Faculty Profiles - HASEGAWA Hitoshi

Papers - HASEGAWA Hitoshi

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CRISPR/CasRx suppresses KRAS-induced brain arteriovenous malformation developed in postnatal brain endothelial cells in mice. International journal

Shoji Saito, Yuka Nakamura, Satoshi Miyashita, Tokiharu Sato, Kana Hoshina, Masayasu Okada, Hitoshi Hasegawa, Makoto Oishi, Yukihiko Fujii, Jakob Körbelin, Yoshiaki Kubota, Kazuki Tainaka, Manabu Natsumeda, Masaki Ueno

JCI insight 9 ( 22 ) 2024.11

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

Brain arteriovenous malformations (bAVMs) are anomalies forming vascular tangles connecting the arteries and veins, which cause hemorrhagic stroke in young adults. Current surgical approaches are highly invasive, and alternative therapeutic methods are warranted. Recent genetic studies identified KRAS mutations in endothelial cells of bAVMs; however, the underlying process leading to malformation in the postnatal stage remains unknown. Here we established a mouse model of bAVM developing during the early postnatal stage. Among 4 methods tested, mutant KRAS specifically introduced in brain endothelial cells by brain endothelial cell-directed adeno-associated virus (AAV) and endothelial cell-specific Cdh5-CreERT2 mice successfully induced bAVMs in the postnatal period. Mutant KRAS led to the development of multiple vascular tangles and hemorrhage in the brain with increased MAPK/ERK signaling and growth in endothelial cells. Three-dimensional analyses in cleared tissue revealed dilated vascular networks connecting arteries and veins, similar to human bAVMs. Single-cell RNA-Seq revealed dysregulated gene expressions in endothelial cells and multiple cell types involved in the pathological process. Finally, we employed CRISPR/CasRx to knock down mutant KRAS expression, which efficiently suppressed bAVM development. The present model reveals pathological processes that lead to postnatal bAVMs and demonstrates the efficacy of therapeutic strategies with CRISPR/CasRx.

DOI： 10.1172/jci.insight.179729

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms. International journal

Tomoaki Suzuki, Hitoshi Hasegawa, Kohei Shibuya, Hidemoto Fujiwara, Makoto Oishi

Diagnostics (Basel, Switzerland) 14 ( 11 ) 2024.6

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

Intraprocedural rupture (IPR) during coil embolization (CE) of an intracranial aneurysm is a significant clinical concern that necessitates a comprehensive understanding of its clinical and hemodynamic predictors. Between January 2012 and December 2023, 435 saccular cerebral aneurysms were treated with CE at our institution. The inclusion criterion was extravasation or coil protrusion during CE. Postoperative data were used to confirm rupture points, and computational fluid dynamics (CFD) analysis was performed to assess hemodynamic characteristics, focusing on maximum pressure (Pmax) and wall shear stress (WSS). IPR occurred in six aneurysms (1.3%; three ruptured and three unruptured), with a dome size of 4.7 ± 1.8 mm and a D/N ratio of 1.5 ± 0.5. There were four aneurysms in the internal carotid artery (ICA), one in the anterior cerebral artery, and one in the middle cerebral artery. ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with Pmax in five aneurysms (83.3%). Time-averaged WSS was locally reduced around this area (1.3 ± 0.7 [Pa]), significantly lower than the aneurysmal dome (p < 0.01). Hemodynamically unstable areas have fragile, thin walls with rupture risk. A microcatheter was inserted along the inflow zone, directed towards the caution area. These findings underscore the importance of identifying hemodynamically unstable areas during CE. Adjunctive techniques should be applied with caution, especially in small aneurysms with axial misalignment, to minimize the rupture risk.

DOI： 10.3390/diagnostics14111203

Posterior cerebral artery involvement in unilateral moyamoya disease is exclusively ipsilateral and influenced by RNF213 mutation gene dose: The SUPRA Japan study: PCA involvement in unilateral moyamoya. International journal

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 stroke and cerebrovascular diseases : the official journal of National Stroke Association 33 ( 2 ) 107513 - 107513 2024.2

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

OBJECTIVES: The characteristics and clinical implications of posterior cerebral artery (PCA) involvement in unilateral moyamoya disease (U-MMD), such as laterality, frequency of the RNF213 p.R4810K mutation, and clinical outcomes, have not been well studied. POPULATION AND METHODS: We analyzed a cohort of 93 patients with U-MMD who participated in the SUPRA Japan study. Clinical characteristics and radiological examinations were collected from medical records. The presence of the p.R4810K mutation was determined using a TaqMan assay. The clinical outcome was assessed using the modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were performed to assess the associations. RESULTS: Among the patients with U-MMD, PCA involvement was observed in 60.0 % (3/5) of patients with homozygous mutation, 11.3 % (7/62) of those with heterozygous mutation, and 3.8 % (1/26) of those with wild type, showing a significant linear trend (p < 0.001 for trend). PCA involvement was observed exclusively on the same side as the affected anterior circulation. Dyslipidemia and cerebral infarction at initial onset were independently associated with mRS ≥1. Hypertension was associated with mRS ≥1 and it was also linked to infarction at initial onset, suggesting a potential confounding effect. Although PCA involvement showed a trend for higher mRS, it was not statistically significant. CONCLUSIONS: Our findings indicate a gene dose effect of the p.R4810K mutation on PCA involvement, with the homozygous state showing the most significant effect. Both genetic and modifiable factors such as dyslipidemia may influence the progression of U-MMD.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107513

Non-sinus type of transverse sinus dural arteriovenous fistulas on the arachnoid granulation of the dural sinus wall. International journal

Tomoaki Suzuki, Hitoshi Hasegawa, Kouichirou Okamoto, Kohei Shibuya, Hidemoto Fujiwara, Makoto Oishi

Surgical neurology international 15 43 - 43 2024

Language：English

BACKGROUND: The etiology of a non-sinus-type dural arteriovenous fistulas (DAVFs) with shunt points located on the sinus wall, previously described as on-the-wall-type DAVFs, is unknown. CASE DESCRIPTION: Two cases of non-sinus-type transverse sinus DAVF with a shunt point limited to the dural sinus wall, causing cortical venous reflux, were successfully treated with endovascular transarterial Onyx embolization. The Onyx cast showed multiple feeders from the occipital and middle meningeal arteries aggregated in the arachnoid granulation (AG), which dilated the draining vein. CONCLUSION: Non-sinus-type DAVFs with shunt points located on the AG may be one of the presentations of an on-the-wall-type DAVF.

DOI： 10.25259/SNI_930_2023

血栓回収治療成績の県内悉皆調査

渋谷航平, 長谷川仁, 鈴木倫明, 藤原秀元, 西山慶, 大石誠

脳血管内治療 8 ( Suppl. ) S267 - S267 2023.11

Investigation of Mechanical Thrombectomy in Elderly Patients over 85 Years Old: A Multicenter Study.

Kohei Shibuya, Hitoshi Hasegawa, Tomoaki Suzuki, Haruhiko Takahashi, Kei Nishiyama, Makoto Oishi, Yukihiko Fujii

Neurologia medico-chirurgica 63 ( 9 ) 393 - 399 2023.9

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

In Japan, which has a super-aging society, there are increasing opportunities to perform mechanical thrombectomy for the elderly; however, there is no recorded evidence of thrombectomy for the elderly. This study examined the usefulness of thrombectomy in the elderly. We retrospectively analyzed patient data using a multicenter acute ischemic stroke registry (NGT-FAST). We examined outcomes in patients 75 years and older who underwent thrombectomies between January 1, 2021, and December 31, 2021. The patients were divided into two groups: the 75-84-year-old group and the 85+-year-old group. There was no difference in the pretreatment National Institutes of Health Stroke Scale score or Alberta Stroke Program Early Computed Tomography Score between the two groups, but the 85+-year-old group had a significantly lower rate of pre-stroke modified Rankin Scale (mRS) score of 0-2. There were no differences in time from onset to treatment or effective recanalization rate, but complications tended to be more common in the 85+-year-old group. The number of patients with a good outcome at discharge (an mRS score of 0-3) was significantly lower in the 85+-year-old group than in the 75-84-year-old group. In addition, 90.9% of patients in the 85+-year-old group with a pre-stroke mRS score of 3 deteriorated after treatment. The pre-stroke mRS score is very important in determining the indication for thrombectomy in the elderly because their preoperative condition is more likely to influence the outcome than that of younger patients.

DOI： 10.2176/jns-nmc.2023-0039

Usefulness of silent magnetic resonance angiography for intracranial aneurysms treated with a flow re-direction endoluminal device. International journal

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

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 15910199231174546 - 15910199231174546 2023.5

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

PURPOSE: Flow re-direction endoluminal device (FRED) is a novel dual-layer flow-diverting stent to treat cerebral aneurysms with high obliteration rates, however, it induces inevitable metal-related artifacts. We compared silent magnetic resonance angiography (MRA), a new MRA method using ultra-short time of echo and arterial spin-labeling, with conventional time-of-flight (TOF)-MRA for imaging aneurysms treated using FRED. METHODS: Between May 2020 and September 2022, 16 patients with unruptured internal carotid aneurysms treated using FRED simultaneously underwent silent MRA and TOF-MRA after treatment, with 36 follow-up sessions in total. Two observers independently graded the quality of intra-aneurysmal flow and stented parent arteries under both types of MRA from 1 (not visible) to 4 (nearly equal to digital subtraction angiography [DSA]), with reference to DSA images as a standard criterion. RESULTS: The mean scores for intra-aneurysmal flow and stented parent arteries were significantly better for silent MRA (3.93 ± 0.21 and 3.82 ± 0.32, respectively) than for TOF-MRA (2.08 ± 0.99 and 1.92 ± 0.79, respectively) (P < 0.01). Intermodality agreements for intra-aneurysmal flow and stented parent arteries were 0.87 and 0.90, respectively. CONCLUSION: Silent MRA is superior to TOF-MRA for assessing patients treated with FRED, with potential as an alternative imaging modality to DSA.

DOI： 10.1177/15910199231174546

Superior Visualization of Neovascularization with Silent Magnetic Resonance Angiography Compared to Time-of-flight Magnetic Resonance Angiography after Bypass Surgery in Moyamoya Disease. International journal

Tomoaki Suzuki, Hitoshi Hasegawa, Kouichirou Okamoto, Kohei Shibuya, Haruhiko Takahashi, Hidemoto Fujiwara, Makoto Oishi, Yukihiko Fujii

World neurosurgery 2023.5

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

OBJECTIVE: The evaluation of postsurgical neoangiogenesis in patients with moyamoya disease (MMD) is crucial for appropriate patient management. This study aimed to assess the visualization of neovascularization after bypass surgery using non-contrast-enhanced silent magnetic resonance angiography (MRA) with ultra-short echo time (UTE) and arterial spin labeling (ASL). METHODS: After bypass surgery, 13 patients with MMD were followed up for >6 months between September 2019 and November 2022. They underwent silent MRA in the same session as time-of-flight MRA (TOF-MRA) and digital subtraction angiography (DSA). Two observers independently rated the visualization of neovascularization in both types of MRA from 1 (not visible) to 4 (nearly equal to DSA), with reference to DSA images as the standard. RESULTS: The mean scores were significantly higher for silent MRA compared with TOF-MRA (3.81 ± 0.48 and 1.92 ± 0.70, respectively) (p <0.01). The inter-modality agreements were 0.83 and 0.71 for silent MRA and TOF-MRA, respectively. TOF-MRA depicted the donor artery and recipient cortical artery after direct bypass surgery, although fine neovascularization developed after indirect bypass surgery was poorly visualized. Silent MRA could reveal the developed bypass flow signal and perfused MCA territory, which was almost equal to the DSA images. CONCLUSIONS: Silent MRA achieves better visualization of postsurgical revascularization in patients with MMD than TOF-MRA. Moreover, it may have the potential to provide visualization of the developed bypass flow equivalent to DSA.

DOI： 10.1016/j.wneu.2023.04.119

[Arteriovenous Malformations:Endovascular Techniques and Devices].

Hitoshi Hasegawa

No shinkei geka. Neurological surgery 51 ( 2 ) 265 - 277 2023.3

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

Endovascular embolization using liquid materials is a safe and effective treatment option for cerebral arteriovenous malformations(AVM). Onyx and n-butyl cyanoacrylate, currently available in Japan, have specific features. Appropriate embolic agents should be selected based on their characteristics. Transarterial embolization(TAE)is the standard endovascular treatment approach. However, there have been some recent reports regarding the efficacy of transvenous embolization(TVE). TVE is potentially curative for small AVM with hemorrhagic onset, inaccessible arterial feeders, deep location, and/or a single draining vein. In specific cases, TVE may provide a higher chance of complete obliteration of the AVM than TAE. Some unsolved problems need further clarification, such as the relative positions of liquid embolization against direct surgery, dealing with unruptured AVM, and effective treatment for high-grade AVM.

DOI： 10.11477/mf.1436204742

A Case of Paradoxical Cerebral Embolism Due to Pulmonary Arteriovenous Fistula Mimicking Vertebral Artery Dissection With Wallenberg Syndrome. International journal

Masaru Isogai, Tomoaki Suzuki, Shyunichi Kato, Yoshinori Taniguchi, Hitoshi Hasegawa, Makoto Oishi, Yukihiko Fujii

Cureus 15 ( 2 ) e34564 2023.2

Language：English

Pulmonary arteriovenous fistula (PAVF) leads to paradoxical cerebral embolism, which can be fatal if left untreated. We report a rare case of brainstem infarction with acute severe headache and Wallenberg syndrome caused by a PAVF mimicking vertebral artery (VA) dissection. A 40-year-old man presented with a sudden occipital headache accompanied by right hemisensory disturbance. Magnetic resonance imaging revealed left lateral medullary infarction and poor depiction of the left VA. However, it was clearly recanalized on day six, and there were no findings of VA dissection. Whole-body contrast-enhanced computed tomography (CT) revealed a PAVF in the right lung and a thrombus in the feeding artery. The patient was diagnosed with hereditary hemorrhagic telangiectasia due to recurrent epistaxis and peripheral vasodilation of the tongue. An anticoagulant was administered for preventing further ischemic stroke, and a follow-up CT confirmed the disappearance of the thrombus in three months. Thoracoscopic partial lung resection was performed five months after the onset, and no recurrence of ischemic stroke was observed.

DOI： 10.7759/cureus.34564

Usefulness of Y-shaped PulseRider-assisted coil embolization for basilar artery tip aneurysm with a misaligned axis: A case report. International journal

Kohei Shibuya, Hitoshi Hasegawa, Tomoaki Suzuki, Hidemoto Fujiwara, Satoshi Shibuma, Kazuki Shida, Makoto Oishi

Surgical neurology international 14 300 - 300 2023

Language：English

BACKGROUND: Endovascular treatment of wide-necked bifurcation aneurysms remains challenging. Although the advent of PulseRider and Web has expanded treatment options, aneurysms with a large deviation from the parent artery axis remains difficult to treat. We present the case of a wide-necked bifurcation aneurysm that was misaligned with the angle between the long axis of the parent artery and the aneurysm and was successfully treated with Y-shaped PulseRider-assisted coil embolization. CASE DESCRIPTION: A 64-year-old woman presented with an unruptured basilar tip aneurysm. Cerebral angiography showed a wide-necked aneurysm measuring 8.1 mm × 6.1 mm, neck 5.7 mm. The aneurysm was strongly tilted to the right and posterior relative to the basilar artery, and the bilateral posterior cerebral artery (PCA) and superior cerebellar artery (SCA) diverged from the aneurysm body. PulseRider-assisted coil embolization was performed. A Y-shaped PulseRider was selected to be placed in a hybrid fashion with the right arch in the aneurysm and the left arch in the branch. Adequate coil embolization with preservation of the bilateral PCA and SCA was possible, and cerebral angiography immediately after the treatment showed slight dome filling. Cerebral angiography 6 months after the procedure showed that the embolic status had improved to complete occlusion. CONCLUSION: For wide-neck bifurcation aneurysms with a misaligned axis, a Y-shaped PulseRider used in a hybrid fashion, in which the leaflet on the side with the tilted axis is placed in the aneurysm, allows the PulseRider to be deployed more closely to the aneurysm, thereby enabling good coil embolization.

DOI： 10.25259/SNI_449_2023

Opposite L-configuration double stenting for rupture of an extremely wide-necked anterior communicating artery aneurysm at the acute stage: illustrative case. International journal

Nobuyuki Genkai, Kouichirou Okamoto, Hitoshi Hasegawa

Journal of neurosurgery. Case lessons 4 ( 18 ) 2022.10

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

BACKGROUND: Wide-necked aneurysms can be treated by double stenting in an X- or Y-configuration or by a double waffle-cone technique. However, some aneurysms remain untreatable. OBSERVATIONS: The rupture of a complex wide-necked anterior communicating artery (AcomA) aneurysm that caused acute subarachnoid hemorrhage (SAH) was treated successfully using double stents with an opposite L-configuration as an alternative to the X-stent technique. The aneurysm involved both A1-A2 junctions in the aneurysm neck with acutely oriented A2 segments of the anterior cerebral artery bilaterally. It was densely packed and completely obliterated angiographically with preserved blood flow by implanting each stent in the ipsilateral A1-A2 bilaterally. Blood flow from the left A1 to the right A2 was confirmed through the AcomA on injection of the left internal carotid artery immediately after the procedure without critical infarction in the subthalamic area. Although the AcomA was not demonstrated by injection of the left internal carotid artery on angiography at 3 months or 1 year later, no cerebral infarction was seen on magnetic resonance images at the final hospital visit. LESSONS: Opposite L-configuration double stenting was used successfully as rescue stent-assisted coiling for a rupture of a complex wide-necked AcomA aneurysm in a patient with acute SAH.

DOI： 10.3171/CASE22165

Long-Term Characteristics of De Novo Bleb Formation at the Aneurysm Neck After Coil Embolization in Unruptured Cerebral Aneurysms. International journal

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

World neurosurgery 161 e767-e775 2022.5

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

OBJECTIVE: De novo bleb formation at the aneurysm neck after coil embolization of unruptured intracranial aneurysms is a rarely observed type of recurrence. The aim of this study was to elucidate the clinical characteristics of recurrent aneurysms in the long-term period. METHODS: Between January 2002 and December 2015, 290 unruptured intracranial aneurysms were treated with coil embolization at our institution. Patients who underwent retreatment due to aneurysm recurrence were divided into 2 patterns of recanalization: de novo bleb formation at the neck of a coiled sac (type DNV) and an enlarged residual cavity without de novo bleb formation (type non-DNV). RESULTS: Twenty-seven patients with aneurysms (9.3%) underwent retreatment (type DNV, 7; type non-DNV, 20). The initial aneurysm size of type DNV aneurysms was significantly smaller than that of type non-DNV (6.1 ± 2.2 mm vs. 10.1 ± 3.6 mm; P < 0.01), and time to retreatment in type DNV was significantly longer than that in type non-DNV (9.4 ± 5.3 years vs. 2.0 ± 2.0 years; P < 0.01). Two type DNV basilar artery (BA) aneurysms ruptured after a few years; however, the other type DNV aneurysms, including 4 anterior circulation aneurysms (including the internal carotid artery), were observed to grow gradually without rupture for >10 years until retreatment. CONCLUSIONS: De novo bleb formation at the neck of a coiled sac emerges with insidious growth during long-term follow-up. Constant caution should be exercised, even in cases of small- and medium-sized anterior circulation aneurysms. A risk of rupture risk may be anticipated, especially in BA lesions.

DOI： 10.1016/j.wneu.2022.02.092

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 40 ( 9 ) 979 - 985 2022.4

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

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

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

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

Acta neurochirurgica 164 ( 5 ) 1265 - 1269 2021.9

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

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

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

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 2021.9

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

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

Delayed Bleeding of Unruptured Intracranial Aneurysms After Coil Embolization: A Retrospective Case Series. International journal

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

World neurosurgery 149 e135-e145 2021.5

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

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

Development and natural course of lateral posterior choroidal artery aneurysms arising from fragile choroidal collaterals in moyamoya disease: illustrative cases. International journal

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

Journal of neurosurgery. Case lessons 1 ( 15 ) CASE2110 2021.4

Language：English

BACKGROUND: Choroidal collaterals are a risk factor for hemorrhagic stroke, even in the nonhemorrhagic hemisphere, among patients with moyamoya disease (MMD). Peripheral choroidal aneurysms rupture in fragile collaterals; however, the development and natural course of these aneurysms remain elusive. OBSERVATIONS: A 51-year-old woman, who had experienced a right cerebral hemorrhage 3 years earlier, presented with asymptomatic minor bleeding from a left lateral choroidal artery aneurysm in a predeveloped choroidal anastomosis. Although the aneurysm spontaneously thrombosed within 2 months, the choroidal collaterals persisted. After bypass surgery, the choroidal anastomosis regressed, and neither a de novo aneurysm nor a hemorrhagic stroke occurred. A 75-year-old woman with MMD, who had experienced a left frontal infarction 6 years earlier, experienced recurrent right intraventricular hemorrhage from a ruptured lateral choroidal artery aneurysm that developed in the choroidal anastomosis. The aneurysm spontaneously regressed 3 days after the rebleeding with no recurrence over the following 7 years. LESSONS: Choroidal artery aneurysms may develop in the choroidal anastomosis and rupture in the nonsurgical or contralateral hemispheres. Patients with MMD who have a history of hemorrhagic or ischemic stroke and impaired cerebral blood flow require careful observation. Although aneurysms may rapidly regress spontaneously, bypass surgery can stabilize hemodynamic stress and prevent further hemorrhage.

DOI： 10.3171/CASE2110

Unilateral oculomotor nerve palsy caused by arterial compression accompanying subarachnoid hemorrhage: a case report. International journal

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 2021.3

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

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

Repeated cerebellar infarction in the affected nondominant vertebral artery distribution with reversible vertebral artery occlusion elicited by head tilt: illustrative case. International journal

Takanori Nozawa, Kouichirou Okamoto, Shinji Nakazato, Kunio Motohashi, Tomoaki Suzuki, Kotaro Morita, Hideki Tashi, Kei Watanabe, Hitoshi Hasegawa, Masato Watanabe, Hiroyuki Kawashima, Yukihiko Fujii

Journal of neurosurgery. Case lessons 1 ( 8 ) CASE2061 2021.2

Language：English

BACKGROUND: Bow hunter's syndrome or stroke (BHS) is characterized by rotational vertebrobasilar insufficiency elicited by rotation of the neck. It is caused by dynamic and reversible occlusion of the vertebral artery (VA). Reversible symptoms of rotational vertebrobasilar insufficiency are described as bow hunter's syndrome, although brain infarction is rarely reported as bow hunter's stroke. OBSERVATIONS: A 70-year-old man experienced repeated cerebellar infarctions three times in the posterior inferior cerebellar artery (PICA) distribution of the nondominant right VA connecting the basilar artery. The onset of symptoms indicating cerebellar infarcts and the patient's head position changes were unrelated. Dynamic digital angiography (DA) revealed that the nondominant right VA was occluded by an osteophyte from the C4 vertebral body, and the right PICA branches were shown to be passing through the distal right VA from the left VA. These findings were observed when the patient's head was tilted to the right. An arterio-arterial embolic mechanism was suggested as the cause of repeated cerebellar infarctions. LESSONS: Transient nondominant VA occlusion has been rarely reported as a cause of BHS when the head is tilted. To confirm the diagnosis of BHS, additional head tilt is recommended when performing dynamic DA in patients with a cervical osteophyte.

DOI： 10.3171/CASE2061

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

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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02079&link_issn=&doc_id=20150812200007&doc_link_id=%2Fcp4strok%2F2015%2F004304%2F007%2F0283-0288%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2015%2F004304%2F007%2F0283-0288%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J05194&link_issn=&doc_id=20110808360006&doc_link_id=%2Fcf5jneth%2F2011%2F000501%2F006%2F0043-0049%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5jneth%2F2011%2F000501%2F006%2F0043-0049%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J05194&link_issn=&doc_id=20110808360010&doc_link_id=%2Fcf5jneth%2F2011%2F000501%2F010%2F0068-0073%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5jneth%2F2011%2F000501%2F010%2F0068-0073%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J03120&link_issn=&doc_id=20110712220010&doc_link_id=issn%3D0917-1495%26volume%3D21%26issue%3D7%26spage%3D782&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D21%26issue%3D7%26spage%3D782&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00990&link_issn=&doc_id=20060622220002&doc_link_id=%2Fdg3nigta%2F2006%2F012004%2F002%2F0203-0213%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2006%2F012004%2F002%2F0203-0213%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

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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