aneurysm (maximum diameter: 11 mm, neck diameter: 8.5 mm) during a detailed examination for vertigo. The Pcom artery (2.1 mm) branched from the aneurysmal dome. A microcatheter was guided in retrograde via the Pcom artery from the posterior circulation. A low-profile visualized intraluminal support (LVIS) Jr. 2.5 mm × 17 mm was deployed from the internal carotid artery (ICA) to the Pcom artery, and then, an LVIS 4.5 mm × 23 mm was deployed while pressing the flare of the LVIS Jr. protruding into the ICA. T configuration stenting was completed, and the coil was inserted as tightly as possible. CONCLUSION: The retrograde T-stent technique, which has the advantage of optimal stent positioning, is useful for preserving a Pcom artery branching from the aneurysmal dome.

DOI： 10.5797/jnet.tn.2020-0070

Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography. Reviewed International journal

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 2020.12

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Rinsho shinkeigaku = Clinical neurology 60 ( 6 ) 425 - 428 2020.6

Language：Japanese Publishing type：Research paper (scientific journal)

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

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

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 2020.6

Language：Japanese Publishing type：Research paper (scientific journal)

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

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 Reviewed

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 2020.4

Language：Japanese Publisher：(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)

Other Link： 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) Reviewed

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

JNET: Journal of Neuroendovascular Therapy 14 ( 3 ) 112 - 117 2020.3

Language：English Publisher：(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)

Other Link： 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 2020.3

Language：Japanese Publisher：(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)

Other Link： 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. Reviewed International journal

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 2020.2

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Frontiers in neurology 11 611124 - 611124 2020

Language：English Publishing type：Research paper (scientific journal)

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

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 2019.12

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 2019.11

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03120&link_issn=&doc_id=20191115140004&doc_link_id=issn%3D0917-1495%26volume%3D29%26issue%3D11%26spage%3D1172&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D29%26issue%3D11%26spage%3D1172&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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

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

Neurologia medico-chirurgica 59 ( 9 ) 344 - 350 2019.9

Language：English Publishing type：Research paper (scientific journal)

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

Malignant Hyperthermia and Cerebral Venous Sinus Thrombosis After Ventriculoperitoneal Shunt in Infant with Schizencephaly and COL4A1 Mutation. Reviewed International journal

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

World neurosurgery 127 446 - 450 2019.7

Language：English Publishing type：Research paper (scientific journal)

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

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 2019.7

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03120&link_issn=&doc_id=20190703140008&doc_link_id=issn%3D0917-1495%26volume%3D29%26issue%3D7%26spage%3D740&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D29%26issue%3D7%26spage%3D740&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Long-term outcomes of coil embolization of unruptured intracranial aneurysms. Reviewed International journal

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 2018.12

Language：English Publishing type：Research paper (scientific journal)

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

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Reviewed International journal

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 2018.10

Language：English Publishing type：Research paper (scientific journal)

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

【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 2018.9

Language：Japanese Publisher：(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)

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 Reviewed

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

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 10 138 - 141 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：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
and
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

Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern. Reviewed International journal

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

Journal of neurosurgery 126 ( 1 ) 60 - 68 2017.1

Language：English Publishing type：Research paper (scientific journal) Publisher：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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