Faculty Profiles - HASEGAWA Hitoshi

Papers - HASEGAWA Hitoshi

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Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion. Reviewed International journal

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 2015.8

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

Technical Nuances of Surgical Resection for Onyx‐embolized Brain Arteriovenous Malformations Reviewed

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 2015.7

Language：Japanese Publisher：(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. Reviewed International journal

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 2014.7

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

DOI： 10.3171/2014.4.PEDS13628

Does the carotid artery stenting for geriatric patients really show safety and effectiveness? Reviewed

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 2013.3

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 Reviewed

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 2011.7

Language：Japanese Publisher：(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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Microcatheter pull‐up technique using gooseneck snare in transvenous embolization for cavernous sinus dural arteriovenous fistula: technical note Reviewed

長谷川仁, 伊藤靖, 本道洋昭, 反町隆俊, 藤井幸彦

Journal of Neuroendovascular Therapy 5 ( 1 ) 68 - 73 2011.7

Language：Japanese Publisher：(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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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 Reviewed

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 2011.7

Language：Japanese Publisher：(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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Development of cranial nerve palsy shortly after endosaccular embolization for asymptomatic cerebral aneurysm: report of two cases and literature review. Reviewed International journal

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

Acta neurochirurgica 151 ( 4 ) 379 - 83 2009.4

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

Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils. Reviewed International journal

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

Journal of neurosurgery 109 ( 2 ) 208 - 14 2008.8

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

Modified buddy wire technique for coil embolization of posterior circulation aneurysms. Reviewed International journal

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

Neuroradiology 49 ( 1 ) 49 - 55 2007.1

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

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 Reviewed

長谷川仁

新潟医学会雑誌 120 ( 4 ) 203 - 213 2006.4

Language：Japanese Publisher：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. Reviewed International journal

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

Journal of neurosurgery 101 ( 5 ) 861 - 3 2004.11

Language：English Publishing type：Research paper (scientific journal) Publisher：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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Long‐term Clinical and Surgical Outcomes of Pediatric Patients with Moyamoya Disease

小沢常徳, 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 2004.8

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. Reviewed International journal

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 2003.10

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

DOI： 10.3171/jns.2003.99.4.0746

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Change of Superficial Temporal Artery Flowdynamics after EC-IC Bypass Detected by Percutaneous Microvascular Doppler Flowmetry Reviewed

OZAWA Tsunenori, MORITA Kenichi, HASEGAWA Hitoshi, ITO Yasushi, TANAKA Ryuichi, Tsunenori OZAWA, Kenichi MORITA, Hitoshi HASEGAWA, Yasushi ITO, Ryuichi TANAKA, 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 2003.9

Language：Japanese Publisher：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<0.0001 and p<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 Reviewed

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

Interventional Neuroradiology 9 69 - 82 2003.5

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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