髙橋　淳 （タカハシ　ジュン）

コミュニケーション情報 byコメンテータガイド

• コメント

  （1）くも膜下出血・脳出血 （2）脳動脈瘤、脳動静脈奇形、もやもや病、頚部頚動脈狭窄症の手術治療（血管内治療の詳細な手技は除く） （3）妊産婦脳卒中（最も専門的なコメントが可能）

• 報道関連出演・掲載一覧

  ＜報道関連出演・掲載一覧＞ ●2023/6/30 　読売新聞 　もやもや病のバイパス手術について ●2021/1/21 　朝日放送「キャスト」 　爆笑問題 田中裕二さんのくも膜下出血、脳梗塞について ●2020/9/3 　サンケイスポーツ 　小脳出血について ●2020/6/19 　朝日放送「キャスト」 　脳出血について

研究者情報

学位

• 医学博士（1998年03月 京都大学）

ホームページURL

https://jglobal.jst.go.jp/detail?JGLOBAL_ID=202001005149502511

科研費研究者番号

• 90551408

J-Global ID

• 202001005149502511

現在の研究分野（キーワード）

（1）くも膜下出血・脳出血
（2）脳動脈瘤、脳動静脈奇形、もやもや病、頚部頚動脈狭窄症の手術治療（血管内治療の詳細な手技は除く）
（3）妊産婦脳卒中（最も専門的なコメントが可能）

研究分野

• ライフサイエンス / 脳神経外科学

経歴

• 2020年06月 - 現在  近畿大学医学部脳神経外科
• 2014年01月 - 2020年05月  国立循環器病研究センター脳神経外科
• 2009年06月 - 2013年12月  京都大学大学院医学研究科脳神経外科
• 1998年04月 - 2009年05月  国立循環器病センター脳神経外科
• 1994年04月 - 1998年03月  京都大学大学院医学研究科脳統御医学系
• 1992年04月 - 1994年03月  大阪赤十字病院脳神経外科
• 1991年06月 - 1992年03月  京都大学医学部脳神経外科

学歴

• 1994年04月 - 1998年03月   京都大学大学院医学研究科脳統御医学系
• 1985年04月 - 1991年03月   京都大学医学部

所属学協会

• 日本脳卒中の外科学会   日本脳卒中学会   日本脳神経外科コングレス   日本脳神経外科学会   

研究活動情報

論文

• "Transcallosal" periventricular anastomosis in moyamoya disease: the fourth periventricular anastomosis and a potential predictor of hemorrhage.

  Yukihiro Yamao; Takeshi Funaki; Hiroki Yamada; Masakazu Okawa; Yohei Mineharu; Takayuki Kikuchi; Yasutaka Fushimi; Hiroharu Kataoka; Kazumichi Yoshida; Jun C Takahashi; Susumu Miyamoto; Yoshiki Arakawa

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 32 12 107428 - 107428 2023年12月 

  OBJECTIVES: Choroidal anastomosis is a risk factor for hemorrhage in moyamoya disease. One variant of choroidal anastomosis, "transcallosal anastomosis," originates from the medial posterior choroidal artery, and penetrates the corpus callosum to reconstruct the pericallosal artery. We aimed to investigate the prevalence and the bleeding rate of transcallosal anastomosis using sliding thin-slab maximum intensity projection reformatted from magnetic resonance angiography (MRA). MATERIALS AND METHODS: This study included 222 patients. We defined transcallosal anastomosis grades (0-2) and the stenosis of the anterior (ACA, 0-2), middle (MCA, 1-3), and posterior cerebral artery (PCA, 0-2) by MRA scores, independently by two coauthors. RESULTS: Grade-2 transcallosal anastomosis was detected in 21 patients (9.5 %). There were no correlations of the incidence of transcallosal anastomosis with previous bypass surgery (P = 0.23). Multivariate analysis revealed a significantly higher incidence in hemorrhagic onset and younger age (odds ratio [OR] 3.77, and 0.97). Transcallosal anastomosis had statistically significant correlation with ACA and PCA scores (P = 0.01 and 0.03), but not with MCA scores (P = 0.1). In multivariate analysis, ACA scores 1 and 2 were significantly higher (OR, 15.44 and 11.17), and PCA score 1 was also higher (OR, 3.07), but PCA score 2 was not. Interrater agreement for judgment of transcallosal anastomosis grade was strong (κ = 0.89). Two patients with Grade-2 transcallosal anastomosis had late hemorrhage in the corpus callosum (bleeding rate: 2.5 % per year). CONCLUSIONS: Transcallosal anastomosis may be associated with both advanced ACA and moderate PCA stenosis, and cause hemorrhage at the corpus callosum.
• Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE).

  Satoshi Kuroda; Shusuke Yamamoto; Takeshi Funaki; Miki Fujimura; Hiroharu Kataoka; Tomohito Hishikawa; Jun Takahashi; Hidenori Endo; Tadashi Nariai; Toshiaki Osato; Nobuhito Saito; Norihiro Sato; Emiko Hori; Yoichi M Ito; Susumu Miyamoto

  Stroke 54 6 1494 - 1504 2023年06月 

  BACKGROUND: Long-term outcomes are unknown in patients with asymptomatic moyamoya disease. In this report, we aimed to clarify their 5-year risk of stroke and its predictors. METHODS: We are conducting a multicenter, prospective cohort study (Asymptomatic Moyamoya Registry) in Japan. Participants were eligible if they were 20 to 70 years, had bilateral or unilateral moyamoya disease, experienced no episodes suggestive of TIA and stroke; and were functionally independent (modified Rankin Scale score 0-1). Demographic and radiological information was collected at enrollment. In this study, they are still followed up for 10 years. In this interim analysis, we defined the primary end point as a stroke occurring during a 5-year follow-up period. Independent predictors for stroke were also determined, using a stratification analysis method. RESULTS: Between 2012 and 2015, we enrolled 109 patients, of whom 103 patients with 182 involved hemispheres completed the 5-year follow-up. According to the findings on DSA and MRA, 143 hemispheres were judged as moyamoya disease and 39 hemispheres as questionable manifestations (isolated middle cerebral artery stenosis). The patients with questionable hemispheres were significantly older, more often male, and more frequently had hypertension than those with moyamoya hemisphere. Moyamoya hemispheres developed 7 strokes, including 6 hemorrhagic and 1 ischemic stroke, during the first 5 years. The annual risk of stroke was 1.4% per person, 0.8% per hemisphere, and 1.0% per moyamoya hemisphere. Independent predictor for stroke was Grade-2 choroidal anastomosis (hazard ratio, 5.05 [95% CI, 1.24-20.6]; P=0.023). Furthermore, microbleeds (hazard ratio, 4.89 [95% CI, 1.13-21.3]; P=0.0342) and Grade-2 choroidal anastomosis (hazard ratio, 7.05 [95% CI, 1.62-30.7]; P=0.0093) significantly predicted hemorrhagic stroke. No questionable hemispheres developed any stroke. CONCLUSIONS: The hemispheres with asymptomatic moyamoya disease may carry a 1.0% annual risk of stroke during the first 5 years, the majority of which are hemorrhagic stroke. Grade-2 choroidal anastomosis may predict stroke, and the microbleeds and Grade-2 choroidal anastomosis may carry the risk for hemorrhagic stroke. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: UMIN000006640.
• 緊急脳室ドレナージを要する閉塞性水頭症で発症した脊髄病変合併PRESの1例

  上村 紘也; 濱野 栄佳; 池堂 太一; 太田 剛史; 森 久恵; 佐藤 徹; 髙橋 淳; 飯原 弘二; 片岡 大治

  脳卒中の外科 51 1 51 - 55 一般社団法人 日本脳卒中の外科学会 2023年 

  近年，posterior reversible encephalopathy syndrome（PRES）の中で，脊髄病変を合併するPRES with spinal cord involvement（PRES-SCI）という亜型がまれに報告されている．これまでに報告されたPRES-SCIはすべて，降圧を中心とした内科的治療のみで管理され，外科的治療を要した報告はなかった．今回，急性閉塞性水頭症を合併し，緊急脳室ドレナージ術を要した重症PRES-SCI症例を経験したため報告する． 症例は45歳男性．意識障害を主訴に当院を受診した．頭部CT，頭部および脊髄MRIにて後頭葉，小脳，上位頚髄に広範な浮腫性変化と水頭症の所見を認めた．PRES-SCIによる脳浮腫が原因で，閉塞性水頭症を呈していると診断し，緊急脳室ドレナージと厳重な血圧管理を行った．術後，脳および脊髄浮腫は経時的に改善し，神経脱落所見なく自宅退院となった． PRES-SCIには閉塞性水頭症を併発する症例もあり，時機を逃さない外科的治療介入が肝要である．
• Vessel wall imagingが診断に有用であったくも膜下出血発症両側椎骨動脈解離の一例

  前田拓真; 佐藤徹; 原健司; 濱野栄佳; 橋村直樹; 角真佐武; 池堂太一; 西村真樹; 髙橋淳; 片岡大治

  脳血管内治療 2022年11月 [査読有り]
  
• Quantitative regional cerebral blood flow measurement using near-infrared spectroscopy and indocyanine green in patients undergoing superficial temporal to middle cerebral artery bypass for moyamoya disease: a novel method using a frequency filter.

  Akito Tsukinaga; Kenji Yoshitani; Takeo Ozaki; Jun C Takahashi; Soshiro Ogata; Yoshihiko Ohnishi

  Journal of clinical monitoring and computing 2022年09月 

  Measuring regional cerebral blood flow (rCBF) after revascularization for moyamoya disease, as a type of ischemic cerebrovascular disease, is crucial. This study aims to validate our novel technology that combines near-infrared spectroscopy (NIRS) with a frequency filter to extract the arterial component. We measured rCBF before and after revascularization for moyamoya disease and at the end of the surgery using NIRO-200NX (Hamamatsu Photonics, Japan) and indocyanine green (ICG). rCBF was calculated using Fick's principle, change in arterial ICG concentrations, and maximum arterial ICG concentration. rCBF measured with NIRS (rCBF_N) was compared with pre- and postoperative rCBF measured with SPECT (rCBF_S). Thirty-four procedures were analyzed. rCBF_N increased from baseline to end of the surgery (mean difference (MD), 2.99 ml/min/100 g; 95% confidence interval (CI), 0.40-5.57 ml/min/100 g on the diseased side; MD, 4.94 ml/min/100 g; 95% CI, 2.35-7.52 ml/min/100 g on the non-diseased side). Similar trends were observed for rCBF_S (MD, 3.98 ml/min/100 g; 95% CI, 2.30-5.67 ml/min/100 g on the diseased side; MD, 2.77 ml/min/100 g; 95% CI, 1.09-4.45 ml/min/100 g on the non-diseased side). Intraclass correlations 3 (ICC3s) between rCBF_N and rCBF_S were weak on the diseased side (ICC3, 0.25; 95% CI, -0.03-0.5; p = 0.07) and the non-diseased side (ICC3, 0.24; 95% CI, -0.05-0.5; p = 0.08). rCBF measurements based on this novel method were weakly correlated with rCBF measurements with SPECT.
• Larger Posterior Revascularization Associated with Reduction of Choroidal Anastomosis in Moyamoya Disease: A Quantitative Angiographic Analysis.

  T Funaki; A Miyakoshi; H Kataoka; J C Takahashi; Y Takagi; K Yoshida; T Kikuchi; Y Mineharu; M Okawa; Y Yamao; Y Fushimi; S Miyamoto

  AJNR. American journal of neuroradiology 43 9 1279 - 1285 2022年09月 

  BACKGROUND AND PURPOSE: Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis. MATERIALS AND METHODS: This retrospective cohort study included choroidal anastomosis-positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area. RESULTS: Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], P < .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21-2.03, for every 1% increase). CONCLUSIONS: The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.
• Aspect Ratio Is Associated with Recanalization after Coiling of Unruptured Intracranial Aneurysms.

  Takeshi Hara; Tetsu Satow; Eika Hamano; Naoki Hashimura; Masatake Sumi; Taichi Ikedo; Tsuyoshi Ohta; Jun C Takahashi; Hiroharu Kataoka

  Neurologia medico-chirurgica 62 8 377 - 383 2022年08月 

  The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3%-49%. This study aims to investigate the factors that influence the recanalization after coil embolization for UIAs in our institution. We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent-used cases were excluded. Cerebral angiography and 3D time-of-flight magnetic resonance angiography (TOF MRA) were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. The mean follow-up period ranged from 6 to 172 months (mean: 79.0 ± 39.8 months). Recanalization was noted in 78 (25.4%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p < 0.001), AR (p = 0.003), and VER (p = 0.012) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. To summarize, a higher AR and a lower VER could lead to recanalization after coil embolization of UIAs. Careful follow-up is required for coiled aneurysms with these features.
• Experience With Tirabrutinib in the Treatment of Primary Central Nervous System Lymphoma that Is Difficult to Treat With Standard Treatment.

  Hiromasa Yoshioka; Takeshi Okuda; Takayuki Nakao; Mitsugu Fujita; Jun C Takahashi

  Anticancer research 42 8 4173 - 4178 2022年08月 

  BACKGROUND/AIM: Standard treatment options for primary central nervous system lymphoma (PCNSL) include high-dose methotrexate (HD-MTX)-based drug therapy and whole-brain radiation therapy. However, there are many cases in which these standard treatment options are not tolerated for various reasons. In the present study, five cases of refractory/relapsed PCNSL that are difficult to treat with standard treatment were successfully treated by tirabrutinib. PATIENTS AND METHODS: A total of 5 patients (4 women, 1 man) with refractory (n=3) and relapsed (n=2) PCNSL were included. The patients had a median age of 76 years and a median Karnofsky performance status (KPS) of 40. The reasons why standard treatment cannot be given to these patients are the low KPS, renal dysfunction, and resistance to HD-MTX. Administration of a drug via the oral route was challenging in three patients; thus, these patients were administered tirabrutinib in suspension through a nasogastric tube. RESULTS: Imaging findings showed that the patients achieved a 100% response rate to tirabrutinib, with a median survival of 8 months. As symptoms improved, 2 of the 3 patients who were initially administered tirabrutinib via a nasogastric tube were able to receive the drug via the oral route. Three patients developed adverse reactions; however, treatment was not interrupted because they were manageable. CONCLUSION: Tirabrutinib was effective in the treatment of patients who were unable to receive standard treatment options. Tirabrutinib may be considered one of the novel treatment strategies that could improve the prognosis of PCNSL patients in the future.
• [Complications of Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Their Prevention: Technical Note].

  Jun C Takahashi

  No shinkei geka. Neurological surgery 50 4 788 - 796 2022年07月 

  Complications of the superficial temporal artery-middle cerebral artery(STA-MCA)bypass procedure include skin necrosis, MCA vessel wall injury, and thrombotic occlusion of the anastomotic site. First, deprivation of the STA per se induces ischemia of the skin flap. Skin incisions must be designed carefully to avoid isolating some areas from the blood supply. Secondly, the MCA walls can be extremely thin in moyamoya disease; therefore, the fragile vascular walls must be manipulated gently. The MCA walls should not be grasped directly by forceps. Thirdly, intraluminal thrombi can develop after the completion of the anastomosis. Heparin should be administered intravenously as soon as possible when intraluminal thrombi are detected, followed by aspirin loading via a nasogastric tube. Platelet(white)thrombi are fragile and easily disrupted with mechanical vibration. It is essential to treat them before they develop into a large, firm fibrin thrombus that completely occludes the anastomotic site, which would require suture cutting and surgical thrombus removal.
• Task-specific dystonia in hairdressers: a questionnaire survey and review of the literature.

  Naoki Nakano; Masaharu Miyauchi; Nobuhiro Nakagawa; Yoshiyuki Mitsui; Kiyoshi Tsuji; Norihito Fukawa; Jun C Takahashi

  Acta neurologica Belgica 2022年06月 

  Hairdresser dystonia is one of the occupational dystonias and task-specific movement disorders occurring as a result of long-term repetitive cutting with scissors. The task-specific dystonia manifests itself as a loss of voluntary motor control during extensive practice of cutting requiring a high level of technical proficiency. The prevalence rate of hairdresser dystonia is not well-known worldwide. A questionnaire regarding dystonia was prepared for hairdressers. After sending the questionnaires to 800 hairdressers by direct mail, 134 answers were received by mail. Five of the 134 were suspected to have hairdresser-associated focal dystonia. Thus, 3.7% of hairdressers might have task-specific dystonia. This report was limited because of the small number of participants. However, this research is valuable because it was difficult to find a patient with suspected dystonia due to concerns related to job security.
• Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors.

  Yuko Kataoka; Kazutaka Sonoda; Jun C Takahashi; Hatsue Ishibashi-Ueda; Kazunori Toyoda; Yusuke Yakushiji; Hirofumi Kusaka; Masatoshi Koga

  Journal of neurointerventional surgery 14 5 2022年05月 

  BACKGROUND: The procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer. METHODS: We studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson's trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares. RESULTS: Of the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80). CONCLUSIONS: Thromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.
• Japan Stroke Society Guideline 2021 for the Treatment of Stroke.

  Susumu Miyamoto; Kuniaki Ogasawara; Satoshi Kuroda; Ryo Itabashi; Kazunori Toyoda; Yoshiaki Itoh; Yasuyuki Iguchi; Yoshiaki Shiokawa; Yasushi Takagi; Toshiho Ohtsuki; Hiroyuki Kinouchi; Yasushi Okada; Jun C Takahashi; Hiroyuki Nakase; Wataru Kakuda

  International journal of stroke : official journal of the International Stroke Society 17474930221090347 - 17474930221090347 2022年04月 

  The revised Japan Stroke Society Guidelines for the Treatment of Stroke were published in Japanese in July 2021. In this article, the extracted recommendation statements are published. The revision keeps pace with the great progress in stroke control based on the recently enacted Basic Act on Stroke and Cardiovascular Disease in Japan. The guideline covers the following areas: primary prevention, general acute management of stroke, ischemic stroke and transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, asymptomatic cerebrovascular disease, other cerebrovascular disease, and rehabilitation.
• 2021 Japanese Guidelines for the Management of Moyamoya Disease: Guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society.

  Miki Fujimura; Teiji Tominaga; Satoshi Kuroda; Jun C Takahashi; Hidenori Endo; Kuniaki Ogasawara; Susumu Miyamoto

  Neurologia medico-chirurgica 62 4 165 - 170 2022年04月
• A multicenter prospective registry of Borden type I dural arteriovenous fistula: results of a 3-year follow-up study.

  Hidehisa Nishi; Hiroyuki Ikeda; Akira Ishii; Takayuki Kikuchi; Ichiro Nakahara; Tsuyoshi Ohta; Nobuyuki Sakai; Hirotoshi Imamura; Jun C Takahashi; Tetsu Satow; Tomohisa Okada; Susumu Miyamoto

  Neuroradiology 64 4 795 - 805 2022年04月 

  PURPOSE: Although intracranial dural arteriovenous fistula (DAVF) without retrograde leptomeningeal venous drainage (Borden type I) is reported to have a benign nature, no study has prospectively determined its clinical course. Here, we report a 3-year prospective observational study of Borden type I DAVF. METHODS: From April 2013 to March 2016, consecutive patients with DAVF were screened at 13 study institutions. We collected data on baseline characteristics, clinical symptoms, angiography, and neuroimaging. Patients with Borden type I DAVF received conservative care while palliative intervention was considered when the neurological symptoms were intolerable, and were followed at 6, 12, 24, and 36 months after inclusion. RESULTS: During the study period, 110 patients with intracranial DAVF were screened and 28 patients with Borden type I DAVF were prospectively followed. None of the patients had conversion to higher type of Borden classification or intracranial hemorrhage during follow-up. Five patients showed spontaneous improvement or disappearance of neurological symptoms (5/28, 17.9%), and 5 patients showed a spontaneous decrease or disappearance of shunt flow on imaging during follow-up (5/28, 17.9%). Stenosis or occlusion of the draining sinuses on initial angiography was significantly associated with shunt flow reduction during follow-up (80.0% vs 21.7%, p = 0.02). CONCLUSION: In this 3-year prospective study, patients with Borden type I DAVF showed benign clinical course; none of these patients experienced conversion to higher type of Borden classification or intracranial hemorrhage. The restrictive changes of the draining sinuses at initial diagnosis might be an imaging biomarker for future shunt flow reduction.
• Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment.

  Ryuta Yasuda; Tetsu Satow; Naoki Hashimura; Masaki Nishimura; Jun C Takahashi; Hiroharu Kataoka

  Neurologia medico-chirurgica 62 3 118 - 124 2022年03月 

  While endovascular coil embolization has become one of the major therapeutic modalities for intracranial aneurysms, long-term imaging follow-up is required because of the higher rate of retreatment compared with surgical clipping. The purpose of this study was to show the usefulness of craniograms to discriminate coiled intracranial aneurysms that required retreatment. Under the study protocol approved by institutional review board, a retrospective review of the medical record was done regarding coil embolization for intracranial aneurysms performed between January 2014 and December 2018. Coil embolization performed as the initial treatment and followed up for more than 1 year without additional treatment, and those performed as retreatment after the initial coil embolization performed at our institution were recruited. Craniograms obtained just after the initial treatment were compared with those obtained just before the additional treatment in the retreated cases and compared with the latest ones in the non-recurrence cases. Correlation between the morphological changes in the coil mass on the craniograms and retreatments was evaluated. During the study period, 288 coil embolization procedures for intracranial aneurysms were performed. From these, 191 treatments that were followed up for more than 1 year without any additional treatments and 30 retreatments were included. Morphological change of the coil mass was observed in 4 of the 191 non-recurrence treatments and 26 of the 30 retreatments, which was significantly correlated with retreatments (p <0.001). Craniogram was a useful modality in following up the coiled intracranial aneurysms to detect those required retreatments.
• A Case of Direct Carotid-Cavernous Fistulae Successfully Treated by Bidirectional Double Catheter Technique: A Technical Note.

  Eika Hamano; Tetsu Satow; Takamitsu Hori; Jun C Takahashi; Hiroharu Kataoka

  Journal of neuroendovascular therapy 16 6 307 - 312 2022年 

  OBJECTIVE: Ruptured carotid-cavernous aneurysms (CCAs) are known to result in direct carotid-cavernous fistula (CCF). Although endovascular treatment is recognized as the first-line treatment for direct CCF, obliteration is sometimes difficult because of the high-flow shunt. In this report, we present a case of a direct CCF treated by the combination of transarterial and transvenous approaches. CASE PRESENTATION: A 57-year-old woman presented with conjunctival chemosis, exophthalmos, and tinnitus. Ophthalmological examination revealed increased intraocular pressure. DSA demonstrated a direct CCF due to a right ruptured CCA with retrograde shunted flow through the superior ophthalmic vein (SOV), superficial middle cerebral vein, basal vein of Rosenthal, and middle temporal vein. Two microcatheters were guided into the shunt segment from the internal carotid artery and SOV. In addition, a balloon catheter was placed at the neck of the aneurysm to assist coiling. Coil embolization for the CCF was performed using two microcatheters in the opposite direction, which enabled compact and tight packing of the shunt segment with only six coils. The CCF was eliminated. Two-year-follow-up MRA revealed no recurrence. CONCLUSION: The bidirectional double catheter technique is a useful approach to obliterate a shunt in a short segment with minimal coils.
• Coiling for Ruptured Aneurysms in the Vasospasm Period: Safety and Efficacy Based on a Propensity Score Analysis.

  Takao Koiso; Tetsu Satow; Eika Hamano; Masaki Nishimura; Jun C Takahashi; Hiroharu Kataoka

  Journal of neuroendovascular therapy 16 3 141 - 146 2022年 

  OBJECTIVE: To evaluate the efficacy and safety of interventional radiology (IVR) for aneurysmal subarachnoid hemorrhage (SAH) later than 3 days after onset. METHODS: A total of 71 patients between 2012 and 2017 who underwent endovascular coiling were divided into two groups according to the timing of treatment: Group E (treated within 3 days after onset) and group D (treated between 4 and 14 days after onset), and the outcomes between two groups were compared. A case-matched study was conducted to minimize the selection bias lying in this cohort. RESULTS: There were 56 (78.9%) and 15 (21.1%) patients in groups E and D, respectively. In group D, all patients arrived at the hospital later than 3 days after onset. The rates of patients with WFNS grade 1, 2, 3 and the presence of vasospasm upon the access route to the targeted aneurysm at the time of IVR were significantly higher in group D than in group E (93.3% vs 60.7%; p = 0.027, 33.3% vs 3.6%; p = 0.0037, respectively). There were no significant differences in the rate of intraprocedural complications, symptomatic vasospasm, delayed cerebral infarction due to vasospasm, retreatment, or modified Rankin Scale (mRS) at discharge. After propensity score matching, there were no significant differences in the outcomes between two groups. CONCLUSION: Prompt coiling for patients with ruptured aneurysms who arrived later than 3 days after onset can be safely performed, even if they had vasospasm upon the access route.
• The Japan Neurosurgical Database: Statistics Update 2018 and 2019.

  Koji Iihara; Nobuhito Saito; Michiyasu Suzuki; Isao Date; Yukihiko Fujii; Kiyohiro Houkin; Tooru Inoue; Toru Iwama; Takakazu Kawamata; Phyo Kim; Hiroyuki Kinouchi; Haruhiko Kishima; Eiji Kohmura; Kaoru Kurisu; Keisuke Maruyama; Yuji Matsumaru; Nobuhiro Mikuni; Susumu Miyamoto; Akio Morita; Hiroyuki Nakase; Yoshitaka Narita; Ryo Nishikawa; Kazuhiko Nozaki; Kuniaki Ogasawara; Kenji Ohata; Nobuyuki Sakai; Hiroaki Sakamoto; Yoshiaki Shiokawa; Jun C Takahashi; Keisuke Ueki; Toshihiko Wakabayashi; Koji Yoshimoto; Hajime Arai; Teiji Tominaga

  Neurologia medico-chirurgica 61 12 675 - 710 2021年12月 

  Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
• Outcome of Endovascular Therapy Aiming for Single-session Obliteration of Intracranial Dural Arteriovenous Fistulas.

  Taichi Ishiguro; Tetsu Satow; Eika Hamano; Go Ikeda; Hidekazu Chikuie; Naoki Hashimura; Masaki Nishimura; Jun C Takahashi; Hiroharu Kataoka

  Neurologia medico-chirurgica 61 10 563 - 569 2021年10月 

  The goal of dural arteriovenous fistula (dAVF) treatment is obliteration of the arteriovenous shunt and/or retrograde leptomeningeal venous drainage (RLVD). Single-session obliteration could improve symptoms early and reduce risk of neurological sequelae. This study investigated the efficacy and adverse events of endovascular therapy (EVT) aiming for single-session obliteration in dAVF treatment. We retrospectively examined post-treatment arteriovenous shunt status, number of treatments per case, treatment-related complications, and long-term outcome in 92 dAVF patients who underwent initial EVT at our institution. Single-session obliteration was intended in all cases, but a second session was performed in cases of partial shunt occlusion or remaining RLVD. Complete occlusion was achieved in 85 cases (92.4%) after the single session; RLVD was obliterated in 66 of the 67 Borden type II and III cases combined (98.5%). A second session was necessary in seven cases (7.6%). Complete shunt obliteration was eventually achieved in all cases. The average number of treatments was 1.08 per case. dAVF-related stroke and mortality did not occur after the treatment. On the other hand, radiation-induced skin erythema and alopecia, although all symptoms were transient, occurred in 26 cases (28.3%). Over an average 60.2-month follow-up period, recurrence was observed in seven cases (7.6%). Single-session obliteration was successful in 92% of cases. Especially, single-session obliteration of RLVD may contribute to early prevent of future stroke events. However, reducing total radiation dose during each session is an issue of further study.
• Experience with nasogastric tube administration of tirabrutinib in the treatment of an elderly patient with primary central nervous system lymphoma.

  Hiromasa Yoshioka; Takeshi Okuda; Takayuki Nakao; Mitsugu Fujita; Jun C Takahashi

  International cancer conference journal 10 4 290 - 293 2021年10月 

  We report that tirabrutinib was administered via nasogastric tubes to treat an elderly patient with primary central nervous system lymphoma (PCNSL). The patient was a 76-year-old woman who underwent endoscopic biopsy of multiple intracerebral masses, which resulted in the diagnosis of diffuse large B-cell lymphoma. The patient was diagnosed with PCNSL and was started on an induction regimen of systemic chemotherapy with rituximab in combination with high-dose methotrexate. However, after the second cycle of chemotherapy, the tumor grew rapidly, and the patient went into a coma. As a result, the treatment was changed to nasogastric tube administration of tirabrutinib suspension. After 1 week of tirabrutinib administration, the patient's level of consciousness improved, and furthermore, after 2 weeks of tirabrutinib administration, the patient was able to take tirabrutinib orally. Although oral administration is the standard route of administration for tirabrutinib, this case study showed that the nasogastric tube administration of tirabrutinib suspension is a therapeutic option for patients with impaired consciousness or dysphagia.
• Genetic and nongenetic factors for contralateral progression of unilateral moyamoya disease: the first report from the SUPRA Japan Study Group.

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

  Journal of neurosurgery 136 4 1 - 10 2021年09月 

  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.
• Stroke during pregnancy and puerperium among Japanese women: a single-center registry.

  Shinji Katsuragi; Rieko Suzuki; Kazunori Toyoda; Reiko Neki; Susumu Miyamoto; Koji Iihara; Jun Takahashi; Tomoaki Ikeda; Jun Yoshimatsu

  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 34 18 2957 - 2964 2021年09月 

  BACKGROUND: Stroke is one of the major causes of maternal death. This study aimed to analyze the maternal and fetal outcomes of stroke occurred during pregnancy and puerperium. METHODS: We conducted a retrospective analysis of patients admitted to our perinatology center between 1982 and 2012 with a diagnosis of acute cerebral stroke during pregnancy or within 6 weeks postpartum. RESULTS: Thirty-four patients were registered and all the patients had never been diagnosed as stroke nor detected cerebrovascular abnormalities before the current pregnancies. They were divided into 8 ischemic strokes (ISs) and 26 intracranial hemorrhage group. In the hemorrhage group, there was a spontaneous abortion and two patients chose artificial abortions to avoid rehemorrhage, and there were another three intrauterine fetal deaths (IUFDs) in the acute stage of maternal stroke. More patients in hemorrhage group delivered in preterm than in IS group for the treatment of stroke, 10/23 (43%) versus 0/8 (0%), p < .05. More patients in hemorrhage group had low Glasgow Coma Scale (GCS) (3-8) than in IS group at the onset of the stroke, 12/26 (46%) versus 0/8 (0%), p < .05. There were three maternal deaths and 6/23 (26%) were neurologically dependent in hemorrhage group in the chronic stage, whereas 87% were independent in IS group, p < .05. CONCLUSIONS: Hemorrhagic stroke was more common etiology of stroke related to pregnancy than IS in this study. Intensive and multidisciplinary care was needed especially in hemorrhagic stroke related to pregnancy as in the hemorrhagic stroke the fetal survival rate was lower, and maternal conscious levels at the onset of the stroke and neurological outcomes in the chronic stage were worse than IS.
• Effectiveness of Palliative Cerebrospinal Fluid Shunting for Patients With Leptomeningeal Carcinomatosis-related Hydrocephalus.

  Hiromasa Yoshioka; Takeshi Okuda; Takayuki Nakao; Mitsugu Fujita; Jun C Takahashi

  Anticancer research 41 8 4169 - 4172 2021年08月 

  BACKGROUND/AIM: Leptomeningeal carcinomatosis (LMC) with hydrocephalus is particularly difficult to treat, and its prognosis is extremely poor. The therapeutic outcomes of 14 patients with LMC-associated hydrocephalus who were treated with cerebrospinal fluid shunting are reported. PATIENTS AND METHODS: The study subjects were 14 LMC patients with solid primary cancer who had developed hydrocephalus. RESULTS: Postoperatively, both symptoms and Karnofsky performance status improved in 100% of patients. Postoperative therapy consisted of whole-brain radiotherapy in 4 cases and molecular targeted therapy in 4, with 6 patients not receiving any postoperative treatment. Median overall survival was 3.7 months, with no significant difference between those who underwent postoperative therapy and those who did not. However, two of those who received molecular targeted therapy survived for more than one year. CONCLUSION: Cerebrospinal fluid shunting for LMC-associated hydrocephalus is an effective therapeutic procedure from the palliative viewpoint. Patients for whom molecular targeted therapy is indicated may have better long-term survival.
• Small Unruptured Aneurysm Verification-prevention Effect against Growth of Cerebral Aneurysm Study Using Statin.

  Kazumichi Yoshida; Ikuko Uwano; Makoto Sasaki; Osamu Takahashi; Nobuyuki Sakai; Wataro Tsuruta; Hiroyuki Nakase; Kuniaki Ogasawara; Toshiaki Osato; Jun C Takahashi; Taketo Hatano; Hiroyuki Kinouchi; Susumu Miyamoto

  Neurologia medico-chirurgica 61 7 442 - 451 2021年07月 

  Several basic experimental studies have demonstrated that statins have beneficial effects for intracranial aneurysm (IA). Clinical studies on unruptured IAs, however, remain limited to four retrospective studies that have reached different conclusions. This study was the first open-label, multicenter, randomized controlled trial to assess the preventive effects of atorvastatin. Patients with unruptured small saccular IAs were randomly assigned to statin and control groups. The primary endpoint was a composite of aneurysm growth of ≥0.5 mm, new bleb formation confirmed from magnetic resonance (MR) angiography, and rupture. Enrollment was prematurely terminated due to unexpectedly slow enrollment. Of 231 patients (275 target IAs), 110 patients (128 IAs) were randomly assigned to the statin group and 121 patients (147 IAs) to the control group. After excluding 22 dropout patients, 107 IAs in the 93 statin group patients and 140 IAs in the 116 control group patients were finally analyzed. No significant differences of basic characteristics were evident between groups, except for significantly higher systolic pressure in the statin group (P = 0.03). The primary endpoint occurred in 28 IAs (20.0%) in the control group and in 17 IAs (15.9%) in the statin group. No aneurysm rupture was confirmed in either group. Significant beneficial effects of statin for IAs were not demonstrated for the primary endpoint (log-rank P = 0.359). This randomized trial did not establish any preventive effects of atorvastatin for unruptured small IAs. Further studies of larger cohorts are required to clarify the efficacy of statins for patients with unruptured IAs. Clinical trial registration: UMIN000005135.
• Pregnancy-associated hemorrhagic stroke: A nationwide survey in Japan.

  Naosuke Enomoto; Hiroaki Tanaka; Shinji Katsuragi; Eijiro Hayata; Junichi Hasegawa; Masahiko Nakata; Jun C Takahashi; Akihiko Sekizawa; Isamu Ishiwata; Tomoaki Ikeda

  The journal of obstetrics and gynaecology research 47 6 2066 - 2075 2021年06月 

  AIM: The number of maternal deaths due to pregnancy-associated hemorrhagic stroke has not decreased despite a gradual decrease of maternal death in Japan. This study aimed to clarify the risk factors of hypertensive disorders of pregnancy-associated hemorrhagic stroke. METHODS: This retrospective study analyzed pregnancy-associated hemorrhagic stroke patients with hypertensive disorders of pregnancy between 2013 and 2017 among 407 Japanese maternal and perinatal centers. Patients were divided into good or poor outcome groups and their maternal backgrounds and neonatal prognoses were compared. RESULTS: We analyzed 61 cases, including 41 survival and 20 death cases, obtained from a secondary survey. Among the 61 hemorrhagic stroke cases, 62% were related to hypertensive disorders. Hypertensive disorders of pregnancy were observed in 75% of death cases. Use of MgSO4 or antihypertensive medication did not differ between the poor and good outcomes groups. In cases with antepartum onset of hypertensive disorders of pregnancy, outcomes were poor in 12 and good in 6 cases. Nine patients with poor outcomes and one with a good outcome had hypertension at the outpatient department without systemic evaluation (p = 0.043). Six poor outcomes patients and one good outcome spent more than 1 day from diagnosis at an outpatient clinic. Neurosurgery was performed in 11 poor outcome patients. CONCLUSION: Pregnant women who present with a hypertensive disorder at an outpatient clinic probably need to undergo blood tests and careful observation. Delayed systemic evaluation and intensive care for only a few days may result in the development of hemorrhage.
• Early recurrent ischemic events after mechanical thrombectomy: effect of post-treatment intracranial hemorrhage.

  Junpei Koge; Kanta Tanaka; Takeshi Yoshimoto; Masayuki Shiozawa; Hiroshi Yamagami; Tetsu Satow; Jun C Takahashi; Masafumi Ihara; Masatoshi Koga; Jun-Ichi Kira; Kazunori Toyoda

  Journal of neurology 268 8 2810 - 2820 2021年02月 

  OBJECTIVE: Patients with intracranial hemorrhages (ICH) after mechanical thrombectomy (MT) may have a higher risk of early recurrent embolism (ERE) because of delayed initiation of anticoagulants. We assessed the rate of ischemic events in the early period after MT and the association with post-MT ICH. METHODS: Patients who underwent MT in our institute were retrospectively reviewed. ERE was defined as recurrent ischemic stroke and systemic embolism within 14 days after MT. The association between ERE and parenchymal hematoma (PH) was assessed. Multivariable regression analysis and inverse probability of treatment weighting was used to adjust for differences in baseline characteristics between patients with and without PH. RESULTS: A total of 307 patients (median age, 78 years; female, 47%; median baseline National Institutes of Health Stroke Scale score, 19) were included. ERE was observed in 12 of 307 patients (8 strokes, 4 systemic embolisms; 3.9%). Median time from MT to ERE was 6.5 days (IQR, 3-8 days). PH occurred in 21 patients (6.8%). Median time from MT to initiating oral anticoagulants was longer in patients with PH (8 days) than in those without (3 days) (p < 0.01). In both unweighted and weighted multivariable analysis, PH was significantly associated with an increased risk of ERE (unweighted odds ratio, 10.60; 95% CI, 2.66-42.23; weighted odds ratio, 12.34; 95% CI, 2.49-61.07). CONCLUSIONS: ERE occurred in about 4% of patients after MT. PH after MT was associated with delayed initiation of oral anticoagulants and an increased risk of recurrent ischemic events. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.
• Hyperperfusion Syndrome Detected by 15O-Gas Positron Emission Tomography after Clipping of a Large Unruptured Internal Carotid Artery Aneurysm: A Case Report.

  Takao Koiso; Daisuke Maruyama; Eika Hamano; Hisae Mori; Tetsu Satow; Hiroharu Kataoka; Jyoji Nakagawara; Jun C Takahashi

  NMC case report journal 8 1 275 - 279 2021年 

  Cerebral hyperperfusion syndrome (CHS) after surgical clipping for cerebral aneurysm is a rare entity. The authors present a 76-year-old woman with a large left internal carotid-posterior communicating artery aneurysm. After successful clipping with temporary occlusion of the internal carotid artery, the patient exhibited motor aphasia. 15O-gas positron emission tomography (PET) showed extreme elevation of the regional cerebral blood flow (rCBF) along with a mildly decreased regional cerebral metabolic rate for oxygen (rCMRO2) and a remarkable decrease in the oxygen extraction fraction (OEF) in the territory of the ipsilateral superior trunk of the middle cerebral artery. These data indicated local hyperperfusion. She had fully recovered from the aphasia by postoperative day (POD) 18. PET showed normalization of CBF on POD 27. To our knowledge, this is the first case report to show hyperperfusion syndrome, clearly detected by 15O-gas PET, after aneurysmal neck clipping.
• Transvenous Coil-plugging Technique for a Symptomatic Giant Varix Associated with Arteriovenous Malformation.

  Yuji Kushi; Tetsu Satow; Taichi Ikedo; Tsuyoshi Ohta; Takeshi Hara; Jun C Takahashi; Koji Iihara; Hiroharu Kataoka

  NMC case report journal 8 1 479 - 483 2021年 

  In case of symptomatic varix associated with cerebral arteriovenous malformations (AVM), nidus is usually treated with transarterial embolization (TAE). However, TAE is not always possible due to inaccessible nidus. A man in his 40s presented with numbness and clumsiness in the right hand. Magnetic resonance imaging (MRI) and cerebral angiography revealed a giant varix associated with an AVM nidus in the left parietal lobe. The varix severely compressed the postcentral gyrus with edema. The main feeder was occluded, and tiny collateral vessels fed the nidus. After admission, his symptoms deteriorated rapidly due to the enlarging varix. To extirpate the varix, selective transvenous embolization (TVE) of a small compartment, the varix neck, between the varix and the main cortical drainer with coils was performed. After treatment, the thrombosed varix gradually shrank, and his symptoms improved. The transvenous coil-plugging technique is a potential strategy for symptomatic varix with a varix neck.
• Transarterial and Transvenous Coil Embolization of Direct Carotid-cavernous Fistulas

  Norihito Fukawa; Nobuhiro Nakagawa; Kiyoshi Tsuji; Hiromasa Yoshioka; Kentaro Furukawa; Kazuhiro Nagatsuka; Hisashi Kubota; Naoki Nakano; Jun C. Takahashi

  Journal of Neuroendovascular Therapy 16 2 127 - 134 2021年
• Identifying large ischemic core volume ranges in acute stroke that can benefit from mechanical thrombectomy.

  Takeshi Yoshimoto; Manabu Inoue; Kanta Tanaka; Kodai Kanemaru; Junpei Koge; Masayuki Shiozawa; Naruhiko Kamogawa; Shunsuke Kimura; Tetsuya Chiba; Tetsu Satow; Jun C Takahashi; Kazunori Toyoda; Masatoshi Koga; Masafumi Ihara

  Journal of neurointerventional surgery 13 12 1081 - 1087 2020年12月 

  BACKGROUND: We aimed to identify the large ischemic core (LIC) volume ranges in acute ischemic stroke patients that can benefit from mechanical thrombectomy (MT). METHODS: Consecutive patients within 24 hours of onset of anterior circulation ischemic stroke with large vessel occlusion and ischemic core volumes of 70-300 mL were included from our single-center prospective database from March 2014 to December 2019. Subjects were divided into three groups by baseline ischemic core volume (A: 70-100 mL; B: 101-130 mL; C: >130 mL). We compared modified Rankin Scale (mRS) score 0-2 at 3 months and parenchymal hematoma between patients receiving MT and standard medical treatment (SMT), and determined clinically treatable core volume ranges for MT. RESULTS: Of 157 patients (86 women; median age, 81 years; median ischemic core volume, 123 mL), 49 patients underwent MT. In Group A (n=52), MT patients (n=31) showed a higher proportion of mRS 0-2 at 3 months (52% vs 5%, P<0.05) versus SMT, respectively. Group B (n=36) MT patients (n=14) also had a higher proportion of mRS 0-2 at 3 months (29% vs 9%, P=0.13) versus SMT, respectively. In Group C (n=69), only four patients received MT. The 95% confidence intervals for the probability of mRS 0-2 at 3 months in patients with MT (n=49) versus SMT (n=108) intersected at 120-130 mL. CONCLUSIONS: Ischemic core volumes between 70 and 100 mL may benefit from MT. The treatable upper core limit is approximately 120 mL in selected patients with LIC of 70-300 mL.
• 小児出血型もやもや病に対する直接血行再建

  舟木 健史; 高橋 淳; 宮本 享

  小児の脳神経 45 4 327 - 331 (一社)日本小児神経外科学会 2020年11月 

  大半が虚血型を占める小児もやもや病において、出血型はまれであり、直接血行再建が再出血予防に有効であるかどうかは明らかではない。小児出血型に対して直接血行再建を行った自験例5例を検討した。10半球中9半球で脈絡叢型側副路が陽性であり、脈絡叢型側副路の術後退縮率は他の脆弱側副路と比べて高かった(87.5%)。全例でバイパスは開存し、追跡期間中の再出血はなかった。小児出血型の特徴の一つとして脈絡叢型側副路の存在が示唆され、その退縮効果の高い直接血行再建は小児出血型に対して有効である可能性が示唆される。(著者抄録)
• 広範梗塞に対する機械的血栓回収療法よる臨床転帰及び治療可能な虚血コア体積上限値の解析

  吉本 武史; 井上 学; 田中 寛大; 高下 純平; 塩澤 真之; 鴨川 徳彦; 佐藤 徹; 高橋 淳; 古賀 政利; 猪原 匡史; 豊田 一則

  脳血管内治療 5 Suppl. 16 - 16 (NPO)日本脳神経血管内治療学会 2020年11月
• 広範梗塞に対する機械的血栓回収療法よる臨床転帰及び治療可能な虚血コア体積上限値の解析

  吉本 武史; 井上 学; 田中 寛大; 高下 純平; 塩澤 真之; 鴨川 徳彦; 佐藤 徹; 高橋 淳; 古賀 政利; 猪原 匡史; 豊田 一則

  脳血管内治療 5 Suppl. 16 - 16 (NPO)日本脳神経血管内治療学会 2020年11月
• Low-Dose Activated Protein C Suppresses the Development of Cerebral Infarction and Neurological Deficits in Mice

  Keiko Yamato; Yukako Nakajo; Hitomi Yamamoto-Imoto; Koichi Kokame; Toshiyuki Miyata; Jun C Takahashi; Hiroharu Kataoka; Hiroji Yanamoto

  Neurosurgery Open 1 4 2020年10月 

  A large prospective study previously reported that a higher plasma level of protein C (PC) was associated with a lower incidence of ischemic stroke. To investigate the neuroprotective properties of activated PC (APC) against acute ischemic stroke using the 3-vessel occlusion model. Male C57BL/6J mice received APC (human APC) at 0.25, 0.5, or 1.0 (low dose) or 2.0, 4.0, or 8.0 mg/kg (high dose). Edaravone (Eda) (1.0, 3.0, or 10 mg/kg, a neuroprotectant approved for use in Japan), albumin (2.0 mg/kg), heparin (100 or 600 U/kg), or saline was used as the control. The drug or control was administered intravenously twice in the initial 24 h or 5 times in 3 d, starting 5 min after the induction of ischemia. Low-dose APC significantly reduced lesion volumes, not affecting the depth of ischemia. High-dose APC did not significantly reduce lesion volumes, causing hemorrhagic transformation in some cases. In the chronic phase, lesion volumes were significantly suppressed in the APC or Eda group, and only the APC group showed a significant attenuation of neurological deficits. The protease-activated receptor (PAR)-1 antagonist SCH79797, administered during preischemia, completely abolished APC-induced neuroprotection. The overshoot-like abrupt recovery in regional cerebral blood flow observed in the control in the initial reperfusion phase was significantly suppressed by the APC treatment, indicating that the cerebral autoregulation system, consisting of endothelial cells and blood-brain barrier functions, was preserved. Low-dose APC, potentially via the PAR-1-dependent anti-inflammatory cascade, protects the brain against ischemic stroke without increasing the risk of hemorrhagic transformation or death.
• Mechanical thrombectomy in acute ischemic stroke patients with left ventricular assist device.

  Takaya Kitano; Manabu Sakaguchi; Hiroshi Yamagami; Tatsuya Ishikawa; Hatsue Ishibashi-Ueda; Kanta Tanaka; Shuhei Okazaki; Tsutomu Sasaki; Yoshinori Kadono; Masatoshi Takagaki; Takeo Nishida; Hajime Nakamura; Masanobu Yanase; Norihide Fukushima; Masayuki Shiozawa; Kazunori Toyoda; Jun C Takahashi; Takayuki Funatsu; Bikei Ryu; Daisuke Yoshioka; Koichi Toda; Shigeo Murayama; Takakazu Kawamata; Haruhiko Kishima; Yoshiki Sawa; Hideki Mochizuki; Kenichi Todo

  Journal of the neurological sciences 418 117142 - 117142 2020年09月 [査読有り]
   

  OBJECTIVES: As the number of patients with left ventricular assist device (LVAD) implantation has been increasing, treatment of LVAD-related ischemic stroke is becoming a critical issue. We sought to clarify the features of mechanical thrombectomy in LVAD-related stroke with large vessel occlusion. METHODS: In a multi-center, retrospective case-control study, we compared 20 LVAD-related strokes with 33 non-LVAD strokes, all of which had large vessel occlusion in the anterior circulation treated with mechanical thrombectomy. A comparative histopathological examination of the retrieved thrombi was also performed. RESULTS: Successful reperfusion was achieved in 75% of the LVAD-related strokes. The time from onset to reperfusion was similar to that of non-LVAD strokes, but the total number of device passes required for reperfusion (median, 2.5 versus 1, P = 0.01) and the incidences of post-procedural parenchymal and subarachnoid hemorrhage (25% versus 3%, P = 0.02 and 55% versus 15%, P = 0.01, respectively) were higher in LVAD-related strokes. Symptomatic intracranial hemorrhage occurred in 4 patients (20%) with LVAD-related strokes. The histopathological analysis revealed that the ratio of erythrocyte components was significantly lower in thrombi retrieved from patients with LVAD-related stroke than in those with non-LVAD stroke (19 ± 6% versus 41 ± 17%, P = 0.01). CONCLUSIONS: Mechanical thrombectomy is feasible in patients with LVAD-related stroke. However, repetitive device passes are needed to achieve successful reperfusion mainly because of the structurally organized thrombi, and the higher risk of hemorrhagic complications should be considered, while offering this therapeutic alternative.
• Intracranial arterial stenosis associated with Hashimoto's disease: angiographic features and clinical outcomes.

  Eika Hamano; Masaki Nishimura; Hisae Mori; Tetsu Satow; Jun C Takahashi

  BMC neurology 20 1 345 - 345 2020年09月 [査読有り]
   

  BACKGROUND: Hashimoto's disease has reportedly been associated with stroke; however, cerebrovascular morphology and clinical course remain poorly documented. The present study aimed to determine the angiographic features and clinical outcomes of intracranial arterial stenosis (IAS) associated with Hashimoto's disease in a retrospective cohort. METHODS: Overall, 107 adult patients with IAS were screened for anti-thyroid antibodies; of these, 26 patients tested positive. The 42 affected hemispheres were classified into subgroups according to the steno-occlusion site and the development of abnormal collateral (moyamoya) vessels. These subgroups were dichotomized into moyamoya vessels positive (MM type) and negative (non-MM type). The initial presentation, IAS progression, and vascular events during the follow-up period were compared. RESULTS: The following sites of stenosis were identified: the bifurcation of the internal carotid artery in 11 (26.2%), M1 or A1 in 29 (69.0%), and more distal (M2-M4/A2-A4) in 2 (4.8%) hemispheres. Further, 17 hemispheres were categorized into the MM type and 25 were classified into the non-MM type. During the follow-up period (mean 2.5 years), IAS progression was identified in 8 (32%) hemispheres of the non-MM type and 0 (0%) hemispheres of the MM type (p = 0.041). Ischemic attacks occurred in 5 (20.0%) hemispheres of the non-MM type (4.6%/year) and 0 hemispheres of the MM type (p = 0.08). Further, 4 (23.5%) hemispheres of the MM type experienced intracerebral hemorrhage, whereas none of the non-MM type hemorrhaged (p = 0.012). CONCLUSIONS: Hashimoto's disease-associated IAS exhibits various angiographic morphologies, resulting in different clinical presentations. Screening for anti-thyroid antibodies and careful management based on vascular morphology appears important in adults with IAS.
• Field Assessment of Critical Stroke by Emergency Services for Acute Delivery to a Comprehensive Stroke Center: FACE2AD.

  Yoshinori Okuno; Hiroshi Yamagami; Hiroharu Kataoka; Yoshio Tahara; Shuichi Tonomura; Hidemori Tokunaga; Taichiro Imahori; Daisaku Matsui; Makoto Kobayashi; Hirotoshi Imamura; Nobuyuki Sakai; Jun C Takahashi; Kazunori Toyoda; Kazuyuki Nagatsuka; Masafumi Ihara

  Translational stroke research 11 4 664 - 670 2020年08月 [査読有り]
   

  Patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) should be triaged to an endovascular-capable hospital by the emergency medical service (EMS). We designed a prehospital LVO prediction scale based on EMS assessments. In the derivation cohort, 1157 patients transferred to our hospital by the EMS because of suspected stroke within 24 h of onset were retrospectively examined. Factors associated with AIS due to LVO were identified based on the EMS assessment, and a prehospital scale identifying LVO was developed. The accuracy of this scale was validated in 502 consecutive patients who were transferred to 4 stroke centers, and its accuracy was compared with those of 4 previously reported scales. AIS due to LVO was diagnosed in 149 of 1157 patients (13%) in the derivation cohort. One point each was assigned for facial palsy, arm weakness, consciousness impairment (cannot say his/her name), atrial fibrillation, and diastolic blood pressure ≤ 85 mmHg, with two points for conjugate eye deviation (FACE2AD scale). In the derivation cohort, with the optimal cut-point of FACE2AD ≥ 3 determined by the area under the curve (AUC; 0.88; 95% confidence interval 0.87-0.90), sensitivity, specificity, positive predictive value, and negative predictive value for FACE2AD to predict LVO were 0.85, 0.80, 0.39, and 0.97, respectively. In the validation cohort, the FACE2AD scale had higher accuracy, with an AUC value of 0.84 for predicting LVO compared with the other scales (all p < 0.01). The FACE2AD scale is a simple, reliable tool for identifying AIS due to LVO by the EMS.
• Clinical Outcome of Elderly Patients with Subarachnoid Hemorrhage: Validation of Modality Assignment Based on Aneurysmal Morphology and Location.

  Takuma Maeda; Tetsu Satow; Go Ikeda; Eika Hamano; Naoki Hashimura; Takeshi Hara; Masatake Sumi; Masaki Nishimura; Jun C Takahashi

  World neurosurgery 143 e419-e429  2020年08月 [査読有り]
   

  BACKGROUND: The number of elderly patients with subarachnoid hemorrhage is increasing. Elderly patients have been postulated to benefit more from endovascular coiling, compared with neurosurgical clipping. However, we based our therapeutic modality on the morphology and location of the aneurysms, rather than patients' age or their World Federation of Neurological Surgeons grade. The aim of this study was to investigate the validity of our therapeutic modality over earlier approaches by assessing their clinical outcomes. METHODS: The study sample included 539 patients who underwent surgical procedures between January 2010 and May 2019. Baseline characteristics, aneurysmal morphology and location, surgical and clinical complications, and clinical outcomes were compared between elderly (defined as aged 75 years or older) and young patients. RESULTS: There were 124 elderly patients (23.0%) in the sample. Eighty-five elderly patients (68.5%) received neurosurgical clipping, whereas 67.0% of the young patients (P = 0.827) received neurosurgical clipping. Of the elderly patients who had a poor World Federation of Neurological Surgeons grade, 49.4% and 48.7% underwent neurosurgical clipping and endovascular coiling, respectively (P = 1.000). Elderly patients had fewer favorable outcomes (21.8%) relative to young patients (61.8%; P < 0.001). There were no significant differences in the rate of favorable outcomes between patients undergoing neurosurgical clipping relative to endovascular coiling (21.2% vs. 23.1%; P = 0.818). CONCLUSIONS: Neurosurgical clipping and endovascular coiling yield comparable clinical outcomes in elderly and young patients with subarachnoid hemorrhage. These findings indicate that using a therapeutic modality based on aneurysmal morphology and location may be an effective treatment approach.
• Perinatal outcome in case of maternal death for cerebrovascular acute disorders: a nationwide study in Japan.

  Shinji Katsuragi; Hiroaki Tanaka; Junichi Hasegawa; Akiko Kurasaki; Masamitsu Nakamura; Naohiro Kanayama; Masahiko Nakata; Eijiro Hayata; Takeshi Murakoshi; Jun Yoshimatsu; Kazuhiro Osato; Kayo Tanaka; Tomoaki Oda; Akihiko Sekizawa; Takako Shimaoka; Isamu Ishiwata; Jun Takahashi; Tomoaki Ikeda

  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 35 13 1 - 6 2020年07月 [査読有り]
   

  OBJECTIVE: The goal of this study is to find clues to improve perinatal outcomes in the case of cerebrovascular acute disorders during pregnancy. STUDY DESIGN: We analyzed 35 cases of cerebrovascular diseases related to maternal deaths in Japan those that occurred during pregnancy and reported to the Committee of the Ministry of Health, Labor, and Welfare from 2010 to 2018. RESULTS: Cerebrovascular acute disorders occurred at 34.6 ± 6.6 gestational weeks. There were seven intrauterine fetal deaths (IUFD), and eight cases showed neonatal asphyxia with umbilical arterial pH between 6.7 and 7.0 (asphyxia cases, n = 15). In two of eight newborns, brain hypothermia therapy was given, and all survived without neurological sequelae. Maternal dyspnea was significantly related to severe prolonged decelerations of the fetus (p < .05), and asphyxia cases (p < .005). Median time from maternal onset to delivery (OD time) was significantly longer in asphyxia cases than in the non-asphyxia cases (84 vs 29 min, p < .05). OD time over 30 min was significantly related to the antepartum occurrence, cervical dilatation <5 cm (p < .05), onset outside of the hospital (p < .001), and maternal transfer before delivery (p < .001). CONCLUSION: More than 40% of cases experienced fetal asphyxia, and 20% ended in IUFD in maternal deaths related to cerebrovascular acute disorders. Maternal respiratory support and rapid delivery would be the keys to improve perinatal outcomes in case of cerebrovascular acute disorders during pregnancy.
• In Reply to the Letter to the Editor Regarding "Revascularization Surgery in Childhood Associated with a Low Incidence of Microbleeds in Adult Patients with Moyamoya".

  Yukihiro Yamao; Takeshi Funaki; Jun C Takahashi; Susumu Miyamoto

  World neurosurgery 138 573 - 573 2020年06月 [査読有り]
  
• Difference in periventricular anastomosis in child and adult moyamoya disease: a vascular morphology study.

  Jiwook Ryu; Eika Hamano; Masaki Nishimura; Tetsu Satow; Jun C Takahashi

  Acta neurochirurgica 162 6 1333 - 1339 2020年06月 [査読有り]
   

  BACKGROUNDS: Periventricular anastomosis (PA), which is a novel term for extended collateral vessels in moyamoya disease (MMD), is reportedly associated with a high risk of intracranial hemorrhage in adult patients. The present study aimed to clarify the similarities and the differences in the development of PA between three MMD groups, classified by age at the time of diagnosis and clinical phenotype. METHODS: This study included 232 hemispheres of 132 patients with MMD who underwent surgical revascularization. The subjects were classified into child ischemic (CI) group, adult ischemic (AI) group, and adult hemorrhagic (AH) group. We evaluated the lenticulostriate (LSA), thalamic (THA), choroidal (ChA), anterior choroidal (AChA), and posterior choroidal (PChA) anastomosis as well as the posterior cerebral artery (PCA) involvement. The PA scores and the sums of each grade of LSA, THA, and ChA anastomosis were also calculated in all of the cases. RESULTS: In a multiple comparison test, the PA scores (P < 0.01), LSA (P < 0.01), and ChA anastomosis (P = 0.013) were more prominent in the CI than in the AI group. The PA scores (P < 0.01) and LSA (P = 0.011), ChA (P < 0.01), AChA (P < 0.01), and PChA anastomosis (P = 0.016) were more prominent in the AH group than in the AI group. The CI and AH groups showed similar characteristics except for PCA involvement. After multivariate adjustments using the AI group as a reference group, the PA scores and the positive rates of LSA and ChA anastomosis remained significantly higher in the CI and AH groups. CONCLUSION: The patterns of PA development in the CI and AH groups were similar in that they were more prominent than in the AI group. These findings may contribute to a better understanding of the progression of ischemic and hemorrhagic MMD.
• Transient Neurological Events After Surgery for Pediatric Moyamoya Disease: A Retrospective Study of Postoperative Sedation Practices.

  Hideki Matsuura; Kenji Yoshitani; Yuki Nakamori; Akito Tsukinaga; Jun C Takahashi; Michikazu Nakai; Yoshihiko Ohnishi

  Journal of neurosurgical anesthesiology Publish Ahead of Print 1 e68-e69  2020年05月 [査読有り]
  
• The Japan Neurosurgical Database: Overview and Results of the First-year Survey.

  Koji Iihara; Teiji Tominaga; Nobuhito Saito; Michiyasu Suzuki; Isao Date; Yukihiko Fujii; Kazuhiro Hongo; Kiyohiro Houkin; Amami Kato; Yoko Kato; Takakazu Kawamata; Phyo Kim; Hiroyuki Kinouchi; Eiji Kohmura; Kaoru Kurisu; Keisuke Maruyama; Nobuhiro Mikuni; Susumu Miyamoto; Akio Morita; Hiroyuki Nakase; Yoshitaka Narita; Ryo Nishikawa; Kazuhiko Nozaki; Kuniaki Ogasawara; Kenji Ohata; Nobuyuki Sakai; Hiroaki Sakamoto; Yoshiaki Shiokawa; Yukihiko Sonoda; Jun C Takahashi; Keisuke Ueki; Toshihiko Wakabayashi; Takamitsu Yamamoto; Kazunari Yoshida; Takamasa Kayama; Hajime Arai

  Neurologia medico-chirurgica 60 4 165 - 190 2020年04月 [査読有り]
   

  The Japan Neurosurgical Database (JND) is a prospective observational study registry established in 2017 by the Japan Neurosurgical Society (JNS) to visualize real-world clinical practice, promote science, and improve the quality of care and neurosurgery board certification in Japan. We summarize JND's aims and methods, and describes the 2018 survey results. The JND registered in-hospital patients' clinical data mainly from JNS training institutions in 2018. Caseload, patient demographics, and in-hospital outcomes of the overall cohort and a neurosurgical subgroup were examined according to major classifications of main diagnosis. Neurosurgical caseload per neurosurgeon in training in core hospitals in 2018 was calculated as an indicator of neurosurgical training. Of 523,283 cases (male 55.3%) registered from 1360 participating institutions, the neurosurgical subgroup comprised of 33.9%. Among the major classifications, cerebrovascular diseases comprised the largest proportion overall and in the neurosurgical subgroup (53.1%, 41.0%, respectively), followed by neurotrauma (19.1%, 25.5%), and brain tumor (10.4%, 12.8%). Functional neurosurgery (6.4%, 3.7%), spinal and peripheral nerve disorders (5.1%, 10.1%), hydrocephalus/developmental anomalies (2.9%, 5.3%), and encephalitis/infection/inflammatory and miscellaneous diseases (2.9%, 1.6%) comprised smaller proportions. Most patients were aged 70-79 years in the overall cohort and neurosurgical subgroup (27.8%, 29.4%). Neurotrauma and cerebrovascular diseases in the neurosurgical subgroup comprised a higher and lower proportion, respectively, than in the overall cohort in elderly patients (e.g. 80 years, 46.9% vs. 33.5%, 26.8% vs. 54.4%). The 2018 median neurosurgical caseload per neurosurgeon in training was 80.7 (25-75th percentile 51.5-117.5). These initial results from 2018 reveal unique aspects of neurosurgical practice in Japan.
• Transient Neurological Events After Surgery for Pediatric Moyamoya Disease: A Retrospective Study of Postoperative Sedation Practices.

  Hideki Matsuura; Kenji Yoshitani; Yuki Nakamori; Akito Tsukinaga; Jun C Takahashi; Michikazu Nakai; Yoshihiko Ohnishi

  Journal of neurosurgical anesthesiology 32 2 182 - 185 2020年04月 [査読有り]
   

  BACKGROUND: Moyamoya disease is a cerebrovascular disease characterized by bilateral stenosis of the intracranial internal carotid arteries and an abnormal collateral vascular network at the base of the brain. Transient neurological events (TNEs), which are episodes of neurological dysfunction lasting <24 hours, are associated with stroke in pediatric patients with Moyamoya disease. Perioperative agitation often occurs in pediatric patients. We hypothesized that anesthetic technique and postoperative sedation would modify the association between TNE and superficial temporal artery-middle cerebral artery (STA-MCA) bypass in pediatric patients with Moyamoya disease. METHODS: We retrospectively reviewed the medical records of patients with Moyamoya disease aged 15 years and below who underwent STA-MCA bypass under general anesthesia at a single cerebrovascular center in Japan between January 1999 and March 2016. The primary outcome was TNE. Mixed-effects logistic regression was used to evaluate whether postoperative sedation and anesthetic agents were associated with TNE. RESULTS: Among 277 hemispheres in 154 pediatric patients who underwent STA-MCA bypass, 107 patients (39%) experienced TNE within 1 week after surgery. Crying (adjusted odds ratio, 3.11; 95% confidence interval, 1.01-9.59; P=0.048) was an independent risk factor for TNE. Postoperative sedation was associated with a lower incidence of TNE (adjusted odds ratio, 0.514; 95% confidence interval, 0.264-0.997; P=0.049), but premedication and anesthetic agents were not associated with TNE. CONCLUSION: In pediatric patients with Moyamoya disease, crying was associated with increased TNE and postoperative sedation is associated with decreased TNE.
• Impact of cortical hemodynamic failure on both subsequent hemorrhagic stroke and effect of bypass surgery in hemorrhagic moyamoya disease: a supplementary analysis of the Japan Adult Moyamoya Trial.

  Jun C Takahashi; Takeshi Funaki; Kiyohiro Houkin; Satoshi Kuroda; Miki Fujimura; Yasutake Tomata; Susumu Miyamoto

  Journal of neurosurgery 134 3 1 - 6 2020年03月 [査読有り]
   

  OBJECTIVE: Here, the authors aimed to determine whether the presence of cerebral hemodynamic failure predicts subsequent bleeding attacks and how it correlates with the effect of direct bypass surgery in hemorrhagic moyamoya disease. METHODS: Data from the Japanese Adult Moyamoya (JAM) Trial were used in this study: 158 hemispheres in 79 patients. A newly formed expert panel evaluated the SPECT results submitted at trial enrollment and classified the cortical hemodynamic state of the middle cerebral artery territory of each hemisphere into one of the following three groups: SPECT stage (SS) 0 as normal, SS1 as decreased cerebrovascular reserve (CVR), and SS2 as decreased CVR with decreased baseline blood flow. In the nonsurgical cohort of the JAM Trial, the subsequent hemorrhage rate during the 5-year follow-up was compared between the SS0 (hemodynamic failure negative) and SS1+2 (hemodynamic failure positive) groups. The effect of direct or combined direct/indirect bypass surgery on hemorrhage prevention was examined in each subgroup. RESULTS: The hemodynamic grade was SS0 in 59 (37.3%) hemispheres, SS1 in 87 (55.1%), and SS2 in 12 (7.6%). In the nonsurgical cohort, subsequent hemorrhage rates in the SS0 and SS1+2 groups were 12 cases per 1000 person-years and 67 cases per 1000 person-years, respectively. Kaplan-Meier analysis revealed that hemorrhagic events were significantly more common in the SS1+2 group (p = 0.019, log-rank test). Cox regression analysis showed that hemodynamic failure was an independent risk factor for subsequent hemorrhage (HR 5.37, 95% CI 1.07-27.02). In the SS1+2 subgroup, bypass surgery significantly suppressed hemorrhagic events during 5 years (p = 0.001, HR 0.16, 95% CI 0.04-0.57), with no significant effect in the SS0 group (p = 0.655, HR 1.56, 95% CI 0.22-11.10). Examination of effect modification revealed that the effect of surgery tended to differ nonsignificantly between these two subgroups (p = 0.056). CONCLUSIONS: Hemodynamic failure is an independent risk factor for subsequent hemorrhage in hemorrhagic moyamoya disease. Direct bypass surgery showed a significant preventive effect in the hemodynamically impaired hemispheres. Thus, hemodynamic failure, as well as previously proposed factors such as choroidal anastomosis, should be considered for the surgical indication in hemorrhagic moyamoya disease.Clinical trial registration no.: C000000166 (umin.ac.jp).
• Coil Embolization for Unruptured Intracranial Aneurysms at the Dawn of Stent Era: Results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3.

  Tetsu Satow; Go Ikeda; Jun C Takahashi; Koji Iihara; Nobuyuki Sakai

  Neurologia medico-chirurgica 60 2 55 - 65 2020年02月 [査読有り]
   

  Endosaccular coiling is recognized as a feasible method for treating unruptured intracranial aneurysms (UIAs). We retrospectively reviewed cases of UIAs treated by coiling in the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey of NET between 2010 and 2014, the beginning period of intracranial stents in Japan. Data were extracted for 6844 UIAs (6619 procedures) from 40,169 registered records of all NETs in the JR-NET 3 databases. The features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures were assessed. Of 6844 UIAs, 81.8% were located in the anterior circulation. The mean patient age was 61.3 years (72.4% females). Compared with the preceding JR-NET 1 and 2, there were significant increases (P <0.05) in the rates of the following in JR-NET 3: wide-necked and small UIAs measuring <10 mm (from 56.4% to 58.8%), adjunctive techniques (54.8% to 71.8%), and stent usage (1.1% to 22.1%). Both pre- (85.6% to 96.7%) and post-procedural (84.0% to 94.6%) antiplatelet therapy were more frequently administered in JR-NET 3. Although procedure-related complication rates did not differ between the two groups, ischemic complication rates increased from 4.6% to 5.9%, leading to an increase in the 30-day morbidity (modified Rankin Scale >2) from 2.1% to 2.8%. In conclusion, introduction of neck-bridge stent was associated with an increase in cases of wide-necked aneurysms. However, the ischemic complication rate increased despite the greater use of periprocedural antiplatelet therapy.
• Correction to: Field Assessment of Critical Stroke by Emergency Services for Acute Delivery to a Comprehensive Stroke Center: FACE2AD.

  Yoshinori Okuno; Hiroshi Yamagami; Hiroharu Kataoka; Yoshio Tahara; Shuichi Tonomura; Hidemori Tokunaga; Taichiro Imahori; Daisaku Matsui; Makoto Kobayashi; Hirotoshi Imamura; Nobuyuki Sakai; Jun C Takahashi; Kazunori Toyoda; Kazuyuki Nagatsuka; Masafumi Ihara

  Translational stroke research 11 4 664 - 670 2020年01月 [査読有り]
   

  The original version of this article unfortunately contained mistakes.
• もやもや病に対する脳血行再建術のエビデンス

  舟木 健史; 髙橋 淳; 宮本 享

  脳神経外科ジャーナル 29 10 702 - 708 日本脳神経外科コングレス 2020年 

   もやもや病脳血行再建術のエビデンスを①成人虚血型, ②成人出血型, ③小児例, に分類して論じる. 成人虚血型ではメタアナリシスにより直接バイパスを含む術式が有効であることが示されている. 成人出血型ではJAM Trialやメタアナリシスにより, 直接バイパスを含む術式が再出血予防に有効であることが示されており, 後方出血群が自然予後不良かつ手術効果の高いサブグループであることや, 脈絡叢動脈型側副路が特に出血しやすい脆弱血管であることも明らかになりつつある. 小児例では術後成人期までの超長期追跡研究が注目されており, 血行再建の長期的虚血改善効果が明らかとなる一方, 成人後出血転化の問題が浮き彫りとなっている.

• A Case of Internal Carotid Artery Dissection with Ischemic Onset, Followed by Subarachnoid Hemorrhage during Diagnostic Angiography

  Takuma Maeda; Tetsu Satow; Eika Hamano; Naoki Hashimura; Junpei Koge; Kanta Tanaka; Takeshi Yoshimoto; Manabu Inoue; Masatoshi Koga; Masaki Nishimura; Jun C Takahashi

  Journal of Neuroendovascular Therapy 2020年
• Revascularization Surgery in Childhood Associated with a Low Incidence of Microbleeds in Adult Patients with Moyamoya.

  Yukihiro Yamao; Jun C Takahashi; Takeshi Funaki; Yohei Mineharu; Takyuki Kikuchi; Tomohisa Okada; Kaori Togashi; Susumu Miyamoto

  World neurosurgery 133 e716-e721  2020年01月 [査読有り]
   

  BACKGROUND: The clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds. METHODS: This retrospective study included 142 adult patients (mean age, 37.7 ± 13.5 years) with moyamoya disease, 36 of whom (25.3%) underwent bypass surgery in childhood. Hemorrhagic onset was diagnosed in 31 patients (21.8%). The incidence of microbleeds was evaluated on T2*-weighted or susceptibility-weighted imaging from 3-T magnetic resonance imaging. The patients were subsequently categorized into MBs (microbleeds) or non-MBs groups. Because previous microbleeds potentially lead to hemorrhage, the MBs group was defined as patients with radiographic evidence of bleeding, including asymptomatic microbleeds and/or hemorrhagic onset. The association of baseline characteristics was evaluated. RESULTS: Asymptomatic microbleeds were detected in 38 patients (26.8%). Of 31 patients with hemorrhagic onset, 18 had microbleeds, whereas 13 had no microbleeds. Therefore, 51 patients (35.9%) were classified into the MBs group. Bypass surgery in childhood (MBs, 7.8% vs. non-MBs, 35.2%; P < 0.01) and age (MBs, 42.9 ± 1.8 years vs. non-MBs, 34.7 ± 1.4 years; P < 0.01) were statistically significant factors associated with microbleeds, but only bypass surgery in childhood remained statistically significant after multivariable adjustment (odds ratio, 0.25; 95% confidence interval, 0.07-0.87; P = 0.03). CONCLUSIONS: This study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.
• 脳動脈瘤治療用多孔性カバードステントシステム医師主導治験最終報告

  佐藤 徹; 坂井 信幸; 山本 晴子; 大石 英則; 石井 暁; 高橋 淳

  脳血管内治療 4 Suppl. S85 - S85 (NPO)日本脳神経血管内治療学会 2019年11月
• 機械的血栓回収術後早期の塞栓症再発の頻度と予測因子

  高下 純平; 田中 寛大; 吉本 武史; 塩澤 真之; 山上 宏; 佐藤 徹; 高橋 淳; 猪原 匡史; 古賀 政利; 豊田 一則

  脳血管内治療 4 Suppl. S42 - S42 (NPO)日本脳神経血管内治療学会 2019年11月
• 脳底動脈閉塞症における脳底動脈癒合パターン,視床梗塞,および機能予後

  石井 辰仁; 田中 寛大; 高下 純平; 吉本 武史; 塩澤 真之; 佐藤 徹; 高橋 淳; 猪原 匡史; 豊田 一則; 古賀 政利

  脳血管内治療 4 Suppl. S309 - S309 (NPO)日本脳神経血管内治療学会 2019年11月
• 日本人のアテローム血栓性脳梗塞の強力な遺伝子多型RNF213 p.4810K

  猪原 匡史; 岡崎 周平; 森本 貴昭; 鎌谷 洋一郎; 上村 鉄平; 原田 浩二; 冨田 努; 東山 綾; 高橋 淳; 中川原 譲二; 古賀 政利; 豊田 一則; 鷲田 和夫; 齊藤 聡; 望月 秀樹; 秦 淳; 二宮 利治; 吾郷 哲朗; 久保 充明; 小泉 昭夫

  臨床神経学 59 Suppl. S233 - S233 (一社)日本神経学会 2019年11月
• 日本人のアテローム血栓性脳梗塞の強力な遺伝子多型RNF213 p.4810K

  猪原 匡史; 岡崎 周平; 森本 貴昭; 鎌谷 洋一郎; 上村 鉄平; 原田 浩二; 冨田 努; 東山 綾; 高橋 淳; 中川原 譲二; 古賀 政利; 豊田 一則; 鷲田 和夫; 齊藤 聡; 望月 秀樹; 秦 淳; 二宮 利治; 吾郷 哲朗; 久保 充明; 小泉 昭夫

  臨床神経学 59 Suppl. S233 - S233 (一社)日本神経学会 2019年11月
• Development of Hemorrhage-prone Anastomoses in Asymptomatic Moyamoya Disease-A Comparative Study with Japan Adult Moyamoya Trial.

  Shusuke Yamamoto; Takeshi Funaki; Miki Fujimura; Jun C Takahashi; Haruto Uchino; Kiyohiro Houkin; Teiji Tominaga; Susumu Miyamoto; Satoshi Kuroda

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 28 11 104328 - 104328 2019年11月 [査読有り]
   

  OBJECTIVE: Present study was aimed to precisely evaluate the angio-architectures in patients with asymptomatic moyamoya disease (MMD) by comparing with those with hemorrhagic stroke. METHODS: This study used the data set of cerebral angiography in Asymptomatic Moyamoya Registry (AMORE) Study and Japan Adult Moyamoya (JAM) Trial at enrollment. The development of 3 subtypes of collateral vessels, including lenticulostriate, thalamic, and choroidal anastomosis, was evaluated on cerebral angiography. Suzuki's angiographical stage and posterior cerebral artery (PCA) involvement were also assessed. These findings were compared between asymptomatic (AMORE) and hemorrhagic (JAM) groups. RESULTS: This study included 55 hemispheres of 35 patients in asymptomatic group and 75 hemispheres of 75 patients in hemorrhagic group. In asymptomatic group, thalamic anastomosis was less developed than in hemorrhagic group (P = .011), but there were no significant differences in the development of lenticulostriate and choroidal anastomosis between the 2 groups (P = .077 and P = .26, respectively). Suzuki's stage was more progressed and the prevalence of PCA involvement was significantly higher in hemorrhagic group than in asymptomatic group (P = .0033 and P = .016, respectively). CONCLUSIONS: This study reveals no significant differences in the development of choroidal anastomoses between asymptomatic and hemorrhagic-onset MMD. On the other hand, disease stage and PCA involvement were less advanced in asymptomatic MMD than in hemorrhagic-onset MMD. These findings strongly suggest a certain subgroup of asymptomatic patients with MMD is at potential risk for hemorrhagic stroke.
• Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA

  A. Miyakoshi; T. Funaki; Y. Fushimi; T. Kikuchi; H. Kataoka; K. Yoshida; Y. Mineharu; J.C. Takahashi; S. Miyamoto

  American Journal of Neuroradiology 40 10 1674 - 1680 2019年09月 [査読有り]
   

  BACKGROUND AND PURPOSE: The location of intracerebral hemorrhage in Moyamoya disease is a prognostic factor for rebleeding and the degree of preventive effects obtainable with bypass surgery. We evaluated whether the bleeding point and responsible vessel were detectable using fusion images of SWI and time-of-flight MRA performed during chronic-phase hemorrhage. MATERIALS AND METHODS: We retrospectively enrolled 42 patients with hemorrhagic Moyamoya disease (48 hemorrhagic events). Fusion images of SWI and MRA were made using workstations, and we defined the bleeding point as the point at which the signal of an abnormally extended artery on MRA overlapped the hypointense area on SWI. Two independent raters identified the bleeding point, and classified the location and responsible vessels. RESULTS: The bleeding point was detectable at a frequency of 79.2% by rater 1. Agreement for the presence of a bleeding point was high (interrater κ = 0.83; 95% CI, 0.65-1; intrarater κ = 0.86; 95% CI, 0.68-1). The frequency of a periventricular location of the bleeding point was 65.8% by rater 1, and agreement on the location was again high (interrater κ = 0.92; 95% CI, 0.82-1; intrarater κ = 0.85; 95% CI, 0.72-0.99). The choroidal artery was the most frequent responsible vessel (57.9% by rater 1), and agreement on the responsible vessel was high (interrater κ = 0.84; 95% CI, 0.69-1; intrarater κ = 0.90; 95% CI, 0.78-1). CONCLUSIONS: Detection of the bleeding point in hemorrhagic Moyamoya disease using SWI and MRA fusion images offers highly reproducible results.
• Case of Iatrogenic Vertebro-Vertebral Arteriovenous Fistula Treated by Combination of Double-Catheter and Balloon Anchoring Techniques.

  Isao Ono; Tetsu Satow; Yoshiro Ito; Eika Hamano; Hirofumi Matsubara; Hiroharu Kataoka; Jun C Takahashi

  World neurosurgery 128 98 - 101 2019年08月 [査読有り]
   

  BACKGROUND: A case of high-flow cervical vertebro-vertebral arteriovenous fistula (VVAVF), which was occluded with detachable coils by the transarterial/transvenous double-catheter technique and balloon anchoring technique, is reported. CASE DESCRIPTION: A 32-year-old male who had a history of dilated cardiomyopathy, heart failure, and arrhythmia under anticoagulation presented with a neck bruit after a right internal jugular vein puncture. A high-flow VVAVF between the right vertebral artery (VA) and vertebral vein (VV) was revealed by ultrasonography and angiography. To extirpate the shunt while preserving the right VA without using a stent to avoid antiplatelet therapy, the double-catheter technique was used to occlude the vein and shunt tightly, 1 catheter from the venous side and the other from the VA to the VV through the shunt. Finally, stabilization of the coil cage in the dilating VV was secured by placing a balloon distally as an anchor and successfully occluding the shunt with small amounts of coils only on the venous side. The shunt and cervical bruit disappeared immediately after the treatment, and no recurrence was observed. CONCLUSIONS: The double-catheter technique and balloon anchoring technique used in this case seem effective for transvenous embolization of VVAVF when preservation of the VA is desired.
• Spontaneous Persistent Primitive Trigeminal Artery-Cavernous Sinus Fistula Successfully Treated by Multipronged Coil Embolization: Case Report and Literature Review.

  Taichi Ishiguro; Tetsu Satow; Akihiro Okada; Eika Hamano; Go Ikeda; Hidekazu Chikuie; Takao Koiso; Naoki Hashimura; Masaki Nishimura; Jun C Takahashi

  World neurosurgery 128 122 - 126 2019年08月 [査読有り]
   

  BACKGROUND: A spontaneous persistent primitive trigeminal artery-cavernous sinus fistula (PCF) is extremely rare. Until recently, endovascular treatment for PCF involving transarterial and/or transvenous coil embolization of the cavernous sinus (with/without the persistent trigeminal artery) was commonly performed. However, it may result in remaining shunt flow or exacerbation of cranial nerve palsy. CASE DESCRIPTION: A 51-year-old woman presented with headache and left abducens palsy. Digital subtraction angiography demonstrated a direct fistula between the cavernous segment of the persistent primitive trigeminal artery (PPTA) and posterosuperior compartment of the left cavernous sinus (CS). Three microcatheters were guided into the fistula as follows: 1) through the PPTA to the CS from the left internal carotid artery, 2) through the PPTA to the CS from the basilar artery, and 3) through the CS to the PPTA from the internal jugular vein. Using the double-catheter technique in a multidirectional fashion, shunt occlusion was achieved with a small number of coils. No signs of recurrence were observed during the follow-up period. CONCLUSIONS: The multipronged approach is safe and effective for embolization of a small tortuous artery and shunt segment to avoid incomplete shunt occlusion.
• Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke.

  Kyohei Fujita; Kanta Tanaka; Hiroshi Yamagami; Toshihiro Ide; Hiroyuki Ishiyama; Kazutaka Sonoda; Tetsu Satow; Jun C Takahashi; Masafumi Ihara; Masatoshi Koga; Takanori Yokota; Kazunori Toyoda

  Stroke 50 7 1751 - 1757 2019年07月 [査読有り]
   

  Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications ( P for trend <0.001). Conclusions- Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.
• 経頭蓋カラードプラ法にて頭蓋内動脈ステントの急性閉塞を診断し、速やかに再治療し得た急性期脳梗塞の1例

  吉本 武史; 田中 寛大; 山上 宏; 園田 和隆; 濱野 栄佳; 佐藤 徹; 高橋 淳; 豊田 一則; 古賀 政利; 猪原 匡史

  Neurosonology 32 増刊 88 - 88 (一社)日本脳神経超音波学会 2019年06月
• Prevalence of RNF213 p.R4810K Variant in Early-Onset Stroke With Intracranial Arterial Stenosis.

  Teppei Kamimura; Shuhei Okazaki; Takaaki Morimoto; Hatasu Kobayashi; Kouji Harada; Tsutomu Tomita; Aya Higashiyama; Takeshi Yoshimoto; Jun C Takahashi; Jyoji Nakagawara; Masatoshi Koga; Kazunori Toyoda; Hirofumi Maruyama; Akio Koizumi; Masafumi Ihara

  Stroke 50 6 1561 - 1563 2019年06月 [査読有り]
   

  Background and Purpose- The ring finger protein 213 gene ( RNF213) is a susceptibility gene for moyamoya disease and large-artery ischemic stroke in East Asia. We examined the prevalence and correlates of the RNF213 p.R4810K variant in patients with early-onset ischemic stroke in a Japanese single-center cohort. Methods- We analyzed 70 early-onset stroke patients with intracranial arterial stenosis who developed a noncardioembolic stroke or transient ischemic attack from 20 to 60 years of age. Patients with moyamoya disease were excluded. Results- The RNF213 p.R4810K variant was found in 17 patients (24%), and more often in women than men (38% versus 16%, odds ratio 3.3; 95% CI, 1.1-10.2, P=0.04). The variant was identified in 35% of patients with stenosis in the M1 segment of the middle cerebral artery or the A1 segment of the anterior cerebral artery (odds ratio, 25.0; 95% CI, 1.4-438; P<0.01) but in only one patient (9%) with intracranial posterior circulation stenosis. Conventional atherosclerotic risk factors did not differ between variant carriers and noncarriers. Conclusions- The RNF213 p.R4810K variant is common in early-onset ischemic stroke with anterior circulation stenosis in Japan. Further investigation of the RNF213 gene will provide new insights into pathogenetic mechanisms of early-onset stroke.
• Ex Vivo Assessment of Various Histological Differentiation in Human Carotid Plaque with Near-infrared Spectroscopy Using Multiple Wavelengths.

  Toshihiro Munemitsu; Akira Ishii; Eiji Okada; Hideo Chihara; Kazumichi Yoshida; Jun C Takahashi; Yasushi Takagi; Susumu Miyamoto

  Neurologia medico-chirurgica 59 5 163 - 171 2019年05月 [査読有り]
   

  We previously reported that near-infrared hyperspectral imaging enabled the localization of atherosclerotic plaques from outside the vessels, but not the optical characteristics of each histological component. Therefore, the near-infrared spectrum of each component was collected from the sliced section of the human carotid plaque obtained with endarterectomy and the optical characteristics were confirmed in several wavelengths. Based on this information, we assessed the diagnostic accuracy for ex vivo chemogram in each plaque component created with near-infrared spectroscopy (NIRS), using multiple wavelengths. The chemogram projected on the actual image of plaque was created based on light intensity and transmittance change at three wavelengths. The wavelengths that were mainly were 1440, 1620, 1730, and 1930 nm. We evaluated the accuracy of histological diagnosis in chemogram compared with pathological findings, analyzing interobserver agreement with κ-statistics. The chemograms that we created depicted the components of fibrous tissue, smooth muscle, lipid tissue, intraplaque hemorrhage, and calcification. Diagnostic odds ratio in each component was as follows: 259.6 in fibrous tissue, 144 in smooth muscle, 1123.5 in lipid tissue, 29.3 in intraplaque hemorrhage, and 136.3 in calcification. The κ-statistics revealed that four components, excluding intraplaque hemorrhage, had substantial or almost perfect agreement. Thus, this study demonstrated the feasibility of using chemogram focused on specific component during the histological assessment of atherosclerotic plaques, highlighting its potential diagnostic ability. Chemograms of various target components can be created by combining multiple wavelengths. This technology may prove to be useful in improving the histological assessment of plaque using NIRS.
• Intrinsic development of choroidal and thalamic collaterals in hemorrhagic-onset moyamoya disease: case-control study of the Japan Adult Moyamoya Trial.

  Miki Fujimura; Takeshi Funaki; Kiyohiro Houkin; Jun C Takahashi; Satoshi Kuroda; Yasutake Tomata; Teiji Tominaga; Susumu Miyamoto

  Journal of neurosurgery 130 5 1453 - 1459 2019年05月 [査読有り]
   

  OBJECTIVE: This study was performed to identify the angiographic features of hemorrhagic-onset moyamoya disease (MMD) in comparison with those of patients with ischemic-onset MMD. METHODS: This case-control study compared the data set of the Japan Adult Moyamoya (JAM) Trial with the angiographic data of adult patients with ischemic-onset MMD. The authors analyzed angiograms obtained at onset, classifying the collaterals into 3 subtypes: lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. They then compared the extent of these collaterals, as indicated by the collateral development grade from 0 to 2 in each subtype, between the JAM Trial group and the ischemic-onset group. They also compared the involvement of the posterior cerebral artery (PCA) and Suzuki's angiographic staging between each group. RESULTS: Among 89 ischemic-onset patients, 103 symptomatic hemispheres in 80 patients were analyzed and compared with 75 hemorrhagic hemispheres from the JAM Trial. The hemorrhagic-onset patients showed a significantly higher proportion of thalamic anastomosis (p = 0.043) and choroidal anastomosis (< 0.001), as indicated by grade 2 in each subtype, compared with ischemic-onset patients. Suzuki's angiographic staging was significantly higher in the hemorrhagic group (< 0.038). There was no difference in the extent of lenticulostriate anastomosis and PCA involvement between the groups. CONCLUSIONS: In adult MMD, the characteristic pattern of the abnormal vascular networks at the base of the brain is different between each onset type. In light of the more prominent development of thalamic and choroidal anastomosis in the JAM Trial group in the present study, development of these collaterals, especially the choroidal collateral extending beyond the lateral ventricle, may play a critical role in hemorrhagic presentation in MMD.Clinical trial registration no. C000000166 (http://www.umin.ac.jp/ctr/index.htm).
• Restoration of periventricular vasculature after direct bypass for moyamoya disease: intra-individual comparison.

  Akinori Miyakoshi; Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Takayuki Kikuchi; Kazumichi Yoshida; Hiroharu Kataoka; Yohei Mineharu; Masakazu Okawa; Yukihiro Yamao; Yasutaka Fushimi; Tomohisa Okada; Kaori Togashi; Susumu Miyamoto

  Acta neurochirurgica 161 5 947 - 954 2019年05月 [査読有り]
   

  BACKGROUND: While periventricular anastomosis, a unique abnormal vasculature in moyamoya disease, has been studied in relation to intracranial hemorrhage, no study has addressed its change after bypass surgery. The authors sought to test whether direct bypass surgery could restore normal periventricular vasculature. METHODS: Patients who had undergone direct bypass surgery for moyamoya disease at a single institution were eligible for the study. Baseline, postoperative, and follow-up magnetic resonance angiography (MRA) scans were scheduled before surgery, after the first surgery, and 3 to 6 months after contralateral second surgery, respectively. Sliding-thin-slab maximum-intensity-projection coronal MRA images of periventricular anastomoses were scored according to the three subtypes (lenticulostriate, thalamic, and choroidal anastomosis). Baseline and postoperative MRA images were compared to obtain a matched comparison of score changes in the surgical and nonsurgical hemispheres within individuals (intra-individual comparison). RESULTS: Of 110 patients, 42 were identified for intra-individual comparisons. The periventricular anastomosis score decreased significantly in the surgical hemispheres (median, 2 versus 1; p < 0.001), whereas the score remained unchanged in the nonsurgical hemispheres (median, 2 versus 2; p = 0.57); the score change varied significantly between the surgical and nonsurgical hemispheres (p < 0.001). Of the 104 periventricular-anastomosis-positive hemispheres undergoing surgery, 47 (45.2%) were assessed as negative in the follow-up MRA. Among the subtypes, choroidal anastomosis was most likely to be assessed as negative (79.7% of positive hemispheres). CONCLUSIONS: Periventricular vasculature can be restored after direct bypass. The likelihood of correction of choroidal anastomosis is a subject requiring further studies.
• Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques.

  Rie Motoyama; Kozue Saito; Shuichi Tonomura; Hatsue Ishibashi-Ueda; Hiroshi Yamagami; Hiroharu Kataoka; Yoshiaki Morita; Yuto Uchihara; Koji Iihara; Jun C Takahashi; Kazuma Sugie; Kazunori Toyoda; Kazuyuki Nagatsuka

  Journal of the American Heart Association 8 8 e011302  2019年04月 [査読有り]
   

  Background We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound ( CEUS ). Methods and Results We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high-signal-intensity plaques ( HIP s) and non- HIP s based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIP s (43 symptomatic) and 11 were classified as non- HIP s (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms ( P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation ( P<0.0001). CEUS showed that all 5 symptomatic non- HIP s had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.
• Vascular wall components in thrombi obtained by acute stroke thrombectomy: clinical significance and related factors.

  Naoko Funatsu; Mikito Hayakawa; Tetsuya Hashimoto; Hiroshi Yamagami; Tetsu Satow; Jun C Takahashi; Masatoshi Koga; Kazuyuki Nagatsuka; Hatsue Ishibashi-Ueda; Toru Iwama; Kazunori Toyoda

  Journal of neurointerventional surgery 11 3 232 - 236 2019年03月 [査読有り]
   

  BACKGROUND AND PURPOSE: Vascular wall components (VWCs) are sometimes identified as collagen fibers in specimens retrieved by thrombectomy from acute stroke patients. However, their clinical significance and associated factors remain unclear. The purpose of this study was to clarify the factors associated with VWCs in retrieved thrombi. METHODS: Consecutive acute stroke patients treated endovascularly using the Penumbra aspiration catheter or stent retrievers (SRs) at our institute from November 2013 to April 2016 were retrospectively reviewed, and the retrieved thrombi were evaluated histopathologically. VWCs were defined as banded collagen fibers with a distinct boundary observed at the rim or outside of the retrieved thrombi. Factors associated with the presence of VWCs were studied. RESULTS: A total of 150 specimens (76 specimens retrieved by the Penumbra, 74 by SRs) from 101 patients (47 women, age 74.9±11.1 years) were investigated. Applied thrombectomy devices were aspiration catheters in 42 patients, SRs in 21 patients, and both in 38 patients. VWCs were observed in 24 specimens (16%) from 22 patients. A low proportion of erythrocyte components (41.7±24.8% vs 55.0±26.3%, P=0.01), a high frequency of the devices reaching the M2/P2 (75% vs 50%, P=0.02), and a high number of device passages (P for trend=0.02) were associated with VWC positive thrombi. Successful recanalization (Treatment in Cerebral Ischemia ≥2b) tended to be less frequent in patients with VWC positive thrombi than in those without (73% vs 89%, P=0.06). CONCLUSIONS: The histopathology of occlusive thrombi, arterial sites where devices reached, and number of device passages, might affect the presence of VWCs in retrieved thrombi.
• Effect of choroidal collateral vessels on de novo hemorrhage in moyamoya disease: analysis of nonhemorrhagic hemispheres in the Japan Adult Moyamoya Trial.

  Takeshi Funaki; Jun C Takahashi; Kiyohiro Houkin; Satoshi Kuroda; Miki Fujimura; Yasutake Tomata; Susumu Miyamoto

  Journal of neurosurgery 132 2 408 - 414 2019年02月 [査読有り]
   

  OBJECTIVE: Following hemorrhagic stroke in moyamoya disease, de novo intracranial hemorrhage can occur in the previously unaffected nonhemorrhagic hemisphere. In the present analysis the authors intended to determine whether the presence in the nonhemorrhagic hemisphere of choroidal collateral vessels, which have been the focus of attention as a source of bleeding, affects the risk of de novo hemorrhage. METHODS: The subject of focus of the present cohort study was the nonhemorrhagic hemispheres of adult patients with hemorrhagic moyamoya disease enrolled in the Japan Adult Moyamoya Trial and allocated to the nonsurgical arm. The variable of interest was the presence of choroidal collaterals (also termed choroidal anastomoses), identified with baseline angiography and represented by a connection (anastomosis) between the anterior or posterior choroidal arteries and the medullary arteries. The outcome measure was de novo hemorrhage during the 5-year follow-up period, assessed in all nonhemorrhagic hemispheres. The incidence of de novo hemorrhage in the collateral-positive and -negative groups was compared. RESULTS: Choroidal collaterals were present in 15 of 36 (41.7%) nonhemorrhagic hemispheres analyzed. The overall annual risk of de novo hemorrhage was 2.0%. Three de novo hemorrhages occurred in the collateral-positive group, whereas no hemorrhage occurred in the collateral-negative group. The annual risk of de novo hemorrhage was significantly higher in the collateral-positive group than in the collateral-negative group (5.8% per year vs 0% per year; p = 0.017). All hemorrhage sites corresponded to the distribution of choroidal collaterals. CONCLUSIONS: The present preliminary results suggest that the presence of choroidal collaterals affects the risk of de novo hemorrhage in the nonhemorrhagic hemisphere, subject to verification in larger studies. Further studies are needed to determine the optimal treatment strategy for nonhemorrhagic hemispheres and asymptomatic patients.
• High rebleeding risk associated with choroidal collateral vessels in hemorrhagic moyamoya disease: analysis of a nonsurgical cohort in the Japan Adult Moyamoya Trial.

  Takeshi Funaki; Jun C Takahashi; Kiyohiro Houkin; Satoshi Kuroda; Shigekazu Takeuchi; Miki Fujimura; Yasutake Tomata; Susumu Miyamoto

  Journal of neurosurgery 130 2 337 - 673 2019年02月 [査読有り]
   

  OBJECTIVEChoroidal collateral vessels typical of moyamoya disease have received attention as a potential bleeding source. The authors' previous angiographic cross-sectional analysis suggested a possible association between choroidal collaterals and posterior hemorrhage, indicating a high risk for rebleeding. The present longitudinal analysis is intended to determine whether choroidal collaterals are a predictor of rebleeding in hemorrhagic moyamoya disease.METHODSThe Japan Adult Moyamoya Trial group designed an ancillary cohort study using 5-year follow-up data on 37 patients included in the nonsurgical arm of the original randomized controlled trial and compared the rebleeding rate of those with and those without choroidal collaterals, represented by the connection between the anterior or posterior choroidal arteries and the medullary arteries. An expert panel determined whether a choroidal collateral was present in each patient through the measurement of baseline angiography studies. The rebleeding rate comparison was adjusted for age, diagnosis of hypertension, and involvement of the posterior cerebral artery.RESULTSChoroidal collaterals were present in 21 patients (56.8%). The rebleeding rate was 13.1% per year in the collateral-positive group as compared with 1.3% in the negative group (p = 0.008, log-rank test). The adjusted hazard ratio for rebleeding in the collateral-positive group relative to the negative group remained statistically significant (HR 11.10, 95% CI 1.37-89.91). Radiographic assessment of the collateral-positive group revealed good correspondence between the distribution of collaterals and rebleeding sites.CONCLUSIONSResults of this study suggest that choroidal collaterals are a bleeding source with a high risk for hemorrhagic recurrence and a predictor of rebleeding in hemorrhagic moyamoya disease.
• Selective Shunt Occlusion of Direct Carotid-Cavernous Fistula with Vascular Ehlers-Danlos Syndrome by Multidevice Technique: A Case Report and Technical Note.

  Yoshiro Ito; Tetsu Satow; Hirofumi Matsubara; Hiroharu Kataoka; Jun C Takahashi

  World neurosurgery 122 123 - 128 2019年02月 [査読有り]
   

  BACKGROUND: Vascular Ehlers-Danlos syndrome (vEDS) is a vascular disease associated with a genetic collagen abnormality. It is characterized by vessel fragility, vessel rupture, and massive hemorrhage. Carotid-cavernous fistula (CCF) is the most frequent neurovascular complication of vEDS. However, CCF treatment using conventional diagnostic angiography and neuroendovascular therapy can result in a high rate of major complications. CASE DESCRIPTION: We report a case of a right CCF in a 48-year-old man with vEDS. The carotid artery and jugular vein were exposed by direct neck dissection. To avoid systemic vascular complications, multiple catheters were inserted into the shunt segment via the carotid artery and jugular vein. This transarterial and transvenous multidevice technique enabled compact placement of coils in the shunt segment. The CCF was eliminated via selective shunt occlusion. Postoperative magnetic resonance imaging revealed occlusion of the right CCF. CONCLUSIONS: Selective shunt occlusion via a transarterial and transvenous multidevice technique is a useful and safe approach for treating vEDS-associated CCF.
• Moyamoya Disease Susceptibility Variant RNF213 p.R4810K Increases the Risk of Ischemic Stroke Attributable to Large-Artery Atherosclerosis.

  Shuhei Okazaki; Takaaki Morimoto; Yoichiro Kamatani; Teppei Kamimura; Hatasu Kobayashi; Kouji Harada; Tsutomu Tomita; Aya Higashiyama; Jun C Takahashi; Jyoji Nakagawara; Masatoshi Koga; Kazunori Toyoda; Kazuo Washida; Satoshi Saito; Atsushi Takahashi; Makoto Hirata; Koichi Matsuda; Hideki Mochizuki; Michael Chong; Guillaume Paré; Martin O'Donnell; Tetsuro Ago; Jun Hata; Toshiharu Ninomiya; Martin Dichgans; Stéphanie Debette; Michiaki Kubo; Akio Koizumi; Masafumi Ihara

  Circulation 139 2 295 - 298 2019年01月 [査読有り]
  
• Early Detection of Cerebral Infarction After Focal Ischemia Using a New MRI Indicator.

  Yukako Nakajo; Qiang Zhao; Jun-Ichiro Enmi; Hidehiro Iida; Jun C Takahashi; Hiroharu Kataoka; Keiko Yamato; Hiroji Yanamoto

  Molecular neurobiology 56 1 658 - 670 2019年01月 [査読有り]
   

  Prolongation of the T2 relaxation time, an increase in T2-weighted signal intensity (T2-SI), and a decrease in the apparent diffusion coefficient (ADC) calculated from diffusion-weighted images (DWI) on magnetic resonance imaging (MRI) are conventional indicators of the vasogenic (interstitial) or cytotoxic (cellular) cerebral edema that develops after ischemic stroke. However, these parameters obtained on stroke imaging have not given us a precise threshold at which we can determine the viability or vulnerability of the tissue, allowing us to decide on an intervention that will help reversible tissue in the acute phase. Here, we introduce a new indicator-the essential diffusion coefficient or EDC, calculated from the T2-SI and ADC-that permits detection of irreversible brain damage after induction of experimental, focal cerebral ischemia. Our three-vessel occlusion (3-VO) method (Yang et al. Eur Neurol 71:4-18, 2014) was applied to investigate early changes on 7-T MRI. In the 3-VO model, which targets only a part of the cortex, animals seldom die at least within 24 h. The T2-SI and the ADC value were monitored, starting at 60 min after reperfusion, and every 30-60 min, for 10 h after the induction of focal ischemia. The region of interest (ROI) was set in each of the following: (1) the ischemic core (the dead zone); (2) the medial border area (the dying/dead mixed zone, including the ischemic penumbra); (3) the lateral border area (the surviving zone after the ischemic stress, where the rCBF is above the threshold for death); and (4) The intact area (outside the ischemic zone). The diagnosis was made by histological analysis performed 24 h after reperfusion. Significant increases in the T2-SI were observed, in ROI-1 at 1 h, in ROI-2 at 2.5 h, and in ROI-3 at 4 h post-reperfusion (1.10, 1.11, or 1.11; > 1.10, respectively, p < 0.001). Significant reductions in the ADC were also observed in ROI-1, ROI-2, and ROI-3, at 1 h post-reperfusion (0.55, 0.52, or 0.58; < 0.60, respectively, p < 0.001), indicating that both types of cerebral edema develop simultaneously in the acute phase. In the EDC analysis, from 5.0 h post-reperfusion, the value in the dying/dead zone (ROI-1 and ROI-2) was consistently reduced to < 50%, showing repeated, significant differences from the value in the surviving zone (ROI-3). A reduction in the EDC to below 50% indicated irreversible tissue damage, with transformation to cerebral infarction. We could detect a sign of cerebral infarction (initial necrosis-like irreversible lesion) as early as 5.25 h after the onset of ischemia. Although the biological time that depends on the body weight must be different between mice and humans, the earliest irreversible tissue damage or tissue destruction (to have achieved the risk of hemorrhagic transformation) that progressed after invisible or silent cell death in the ultra-acute phase, seems to occur at a similar time point.
• System evaluation of automated production and inhalation of 15O-labeled gaseous radiopharmaceuticals for the rapid 15O-oxygen PET examinations.

  Satoshi Iguchi; Tetsuaki Moriguchi; Makoto Yamazaki; Yuki Hori; Kazuhiro Koshino; Kazunori Toyoda; Jarmo Teuho; Saeka Shimochi; Yusuke Terakawa; Tetsuya Fukuda; Jun C Takahashi; Jyoji Nakagawara; Shigehiko Kanaya; Hidehiro Iida

  EJNMMI physics 5 1 37 - 37 2018年12月 [査読有り]
   

  BACKGROUND: 15O-oxygen inhalation PET is unique in its ability to provide fundamental information regarding cerebral hemodynamics and energy metabolism in man. However, the use of 15O-oxygen has been limited in a clinical environment largely attributed to logistical complexity, in relation to a long study period, and the need to produce and inhale three sets of radiopharmaceuticals. Despite the recent works that enabled shortening of the PET examination period, radiopharmaceutical production has still been a limiting factor. This study was aimed to evaluate a recently developed radiosynthesis/inhalation system that automatically supplies a series of 15O-labeled gaseous radiopharmaceuticals of C15O, 15O2, and C15O2 at short intervals. METHODS: The system consists of a radiosynthesizer which produces C15O, 15O2, and C15O2; an inhalation controller; and an inhalation/scavenging unit. All three parts are controlled by a common sequencer, enabling automated production and inhalation at intervals less than 4.5 min. The gas inhalation/scavenging unit controls to sequentially supply of qualified radiopharmaceuticals at given radioactivity for given periods at given intervals. The unit also scavenges effectively the non-inhaled radioactive gases. Performance and reproducibility are evaluated. RESULTS: Using an 15O-dedicated cyclotron with deuteron of 3.5 MeV at 40 μA, C15O, 15O2, and C15O2 were sequentially produced at a constant rate of 1400, 2400, and 2000 MBq/min, respectively. Each of radiopharmaceuticals were stably inhaled at < 4.5 min intervals with negligible contamination from the previous supply. The two-hole two-layered face mask with scavenging device minimized the gaseous radioactivity surrounding subject's face, while maintaining the normocapnia during examination periods. Quantitative assessment of net administration doses could be assessed using a pair of radio-detectors at inlet and scavenging tubes, as 541 ± 149, 320 ± 103, 523 ± 137 MBq corresponding to 2-min supply of 2574 ± 255 MBq for C15O, and 1-min supply of 2220 ± 766 and 1763 ± 174 for 15O2 and C15O2, respectively. CONCLUSIONS: The present system allowed for automated production and inhalation of series of 15O-labeled radiopharmaceuticals as required in the rapid 15O-Oxygen PET protocol. The production and inhalation were reproducible and improved logistical complexity, and thus the use of 15O-oxygen might have become practically applicable in clinical environments.
• Long-term outcomes of coil embolization of unruptured intracranial aneurysms.

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

  Journal of neurosurgery 129 6 1492 - 1498 2018年12月 [査読有り]
   

  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.
• 脳動脈瘤治療用多孔性カバードステントシステム医師主導治験中間報告

  佐藤 徹; 坂井 信幸; 山本 晴子; 大石 英則; 石井 暁; 中山 泰秀; 高橋 淳

  脳血管内治療 3 Suppl. S88 - S88 (NPO)日本脳神経血管内治療学会 2018年11月
• Vascular responses to abrupt blood flow change after bypass surgery for complex intracranial aneurysms.

  Hiroharu Kataoka; Yasuhide Makino; Kiyofumi Takanishi; Yohei Kimura; Kenji Takamura; Takanobu Yagi; Satoshi Iguchi; Akihide Yamamoto; Hidehiro Iida; Soshiro Ogata; Kunihiro Nishimura; Masanori Nakamura; Mitsuo Umezu; Koji Iihara; Jun C Takahashi

  Acta neurochirurgica 160 10 1945 - 1953 2018年10月 [査読有り]
   

  BACKGROUND: Bypass surgery for complex intracranial aneurysms (IAs) results in drastic blood flow changes in intracranial arteries. The aim of the study was to elucidate how vessels adapt to blood flow changes after bypass surgery with phase-contrast magnetic resonance imaging (PC-MRI). METHODS: This is a prospective observational study to assess changes of the blood flow in intracranial arteries after bypass surgery for IAs. Flow rates and vessel diameters were measured with PC-MRI in 52 intracranial arteries of 7 healthy volunteers and 31 arteries of 8 IA patients who underwent bypass surgery. Wall shear stress (WSS) was calculated with the Hagen-Poiseuille formula. In 18 arteries of 5 patients, the same measurement was performed 1, 3, and 12 months after surgery. RESULTS: PC-MRI showed a strong positive correlation between the flow rate and the third power of vessel diameter in both healthy volunteers (r = 0.82, P < 0.0001) and IA patients (r = 0.90, P < 0.0001), indicating the constant WSS. Of the 18 arteries in 5 patients, WSS increased in 7 arteries and decreased in 11 arteries immediately after surgery. In the WSS-increased group, WSS returned to the preoperative value in the third postoperative month. In the WSS-decreased group, WSS increased in the 12th month, but did not return to the preoperative level. CONCLUSIONS: In a physiological state, WSS was constant in intracranial arteries. Changed WSS after bypass surgery tended to return to the preoperative value, suggesting that vessel diameter and flow rate might be controlled so that WSS remains constant.
• Neurosurgical Management and Outcomes of Cerebrovascular Disease in Pediatric Patients with Heart Disease.

  Daisuke Maruyama; Hiroharu Kataoka; Tetsu Satow; Hisae Mori; Yoshiro Ito; Eika Hamano; Shunichi Tanaka; Taichi Ishiguro; Hidekazu Chikuie; Jun C Takahashi

  Neurologia medico-chirurgica 58 8 334 - 340 2018年08月 [査読有り]
   

  Antithrombotic treatment has substantial risks, even in pediatric patients. We retrospectively evaluated the management and outcomes of consecutive pediatric patients who underwent neurosurgical treatment for cerebrovascular disease with cardiovascular disease between 1998 and 2017. Patients were divided into patients with comorbid cardiovascular disease (group I); and patients with cardiovascular disease as a primary disease of intracranial complication, without (group IIa) or with (group IIb) extracorporeal circulations. Postoperative resumption of antithrombotic agents was generally initiated within 48 h. Our study included 26 patients; five were categorized as group I, 15 as group IIa, and six as group IIb. All intracranial diseases in groups IIa and IIb were exclusively hemorrhagic. Preoperative anticoagulation therapy was used in one patient (20%) in group I, 13 patients (86.7%) in group IIa, and six patients (100%) in group IIb. Postoperative intracranial hemorrhagic events were observed in one patient (20%) in group I, three patients (20%) in group IIa, and four patients (66.7%) in group IIb. Re-operations were conducted in two (13.3%) and three patients (50%) in groups IIa and IIb, respectively. Death occurred in five (33.3%) and four patients (66.7%) in groups IIa and IIb, respectively. The remaining two patients in group IIb returned to candidate status for implantation. Emergent surgery for patients with intracranial hemorrhage associated with cardiovascular disease has a high risk of postoperative hemorrhagic events and high rate of re-operations with poor vital outcomes, especially in patients with extracorporeal circulations. We should consider maximum neurosurgical treatment achievable with optimal management of antithrombotic treatment.
• 小児・若年性心疾患と脳卒中 小児心疾患に合併した脳卒中に対する外科治療の成績と転帰

  丸山 大輔; 片岡 大治; 佐藤 徹; 森 久恵; 伊藤 嘉郎; 濱野 栄佳; 田中 俊一; 石黒 太一; 築家 秀和; 高橋 淳

  The Mt. Fuji Workshop on CVD 36 87 - 93 (株)にゅーろん社 2018年07月 [査読有り]
   

  過去19年間に当院で脳外科手術を行った小児患者233例のうち、心疾患を合併した26例の成績と転帰について検討した。その結果、心疾患を併存していたI群:5例に対する脳外科手術の成績と予後は良好であった。一方、心疾患が頭蓋内出血を引き起こす原疾患であったII群:21例では高率に抗凝固療法が施行され、特に体外循環装置を装着していたIIb群では術後の頭蓋内出血性イベント発生率が67%(4/6例)、再手術率が50%(3/6例)と高率で、最終フォローにおける生命予後も不良であった。一方で、IIb群のうち生存した2例は心移植待機のステータスへ復帰できた。
• 小児もやもや病診断・治療の進歩と長期予後 小児もやもや病に対する外科治療と中長期予後

  濱野 栄佳; 片岡 大治; 佐藤 徹; 舟木 健史; 飯原 弘二; 宮本 享; 高橋 淳

  The Mt. Fuji Workshop on CVD 36 5 - 9 (株)にゅーろん社 2018年07月 [査読有り]
   

  当科で外科的治療を行った小児もやもや病患者95例の中長期予後について検討した。平均追跡期間は8.9年で、平均年齢は発症時7.4歳、最終観察時15.8歳であった。81例は基本治療であるSTA-MCA+EMSのみで治療が完了した。追加バイパスはSTA-ACAバイパスが16例、OA-PCAバイパスが7例で施行され、特に6歳以下の低年齢児で追加治療を要する例が多かった。経過中に脳梗塞または頭蓋内出血を発生した例はなく、治療により脳血管イベントは抑制されたと考えられた。社会的予後不良は5例(5.3%)に認め、うち1例は精神発達遅滞により日常生活全般に介助を要する状態で、他の4例は高次脳機能障害によって普通学級への通学が困難、または義務教育卒業後は高等学校への進学や就業が困難な状態であった。社会的予後不良は低年齢発症および梗塞発症、PCA病変の有無と相関を示していた。
• Response to "Letter on 'Management of pregnancy complicated with intracranial arteriovenous malformation'".

  Shinji Katsuragi; Jun Yoshimatsu; Hiroaki Tanaka; Kayo Tanaka; Masafumi Nii; Takekazu Miyoshi; Reiko Neki; Kazunori Toyoda; Kazuyuki Nagatsuka; Jun C Takahashi; Kenji Fukuda; Eika Hamano; Tetsu Satow; Susumu Miyamoto; Koji Iihara; Tomoaki Ikeda

  The journal of obstetrics and gynaecology research 44 7 1335 - 1335 2018年07月 [査読有り]
  
• Late Cerebrovascular Events and Social Outcome after Adolescence: Long-term Outcome of Pediatric Moyamoya Disease.

  Takeshi Funaki; Jun C Takahashi; Susumu Miyamoto

  Neurologia medico-chirurgica 58 6 240 - 246 2018年06月 [査読有り]
   

  In this article, the authors review the literature related to long-term outcome of pediatric moyamoya disease, focusing on late cerebrovascular events and social outcome of pediatric patients once they reach adulthood. Late-onset de novo hemorrhage is rare but more serious than recurrence of ischemic stroke. Long-term follow-up data on Asian populations suggest that the incidence of de novo hemorrhage might increase at age 20 or later, even more than 10 years after bypass surgery. Social adaptation difficulty, possibly related to cognitive impairment caused by frontal ischemia, continues in 10-20% of patients after they reach adulthood, even if no significant disability is present in daily life. A treatment strategy aimed at improving long-term outcome and careful follow-up might be required.
• Correlation between reduction in microvascular transit time after superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease and the development of postoperative hyperperfusion syndrome.

  Tao Yang; Yoshifumi Higashino; Hiroharu Kataoka; Eika Hamano; Daisuke Maruyama; Koji Iihara; Jun C Takahashi

  Journal of neurosurgery 128 5 1304 - 1310 2018年05月 [査読有り]
   

  OBJECTIVE Hyperperfusion syndrome (HPS) is a notable complication that causes various neurological symptoms after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD). The authors used intraoperative indocyanine green (ICG) videoangiography to measure the change in microvascular transit time (MVTT) after bypass surgery. An analysis was then conducted to identify the correlation between change in MVTT and presence of postoperative HPS. METHODS This study included 105 hemispheres of 81 patients with MMD who underwent STA-MCA single bypass surgery between January 2010 and January 2015. Intraoperative ICG videoangiography was performed before and after bypass surgery. The MVTT was calculated from the ICG time intensity curve recorded in the pial arterioles and venules. Multivariate logistic regression analysis was conducted to test the effect of multiple variables, including the change in MVTT after bypass surgery, on postoperative HPS. RESULTS Postoperative HPS developed in 28 (26.7%) of the 105 hemispheres operated on. MVTT was reduced significantly after bypass surgery (prebypass 5.34 ± 2.00 sec vs postbypass 4.12 ± 1.60 sec; p < 0.001). The difference between prebypass and postbypass MVTT values, defined as ΔMVTT, was significantly greater in the HPS group than in the non-HPS group (2.55 ± 2.66 sec vs 0.75 ± 1.78 sec; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cutoff point of ΔMVTT was 2.6 seconds (sensitivity 46.4% and specificity 85.7% as a predictor of postoperative HPS). A ΔMVTT > 2.6 seconds was an independent predictor of HPS in multivariate analysis (hazard ratio 4.88, 95% CI 1.76-13.57; p = 0.002). CONCLUSIONS MVTT in patients with MMD was reduced significantly after bypass surgery. Patients with a ΔMVTT > 2.6 seconds tended to develop postoperative HPS. Because ΔMVTT can be easily measured during surgery, it is a useful diagnostic tool for identifying patients at high risk for HPS after STA-MCA bypass surgery for MMD.
• Management of pregnancy complicated with intracranial arteriovenous malformation.

  Shinji Katsuragi; Jun Yoshimatsu; Hiroaki Tanaka; Kayo Tanaka; Masafumi Nii; Takekazu Miyoshi; Reiko Neki; Kazunori Toyoda; Kazuyuki Nagatsuka; Jun C Takahashi; Kenji Fukuda; Eika Hamano; Tetsu Satow; Susumu Miyamoto; Koji Iihara; Tomoaki Ikeda

  The journal of obstetrics and gynaecology research 44 4 673 - 680 2018年04月 [査読有り]
   

  AIM: To clarify the perinatal outcomes in pregnancy complicated with intracranial arteriovenous malformation (i-AVM). METHODS: A retrospective study was performed in 36 pregnancies complicated by i-AVM from 1981 to 2013 at one institution. RESULTS: In total, 6 women miscarried, and 30 had live births. The median (range) gestational age at delivery was 38 (24-40) weeks; 11 cases experienced initial i-AVM rupture during pregnancy (first, second and third trimester: 18%, 64% and 18%, respectively). At onset, 4 cases had a Glasgow Coma Scale ≤10, 10 cases needed emergency maternal transport, 4 underwent neurosurgery with the fetus in utero and 4 had termination of pregnancy in the second trimester for emergent treatment for i-AVM. Two cases delivered vaginally. Another 25 cases had already been diagnosed as i-AVM at conception. Of these, as an indication for epidural birth, 18 cases had either residual lesion of i-AVM or neurological symptoms, although 18 cases had received treatments of i-AVM before conception. Without rupture of i-AVM and worsening of symptoms, 15 cases succeeded in epidural birth. One case was delivered by cesarean section for residual i-AVM with indication of treatment. Another case who had refused treatment of i-AVM experienced rupture of i-AVM 1 year after delivery. CONCLUSION: Most of the cases with residual i-AVM lesion and neurological symptoms could deliver vaginally without worsening of symptoms. However, pregnancy with i-AVM can be complicated by rupture of i-AVM. In cases with a residual lesion with indication of treatment and rupture of i-AVM during pregnancy, meticulous care is required during pregnancy and after delivery.
• Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: a supplementary analysis of the Japan Adult Moyamoya Trial.

  Takeshi Funaki; Jun C Takahashi; Kiyohiro Houkin; Satoshi Kuroda; Shigekazu Takeuchi; Miki Fujimura; Yasutake Tomata; Susumu Miyamoto

  Journal of neurosurgery 128 3 777 - 784 2018年03月 [査読有り]
   

  OBJECTIVE In this paper, the authors set out to identify the angiographic features of moyamoya disease with posterior hemorrhage, which is a strong predictor of rebleeding. METHODS This cross-sectional study used the data set of the Japan Adult Moyamoya Trial (clinical trial registration no.: C000000166 [ www.umin.ac.jp/ctr/index.htm ]). The panel designed the ancillary measurement of angiography at onset, classifying the collateral vessels into 3 subtypes: lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. The association between each collateral and the hemorrhage site (anterior vs posterior) was assessed in the hemorrhagic hemisphere by using multivariate adjustment for potential confounders, including age, sex, and involvement of the posterior cerebral artery (PCA). The association was confirmed through topographical analysis of bleeding points. RESULTS Among the 80 participants, 75 hemorrhagic hemispheres of 75 patients were analyzed. Lenticulostriate anastomosis was detected in 21 (28.0%) hemorrhagic hemispheres, thalamic anastomosis in 22 (29.3%), and choroidal anastomosis in 35 (46.7%). Choroidal anastomosis was a factor associated with posterior hemorrhage (OR 2.77 [95% CI 1.08-7.10], p = 0.034) and remained statistically significant after the multivariate adjustment (OR 2.66 [95% CI 1.00-7.07], p = 0.049). PCA involvement was also associated with posterior hemorrhage in both univariate and multivariate analyses. Topographical analysis revealed good correspondence between bleeding points associated with positive choroidal anastomosis and the anatomical distribution of the choroidal arteries, including the thalamus and the wall of the atrium. CONCLUSIONS Choroidal anastomosis and PCA involvement are characteristic of posterior hemorrhage in moyamoya disease. Choroidal anastomosis might be considered a potential source of posterior hemorrhage at high risk of rebleeding.
• Natural history of unruptured intracranial aneurysms

  Jun C. Takahashi; Hiroharu Kataoka; Tetsu Satow; Hisae Mori

  Japanese Journal of Neurosurgery 27 3 184 - 191 2018年 [査読有り]
   

  Since 2003, five prospective studies on unruptured intracranial aneurysms have demonstrated their natural course (i.e. annual rupture rates) in detail. Recently, in addition, several meta-analyses, pooled analyses, risk scoring studies have been reported. Because there are many quotations of clinical data between these kinds of analyses, one must understand precisely where the pooled data come from. The risk factors for aneurysmal rupture proposed in the five prospective studies differ greatly from each other, and one must also understand these differences as well. UCAS, which is the prospective multicenter study across Japan published in 2012, has marked the milestone in the field of intracranial aneurysm research especially in the Japanese cohort. To make reasonable judgements in daily clinical activities, physicians should read the UCAS manuscript and its supplementary appendix carefully and understand the true natural course of unruptured intracranial aneurysms in Japan.
• Magnetic resonance angiography with compressed sensing: An evaluation of moyamoya disease.

  Takayuki Yamamoto; Tomohisa Okada; Yasutaka Fushimi; Akira Yamamoto; Koji Fujimoto; Sachi Okuchi; Hikaru Fukutomi; Jun C Takahashi; Takeshi Funaki; Susumu Miyamoto; Aurélien F Stalder; Yutaka Natsuaki; Peter Speier; Kaori Togashi

  PloS one 13 1 e0189493 - e0189493 2018年 [査読有り]
   

  Compressed sensing (CS) reconstructions of under-sampled measurements generate missing data based on assumptions of image sparsity. Non-contrast time-of-flight MR angiography (TOF-MRA) is a good candidate for CS based acceleration, as MRA images feature bright trees of sparse vessels over a well-suppressed anatomical background signal. A short scan time derived from CS is beneficial for patients of moyamoya disease (MMD) because of the frequency of MR scans. The purpose of this study was to investigate the reliability of TOF-MRA with CS in the evaluation of MMD. Twenty-two patients were examined using TOF-MRA with CS (CS-TOF) and parallel imaging (PI-TOF). The acceleration factors were 3 (CS3) and 5 (CS5) for CS-TOF, and 3 (PI3) for PI-TOF. Two neuroradiologists evaluated the MMD grading according to stenosis/occlusion scores using the modified Houkin's system, and the visibility of moyamoya vessels (MMVs) using a 3-point scale. Concordance was calculated with Cohen's κ. The numbers of MMVs in the basal ganglia were compared using Bland-Altman analysis and Wilcoxon's signed-rank tests. MRA scan times were 4:07, 3:53, and 2:42 for PI3, CS3, and CS5, respectively. CS-reconstruction completed within 10 minutes. MMD grading and MMV visibility scales showed excellent correlation (κ > .966). Although the number of MMVs was significantly higher in CS3 than in PI3 (p < .0001) and CS5 (p < .0001), Bland-Altman analysis showed a good agreement between PI3, CS3, and CS5. Compressed sensing can accelerate TOF-MRA with improved visualization of small collaterals in equivalent time (CS3) or equivalent results in a shorter scan time (CS5).
• Multimodal Interventional Treatment and Outcomes for Unruptured Arteriovenous Malformations

  Daisuke Maruyama; Tetsu Satow; Hiroharu Kataoka; Hisae Mori; Eika Hamano; Yoji Orita; Seiichiro Eguchi; Jun C. Takahashi

  Acta Neurochirurgica Supplement 129 115 - 120 2018年 [査読有り]
   

  BACKGROUND: This study aimed to evaluate the selection and outcomes of multimodal interventional treatment for unruptured brain arteriovenous malformations (uAVMs) in ARUBA-eligible patients in a single institution. METHODS: We retrospectively reviewed the data of 94 patients with uAVMs treated between 2002 and 2014. They were divided into an intervention group and a conservative group. The primary outcome was defined as the composite of death or symptomatic stroke. Functional outcome was assessed using the modified Rankin Scale (mRS). RESULTS: The intervention and conservative groups included 75 and 19 patients, respectively, with mean follow-up periods of 59.2 ± 41.6 and 72.8 ± 39.2 months (P = 0.20), among whom the primary outcome occurred in 9 (12.3%) and 3 (17.6%) patients, respectively (P = 0.91). The proportion of patients with an mRS score ≥ 2 at last follow-up was not significantly different between the two groups (6.9% vs. 11.7%). In the intervention group, the incidence of death or stroke was lower and functional outcomes were better among patients with grade I/II AVMs than among patients with grade III AVMs. CONCLUSION: For patients with uAVMs, interventional treatment is not inferior to medical treatment alone, and careful selection should be made for patients with grade III AVMs.
• Erratum to: Development of in vivo tissue-engineered microvascular grafts with an ultra small diameter of 0.6 mm (MicroBiotubes): acute phase evaluation by optical coherence tomography and magnetic resonance angiography.

  Daizo Ishii; Jun-Ichiro Enmi; Takeshi Moriwaki; Hastue Ishibashi-Ueda; Mari Kobayashi; Shinichi Iwana; Hidehiro Iida; Tetsu Satow; Jun C Takahashi; Kaoru Kurisu; Yasuhide Nakayama

  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 20 4 403 - 403 2017年12月 [査読有り]
  
• 頭蓋内主幹動脈閉塞・高度狭窄による急性期脳梗塞に対するPTA前の抗血小板薬併用療法はPTA後の有効再灌流と関連する

  吉本 武史; 山上 宏; 園田 和隆; 佐藤 徹; 高橋 淳; 豊田 一則; 猪原 匡史

  脳血管内治療 2 Suppl. S114 - S114 (NPO)日本脳神経血管内治療学会 2017年11月
• Impact of pregnancy on the size of small cerebral aneurysm.

  Hiroaki Tanaka; Shinji Katsuragi; Kayo Tanaka; Naoko Iwanaga; Jun Yoshimatsu; Jun C Takahashi; Tomoaki Ikeda

  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 30 22 2759 - 2762 2017年11月 [査読有り]
   

  OBJECTIVE: Because the management of cerebral aneurysms during pregnancy remains controversial, the objective of this study was to perform a retrospective review of pregnant women with cerebral aneurysms to determine whether pregnancy is a risk factor for aneurysm rupture. METHODS: The change in size of aneurysms during pregnancy was examined by performing repeat magnetic resonance angiography in five pregnant women with cerebral aneurysms between 2005 and 2013. The outcome examined was development of subarachnoid hemorrhage. RESULTS: Among the five pregnancies, there were eight cerebral aneurysms. Subarachnoid hemorrhage did not developed during any pregnancy. In four of the pregnancies, the cerebral aneurysms did not change in size during pregnancy, remaining 2-5 mm. Although in one pregnancy, the aneurysm increased from 6 to 7 mm during the third trimester, it returned to its original size in the postpartum period. CONCLUSIONS: We suggest that if the cerebral aneurysm is small (≤ 5 mm), it is likely to remain unchanged despite the increase in circulating blood volume during pregnancy. Cerebral aneurysms greater than 5 mm but without blebs, irregular shape, high-risk location, or increased aspect ratio are also at low risk of rupture and are not likely to change during pregnancy.
• 脳動脈瘤治療の標準化と最適化 未破裂脳動脈瘤塞栓術周術期におけるneck径に基づいた抗血小板療法レジメンの有用性

  佐藤 徹; 濱野 栄佳; 丸山 大輔; 織田 祥至; 江口 盛一郎; 田中 俊一; 松原 博文; 片岡 大治; 高橋 淳

  The Mt. Fuji Workshop on CVD 35 89,98 - 95,98 (株)にゅーろん社 2017年07月 [査読有り]
   

  未破裂脳動脈瘤に対して初回の瘤内コイル塞栓術を行った146例中、ステント併用を除いた124例(女性90名、平均62.8±10.6歳)を対象とし、動脈瘤の最大neck径が4mm以上のwide neck群(W群)66例、4mm未満のnarrow neck群(N群)58例に分けた。N群における抗血小板薬の内容はアスピリンの連日投与が53例で、残りの5例中2例はクロピドグレル、3例でdual周術期抗血小板療法(DAPT)が行われた。W群では全例においてDAPTが行われた。動脈瘤最大径、neck径は、有意差にてW群で大きかった。術前日のコラーゲン、ADPに対する凝集能はともにW群で有意に低かった。手技に関する因子としてadjunctive techniqueの使用率はW群で有意に高かった。一次エンドポイントである治療後3ヵ月迄のTIAを含む虚血性合併症はN群で1例(1.7%)、W群で4例(6.1%)であった。二次エンドポイントはN群で1例(1.7%)、W群で3例(4.5%)であった。治療2日後のMRI拡散強調画像における新規梗塞巣の出現率はN群で12例(21.4%)、W群で27例(40.9%)であった。
• Prothrombin complex concentrate administration for bleeding associated with non-vitamin K antagonist oral anticoagulants: The SAMURAI-NVAF study.

  Sohei Yoshimura; Shoichiro Sato; Kenichi Todo; Yasushi Okada; Eisuke Furui; Takayuki Matsuki; Hiroshi Yamagami; Masatoshi Koga; Jun C Takahashi; Kazuyuki Nagatsuka; Shoji Arihiro; Kazunori Toyoda

  Journal of the neurological sciences 375 150 - 157 2017年04月 [査読有り]
   

  BACKGROUND: Antidotes appropriate for non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are not yet in widespread clinical use. Efficacy of prothrombin complex concentrate (PCC) in NOAC-associated bleeding remains unclarified. METHODS: Ten NOAC users (4 women, median 74years old) who developed major bleeding and received PCC were prospectively enrolled. Eight single-center NOAC users (0 women, median 74years old) with intracerebral hemorrhage, who over the same period did not receive PCC, were studied for comparison. RESULTS: Of the 10 PCC-treated patients, 8 developed intracerebral hemorrhage, 1 developed subdural hematoma, and another developed gastrointestinal bleeding. The median size of intracerebral hemorrhage was 8mL, relatively lower than the reported size for patients without NOACs. Patients received a median of 1000IU or 16IU/kg of PCC. Before and 1h after PCC administration, the median PT-INR changed from 1.41 to 1.09 (p<0.05) and median aPTT changed from 35.4 to 38.0s (p=0.39). Five patients developed intracranial hematoma expansion and 4 required surgical hematoma evacuation. No symptomatic thrombotic events occurred in either group, no participants died, and 2 participants from each group were independent. CONCLUSIONS: Ten NOAC users developed major bleeding and were given relatively low doses of PCC. The effect of PCC on early cessation of bleeding was unclear, while the therapy did not trigger thromboembolic complications.
• Strokes Associated With Pregnancy and Puerperium: A Nationwide Study by the Japan Stroke Society.

  Kazumichi Yoshida; Jun C Takahashi; Yohei Takenobu; Norihiro Suzuki; Akira Ogawa; Susumu Miyamoto

  Stroke 48 2 276 - 282 2017年02月 [査読有り]
   

  BACKGROUND AND PURPOSE: The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques. METHODS: A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted. RESULTS: Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke. CONCLUSIONS: The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively.
• 【State of the Art-難治例に対する手術-】出血発症もやもや病に対する外科治療のエビデンスと最新の知見

  舟木 健史; 高橋 淳; 宮本 享

  脳神経外科ジャーナル 26 1 4 - 11 日本脳神経外科コングレス 2017年01月 [査読有り]
   

  The Japan Adult Moyamoya(JAM)Trialは、出血発症もやもや病に対する直接バイパス術の有効性を初めて示した無作為比較試験である。事前に定められたJAM Trialのサブ解析では、初回後方出血が再出血の予後予測因子かつ手術の効果修飾因子であることが明らかとなった。レンズ核線条体動脈・視床穿通枝・脈絡叢動脈から形成される脆弱側副路であるperiventricular anastomosisが、後方出血群の高い再出血率を説明する鍵となるかもしれない。JAM Trialの血管撮影解析では、脈絡叢動脈からの側副路や後大脳動脈病変の存在が、初回後方出血に関わる要因であった。脈絡叢動脈や後大脳動脈に関する知見の蓄積により、出血発症もやもや病外科治療のさらなる発展が期待される。(著者抄録)
• 脳動脈治療における直達手術の役割.

  片岡大治; 佐藤徹; 髙橋淳

  脳神経外科ジャーナル 26 2 92 - 103 The Japanese Congress of Neurological Surgeons 2017年 [査読有り][招待有り]
   

   脳動脈瘤に対する直達術もしくは血管内治療の治療選択は, 動脈瘤の部位や形状などから, それぞれの長所短所を考慮して, 症例ごとに決定する必要がある. クリッピング術には, 血管壁および分枝の性状を直視下におさめて適切な状態に血管を形成することができるという利点があり, 特に複雑な形状の瘤, 穿通枝や分枝が動脈瘤から分岐する場合などでその長所を生かすことができる. そのためには, 病変周囲の解剖の可視化, 動脈瘤の可動性をもたせるための全周性剝離, さまざまな角度からの操作を可能にする広い術野の確保が必要である. 一方, 直達術では血管内の血流を直接観察することができないため, ドップラー, ICG蛍光造影, 電気生理学的検査などの術中モニタリングが必須である. 頭蓋内ステントの進歩により, 大型瘤や広頚部瘤に対する血管内治療の適応は拡大しつつあるが, ネックで確実に血流を遮断できるクリッピング術は有力な治療選択肢の1つである. バイパスを併用して末梢への血行再建ができることが, 直達術のもう1つの利点である. バイパスは血管内治療との複合治療でも, 脳への侵襲を最小限にして, 複雑な動脈瘤を根治させる有効な治療法となり得る. 直達手術の特性をよく理解し, その利点を最大限に生かすような治療を行うことにより, 脳動脈瘤治療全体の成績向上につなげることができる.

• Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease.

  Eika Hamano; Hiroharu Kataoka; Naomi Morita; Daisuke Maruyama; Tetsu Satow; Koji Iihara; Jun C Takahashi

  Journal of neurosurgery 126 1 1 - 7 2017年01月 [査読有り]
   

  OBJECTIVE Transient neurological symptoms are frequently observed during the early postoperative period after direct bypass surgery for moyamoya disease. Abnormal signal changes in the cerebral cortex can be seen in postoperative MR images. The purpose of this study was to reveal the radiological features of the "cortical hyperintensity belt (CHB) sign" in postoperative FLAIR images and to verify its relationship to transient neurological events (TNEs) and regional cerebral blood flow (rCBF). METHODS A total of 141 hemispheres in 107 consecutive patients with moyamoya disease who had undergone direct bypass surgery were analyzed. In all cases, FLAIR images were obtained during postoperative days (PODs) 1-3 and during the chronic period (3.2 ± 1.13 months after surgery). The CHB sign was defined as an intraparenchymal high-intensity signal within the cortex of the surgically treated hemisphere with no infarction or hemorrhage present. The territory of the middle cerebral artery was divided into anterior and posterior parts, with the extent of the CHB sign in each part scored as 0 for none; 1 for presence in less than half of the part; and 2 for presence in more than half of the part. The sum of these scores provided the CHB score (0-4). TNEs were defined as reversible neurological deficits detected both objectively and subjectively. The rCBF was measured with SPECT using N-isopropyl-p-[123I]iodoamphetamine before surgery and during PODs 1-3. The rCBF increase ratio was calculated by comparing the pre- and postoperative count activity. RESULTS Cortical hyperintensity belt signs were detected in 112 cases (79.4%) and all disappeared during the chronic period. Although all bypass grafts were anastomosed to the anterior part of the middle cerebral artery territory, CHB signs were much more pronounced in the posterior part (p < 0.0001). TNEs were observed in 86 cases (61.0%). Patients with TNEs showed significantly higher CHB scores than those without (2.31 ± 0.13 vs 1.24 ± 0.16, p < 0.0001). The CHB score, on the other hand, showed no relationship with the rCBF increase ratio (p = 0.775). In addition, the rCBF increase ratio did not differ between those patients with TNEs and those without (1.15 ± 0.033 vs 1.16 ± 0.037, p = 0.978). CONCLUSIONS The findings strongly suggest that the presence of the CHB sign during PODs 1-3 can be a predictor of TNEs after bypass surgery for moyamoya disease. On the other hand, presence of this sign appears to have no direct relationship with the postoperative local hyperperfusion phenomenon. Vasogenic edema can be hypothesized as the pathophysiology of the CHB sign, because the sign was transient and never accompanied by infarction in the present series.
• Possible Signaling Pathways Mediating Neuronal Calcium Sensor-1-Dependent Spatial Learning and Memory in Mice.

  Tomoe Y Nakamura; Shu Nakao; Yukako Nakajo; Jun C Takahashi; Shigeo Wakabayashi; Hiroji Yanamoto

  PloS one 12 1 e0170829 - e0170829 2017年 [査読有り]
   

  Intracellular Ca2+ signaling regulates diverse functions of the nervous system. Many of these neuronal functions, including learning and memory, are regulated by neuronal calcium sensor-1 (NCS-1). However, the pathways by which NCS-1 regulates these functions remain poorly understood. Consistent with the findings of previous reports, we revealed that NCS-1 deficient (Ncs1-/-) mice exhibit impaired spatial learning and memory function in the Morris water maze test, although there was little change in their exercise activity, as determined via treadmill-analysis. Expression of brain-derived neurotrophic factor (BDNF; a key regulator of memory function) and dopamine was significantly reduced in the Ncs1-/- mouse brain, without changes in the levels of glial cell-line derived neurotrophic factor or nerve growth factor. Although there were no gross structural abnormalities in the hippocampi of Ncs1-/- mice, electron microscopy analysis revealed that the density of large dense core vesicles in CA1 presynaptic neurons, which release BDNF and dopamine, was decreased. Phosphorylation of Ca2+/calmodulin-dependent protein kinase II-α (CaMKII-α, which is known to trigger long-term potentiation and increase BDNF levels, was significantly reduced in the Ncs1-/- mouse brain. Furthermore, high voltage electric potential stimulation, which increases the levels of BDNF and promotes spatial learning, significantly increased the levels of NCS-1 concomitant with phosphorylated CaMKII-α in the hippocampus; suggesting a close relationship between NCS-1 and CaMKII-α. Our findings indicate that NCS-1 may regulate spatial learning and memory function at least in part through activation of CaMKII-α signaling, which may directly or indirectly increase BDNF production.
• Histopathologic Analysis of Retrieved Thrombi Associated With Successful Reperfusion After Acute Stroke Thrombectomy.

  Tetsuya Hashimoto; Mikito Hayakawa; Naoko Funatsu; Hiroshi Yamagami; Tetsu Satow; Jun C Takahashi; Kazuyuki Nagatsuka; Hatsue Ishibashi-Ueda; Jun-Ichi Kira; Kazunori Toyoda

  Stroke 47 12 3035 - 3037 2016年12月 [査読有り]
   

  BACKGROUND AND PURPOSE: Histopathologic evaluation of occlusive thrombi retrieved from cerebral arteries using endovascular therapy is possible. We investigated the relationship between successful reperfusion after thrombectomy and histopathologic characteristics of retrieved thrombi. METHODS: Among consecutive patients with acute ischemic stroke treated with endovascular therapy at our institute from December 2010 to July 2015, we retrospectively reviewed those with acute major arterial occlusion from which retrieved thrombi were evaluated histopathologically. Obtained thrombi were assessed for the existence of atheromatous gruel, organization, and the ratios of erythrocyte and fibrin/platelet components. Successful reperfusion was defined as the modified Treatment in Cerebral Ischemia grade of 2b to 3. RESULTS: Of 83 patients studied, 58 (70%) underwent successful reperfusion. Atheromatous gruel was less frequently identified (3% versus 20%; P=0.024), and the proportion of erythrocyte components was higher (57±23% versus 47±24%; P=0.042) in thrombi retrieved from the reperfused than the unreperfused group. On multivariate logistic regression analysis, atheromatous gruel was inversely related (odds ratio, 0.062; 95% confidence interval, 0.002-0.864), and >64% erythrocyte components (cutoff obtained from receiver operating characteristic curve) were positively related (odds ratio, 4.352; 95% confidence interval, 1.185-19.363) to successful reperfusion. CONCLUSIONS: Successful reperfusion could be associated with the histopathology of occlusive thrombi, including the existence of atheromatous gruel and proportion of erythrocyte components. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02251665.
• 【脳卒中治療-Consensus、Controversy、New Trials】Consensus 出血発症もやもや病に対するバイパス治療

  舟木 健史; 高橋 淳; 宮本 享

  Clinical Neuroscience 34 11 1218 - 1221 (株)中外医学社 2016年11月 [査読有り]
  
• 未破裂脳底動脈瘤における両側椎骨動脈アプローチの安全性と有用性

  福本 博順; 佐藤 徹; 丸山 大輔; 伊藤 嘉朗; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 田中 俊一; 松原 博文; 片岡 大治; 高橋 淳

  脳血管内治療 1 Suppl. S91 - S91 (NPO)日本脳神経血管内治療学会 2016年11月
• 再灌流療法後の急性期中大脳動脈閉塞例におけるMRI 3次元Arterial Spin Labeling灌流イメージング法による脳血流評価

  吉本 武史; 岡崎 周平; 梶本 勝文; 山上 宏; 早川 幹人; 佐藤 徹; 高橋 淳; 豊田 一則; 長束 一行

  脳血管内治療 1 Suppl. S119 - S119 (NPO)日本脳神経血管内治療学会 2016年11月
• Reversible striatal hypermetabolism in chorea associated with moyamoya disease: a report of two cases.

  Yoshito Sugita; Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Yasutaka Fushimi; Takayuki Kikuchi; Kazumichi Yoshida; Taketo Hatano; Natsuhi Sasaki; Susumu Miyamoto

  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 32 11 2243 - 2247 2016年11月 [査読有り]
   

  BACKGROUND: The pathophysiological mechanism of chorea as a presentation of pediatric moyamoya disease remains unknown, although ischemia is suspected as a likely cause. The authors describe two cases of pediatric moyamoya disease, both of which presented with hemichorea in the stable phase after successful bypass surgery. CLINICAL PRESENTATION: Cerebral blood flow was almost normal in one case and decreased in the basal ganglia and watershed area in the other case due to infarcts occurring before surgery. In both cases, 18F-fluorodeoxyglucose positron emission tomography revealed elevated glucose metabolism in the corresponding side of the striatum, which reverted to normal after recovery from chorea. Magnetic resonance angiography revealed a dilated and extended lenticulostriate artery at the exact site of the hypermetabolic lesion.
• Development of in vivo tissue-engineered microvascular grafts with an ultra small diameter of 0.6 mm (MicroBiotubes): acute phase evaluation by optical coherence tomography and magnetic resonance angiography.

  Daizo Ishii; Jun-Ichiro Enmi; Takeshi Moriwaki; Hastue Ishibashi-Ueda; Mari Kobayashi; Shinichi Iwana; Hidehiro Iida; Tetsu Satow; Jun C Takahashi; Kaoru Kurisu; Yasuhide Nakayama

  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 19 3 262 - 9 2016年09月 [査読有り]
   

  Biotubes, i.e., in vivo tissue-engineered connective tubular tissues, are known to be effective as vascular replacement grafts with a diameter greater than several millimeters. However, the performance of biotubes with smaller diameters is less clear. In this study, MicroBiotubes with diameters <1 mm were prepared, and their patency was evaluated noninvasively by optical coherence tomography (OCT) and magnetic resonance angiography (MRA). MicroBiotube molds, containing seven stainless wires (diameter 0.5 mm) covered with silicone tubes (outer diameter 0.6 mm) per mold, were embedded into the dorsal subcutaneous pouches of rats. After 2 months, the molds were harvested with the surrounding capsular tissues to obtain seven MicroBiotubes (internal diameter 0.59 ± 0.015 mm, burst pressure 4190 ± 1117 mmHg). Ten-mm-long MicroBiotubes were allogenically implanted into the femoral arteries of rats by end-to-end anastomosis. Cross-sectional OCT imaging demonstrated the patency of the MicroBiotubes immediately after implantation. In a 1-month follow-up MRA, high patency (83.3 %, n = 6) was observed without stenosis, aneurysmal dilation, or elongation. Native-like vascular structure was reconstructed with completely endothelialized luminal surfaces, mesh-like elastin fiber networks, regular circumferential orientation of collagen fibers, and α-SMA-positive cells. Although the long-term patency of MicroBiotubes still needs to be confirmed, they may be useful as an alternative ultra-small-caliber vascular substitute.
• ADAPTを第一選択とした急性期再開通療法の検討

  織田 祥至; 佐藤 徹; 山上 宏; 早川 幹人; 菅田 真生; 丸山 大輔; 濱野 栄佳; 江口 盛一郎; 片岡 大治; 長束 一行; 豊田 一則; 高橋 淳

  The Mt. Fuji Workshop on CVD 34 169 - 172 (株)にゅーろん社 2016年08月 [査読有り]
   

  ADAPT(A Direct Aspiration first Pass Technique)を第一選択とした急性期再開通療法について検討した。脳主幹動脈急性閉塞に対し血管内治療を行った93例(女性32名、中央値75歳)を対象とした。ADAPTを第一選択とした群(A群)とADAPT以外の手技を第一選択とした群(N群)、またN群の中でstent retrieverを第一選択とした群(S群)に分けた。3ヵ月後の転帰良好例は転帰不良例(mRS≧3)と比較して、PTRが有意に短く、TICI≧2bの再灌流率が有意に高かった。A群はR群やS群と比較し治療成績において明らかな差を認めなかったが、単独デバイスで再開通を得られた際のPTRはA群で有意に短かった。追加デバイスを要した割合や、全治療手技を通じたPTR、TICI≧2bの再灌流率、3ヵ月後のmRSにおいても明らかな差を認めなかった。
• JAM Trial 結果と今後の展望

  舟木 健史; 高橋 淳; 宮本 享

  脳卒中の外科 44 4 272 - 275 (一社)日本脳卒中の外科学会 2016年07月 [査読有り]
   

  Japan Adult Moyamoya Trial(JAM Trial)は、「出血型もやもや病に頭蓋内外バイパス術は有効か」という疑問に高いエビデンスレベルで答えるための、前向き多施設共同研究である。手術群42例、非手術群38例の計80例が登録され、追跡が完遂された。再出血を含む不良イベントの発生率が手術群で有意に低いことが統計学的に示された。JAM Trialが行われるようになった背景と、JAM Trialの結果と、今後の展望について述べた。
• Histopathological Characteristics of Distal Middle Cerebral Artery in Adult and Pediatric Patients with Moyamoya Disease.

  Yasushi Takagi; Yulius Hermanto; Jun C Takahashi; Takeshi Funaki; Takayuki Kikuchi; Yohei Mineharu; Kazumichi Yoshida; Susumu Miyamoto

  Neurologia medico-chirurgica 56 6 345 - 9 2016年06月 [査読有り]
   

  Moyamoya disease (MMD) is a unique progressive steno-occlusive disease of the distal ends of bilateral internal arteries and their proximal branches. The difference in clinical symptoms between adult and children MMD patients has been well recognized. In this study, we sought to investigate the phenomenon through histopathological study. Fifty-one patients underwent surgical procedures for treatment of standard indications of MMD at Kyoto University Hospital. Fifty-nine specimens of MCA were obtained from MMD patients during the surgical procedures. Five MCA samples were also obtained in the same way from control patients. The samples were analyzed by histopathological methods. In this study, MCA specimens from MMD patients had significantly thinner media and thicker intima than control specimens. In subsequent analysis, adult (≥ 20 years) patients had thicker intima of MCA compared to pediatric (< 20 years) patients. There is no difference in internal elastic lamina pathology between adult and pediatric patients. Our results indicated that the pathological feature of MMD in tunica media occurs in both adult and pediatric patients. However, the MMD feature in tunica intima of MCA is more prominent in adult patients. Further analysis from MCA specimens and other researches are necessary to elucidate the pathophysiology of MMD.
• Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography.

  Takeshi Funaki; Jun C Takahashi; Kazumichi Yoshida; Yasushi Takagi; Yasutaka Fushimi; Takayuki Kikuchi; Yohei Mineharu; Tomohisa Okada; Takaaki Morimoto; Susumu Miyamoto

  Journal of neurosurgery 124 6 1766 - 72 2016年06月 [査読有り]
   

  OBJECT The authors' aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage. METHODS This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses. RESULTS Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κw = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p < 0.01 for trend). Univariate analysis revealed that age (p = 0.02) and periventricular anastomosis score (p < 0.01) were factors tentatively associated with hemorrhagic presentation. The score remained statistically significant after adjustment for age (OR 3.38 [95% CI 1.84-7.00]). CONCLUSIONS The results suggest that periventricular anastomosis detected with MR angiography can be scored with good intra- and interrater reliability and is associated with hemorrhagic presentation at onset in moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.
• Construction of 3 animal experimental models in the development of honeycomb microporous covered stents for the treatment of large wide-necked cerebral aneurysms.

  Yasuhide Nakayama; Tetsu Satow; Marina Funayama; Takeshi Moriwaki; Tsutomu Tajikawa; Maya Furukoshi; Eika Hamano; Daizo Ishi; Masataka Hayashi; Sei Sugata; Hatsue Ishibashi-Ueda; Jun C Takahashi

  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 19 2 179 - 87 2016年06月 [査読有り]
   

  The treatment of large or wide-necked cerebral aneurysms is extremely difficult, and carries a high risk of rupture, even when surgical or endovascular methods are available. We are developing novel honeycomb microporous covered stents for treating such aneurysms. In this study, 3 experimental animal models were designed and evaluated quantitatively before preclinical study. The stents were prepared using specially designed balloon-expandable stents (diameter 3.5-5.0 mm, length 16-28 mm) by dip-coating to completely cover their struts with polyurethane film (thickness 20 µm) and microprocessing to form the honeycomb pattern after expansion. (1) In an internal carotid artery canine model (n = 4), all stents mounted on the delivery catheter passed smoothly through the tortuous vessel with minimal arterial damage. (2) In an the large, wide-necked, outer-sidewall aneurysm canine model, almost all parts of the aneurysms had embolized immediately after stenting (n = 4), and histological examination at 2 months revealed neointimal formation with complete endothelialization at all stented segments and entirely organized aneurysms. (3) In a perforating artery rabbit model, all lumbar arteries remained patent (n = 3), with minimal change in the vascular flow pattern for over 1 year, even after placement of a second, overlapping stent (n = 3). At 2 months after stenting, the luminal surface was covered with complete thin neointimal formation. Excellent embolization performance of the honeycomb microporous covered stents without disturbing branching flow was confirmed at the aneurysms in this proof-of-concept study.
• Intracerebral hemorrhage in patients after heart valve replacement.

  Kazutaka Nishimura; Masatoshi Koga; Kazuo Minematsu; Jun C Takahashi; Kazuyuki Nagatsuka; Junjiro Kobayashi; Kazunori Toyoda

  Journal of the neurological sciences 363 195 - 9 2016年04月 [査読有り]
   

  BACKGROUNDS: Although prevention of hematoma enlargement and thromboembolic complications is critically important in acute intracerebral hemorrhage (ICH) patients with prosthetic heart valves, clinical data are scarce. The goal of this study was to elucidate patient characteristics, acute treatments, and the clinical course of them. METHODS: We investigated a retrospective cohort of consecutive acute ICH patients with prosthetic heart valves. Neurological data, hospital management, hemorrhagic and thromboembolic complications and functional disability/mortality were reviewed. RESULTS: We identified 38 patients (27 men; 67.9±16.7 years). The median ICH volume was 22.8 ml. The most frequent location was lobar (50%). All patients with mechanical valves (25/25) and 46% of patients with bioprosthetic valves (6/13) were receiving warfarin at the time of hospital admission. The median anticoagulation withholding period was 2 days in 24 patients who ultimately resumed anticoagulation. Hematoma enlargement within 24 h was observed in eight patients and hemorrhagic complications occurred in three patients. Thromboembolic stroke occurred in four patients. At discharge, death had occurred or severe disability was present in 53% of patients (20/38). CONCLUSIONS: Hematoma enlargement, hemorrhagic complications or thromboembolic stroke occurred in a significant number of patients during hospitalization. ICH was a serious complication among patients with valve replacement.
• Judgment and action in surgery for unruptured intracranial aneurysms

  Jun C. Takahashi; Hiroharu Kataoka; Tetsu Satow; Hisae Mori

  Japanese Journal of Neurosurgery 25 1 4 - 14 2016年01月 [査読有り]
   

  Recent multicenter-prospective studies on unruptured intracranial aneurysms have demonstrated their annual and cumulative rupture rates in detail. These data have been mainly presented according to the location, size, and shape of the aneurysms. It is especially notable that the rupture rates in the Japanese population are significantly higher than those in the West. In the clinical field especially, the therapeutic decision for unruptured aneurysms should be based on these up-to-date data to prevent their rupture. In addition, every neurosurgeon should consider the specific problems of each patient including their life expectancy, possible systemic diseases and health-related quality of life. On the macroscopic point of view, a radical reduction in the number of domestic subarachnoid hemorrhage seems to be quite difficult to achieve when it is solely based on the conventional “Find and Treat” strategy. A simple simulation can show that this strategy requires an extremely large population to be screened to find medium-to large sized aneurysms which are prone to rupture. Only a novel paradigm of the therapeutic management of intracranial aneurysms will solve this problem in the future.
• 【出血性脳血管障害】出血発症成人もやもや病とその外科治療 Japan Adult Moyamoya Trialの結果を中心に

  宮本 享; 高橋 淳; 舟木 健史; JAM Trial Group

  脳神経外科ジャーナル 25 1 52 - 58 日本脳神経外科コングレス 2016年01月 [査読有り]
   

  出血発症もやもや病の自然予後は不良であり、再出血率は年間約7%と非常に高い。「頭蓋内外バイパス術が出血発症成人もやもや病の再出血リスクを減少させる」という仮説を検証する目的で、多施設無作為比較試験であるJapan Adult Moyamoya Trial(JAM Trial)が行われ、手術群で有意にエンドポイント発生率が低く、再出血率が1/3に低下することが示された。JAM Trialの結果は出血発症もやもや病に対する直接バイパス術の有効性を支持する一方、この結果は厳格な患者登録基準のもと、高度の周術期管理下に達成されたものであり、臨床上は慎重な手術適応の検討が望まれる。(著者抄録)
• Moyamoya disease (spontaneous occlusion of the circle of willis)

  Akira Yamamoto; Tomohisa Okada; Jun C. Takahashi

  Neurovascular Imaging: From Basics to Advanced Concepts 817 - 863 2016年01月 [査読有り]
   

  Moyamoya is a disease affecting the cerebral arteries, which predisposes individuals to recurrent ischemic attack in association with progressive steno-occlusive change of the intracranial internal carotid arteries and their proximal branches. The disorder is typically characterized by a reduction in blood flow in the major vessels of the anterior circulation of the brain. This results in the development of a compensatory collateral vasculature around the stenosed vessels, near the apex of the internal carotid, on the cortical surface, leptomeninges, and branches of the external carotid artery and the base of the skull. In advanced cases, the posterior circulation is also involved, including the basilar and posterior cerebral arteries. While it was first described as a “hypoplasia of the bilateral internal carotid arteries,” the characteristic appearance of the network of abnormally dilated collateral vessels on conventional angiography was compared to “a puff of cigarette smoke” (Arch Neurol 20(3):288–899, 1969) or “moyamoya” in Japanese. The designation “spontaneous occlusion of the circle of Willis” was recently suggested as an alternative by the International Classification of Diseases (ICD). Moyamoya disease patients are predominantly found in Eastern Asian countries such as Japan and the Republic of Korea. Moyamoya disease patients show bimodal distribution, adult type and pediatric type. Symptom of adult moyamoya patients can be either ischemic or hemorrhagic nevertheless, pediatric patients usually present with ischemia. In ischemic moyamoya disease, the therapeutic effect of surgical revascularization (extracranial-intracranial bypass) has been well established. Bypass surgery can improve the impaired cerebral hemodynamic state and decrease the recurrent ischemic events. Management of the hemorrhagic moyamoya disease, on the other hand, presents a serious challenge. Despite the extremely high rate of rebleeding attacks, no therapeutic method has been established until recently. In 2013, the 818 A. Yamamoto et al. Japan Adult Moyamoya (JAM) Trial, a multicentered prospective randomized controlled trial, was completed. It has been revealed that bypass surgery significantly decreases the rate of rebleeding attacks and improve the patients’ prognosis during the following 5 years. This epoch-making study is expected to establish a guiding principle for the treatment of hemorrhagic moyamoya disease.
• Significance of the Hemorrhagic Site for Recurrent Bleeding: Prespecified Analysis in the Japan Adult Moyamoya Trial.

  Jun C Takahashi; Takeshi Funaki; Kiyohiro Houkin; Tooru Inoue; Kuniaki Ogasawara; Jyoji Nakagawara; Satoshi Kuroda; Keisuke Yamada; Susumu Miyamoto

  Stroke 47 1 37 - 43 2016年01月 [査読有り]
   

  BACKGROUND AND PURPOSE: The primary results of the Japan Adult Moyamoya Trial revealed the statistically marginal superiority of bypass surgery over medical treatment alone in preventing rebleeding in moyamoya disease. The purpose of this analysis is to test the prespecified subgroup hypothesis that the natural course and surgical effects vary depending on the hemorrhagic site at onset. METHODS: The hemorrhagic site, classified as either anterior or posterior, was the only stratifying variable for randomization. Statistical analyses were focused on the assessment of effect modification according to the hemorrhagic site and were based on tests of interaction. RESULTS: Of 42 surgically treated patients, 24 were classified as anterior hemorrhage and 18 as posterior hemorrhage; of 38 medically treated patients, 21 were classified as anterior and 17 as posterior. The hazard ratio of the primary end points (all adverse events) for the surgical group relative to the nonsurgical group was 0.07 (95% confidence interval, 0.01-0.55) for the posterior group, as compared with 1.62 (95% confidence interval, 0.39-6.79) for the anterior group (P=0.013 for interaction). Analysis within the nonsurgical group revealed that the incidence of the primary end point was significantly higher in the posterior group than in the anterior group (17.1% per year versus 3.0% per year; hazard ratio, 5.83; 95% confidence interval, 1.60-21.27). CONCLUSIONS: Careful interpretation of the results suggests that patients with posterior hemorrhage are at higher risk of rebleeding and accrue greater benefit from surgery, subject to verification in further studies. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000166.
• Voxel Based Analysis of Surgical Revascularization for Moyamoya Disease: Pre- and Postoperative SPECT Studies.

  Yasutaka Fushimi; Tomohisa Okada; Yasushi Takagi; Takeshi Funaki; Jun C Takahashi; Susumu Miyamoto; Kaori Togashi

  PloS one 11 2 e0148925  2016年 [査読有り]
   

  Moyamoya disease (MMD) is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels) in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD, improving the compromised cerebral blood flow (CBF). However, voxel based analysis (VBA) of revascularization surgery for MMD based on data from pre- and postoperative data has not been established. The latest algorithm called as Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) has been introduced for VBA as the function of statistical parametric mapping (SPM8), and improved registration has been achieved by SPM8 with DARTEL. In this study, VBA was conducted to evaluate pre- and postoperative single photon emission computed tomography (SPECT) images for MMD by SPM8 with DARTEL algorithm, and the results were compared with those from SPM8 without DARTEL (a conventional method). Thirty-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery as the first surgery were included and all patients underwent pre- and postoperative 3D T1-weighted imaging and SPECT. Pre- and postoperative SPECT images were registered to 3D T1-weighted images, then VBA was conducted. Postoperative SPECT showed more statistically increased CBF areas in the bypassed side cerebral hemisphere by using SPM8 with DARTEL (58,989 voxels; P<0.001), and increased ratio of CBF after operation was less than 15%. Meanwhile, postoperative SPECT showed less CBF increased areas by SPM8 without DARTEL. In conclusion, VBA was conducted for patients with MMD, and SPM8 with DARTEL revealed that postoperative SPECT showed statistically significant CBF increases over a relatively large area and with at most 15% increase ratio.
• 瘤状拡張部からの細分枝を有する破裂椎骨動脈解離性動脈瘤におけるproximal occlusionの有用性

  堀尾 欣伸; 佐藤 徹; 石井 大造; 菅田 真生; 丸山 大輔; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 植松 幸大; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S246 - S246 (NPO)日本脳神経血管内治療学会 2015年11月
• ONYXはAVMの治療成績を向上させたか? OnyxによるAVM塞栓術 有用性と安全性の検証

  濱野 栄佳; 佐藤 徹; 堀尾 欣伸; 植松 幸大; 江口 盛一郎; 織田 祥至; 丸山 大輔; 菅田 真生; 森 久恵; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S192 - S192 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• 脳動脈瘤 通常瘤と高難度瘤の治療成績 "高難度"未破裂脳動脈瘤コイル塞栓術後再開通に関与する因子の検討

  佐藤 徹; 菅田 真生; 丸山 大輔; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 植松 幸大; 宮田 武; 堀尾 欣伸; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S198 - S198 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• 頭蓋内tandem occlusionを伴う急性期頸部内頸動脈閉塞に対する急性期血管内再開通療法の選択とその治療成績

  宮田 武; 佐藤 徹; 山上 宏; 早川 幹人; 菅田 真生; 丸山 大輔; 織田 祥至; 濱野 栄佳; 片岡 大治; 長束 一行; 豊田 一則; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S306 - S306 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• ステント支援下脳動脈瘤塞栓術後のMRI評価

  菅田 真生; 佐藤 徹; 植松 幸大; 濱野 栄佳; 丸山 大輔; 織田 祥至; 江口 盛一郎; 宮田 武; 堀尾 欣伸; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S308 - S308 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• ワイドネック脳動脈瘤に対するステント併用コイル塞栓術の適応 Aspect Ratioと最大径に着目して

  植松 幸大; 佐藤 徹; 菅田 真生; 丸山 大輔; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 宮田 武; 堀尾 欣伸; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S381 - S381 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• 症候性のBorden Type 1硬膜動静脈瘻における治療介入の検討

  江口 盛一郎; 佐藤 徹; 濱野 栄佳; 菅田 真生; 丸山 大輔; 織田 祥至; 植松 幸大; 宮田 武; 堀尾 欣伸; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 6 S416 - S416 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
  
• ガイディングカテーテルによる機械的血管攣縮を惹起する因子の検討

  金丸 英樹; 佐藤 徹; 菅田 真生; 石井 大造; 丸山 大輔; 林 正孝; 濱野 栄佳; 井手口 稔; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 9 5 233 - 237 (NPO)日本脳神経血管内治療学会 2015年11月 [査読有り]
   

  【目的】近年脳血管内治療は普及の一途をとげているが,病変へのアクセス時に,ガイディングカテーテル(GC)を母血管に干渉せず留置できるかどうかは治療の成否に関与する重要な因子の一つである.そこで,GCを留置する際に機械的血管攣縮(mechanical vasospasm;mVS)を惹起する因子について検討した.【方法】対象は2012年8月1日より2014年7月31日までの2年間に未破裂脳動脈瘤に対しコイル塞栓術を施行した連続64例とし後方視的に検討した.mVSの定義として,GCを留置した母血管径が25%以上狭小化するものとした.【結果】mVSは24例(38%)に認め,そのうちGCのサイズ変更を要したものは5例,その他の症例では先端位置を変えることで攣縮所見は全例軽快した.mVSと関連する因子として,より年齢が若いこと(p<0.001),女性(p=0.03),高血圧でないもの(p=0.03)を認めた.Body Mass Index,Adjunctive techniqueの有無,治療後のDWI高信号域の有無,治療時間,部位(ICA/VA),抗血小板療法(Single/Dual)は関連を認めなかった.【結論】より年齢の若い症例,女性,高血圧のない症例では機械的血管攣縮を引き起こしやすいと考えられる.(著者抄録)
• [Three Cases of Moyamoya Disease with a History of Kawasaki Disease].

  Toshinari Kawasaki; Yoshiki Arakawa; Toshiya Sugino; Takafumi Mitsuhara; Takeshi Funaki; Takayuki Kikuchi; Masaomi Koyanagi; Kazumichi Yoshida; Takeharu Kunieda; Jun C Takahashi; Yasushi Takagi; Susumu Miyamoto

  No shinkei geka. Neurological surgery 43 11 1005 - 10 2015年11月 [査読有り]
   

  Here, we report three cases of moyamoya disease with a history of Kawasaki disease. A 33-year-old man was found to have stenotic lesions of the internal carotid arteries(ICAs)on both sides at a nearby hospital where he visited complaining of headache and lisping. He had received immunoglobulin therapy for Kawasaki disease at the ages of 1, 2, and 6 years. MRI showed only a chronic ischemic lesion in the white matter. Angiography showed occlusion at the terminal portion of the ICAs on both sides. He was diagnosed with moyamoya disease, but as he had no symptoms and preserved cerebral blood flow (CBF), he was kept under observation. An 8-year-old boy was diagnosed with moyamoya disease and underwent right encephaloduroarteriosynangiosis at a nearby hospital. He had received immunoglobulin therapy for Kawasaki disease at the age of 1 year. His ischemic symptoms worsened. Although MRI detected no apparent ischemic lesion, angiography revealed severe stenosis at the terminal portions of the ICAs on both sides, and 123I-IMP SPECT showed CBF impairment. Bilateral direct bypass was performed. His father was subsequently also diagnosed with moyamoya disease. A 4-year-old girl with epilepsy was diagnosed with moyamoya disease at a nearby hospital. She had been treated with aspirin for Kawasaki disease at the age of 1 year. MRI detected no remarkable ischemic lesions, but angiography revealed mild stenosis at the terminal portions of the ICAs on both sides. Five months later, her ischemic symptoms were worsening with progressing stenotic lesions, and she underwent bilateral direct bypass.
• Apparent Diffusion Coefficient and Transient Neurological Deficit after Revascularization Surgery in Moyamoya Disease.

  Yoshio Araki; Yasushi Takagi; Yasutaka Fushimi; Yoshiki Arakawa; Takeshi Funaki; Takayuki Kikuchi; Jun C Takahashi; Kaori Togashi; Susumu Miyamoto

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 24 9 2054 - 9 2015年09月 [査読有り]
   

  BACKGROUND: Transient neurological deficits are relatively common after direct revascularization surgery for moyamoya disease (MMD). Although recent evidence has revealed the clinical features and pathophysiology, preoperative predictors have remained unclear. This study investigated whether the apparent diffusion coefficient (ADC) in normal-appearing white matter (NAWM) on magnetic resonance imaging could offer a predictor of postoperative transient neurological deficits. METHODS: This study included adult patients with MMD who underwent superficial temporal artery-middle cerebral artery bypass. Preoperative ADCs were measured in NAWM on ipsilateral hemisphere. Single photon emission computed tomography (SPECT) with (123)I-iodoamphetamine was performed on postoperative days 2-6. Relationships between mean ADC and postoperative transient neurological deficits were assessed. RESULTS: Twenty of the 26 subjects (76.9%) experienced transient neurological deficits. Focal hyperemia on postoperative SPECT appeared in 11 of the 20 subjects with postoperative transient neurological deficits and 1 of the 6 subjects without (P = .12). Mean ADCs in patients with and without postoperative transient neurological deficits were 748.3 ± 12 mm(2)/second × 10(-6) and 679.7 ± 21.9 mm(2)/second × 10(-6), respectively (P = .0091). CONCLUSIONS: Preoperative ADC elevation in NAWM may indicate postoperative transient neurological deficits not only in patients with postoperative hyperemia on SPECT, but also in patients with this pathology.
• The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation.

  Kazumichi Yoshida; Ryu Fukumitsu; Yoshitaka Kurosaki; Takeshi Funaki; Takayuki Kikuchi; Jun C Takahashi; Yasushi Takagi; Sen Yamagata; Susumu Miyamoto

  Journal of neurosurgery 123 2 434 - 40 2015年08月 [査読有り]
   

  OBJECT: The purpose of the present study was to investigate the association between carotid artery (CA) expansive remodeling (ER) and symptoms of cerebral ischemia. METHODS: One hundred twenty-two consecutive CAs scheduled for CA endarterectomy (CEA) or CA stent placement (CAS) were retrospectively studied. After excluding 22 CAs (2 were contraindicated for MRI, 8 had near-occlusion, 6 had poor image quality, and 6 had restenosis after CEA or CAS), there were 100 CAs (100 patients) included in the final analysis. The study included 50 symptomatic patients (mean age 73.6 ± 8.9 years, 6 women, mean stenosis 68.5% ± 21.3%) and 50 asymptomatic patients (mean age 72.0 ± 5.9 years, 5 women, mean stenosis 79.4% ± 8.85%). Expansive remodeling was defined as enlargement of the internal carotid artery (ICA) with outward plaque growth. The ER ratio was calculated by dividing the maximum distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA by the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis using long-axis, high-resolution MRI. RESULTS: The ER ratio of the atherosclerotic CA was significantly greater than that of normal physiological expansion (carotid bulb; p < 0.01). The ER ratio of symptomatic CA stenosis (median 1.94, interquartile range [IQR] 1.58-2.23) was significantly greater than that of asymptomatic CA stenosis (median 1.52, IQR 1.34-1.81; p = 0.0001). When the cutoff value of the ER ratio was set to 1.88, the sensitivity and specificity to detect symptoms were 0.6 and 0.78, respectively. The ER ratio of symptomatic patients was consistently high regardless of the degree of stenosis. CONCLUSIONS: There was a significant correlation between ER ratio and ischemic symptoms. The ER ratio might be a potential indicator of vulnerable plaque, which requires further validation by prospective observational study of asymptomatic patients.
• 【脳卒中における脳循環代謝画像のすべて-初心者からエキスパートまで-】新たな方法による脳循環代謝画像 15O標識ガス吸入PETを用いた脳動静脈奇形における新たな循環代謝評価の可能性

  丸山 大輔; 中川原 譲二; 飯田 秀博; 越野 一博; 森田 奈緒美; 安部倉 友; 濱野 栄佳; 佐藤 徹; 片岡 大治; 飯原 弘二; 高橋 淳

  The Mt. Fuji Workshop on CVD 33 56,67 - 60,67 (株)にゅーろん社 2015年07月 [査読有り]
   

  Nidusの最大径が30mm以上の脳動静脈奇形(AVM)8例(男4例、女4例、平均年齢36.3歳)を対象に、PET(DARG法およびDBFM法)、MRI、123I-IMP SPECTデータを収集し、病変側および非病変側のregional cerebral blood flow(rCBF)、metabolic rate of oxygen(rCMRO2)、oxygen extraction fraction(rOEF)を定量的に計測した。非病変側におけるDARGとDBFMによる測定パラメータ(rCBF、rCMRO2、rOEF)の強い相関が確認され、病変側においてはperinidal領域でDARGとDBFMの各パラメータ測定値は解離してDARGではDBFMより過大評価する傾向にあり、rCBFに関してDBFMではDARGと比較してperinidal領域でもIMP SPECTとの相関性が維持される可能性が示された。新たなPET撮像法であるDBFMの妥当性が示され、AVMのnidus周囲における精度の高い脳循環代謝をrCMRO2およびrOEFを指標にして評価できる可能性が示唆された。
• ERV enhances spatial learning and prevents the development of infarcts, accompanied by upregulated BDNF in the cortex.

  Yukako Nakajo; Dong Yang; Jun C Takahashi; Qiang Zhao; Hiroharu Kataoka; Hiroji Yanamoto

  Brain research 1610 110 - 23 2015年06月 [査読有り]
   

  PURPOSES: An anti-allergic and analgesic drug, "an extract derived from the inflamed cutaneous tissue of rabbits inoculated with vaccinia virus (ERV)", has been used in medical practice in Japan and some other countries. We examined the effect of ERV, prior to induction of ischemia, on the development of cerebral infarction, on learning and memory, or on brain-derived neurotrophic factor (BDNF) levels in C57BL/6J mice. METHODS: Following oral administration of ERV (the same in humans: ×1) or vehicle, daily for three consecutive weeks, temporary focal ischemia was induced by the three vessel occlusion technique. In the other group of animals, after daily ERV (Low: ×1; Med: ×3, or High dose: ×9) or vehicle administration for three weeks, we performed a quantitative assessment of spatial learning or intracerebral BDNF levels. RESULTS: The volumes of infarcted lesions, brain edema and the extent of the neurological deficits were significantly reduced in the ERV-treated group. ERV treatment also enhanced spatial learning, accompanied by upregulated BDNF in the cortex. CONCLUSIONS: Daily oral intake of ERV, at a clinically relevant dose, protects the brain from ischemic stroke, and also enhances the learning function in normal mice. As millions of people are currently taking the drug safely, and have been for many years in some cases, there is a need to test the inhibitory actions of the drug on progressive dementia encountered in humans with recurrent ischemic attacks or Alzheimer's disease.
• Primary central nervous system lymphoma: is absence of intratumoral hemorrhage a characteristic finding on MRI?

  Akihiko Sakata; Tomohisa Okada; Akira Yamamoto; Mitsunori Kanagaki; Yasutaka Fushimi; Toshiki Dodo; Yoshiki Arakawa; Jun C Takahashi; Susumu Miyamoto; Kaori Togashi

  Radiology and oncology 49 2 128 - 34 2015年06月 [査読有り]
   

  BACKGROUND: Previous studies have shown that intratumoral hemorrhage is a common finding in glioblastoma multi-forme, but is rarely observed in primary central nervous system lymphoma. Our aim was to reevaluate whether intratumoral hemorrhage observed on T2-weighted imaging (T2WI) as gross intratumoral hemorrhage and on susceptibility-weighted imaging as intratumoral susceptibility signal can differentiate primary central nervous system lymphoma from glioblastoma multiforme. PATIENTS AND METHODS: A retrospective cohort of brain tumors from August 2008 to March 2013 was searched, and 58 patients (19 with primary central nervous system lymphoma, 39 with glioblastoma multiforme) satisfied the inclusion criteria. Absence of gross intratumoral hemorrhage was examined on T2WI, and an intratumoral susceptibility signal was graded using a 3-point scale on susceptibility-weighted imaging. Results were compared between primary central nervous system lymphoma and glioblastoma multiforme, and values of P < 0.05 were considered significant. RESULTS: Gross intratumoral hemorrhage on T2WI was absent in 15 patients (79%) with primary central nervous system lymphoma and 23 patients (59%) with glioblastoma multiforme. Absence of gross intratumoral hemorrhage could not differentiate between the two disorders (P = 0.20). However, intratumoral susceptibility signal grade 1 or 2 was diagnostic of primary central nervous system lymphoma with 78.9% sensitivity and 66.7% specificity (P < 0.001), irrespective of gross intratumoral hemorrhage. CONCLUSIONS: Low intratumoral susceptibility signal grades can differentiate primary central nervous system lymphoma from glioblastoma multiforme. However, specificity in this study was relatively low, and primary central nervous system lymphoma cannot be excluded based solely on the presence of an intratumoral susceptibility signal.
• 【Stroke 2015-脳卒中対策基本法制定、脳卒中治療ガイドライン改訂を前に】Japan Adult Moyamoya Trialの概要

  舟木 健史; 高橋 淳; 宮本 享

  脳神経外科速報 25 4 362 - 366 (株)メディカ出版 2015年04月 [査読有り]
   

  出血型もやもや病の予後は不良であり、その治療法の確立は長年の課題であった。Japan Adult Moyamoya Trial(JAM Trial)は「出血型もやもや病患者に頭蓋内外直接バイパス術が有効である」という仮説を検証する多施設ランダム化比較試験であり、非手術群と比べて手術群で再出血率の有意な低下が証明された。JAM Trialの結果を一般化する際には、確実な手術技術と習熟した周術期管理が不可欠であることを銘記し、適応基準の遵守を心がけるべきである。(著者抄録)
• Vaginal delivery in pregnancy with Moyamoya disease: experience at a single institute.

  Hiroaki Tanaka; Shinji Katsuragi; Kayo Tanaka; Takekazu Miyoshi; Chizuko Kamiya; Naoko Iwanaga; Reiko Neki; Jun C Takahashi; Tomoaki Ikeda; Jun Yoshimatsu

  The journal of obstetrics and gynaecology research 41 4 517 - 22 2015年04月 [査読有り]
   

  AIM: Cesarean section is commonly selected in pregnancy with Moyamoya disease. We consider vaginal delivery with epidural anesthesia a viable alternative in such cases. METHODS: Mode of delivery and outcomes were examined in 27 pregnancies in 19 women with Moyamoya disease treated at the Department of Perinatology, National Cardiovascular Center, Japan, from 1983 to 2013. Of these 27 pregnancies, 20 were delivered vaginally with epidural anesthesia. The cerebral circulation, mode of delivery, maternal outcome (presence of symptoms due to Moyamoya disease intrapartum) and neonatal outcome (gestational week, birthweight, Apgar score at 5 min and pH of umbilical artery) were investigated. RESULTS: The cerebral circulation was judged to be good in all pregnancies. No symptoms due to Moyamoya disease intrapartum were seen in the vaginal delivery cases. CONCLUSION: Our findings indicate that vaginal delivery is viable in pregnancy with Moyamoya disease and that unnecessary cesarean section may be avoided. These findings are limited by the retrospective nature of the study.
• Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications.

  Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Takayuki Kikuchi; Kazumichi Yoshida; Takafumi Mitsuhara; Hiroharu Kataoka; Tomohisa Okada; Yasutaka Fushimi; Susumu Miyamoto

  Journal of neurosurgery 122 2 400 - 7 2015年02月 [査読有り]
   

  OBJECT: Unstable moyamoya disease, reasonably defined as cases exhibiting either rapid disease progression or repeated ischemic stroke, represents a challenge in the treatment of moyamoya disease. Despite its overall efficacy, direct bypass for such unstable disease remains controversial in terms of safety. This study aims to reveal factors associated with unstable disease and to assess its impact on postoperative silent or symptomatic ischemic lesions. METHODS: This retrospective cohort study included both pediatric and adult patients with moyamoya disease who had undergone 140 consecutive direct bypass procedures at Kyoto University Hospital. "Unstable moyamoya disease" was defined as either the rapid progression of a steno-occlusive lesion or repeat ischemic stroke, either occurring within 6 months of surgery. The extent of progression was determined through a comparison of the findings between 2 different MR angiography sessions performed before surgery. The clinical variables of the stable and unstable disease groups were compared, and the association between unstable disease and postoperative diffusion-weighted imaging (DWI)-detected lesion was assessed through univariate and multivariate analyses with generalized estimating equations. RESULTS: Of 134 direct bypass procedures performed after patients had undergone at least 2 sessions of MR angiography, 24 (17.9%) were classified as cases of unstable disease. Age younger than 3 years (p=0.029), underlying disease causing moyamoya syndrome (p=0.049), and radiographic evidence of infarction (p=0.030) were identified as factors associated with unstable disease. Postoperative DWI-defined lesions were detected after 13 of 140 procedures (9.3%), although only 4 lesions (2.9%) could be classified as a permanent complication. The incidence of postoperative DWI-detected lesions in the unstable group was notable at 33.3% (8 of 24). Univariate analysis revealed that unstable disease (p<0.001), underlying disease (p=0.028), and recent stroke (p=0.012) were factors associated with DWI-detected lesions. Unstable disease remained statistically significant after adjustment for covariates in both the primary and sensitivity analyses (primary analysis: OR 6.62 [95% CI 1.79-24.5]; sensitivity analysis: OR 5.36 [95% CI 1.47-19.6]). CONCLUSIONS: Unstable moyamoya disease, more prevalent in younger patients and those with underlying disease, is a possible risk factor for perioperative ischemic complications. Recognition of unstable moyamoya disease may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.
• Grading meningioma: a comparative study of thallium-SPECT and FDG-PET.

  Sachi Okuchi; Tomohisa Okada; Akira Yamamoto; Mitsunori Kanagaki; Yasutaka Fushimi; Tsutomu Okada; Moritaka Yamauchi; Masako Kataoka; Yoshiki Arakawa; Jun C Takahashi; Sachiko Minamiguchi; Susumu Miyamoto; Kaori Togashi

  Medicine 94 6 e549  2015年02月 [査読有り]
   

  The purpose was to compare capability of fluorine-18 fluorodeoxyglucose (FDG)-PET and thallium-201 (Tl)-SPECT for grading meningioma.This retrospective study was conducted as a case-control study under approval by the institutional review board. In the hospital information system, 67 patients (22 men and 45 women) who had both FDG-PET and Tl-SPECT preoperative examinations were found with histopathologic diagnosis of meningioma. The maximum FDG uptake values of the tumors were measured, and they were standardized to the whole body (SUVmax) and normalized as gray matter ratio (SUVRmax). Mean and maximum Tl uptake ratios (TURmean and TURmax, respectively) of the tumors were measured and normalized as ratios to those of the contralateral normal brain. Receiver-operating characteristic curve analyses of the 4 indexes were conducted for differentiation between low- and high-grade meningiomas, and areas under the curves (AUCs) were compared. Correlation coefficients were calculated between these indexes and Ki-67.Fifty-six meningiomas were classified as grade I (low grade), and 11 were grade II or III (high grade). In all 4 indexes, a significant difference was observed between low- and high-grade meningiomas (P < 0.05). AUCs were 0.817 (SUVmax), 0.781 (SUVRmax), 0.810 (TURmean), and 0.831 (TURmax), and no significant difference was observed among the indexes. Their sensitivity and specificity were 72.7% to 90.9% and 71.4% to 87.5%, respectively. Correlation of the 4 indexes to Ki-67 was statistically significant, but coefficients were relatively low (0.273-0.355).Tl-SPECT, which can be used at hospitals without a cyclotron or an FDG distribution network, has high diagnostic capability of meningioma grades comparable to FDG-PET.
• 各種疾患 脳血管障害 もやもや病の再出血予防(Japan Adult Moyamoya Trial)

  舟木 健史; 高橋 淳; 宮本 享

  Annual Review神経 2015 147 - 151 (株)中外医学社 2015年01月 [査読有り]
   

  出血型もやもや病の予後は不良であり,さらに年間約7%という高い再出血率が報告されている.出血型もやもや病に対する治療法の確立は長年の課題であった.Japan Adult Moyamoya Trial(JAM Trial)は「出血型もやもや病患者に頭蓋内外直接バイパス術が有効か」という仮説を検証するmulticenter randomized controlled trailである.この結果,非手術群と比べて手術群で再出血率が有意に低下することが示された.一方,JAM Trialの結果を一般化する際には,確実な手術技術と習熟した周術期管理が必要不可欠であることを銘記し,適応基準の遵守を心がけるべきである.(著者抄録)
• 【知っておくべき脳卒中最新治療】もやもや病出血予防のための手術療法

  舟木 健史; 高橋 淳; 宮本 享

  診断と治療 103 1 95 - 99 (株)診断と治療社 2015年01月 [査読有り]
   

  ＜Headline＞1 出血型もやもや病は、再出血を高率にきたす予後不良な病型であるが、今まで有効な治療法は確立されていなかった。2 Japan Adult Moyamoya Trial(JAM Trial)は「出血型もやもや病患者に頭蓋内外直接バイパス術が有効か」を検証するmulticenter randomized controlled trailである。3 JAM Trialの結果、直接バイパス術により再出血率は約3分の1に有意に減少することが示された。4 出血性もやもや病の外科治療においては、確実な手術技術と習熟した周術期管理が必要不可欠である。JAM Trialの結果を臨床に適応するにあたっては、プロトコールにおける適応基準を遵守し、手術適応のいたずらな拡大は避けられるべきである。(著者抄録)
• Estimation of proliferative potentiality of central neurocytoma: correlational analysis of minimum ADC and maximum SUV with MIB-1 labeling index.

  Ryo Sakamoto; Tomohisa Okada; Mitsunori Kanagaki; Akira Yamamoto; Yasutaka Fushimi; Takahide Kakigi; Yoshiki Arakawa; Jun C Takahashi; Yoshiki Mikami; Kaori Togashi

  Acta radiologica (Stockholm, Sweden : 1987) 56 1 114 - 20 2015年01月 [査読有り]
   

  BACKGROUND: Central neurocytoma was initially believed to be benign tumor type, although atypical cases with more aggressive behavior have been reported. Preoperative estimation for proliferating activity of central neurocytoma is one of the most important considerations for determining tumor management. PURPOSE: To investigate predictive values of image characteristics and quantitative measurements of minimum apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) for proliferative activity of central neurocytoma measured by MIB-1 labeling index (LI). MATERIAL AND METHODS: Twelve cases of central neurocytoma including one recurrence from January 2001 to December 2011 were included. Preoperative scans were conducted in 11, nine, and five patients for computed tomography (CT), diffusion-weighted imaging (DWI), and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET), respectively, and ADCmin and SUVmax of the tumors were measured. Image characteristics were investigated using CT, T2-weighted (T2W) imaging and contrast-enhanced T1-weighted (T1W) imaging, and their differences were examined using the Fisher's exact test between cases with MIB-1 LI below and above 2%, which is recognized as typical and atypical central neurocytoma, respectively. Correlational analysis was conducted for ADCmin and SUVmax with MIB-1 LI. A P value <0.05 was considered significant. RESULTS: Morphological appearances had large variety, and there was no significant correlation with MIB-1 LI except a tendency that strong enhancement was observed in central neurocytomas with higher MIB-1 LI (P = 0.061). High linearity with MIB-1 LI was observed in ADCmin and SUVmax (r = -0.91 and 0.74, respectively), but only ADCmin was statistically significant (P = 0.0006). CONCLUSION: Central neurocytoma had a wide variety of image appearance, and assessment of proliferative potential was considered difficult only by morphological aspects. ADCmin was recognized as a potential marker for differentiation of atypical central neurocytomas from the typical ones.
• Visualization of periventricular collaterals in moyamoya disease with flow-sensitive black-blood magnetic resonance angiography: preliminary experience.

  Takeshi Funaki; Yasutaka Fushimi; Jun C Takahashi; Yasushi Takagi; Yoshio Araki; Kazumichi Yoshida; Takayuki Kikuchi; Susumu Miyamoto

  Neurologia medico-chirurgica 55 3 204 - 9 2015年 [査読有り]
   

  Fragile abnormal collaterals in moyamoya disease, known as "moyamoya vessels," have rarely been defined. While flow-sensitive black-blood magnetic resonance angiography (FSBB-MRA) is a promising technique for visualizing perforating arteries, as of this writing no other reports exist regarding its application to moyamoya disease. Six adults with moyamoya disease underwent FSBB-MRA. It depicted abnormal collaterals as extended lenticulostriate, thalamic perforating, or choroidal arteries, which were all connected to the medullary or insular artery in the periventricular area and supplied the cortex. This preliminary case series illustrates the potential for FSBB-MRA to reveal abnormal moyamoya vessels, which could be reasonably defined as periventricular collaterals.
• Results of Prospective Cohort Study on Symptomatic Cerebrovascular Occlusive Disease Showing Mild Hemodynamic Compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 Study].

  Hiroharu Kataoka; Susumu Miyamoto; Kuniaki Ogasawara; Koji Iihara; Jun C Takahashi; Jyoji Nakagawara; Tooru Inoue; Etsuro Mori; Akira Ogawa

  Neurologia medico-chirurgica 55 6 460 - 8 2015年 [査読有り]
   

  The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.
• 安全性と永続性を目指した破裂脳動脈瘤に対するコイル塞栓術

  石井 大造; 佐藤 徹; 森田 健一; 菅田 真生; 丸山 大輔; 林 正孝; 濱野 栄佳; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 8 6 230 - 230 (NPO)日本脳神経血管内治療学会 2014年12月 [査読有り]
  
• CCC(Circular Color Coding) 硬膜動静脈瘻におけるshunt point同定のための新手法の開発

  丸山 大輔; 佐藤 徹; 大石 悟; 横山 博典; 山田 雅亘; 石井 大造; 片岡 大治; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 8 6 287 - 287 (NPO)日本脳神経血管内治療学会 2014年12月 [査読有り]
  
• 急性期血行再建術においてATBI(atherosclerotic brain infarction)と判断する因子の検討

  林 正孝; 佐藤 徹; 山上 宏; 早川 幹人; 丸山 大輔; 石井 大造; 濱野 栄佳; 菅田 真生; 片岡 大治; 長束 一行; 豊田 一則; 高橋 淳

  JNET: Journal of Neuroendovascular Therapy 8 6 358 - 358 (NPO)日本脳神経血管内治療学会 2014年12月 [査読有り]
  
• もやもや病周術期の神経脱落症候と脳循環代謝に関する検討

  濱野 栄佳; 片岡 大治; 安倍倉 友; 丸山 大輔; 中川原 譲二; 高橋 淳

  脳循環代謝 26 1 180 - 180 (一社)日本脳循環代謝学会 2014年11月 [査読有り]
  
• 【最新臨床脳卒中学[下]-最新の診断と治療-】日本における大規模臨床試験 Japan Adult Moyamoya(JAM)Trial

  宮本 享; 高橋 淳; 舟木 健史

  日本臨床 72 増刊7 最新臨床脳卒中学(下) 639 - 642 (株)日本臨床社 2014年10月 [査読有り]
  
• 3D dynamic pituitary MR imaging with CAIPIRINHA: initial experience and comparison with 2D dynamic MR imaging.

  Yasutaka Fushimi; Tomohisa Okada; Mitsunori Kanagaki; Akira Yamamoto; Yumiko Kanda; Ryo Sakamoto; Masato Hojo; Jun C Takahashi; Susumu Miyamoto; Kaori Togashi

  European journal of radiology 83 10 1900 - 6 2014年10月 [査読有り]
   

  OBJECTIVES: To evaluate the validity of 3D dynamic pituitary MR imaging with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA), with special emphasis on demarcation of pituitary posterior lobe and stalk. METHODS: Participants comprised 32 patients who underwent dynamic pituitary MR imaging due to pituitary or parasellar lesions. 3D dynamic MR with CAIPIRINHA was performed at 3T with 20-s-interval, precontrast, 1st to 5th dynamic images. Normalized values and enhanced ratios (dynamic postcontrast image values divided by precontrast ones) were compared between 3D and 2D dynamic MR imaging for patients with visual identification of posterior lobe and stalk. RESULTS: In 3D, stalk was identified in 29 patients and unidentified in 3, and posterior lobe was identified in 28 and unidentified in 4. In 2D, stalk was identified in 26 patients and unidentified in 6 patients, and posterior lobe was identified in 15 and unidentified in 17. Normalized values of pituitary posterior lobe and stalk were higher in 3D than 2D (P<0.001). No significant difference in enhancement ratio was seen between 3D and 2D. CONCLUSIONS: 3D dynamic pituitary MR provided better identification and higher normalized values of pituitary posterior lobe and stalk than 2D.
• Usefulness of Tumor Blood Flow Imaging by Intraoperative Indocyanine Green Videoangiography in Hemangioblastoma Surgery

  Masato Hojo; Yoshiki Arakawa; Takeshi Funaki; Kazumichi Yoshida; Takayuki Kikuchi; Yasushi Takagi; Yoshio Araki; Akira Ishii; Takeharu Kunieda; Jun C. Takahashi; Susumu Miyamoto

  WORLD NEUROSURGERY 82 3-4 E495 - E501 2014年09月 

  OBJECTIVE: Hemangioblastomas remain a surgical challenge because of their arteriovenous malformation-like character. Recently, indocyanine green (ICG) videoangiography has been applied to neurosurgical vascular surgery. The aim of this study was to evaluate the usefulness of tumor blood flow imaging by intraoperative ICG videoangiography in surgery for hemangioblastomas.METHODS: Twenty intraoperative ICG videoangiography procedures were performed in 12 patients with hemangioblastomas. Seven lesions were located in the cerebellum, two lesions were in the medulla oblongata, and three lesions were in the spinal cord.RESULTS: Ten procedures were performed before or during dissection, and 10 procedures were performed after tumor resection. ICG videoangiography could provide dynamic images of blood flow in the tumor and its related vessels under surgical view. Interpretation of these dynamic images of tumor blood flow was useful for discrimination of transit feeders (feeders en passage) and also for estimation of unexposed feeders covered with brain parenchyma. Postresection ICG videoangiography could confirm complete tumor resection and normalized blood flow in surrounding vessels.CONCLUSIONS: In surgery for hemangioblastomas, careful interpretation of dynamic ICG images can provide useful information on transit feeders and unexposed hidden vessels that cannot be directly visualized by ICG.
• Cognitive function of patients with adult moyamoya disease.

  Yoshio Araki; Yasushi Takagi; Keita Ueda; Shiho Ubukata; Junko Ishida; Takeshi Funaki; Takayuki Kikuchi; Jun C Takahashi; Toshiya Murai; Susumu Miyamoto

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 23 7 1789 - 94 2014年08月 [査読有り]
   

  BACKGROUND: Neurocognitive impairment is one of several unsolved social issues faced by patients with moyamoya disease. Although efforts have been made to investigate cognitive function using neuropsychologic tasks, generalizability has been limited. Here, in a preliminary study, we used structured neuropsychologic tasks to establish a standardized neuropsychologic assessment for adult moyamoya patients with and without difficulty in social independence. METHODS: Ten patients with neuroradiologically confirmed adult moyamoya disease (3 male, 7 female) participated. Half of all subjects did not have difficulty with social independence (group 1) and the others had (group 2). Group differences were evaluated after basic cognitive abilities and frontal lobe function were tested. RESULTS: Although the mean age of group 1 was substantially higher than that of group 2, disease duration did not differ significantly between groups. Means scores for intelligence functions including all subtests for basic cognitive abilities were higher in group 1 compared with group 2. Scores from only 2 frontal lobe evaluation tasks (Trail Making Test B and Theory of Mind) were significantly different between groups. CONCLUSIONS: This preliminary study provides a profile of neurocognitive dysfunction in adult patients with moyamoya disease using structured neuropsychologic tasks. A broad range of cognitive functions was disrupted particularly in the patients who had difficulty with social independence. To obtain stronger evidence regarding neurocognitive dysfunction in patients with moyamoya disease, a multicenter prospective study is essential.
• ["True" mixed pial-dural arteriovenous malformation: a case report].

  Yoshinori Maki; Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Akira Ishii; Takayuki Kikuchi; Kazumichi Yoshida; Yasuhide Makino; Susumu Miyamoto

  No shinkei geka. Neurological surgery 42 8 745 - 50 2014年08月 [査読有り]
   

  Mixed pial-dural arteriovenous malformation(AVM) is currently defined as a malformation fed by both the pial and meningeal arteries. Although many cases of mixed pial-dural AVM have been reported, few papers have addressed its pathological locations. The authors report a case of a 43-year-old male patient with mixed pial-dural AVM in the occipital lobe, consisting of two distinct nidi located on the tentorium and in the cerebral parenchyma respectively. The lesions were surgically resected, and the pathological examination confirmed that both were indeed AVM. The authors discuss this rare type of AVM, focusing on the possible pathogenic mechanism thereof.
• Surgical Dissection of the Internal Carotid Artery Under Flow Control by Proximal Vessel Clamping Reduces Embolic Infarcts During Carotid Endarterectomy

  Kazumichi Yoshida; Yoshitaka Kurosaki; Takeshi Funaki; Takayuki Kikuchi; Akira Ishii; Jun C. Takahashi; Yasushi Takagi; Sen Yamagata; Susumu Miyamoto

  WORLD NEUROSURGERY 82 1-2 E229 - E234 2014年07月 [査読有り]
   

  OBJECTIVE: To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). METHODS: Sixty-seven patients (59 men; age, 70.5 +/- 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. RESULTS: New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. CONCLUSION: The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection.
• CHADS2 and CHA2DS2-VASc scores as bleeding risk indices for patients with atrial fibrillation: the Bleeding with Antithrombotic Therapy Study.

  Kazunori Toyoda; Masahiro Yasaka; Shinichiro Uchiyama; Kazunori Iwade; Yukihiro Koretsune; Ken Nagata; Tomohiro Sakamoto; Takehiko Nagao; Masahiro Yamamoto; Jun Gotoh; Jun C Takahashi; Kazuo Minematsu

  Hypertension research : official journal of the Japanese Society of Hypertension 37 5 463 - 6 2014年05月 [査読有り]
   

  The CHADS2 and CHA2DS2-VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS2 and CHA2DS2-VASc scores were assessed based on information at entry. Scores of 0, 1 and ⩾2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA2DS2-VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS2, and 1.44, 1.69 and 2.24% by CHA2DS2-VASc. After multivariate adjustment, the CHADS2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03-3.38 per 1-category increase) and the CHA2DS2-VASc tended to be associated with ischemia (2.18, 0.89-8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS2 and CHA2DS2-VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke.
• Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial.

  Susumu Miyamoto; Takashi Yoshimoto; Nobuo Hashimoto; Yasushi Okada; Ichiro Tsuji; Teiji Tominaga; Jyoji Nakagawara; Jun C Takahashi

  Stroke 45 5 1415 - 21 2014年05月 [査読有り]
   

  BACKGROUND AND PURPOSE: About one half of those who develop adult-onset moyamoya disease experience intracranial hemorrhage. Despite the extremely high frequency of rebleeding attacks and poor prognosis, measures to prevent rebleeding have not been established. The purpose of this study is to determine whether extracranial-intracranial bypass can reduce incidence of rebleeding and improve patient prognosis. METHODS: This study was a multicentered, prospective, randomized, controlled trial conducted by 22 institutes in Japan. Adult patients with moyamoya disease who had experienced intracranial hemorrhage within the preceding year were given either conservative care or bilateral extracranial-intracranial direct bypass and were observed for 5 years. Primary and secondary end points were defined as all adverse events and rebleeding attacks, respectively. RESULTS: Eighty patients were enrolled (surgical, 42; nonsurgical, 38). Adverse events causing significant morbidity were observed in 6 patients in the surgical group (14.3%) and 13 patients in the nonsurgical group (34.2%). Kaplan-Meier survival analysis revealed significant differences between the 2 groups (3.2%/y versus 8.2%/y; P=0.048). The hazard ratio of the surgical group calculated by Cox regression analysis was 0.391 (95% confidence interval, 0.148-1.029). Rebleeding attacks were observed in 5 patients in the surgical group (11.9%) and 12 in the nonsurgical group (31.6%), significantly different in the Kaplan-Meier survival analysis (2.7%/y versus 7.6%/y; P=0.042). The hazard ratio of the surgical group was 0.355 (95% confidence interval, 0.125-1.009). CONCLUSIONS: Although statistically marginal, Kaplan-Meier analysis revealed the significant difference between surgical and nonsurgical group, suggesting the preventive effect of direct bypass against rebleeding. CLINICAL TRIAL REGISTRATION URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000166.
• Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful?

  Takahide Kakigi; Tomohisa Okada; Mitsunori Kanagaki; Akira Yamamoto; Yasutaka Fushimi; Ryo Sakamoto; Yoshiki Arakawa; Yoshiki Mikami; Taro Shimono; Jun C Takahashi; Kaori Togashi

  Neuroradiology 56 4 297 - 303 2014年04月 [査読有り]
   

  INTRODUCTION: Quantitative values of CT attenuation, apparent diffusion coefficient (ADC), and standardized uptake value (SUV) were investigated for differentiation between pineal parenchymal tumors (PPTs) and germinomas. Differences in age, sex, and calcification pattern were also evaluated. METHODS: Twenty-three patients with PPTs and germinomas in 20 years were retrospectively enrolled under the approval of the institutional review board. CT attenuation, ADC, and SUV (20, 13, and 10 patients, respectively) were statistically compared between the two tumors. Differences in sex and patterns of calcification ("exploded" or "engulfed") were also examined. Mean patient ages were compared among three groups of pineoblastoma, pineal parenchymal tumor of intermediate differentiation, (PPTID) and pineocytoma and germinoma. RESULTS: None of the quantitative values of CT attenuation, ADC, and SUV showed significant differences between PPTs and germinomas (p > .05). However, there was a significant difference in age (p < .05) among the three groups of pineoblastoma (mean age ± standard deviation 7.0 ± 8.7 years), PPTID, and pineocytoma (53.7 ± 11.4 years) and germinoma (19.1 ± 8.1 years). Sex also showed significant differences between PPTs and germinomas (p = .039). Exploded pattern of calcification was found in 9 of 11 PPT patients and engulfed pattern in 7 of 9 patients with germinomas. No reverse pattern was observed, and the patterns of calcification were considered highly specific of tumor types. CONCLUSIONS: None of the quantitative imaging values could differentiate PPTs from germinomas. Age, sex, and calcification patterns were confirmed useful in differentiating these tumors to some degree.
• Incidence of late cerebrovascular events after direct bypass among children with moyamoya disease: a descriptive longitudinal study at a single center.

  Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Kazumichi Yoshida; Yoshio Araki; Takayuki Kikuchi; Hiroharu Kataoka; Koji Iihara; Noritaka Sano; Susumu Miyamoto

  Acta neurochirurgica 156 3 551 - 9 2014年03月 [査読有り]
   

  BACKGROUND: The potential for late cerebrovascular events following surgical revascularization presents a challenge in the treatment of pediatric moyamoya disease. Limited information is available on the incidence of such events after direct bypass. The objective of this descriptive study was to examine the incidence of late cerebrovascular events after direct bypass for pediatric moyamoya disease. METHODS: The study cohort comprised consecutive patients with moyamoya disease who had undergone direct bypass at less than 18 years of age in the authors' institute between 1978 and 2003. They were prospectively followed until the end of the study period or, if applicable, the time of death. RESULTS: Fifty-six of 58 enrolled patients (96.6%) were followed for a mean period of 18.1 years. Four patients experienced late cerebrovascular events, comprising one stroke and three hemorrhages, an average of 13 years after surgery, one of whom experienced a fatal second hemorrhage. The only late ischemic stroke in the cohort occurred after a severe head injury and emergent craniotomy. The incidence of late cerebrovascular events was 0.41% per year (95% confidence interval, 0.15-1.08); 10-year, 20-year, and 30-year cumulative incidences were 1.8%, 7.3%, and 13.1%, respectively. CONCLUSIONS: Despite the efficacy of surgical revascularization, pediatric patients remain at risk of future cerebrovascular events, especially hemorrhage, after reaching adulthood and thus require careful long-term follow-up.
• Pregnancy-associated intracranial hemorrhage: results of a survey of neurosurgical institutes across Japan.

  Jun C Takahashi; Koji Iihara; Akira Ishii; Eiju Watanabe; Tomoaki Ikeda; Susumu Miyamoto

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 23 2 e65-71  2014年02月 [査読有り]
   

  BACKGROUND: Pregnancy-associated hemorrhagic stroke is considered a serious complication. Although coagulopathy, pregnancy-induced hypertension, eclampsia, and other systemic complications have been emphasized, pre-existing cerebrovascular diseases (CVDs) have not been fully analyzed. To clarify the role of these vascular lesions more in detail, the Japan Neurosurgical Society conducted a nationwide survey on all the neurosurgical institutes across Japan. METHODS: This 2-year survey focused on hemorrhagic stroke occurring in pregnancy, delivery, and puerperium. Clinical data based on retrospective chart review were obtained through a questionnaire and analyzed according to the time of onset, underlying CVDs, obstetric systemic complications, therapeutic approaches, and maternal and neonatal prognoses. RESULTS: The survey identified 97 hemorrhagic strokes that were associated with pregnancy. Baseline CVDs responsible for hemorrhage were detected in 54 cases (55.7%), among which 47 lesions (87.0%) had been undiagnosed before stroke onset. The detection rate of baseline CVDs before the 32nd week of gestation was significantly higher than that after the 32nd week (90.0% versus 53.3%, P = .0017). Arteriovenous malformations (AVMs) were the most frequent CVDs causing intracranial hemorrhage, occurring at 1.8 times the frequency of ruptured aneurysms during pregnancy. Poor outcomes, including 10 deaths, were seen in 36.1% of the cases despite aggressive treatment. CONCLUSION: Pregnancy-associated hemorrhagic strokes frequently concealed baseline CVDs, especially when they occurred before the 32nd week of gestation. AVMs were the predominant bleeding source. For appropriate treatment, therefore, close examination for cerebral vascular lesions is essential when a pregnancy-associated hemorrhagic stroke is encountered.
• Differential gene expression in relation to the clinical characteristics of human brain arteriovenous malformations.

  Yasushi Takagi; Tomohiro Aoki; Jun C Takahashi; Kazumichi Yoshida; Akira Ishii; Yoshiki Arakawa; Takayuki Kikuchi; Takeshi Funaki; Susumu Miyamoto

  Neurologia medico-chirurgica 54 3 163 - 75 2014年 [査読有り]
   

  Arteriovenous malformations (AVMs) of the central nervous system are considered as congenital disorders. They are composed of abnormally developed dilated arteries and veins and are characterized microscopically by the absence of a capillary network. We previously reported DNA fragmentation and increased expression of apoptosis-related factors in AVM lesions. In this article, we used microarray analysis to examine differential gene expression in relation to clinical manifestations in 11 AVM samples from Japanese patients. We categorized the genes with altered expression into four groups: death-related, neuron-related, inflammation-related, and other. The death-related differentially expressed genes were MMP9, LIF, SOD2, BCL2A1, MMP12, and HSPA6. The neuron-related genes were NPY, S100A9, NeuroD2, S100Abeta, CAMK2A, SYNPR, CHRM2, and CAMKV. The inflammation-related genes were PTX3, IL8, IL6, CXCL10, GBP1, CHRM3, CXCL1, IL1R2, CCL18, and CCL13. In addition, we compared gene expression in those with or without clinical characteristics including deep drainer, embolization, and high-flow nidus. We identified a small number of genes. Using these microarray data we are able to generate and test new hypotheses to explore AVM pathophysiology. Microarray analysis is a useful technique to study clinical specimens from patients with brain vascular malformations.
• Analysis of susceptibility-weighted images of cortico-medullary junction.

  Taha M Mehemed; Akira Yamamoto; Tomohisa Okada; Mitsunori Kanagaki; Takeshi Sawada; Emiko Morimoto; Jun C Takahashi; Susumu Miyamoto; Kaori Togashi

  Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine 13 4 231 - 8 2014年 [査読有り]
   

  OBJECTIVE: We qualitatively evaluated the differences among susceptibility-weighted (SWI), magnitude (MAG), and high pass filtered phase (PHA) images in depicting interlobar differences in the appearance of the signal of the corticomedullary junction (CMJ). We conducted quantitative evaluation to validate the qualitative results. MATERIALS AND METHODS: We obtained SWI images from 25 preoperative brain tumor patients (12 men, 13 women, aged 19 to 82 years, mean, 52 years). Two trained neuroradiologists evaluated MAG, PHA, and SWI images. Qualitative evaluation of the CMJ signal and quantitative calculation of the relative signal ratio (RSR) percentages between the CMJ and deep white matter (WM) were conducted at 3 different slice levels of the brain independently for 4 different lobes (frontal, parietal, temporal, and occipital) and compared among MAG, PHA, and SWI. The extent of the area of the CMJ signal was graded on a 4-point scale (Grade 3, >75%; Grade 2, 50 to 75%; Grade 1, 25 to 50%; Grade 0, <25%). Data were statistically analyzed using a nonparametric Friedman test. RESULTS: The Kappa coefficients between the qualitative and quantitative grades were 0.002 for MAG, 0.0047 for PHA, and 0.050 for SWI. Qualitatively, on the PHA images and SWI, grades of the occipital lobes were significantly higher than those of the other lobes (P < 0.005). Quantitatively, PHA images showed statistically significant interlobar differences in RSR percentage values of the CMJ (P = 0.025). CONCLUSION: Qualitatively, the appearance of the CMJ differed significantly among the different lobes of the brain on SWI and underlying PHA images but not on MAG images. Quantitatively, only PHA images showed significant interlobar differences in the RSR. PHA images are most sensitive to the CMJ signal contrast due to local paramagnetic iron content.
• Successful flow reduction surgery for a ruptured true posterior communicating artery aneurysm caused by the common carotid artery ligation for epistaxis.

  Yukihiro Yamao; Jun C Takahashi; Tetsu Satow; Koji Iihara; Susumu Miyamoto

  Surgical neurology international 5 Suppl 14 S501-5  2014年 [査読有り]
   

  BACKGROUND: Carotid artery occlusion can lead to the development of rare true posterior communicating artery (PCoA) aneurysms because of hemodynamic stress on the PCoA. Surgical treatment of these lesions is challenging. CASE DESCRIPTION: The authors report a case of a true PCoA aneurysm that developed and ruptured 37 years after ligation of the ipsilateral common carotid artery for epistaxis. The lesion was successfully treated with clipping of the distal M1 segment of the middle cerebral artery (MCA) after the occipital artery-radial artery free graft-MCA bypass, which led to extreme reduction in collateral flow through the PCoA. A cortical branch, located just proximal to the obliteration site, functioned as a sufficient flow outlet. The aneurysm shrank, and the patient has been doing well without any symptoms for 5 years after surgery. CONCLUSIONS: M1 obliteration combined with high-flow extra-intracranial bypass might be a promising option for a true PCoA aneurysm, and therapeutic design that leaves a sufficient flow outlet on the M1 is mandatory to avoid unexpected occlusion of the M1 and its perforators.
• Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease.

  Takeshi Funaki; Jun C Takahashi; Yasushi Takagi; Kazumichi Yoshida; Yoshio Araki; Takayuki Kikuchi; Hiroharu Kataoka; Koji Iihara; Susumu Miyamoto

  Journal of neurosurgery. Pediatrics 12 6 626 - 32 2013年12月 [査読有り]
   

  OBJECT: In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. METHODS: Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. RESULTS: Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. CONCLUSIONS: Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.
• Incidence and risk factors of chronic subdural hematoma after aneurysmal clipping.

  Takayuki Ohno; Koji Iihara; Jun C Takahashi; Norio Nakajima; Tetsu Satow; Tomohito Hishikawa; Izumi Nagata; Kazuo Yamada; Susumu Miyamoto

  World neurosurgery 80 5 534 - 7 2013年11月 [査読有り]
   

  OBJECTIVE: Chronic subdural hematoma (CSDH) after aneurysmal clipping is a rare complication, but its incidence and risk factors are not known in detail. We retrospectively reviewed our cases requiring surgery for CSDH after clipping. METHODS: In our hospital, between January 2000 and December 2006, 794 patients (unruptured, 58.0%) underwent clipping surgery for aneurysm of the anterior circulation. We reviewed incidence and risk factors of CSDH after clipping. For the past 2 years, we reviewed all computed tomography scans for 163 unruptured aneurysms, and examined the relationship between an increase of subdural fluid collection (SFC) and development of CSDH. RESULTS: Fifteen patients (1.9%) developed CSDH after clipping, which required evacuation. Among those, 13 had unruptured aneurysms (2.8%), a much higher percentage than for ruptured aneurysms (0.9%). On univariate statistical analysis, risk factors of CSDH were associated with advanced age (P = 0.0005), male gender (P = 0.04), and unruptured aneurysms (P = 0.02). Aneurysmal location was not related to the development of postoperative CSDH. Contralateral CSDH occurred in 3 patients, but no middle cerebral artery aneurysm developed contralateral CSDH. An increase in postoperative SFC during 1 week was a significant risk factor for CSDH (P = 0.001). CONCLUSIONS: In addition to the classic risk factors, this study showed that clipping for unruptured aneurysms carries a higher risk for CSDH compared to ruptured aneurysms. We suggest that an increase of SFC during 1 week postoperatively can be a factor in predicting CSDH after clipping.
• 【脳動脈瘤治療に残る課題】治療困難な脳動脈瘤 開頭手術に残された課題

  菊池 隆幸; 宮本 享; 高橋 淳; 舟木 健史

  脳神経外科ジャーナル 22 10 742 - 748 日本脳神経外科コングレス 2013年10月 [査読有り]
   

  きわめて予後不良である巨大脳動脈瘤に対する治療は、通常の動脈瘤頸部クリッピングや動脈瘤内コイル塞栓術では困難である。治療困難な巨大脳動脈瘤の血栓化および退縮を目的とし、動脈瘤周辺の血管を分離することにより動脈瘤へ流入する血流を減少させる治療をflow reduction treatmentと定義し、この治療のコンセプトと明らかになりつつある問題点および今後の展望について概説する。(著者抄録)
• Successful flow reduction treatment for a middle cerebral artery aneurysm in a patient with systemic lupus erythematosus.

  Koichiro Takemoto; Taketo Hatano; Yu Abekura; Jun C Takahashi; Susumu Miyamoto

  Neurologia medico-chirurgica 53 3 192 - 5 2013年 [査読有り]
   

  A 37-year-old male with a 20-year history of systemic lupus erythematosus (SLE) was referred to our hospital for an unruptured right middle cerebral artery (MCA) aneurysm. Right cerebral angiography detected a saccular aneurysm (9.6 × 7.1 mm) arising from the bifurcation of the right MCA, and a dilatation of the inferior trunk M2 in which three small branches were involved. The MCA aneurysm was treated with neck clipping. The aneurysmal dilatation of the inferior trunk M2 was treated with proximal clipping, followed by double superficial temporal artery-MCA anastomosis. The patient was discharged from our hospital without complications. This is an extremely unusual case of surgical flow reduction treatment using bypass surgery for a complicated cerebral aneurysm in a patient with SLE.
• Pregnancy and delivery management in patients with cerebral arteriovenous malformation: a single-center experience.

  Kenji Fukuda; Eika Hamano; Norio Nakajima; Shinji Katsuragi; Tomoaki Ikeda; Jun C Takahashi; Susumu Miyamoto; Koji Iihara

  Neurologia medico-chirurgica 53 8 565 - 70 2013年 [査読有り]
   

  We described pregnancy and delivery management in 9 patients with cerebral arteriovenous malformation (AVM). Six patients presented with intracerebral hemorrhage (ICH) during pregnancy (first hemorrhagic episode); 2 patients presented with headache; and 1 patient with incidental detection of AVM. In the 3 patients with unruptured AVM, the diagnosis was made before pregnancy. In 3 of 6 patients who presented with ICH, AVM removal was performed during pregnancy. One patient required emergency surgery for the mass effect of the hematoma, and 2 patients with Spetzler-Martin grade I and II AVMs underwent elective surgery for the prevention of rebleeding. Radiosurgery for multiple AVMs was performed after delivery in one patient. Surgical resection and radiosurgery were performed after abortion in two patients. Of 3 patients with unruptured AVM, 2 patients became pregnant after radiosurgery and conservative treatment was initiated in 1 patient for Spetzler-Martin grade V AVM. Cesarean section was performed in 5 patients (one with severe uncontrollable pregnancy-induced hypertension) and vaginal delivery in 2 patients (one with grade V AVM). Delivery by obstetrical indication was possible in patients who underwent AVM resection during pregnancy. No rebleeding during pregnancy occurred. The maternal outcome was good except for the 2 patients with consequences of the initial ICH. The fetal outcome was good except for 2 cases of abortion. Pregnancy and delivery management in patients with AVM was successful in our institution. Early surgical intervention for AVM presenting as ICH during pregnancy could prevent rebleeding and improve the maternal and fetal prognosis.
• Rapid progression of unilateral moyamoya disease in a patient with a family history and an RNF213 risk variant.

  Yohei Mineharu; Yasushi Takagi; Jun C Takahashi; Hirokuni Hashikata; Wanyang Liu; Toshiaki Hitomi; Hatasu Kobayashi; Akio Koizumi; Susumu Miyamoto

  Cerebrovascular diseases (Basel, Switzerland) 36 2 155 - 7 2013年 [査読有り]
  
• Retrospective analysis of bevacizumab in combination with ifosfamide, carboplatin, and etoposide in patients with second recurrence of glioblastoma.

  Yoshiki Arakawa; Takashi Mizowaki; Daiki Murata; Koichi Fujimoto; Takayuki Kikuchi; Takeharu Kunieda; Jun C Takahashi; Yasushi Takagi; Susumu Miyamoto

  Neurologia medico-chirurgica 53 11 779 - 85 2013年 [査読有り]
   

  Bevacizumab has been reported to be effective for recurrent glioblastoma. In our hospital, ifosfamide, carboplatin, etoposide (ICE) is the second-line chemotherapy for first recurrence of glioblastoma after temozolomide failure. In the present analysis, we retrospectively investigated the feasibility and effectiveness of bevacizumab combined with ICE in patients with glioblastoma at second relapse during ICE treatment. Between 2010 and 2012, tumor progressions were diagnosed in consecutive 8 patients who were treated with ICE for the first recurrence of glioblastoma. These patients were administered 3 cycles of 10 mg/kg bevacizumab every two weeks in combination with ICE treatment. The objective response rate of bevacizumab combination was 75% in Neuro-Oncology Working Group (RANO criteria), including complete response and partial response. Median progression free survival (PFS) and median overall survival (OS) after second relapse were 3.7 months (95% confidence interval [CI], 2.5-18.5 months) and 6.0 months (95% CI, 3.2-19.7 months), respectively. The 6-month PFS rates were 25% (95% CI, 0-55.0%). The median OS after initial diagnosis was 23.3 months (95% CI, 16.2-55.8 months). The grade 2 or 3 hematologic adverse events were identified in 7 of 8 patients, most of which might be due to ICE chemotherapy. The results of our retrospective analysis suggest that combination treatment with bevacizumab and ICE may be safe and beneficial in patients with recurrent glioblastoma.
• Evaluation of CT angiography for visualisation of the lenticulostriate artery: difference between normotensive and hypertensive patients

  K. Gotoh; T. Okada; N. Satogami; M. Yakami; J. C. Takahashi; K. Yoshida; A. Ishii; S. Tanaka; S. Miyamoto; K. Togashi

  BRITISH JOURNAL OF RADIOLOGY 85 1019 E1004 - E1008 2012年11月 [査読有り]
   

  Objective: High-resolution CT angiography (CTA) is currently available using multidetector row CT (MDCT); however, its use for small artery visualisation has been limited. To evaluate its capability, we investigated CTA visualisation for difference in number of the lenticulostriate artery (LSA) branches between normotensive and hypertensive patients, because hypertension is a major cause of LSA damage. Methods: This was a retrospective study evaluating cerebrovascular CTA at our hospital conducted from February 2008 to June 2009 under approval of the institutional review board. 117 patients (39 males and 78 females, 19-88 years old) were included. CTA was conducted using a 64 channel MDCT. Total numbers of LSA branches were examined for differences by age with regression analysis and the presence or absence of hypertension and/or aneurysm using two-sample t-tests. A p-value <0.016 was considered statistically significant after correction for multiple comparisons. A multiple variable analysis of three factors was also conducted. Results: The average number of LSA branches was 3.6 [95% confidence interval (CI) 3.0-4.1] and 4.4 (95% CI 4.1-4.7), respectively, for a patient with and without history of hypertension, and the difference was statistically significant (p=0.013). The difference was approximately one branch in the multiple variable analysis. No significant correlation was observed for age and no significant difference was observed for the presence or absence of aneurysms. Conclusions: Contrast-enhanced CTA can visualise significant differences in the number of LSA branches among patients with and without hypertension. Advances in knowledge: Current high-resolution CTA can visualise LSA well, which enables finding a difference in the LSA between normotensive subjects and hypertensive patients.
• Diagnosis of moyamoya disease using 3-T MRI and MRA: value of cisternal moyamoya vessels.

  Takeshi Sawada; Akira Yamamoto; Yukio Miki; Ken-Ichiro Kikuta; Tomohisa Okada; Mitsunori Kanagaki; Seiko Kasahara; Susumu Miyamoto; Jun C Takahashi; Hidenao Fukuyama; Kaori Togashi

  Neuroradiology 54 10 1089 - 97 2012年10月 [査読有り]
   

  INTRODUCTION: The purpose of this study was to propose new magnetic resonance (MR) criteria of diagnosing moyamoya disease (MMD) from cisternal moyamoya vessels (MMVs) on 3-T magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) and compare the diagnostic accuracy of the existing MR criteria and the proposed MR criteria. METHODS: Participants comprised 20 consecutive patients with MMD (4 males, 16 females) diagnosed clinically using conventional angiography and 20 controls (13 male and 7 female arteriosclerosis patients). In these participants, 3-T MRI/MRA was evaluated by the existing MR criteria, which use MMVs in the basal ganglia, and the proposed MR criteria, which use cisternal MMVs, and then these two criteria were statistically compared by McNemar's test. RESULTS: Diagnostic accuracy was 62.5% with the existing MR criteria and 97.5% with the proposed MR criteria. The proposed MR criteria was more sensitive (1.00) than the existing MR criteria (0.45), but less specific (0.95) than the existing MR criteria (1.00). CONCLUSION: The proposed MR criteria using cisternal MMVs showed significantly higher diagnostic accuracy than the existing MR criteria. We believe that our proposed MR criteria will be beneficial for diagnosing MMD.
• Transplantation of telencephalic neural progenitors induced from embryonic stem cells into subacute phase of focal cerebral ischemia

  Motoaki Fujimoto; Hideki Hayashi; Yasushi Takagi; Makoto Hayase; Takeshi Marumo; Masanori Gomi; Masaki Nishimura; Hiroharu Kataoka; Jun Takahashi; Nobuo Hashimoto; Kazuhiko Nozaki; Susumu Miyamoto

  LABORATORY INVESTIGATION 92 4 522 - 531 2012年04月 [査読有り]
   

  Cerebral ischemia causes neuronal death and disruption of neural circuits in the central nervous system. Various neurological disorders caused by cerebral infarction can severely impair quality of life and are potentially fatal. Functional recovery in the chronic stage mainly depends on physical treatment and rehabilitation. We aim to establish cell therapy for cerebral ischemia using embryonic stem (ES) cells, which have self-renewing and pluripotent capacities. We previously reported that the transplanted monkey and mouse ES cell-derived neural progenitors, by stromal cell-derived inducing activity method, could survive and differentiate into various types of neurons and glial cells, and form the neuronal network in basal ganglia. In this report, we induced the differentiation of the neural progenitors from mouse ES cells using the serum-free suspension culture method and confirmed the expression of various basal ganglial neuronal markers and neurotransmitter-related markers both in vitro and in vivo, which was thought to be suitable for replacing damaged striatum after middle cerebral artery occlusion. This is the first report that used selectively induced telencephalic neural progenitors into ischemia model. Furthermore, we purified the progenitors expressing the neural progenitor marker Sox1 by fluorescence-activated cell sorting and Sox1-positive neural progenitors prevented tumor formation in ischemic brain for 2 months. We also analyzed survival and differentiation of transplanted cells and functional recovery from ischemic damage. Laboratory Investigation (2012) 92, 522-531; doi:10.1038/labinvest.2012.1; published online 13 February 2012
• Pregnancy and delivery in moyamoya disease: results of a nationwide survey in Japan.

  Jun C Takahashi; Tomoaki Ikeda; Koji Iihara; Susumu Miyamoto

  Neurologia medico-chirurgica 52 5 304 - 10 2012年 [査読有り]
   

  Stroke during pregnancy associated with moyamoya disease (MMD) has been reported sporadically, but no systematic surveys have been undertaken. To reveal the current clinical situation, the authors conducted Japan's first nationwide survey of pregnancy and delivery associated with MMD. A questionnaire was sent to all 270 perinatal medical centers across Japan to survey their experiences with delivery associated with MMD within the preceding 5 years (Survey I); another questionnaire was sent to 554 adult female patients with MMD regarding their experience with childbirth (Survey II). Survey I included 59 deliveries among patients with previously diagnosed MMD. The incidence of perinatal neurological events and morbidity was 5.1% and 1.7%, respectively. In another five cases, newly diagnosed after perinatal attacks, disability was noted in three cases, including one death from intracranial hemorrhage. Survey II included 278 deliveries. The perinatal attack rate was 6.6% in 76 previously diagnosed cases and 2.0% in 202 cases undiagnosed at pregnancy, but neither group reported permanent morbidity. Caesarean section in previously diagnosed cases accounted for 76.3% of deliveries in Survey I and 69.7% in Survey II, but no significant difference in event rate was found between caesarean section and vaginal delivery in either survey. Although the incidence of perinatal neurological events is low when MMD has been diagnosed, careful monitoring is required in light of the potential for stroke. Serious events, especially intracranial hemorrhage, can occur if MMD has not been diagnosed at pregnancy. Further efforts to establish management guidelines are required to ensure safer childbirth in patients with MMD.
• Arachnoid cyst of the velum interpositum originating from tela choroidea.

  Takeshi Funaki; Yasuhide Makino; Yoshiki Arakawa; Masato Hojo; Takeharu Kunieda; Yasushi Takagi; Jun C Takahashi; Susumu Miyamoto

  Surgical neurology international 3 120 - 120 2012年 [査読有り]
   

  BACKGROUND: Arachnoid cysts originating from the velum interpositum are very rare, and their existence as a clinicopathologic entity remains controversial. We report a case of a patient with an arachnoid cyst of the velum interpositum presenting with memory disturbance, focusing on the anatomical origin of the lesion and the physiological mechanisms causing memory disturbance. CASE DESCRIPTION: A 65-year-old man with a large cystic lesion in the velum interpositum experienced progressive memory disturbance and enlargement of the lesion 6 months before referral to our institution. Neuropsychological evaluation on admission demonstrated severe memory disturbance. Radiological examination did not reveal hydrocephalus, but the bilateral fornices and thalami were compressed by the cyst. The patient underwent endoscopic cystoventriculostomy via the frontal horn of the right lateral ventricle through a frontal burr hole. Histopathology of the sample was consistent with that of an arachnoid cyst, and the endoscopic findings suggested that the cyst originated from the tela choroidea, which covers the velum interpositum. The symptoms resolved after surgery with significant improvement in neuropsychological test scores. CONCLUSION: Arachnoid cysts of the velum interpositum are rare but distinct clinicopathologic entities that originate from the tela choroidea. The lesions can cause memory disturbance without hydrocephalus due to compression of the fornices and thalami, but this can be reversed by surgery.
• Surgical treatment of Spetzler-Martin grade III to V cerebral arteriovenous malformations: 10 years experience in Kyoto University.

  Yasushi Takagi; Jun C Takahashi; Kazumichi Yoshida; Akira Ishii; Nobuo Hashimoto; Susumu Miyamoto

  Neurologia medico-chirurgica 52 12 852 - 8 2012年 [査読有り]
   

  Cerebral arteriovenous malformations (AVMs) are abnormal connections between arteries and veins leading to arteriovenous shunting with nidus formation. This study reviewed the clinical outcomes of surgical treatment for AVMs of Spetzler-Martin grades III to V in our institute. In addition, we summarized the technical aspects of surgical treatment for cerebral AVMs. Our development of the surgical modality for high-grade AVMs included intraoperative digital subtraction cerebral angiography, non-stick bipolar forceps, magnetic resonance tractography, and indocyanine green videoangiography. Excellent outcomes were obtained, but about 40% of all patients with AVMs could not receive surgical treatment. Multimodality approach including Onyx embolization may extend the surgical indications.
• Successful obliteration and shrinkage of giant partially thrombosed basilar artery aneurysms through a tailored flow reduction strategy with bypass surgery.

  Susumu Miyamoto; Takeshi Funaki; Koji Iihara; Jun C Takahashi

  Journal of neurosurgery 114 4 1028 - 36 2011年04月 [査読有り]
   

  OBJECT: The authors evaluated the efficacy of a new flow reduction strategy for giant partially thrombosed upper basilar artery (BA) aneurysms, for which proximal parent artery occlusion is not always effective. METHODS: Eight consecutive patients with severely symptomatic, partially thrombosed, giant upper BA aneurysms were treated with a tailored flow reduction strategy, or received conservative therapies. The flow reduction strategy comprised isolation of several branches from the upper BA at their origins with bypasses in addition to parent artery occlusion. RESULTS: The median follow-up period of all 8 patients was 15.0 months (range 4-31 months). In 6 patients treated with flow reduction, the mean decrease in residual blood lumen was -10.7 mm (95% CI -19.7 to -1.7 mm; p = 0.029) and the mean decrease in diameter of the aneurysms was -11.5 mm (95% CI -25.1 to 2.1 mm; p = 0.082). Complete or virtually complete thrombosis was achieved in all but 1 aneurysm (83%) and shrinkage was observed in 4 (67%). In those in whom complete or virtually complete thrombosis was achieved, significant shrinkage of the aneurysm was observed (mean decrease in diameter -14.8 mm; 95% CI -28.8 to -0.8 mm; p = 0.043). Improvement or stabilization of symptoms occurred in 67% of the patients who received flow reduction treatment. Both patients who received conservative treatment had unfavorable outcomes. CONCLUSIONS: The flow reduction strategy is effective at promoting complete thrombosis of the aneurysm. This strategy can also induce shrinkage of the aneurysm if successful thrombosis is achieved. Although the neurological outcome of the treatment appears favorable considering its intractable nature, further study of the treatment is necessary to confirm its clinical efficacy and safety.
• [Surgery for partially thrombosed giant aneurysms of the middle cerebral artery].

  Jun C Takahashi; Susumu Miyamoto

  No shinkei geka. Neurological surgery 39 2 129 - 39 2011年02月 [査読有り]
  
• Surgical treatment and perioperative management of moyamoya disease associated with glycogen storage disease Type 1a.

  Yusuke Egashira; Jun C Takahashi; Hiroyuki Ohnishi; Yukako Kawasaki; Masamune Higashigawa; Koji Iihara; Susumu Miyamoto

  Journal of neurosurgery. Pediatrics 7 1 11 - 4 2011年01月 [査読有り]
   

  The authors report a case of concurrent moyamoya disease and glycogen storage disease Type 1a that was successfully managed with bypass surgery. This 7-year-old Japanese girl, diagnosed with glycogen storage disease Type 1a at the age of 2 years, presented with repeated transient ischemic attacks. Cerebral angiography revealed severe stenosis at the terminal portions of the bilateral internal carotid arteries, with typical moyamoya vessels. The patient underwent superficial temporal artery-middle cerebral artery anastomosis and encephalomyosynangiosis bilaterally, in 2 staged procedures at an interval of 4 months. Despite perioperative administration of glucose, hypoglycemia and metabolic acidosis occurred after both surgeries. The symptoms were milder after the second surgery, in which an increased dose of glucose was used. The patient tolerated the perioperative conditions well under intensified medical treatment, and no further ischemic symptoms occurred.
• [Carotid artery stenting for radiation-induced carotid stenosis].

  Yusuke Egashira; Tetsu Satow; Kosuke Masuda; Masakazu Okawa; Hiroyuki Ohnishi; Takahito Okazaki; Jun C Takahashi; Ken-Ichi Murao; Koji Iihara; Susumu Miyamoto

  No shinkei geka. Neurological surgery 38 10 913 - 20 2010年10月 [査読有り]
   

  PURPOSE AND METHODS: To evaluate the outcome and lesion characteristics in patients with radiation induced carotid stenoses (RI-CS) treated by carotid artery stenting (CAS), a total of five patients with RI-CS (six lesions) were retrospectively analyzed. RESULTS: Four lesions had their most stenotic site at the common carotid artery (CCA). All cases had contralateral carotid or vertebral artery stenosis (>50%). All patients had risk factors of atherosclerosis and all lesions contained unstable plaques at the stenotic site. A total of seven procedures were carried out and procedural success was obtained in all cases. Asymptomatic embolic infarctions associated with procedure were observed in four cases by diffusion-weighted MR imaging. In-stent thrombi were observed in two cases, one of which developed a neurological symptom three days after the procedure. CONCLUSION: CAS is a technically successful intervention for RI-CS. Care should be taken according to the characteristics of the plaque, which usually is vulnerable and long. Appropriate choice of a protection method could help in the reduction of unfavorable embolic complications and close postoperative follow up is mandatory.
• Blood pressure levels and bleeding events during antithrombotic therapy: the Bleeding with Antithrombotic Therapy (BAT) Study.

  Kazunori Toyoda; Masahiro Yasaka; Shinichiro Uchiyama; Takehiko Nagao; Jun Gotoh; Ken Nagata; Yukihiro Koretsune; Tomohiro Sakamoto; Kazunori Iwade; Masahiro Yamamoto; Jun C Takahashi; Kazuo Minematsu

  Stroke 41 7 1440 - 4 2010年07月 [査読有り]
   

  BACKGROUND AND PURPOSE: A prospective, multicenter, observational cohort study was conducted to clarify the association between major bleeding events and blood pressure (BP) levels during follow-up before development of bleeding events in antithrombotic users. METHODS: A total of 4009 patients taking oral antithrombotic agents for cardiovascular or cerebrovascular diseases (2728 men, 69+/-10 years old) were followed. Changes in systolic and diastolic BPs between entry and the last clinic visit before intracranial hemorrhage (ICH) or extracranial hemorrhage were assessed. RESULTS: Over a median follow-up of 19 months, ICH developed in 31 patients and extracranial hemorrhage developed in 77. Entry BP levels were similar among patients with ICH, those with extracranial hemorrhage, and those without hemorrhagic events. Both systolic BP and diastolic BP were relatively high during follow-up as compared with the levels at entry in patients with ICH, whereas they showed plateaus in patients with extracranial hemorrhage and patients without hemorrhagic events. Average systolic BP levels between 1 and 6 months (hazard ratio, 1.45; 95% CI, 1.08 to 1.92 per 10-mm Hg increase) and between 7 and 12 months (hazard ratio, 1.47; 95% CI, 1.05 to 2.01) as well as average diastolic BP levels between 7 and 12 months (hazard ratio, 2.05; 95% CI, 1.15 to 3.62) were independently associated with development of ICH after adjustment for established ICH predictors. The optimal cutoff BP level to predict impending risk of ICH was >or=130/81 mm Hg using receiver operating characteristic curve analysis. CONCLUSIONS: An increase in BP levels during antithrombotic medication was positively associated with development of ICH, suggesting the importance of adequate BP control for avoiding ICH. BP levels did not appear to be associated with extracranial hemorrhage.
• Moyamoya disease: recent progress and outlook.

  Jun C Takahashi; Susumu Miyamoto

  Neurologia medico-chirurgica 50 9 824 - 32 2010年 [査読有り]
   

  Moyamoya disease as a clinical entity has been known for more than 40 years. Constant efforts have been directed at clarifying the pathogenesis of this disorder and improving therapeutic methods for the ischemic and hemorrhagic stroke caused by the characteristic vasculopathy of this disease. Although much knowledge has been gained, unresolved problems remain, such as the true epidemiology of this disease, elucidation of the genetic mechanism, and prevention of repeated hemorrhagic events. In this paper, we review recent progress and discuss the outlook for this disorder.
• [Flow alteration treatment for giant aneurysm in the posterior cranial fossa].

  Susumu Miyamoto; Jun Takahashi; Takeshi Funaki; Koji Iihara

  No shinkei geka. Neurological surgery 37 12 1179 - 90 2009年12月
• Treatment strategy for ruptured aneurysms originating from the anterior wall of the internal carotid artery

  Takayuki Oono; Koji Iihara; Jun C. Takahashi; Norio Nakajima; Tetsu Satow; Hidekazu Takada; Tomohito Hishikawa; Takeshi Funaki; Masakazu Okawa; Yusuke Egashira; Kosuke Masuda; Izumi Nagata; Susumu Miyamoto

  Japanese Journal of Neurosurgery 18 6 450 - 457 2009年 

  The authors retrospectively reviewed their experience treating ruptured aneurysms originating from the anterior wall of the internal carotid artery in the acute stage after subarachnoid hemorrhage. Since 2002, there were 8 cases (mean age : 52 years old, three males) treated at our institution. Early in the study period, clipping was attempted in two cases, which were associated with intra- and post-operative rebleeding. Later, their strategy changed such that trapping of the aneurysms was the first choice of treatment, combined with STA-MCA bypass (4 cases) or high flow bypass using a radial artery graft (3 cases). Recently, the authors prefer to use high flow bypass more frequently, considering the possible occurrence of vasospasm on the collateral route shown at the initial angiograms. Specifically, vasospasm of the radial artery graft is another important issue to consider, even if pressure distension techniques are applied. If such vasospasm causes ischemic symptoms, percutaneous transluminal angioplasty should be performed in a timely fashion. Technical issues of surgical treatment of the anterior wall of the Internal carotid artery were discussed.
• 部分血栓化椎骨動脈瘤に対する血管内治療による親動脈閉塞術の治療成績

  大西 宏之; 佐藤 徹; 大川 将和; 桝田 宏輔; 江頭 裕介; 舟木 健史; 高橋 淳; 飯原 弘二; 宮本 享; 村尾 健一

  JNET: Journal of Neuroendovascular Therapy 2 4 141 - 141 (NPO)日本脳神経血管内治療学会 2008年11月 [査読有り]
  
• Growth potential and response to multimodality treatment of partially thrombosed large or giant aneurysms in the posterior circulation.

  Koji Iihara; Kenichi Murao; Naoaki Yamada; Jun C Takahashi; Norio Nakajima; Tetsu Satow; Tomohito Hishikawa; Izumi Nagata; Susumu Miyamoto

  Neurosurgery 63 5 832 - 42 2008年11月 [査読有り]
   

  OBJECTIVE: This study examined the growth potential and response to multimodality treatment of partially thrombosed large or giant aneurysms in the posterior circulation. METHODS: The 17 aneurysms arose from nonbranching sites of the vertebral artery (VA) in 6 patients and from branching sites in 11 patients (the VA-posteroinferior cerebellar artery [PICA], 3 cases; basilar artery [BA] fenestration, 1 case; BA-superior cerebellar artery [SCA], 5 cases; and BA tip, 2 cases). RESULTS: Endovascular trapping was performed in 5 VA aneurysms at nonbranching sites, 2 VA-PICA cases with or without revascularization of the PICA, and 1 BA fenestration case. Endosaccular embolization was performed in 2 BA-SCA aneurysms as the sole treatment or after superficial temporal artery-SCA bypass for a broad-necked lesion. Surgical proximal occlusion (PO) with or without revascularization of the PICA was performed in 2 VA cases. Endovascular treatment failed to prevent growth in 1 VA-PICA case and the broad-necked BA-SCA case. Simple flow alteration by PO of 3 BA aneurysms, with gadolinium enhancement on T1-weighted images, did not prevent growth. Maximum flow reduction by various combinations of bypass (superficial temporal artery-posterior cerebral artery or superficial temporal artery-SCA) and BA PO, aimed at reducing hemodynamic stress on the neck, was tailored to 5 cases, including those refractory to PO; it achieved marked shrinkage in 2 cases and stabilization of the aneurysms in 3 cases. The aneurysms harboring neither gadolinium enhancement nor hyperintensity on fluid-attenuated inversion recovery images showed significantly lower growth potential before treatment and a lesser degree of shrinkage after tailored treatment than the remaining cases (P = 0.03 and P = 0.01, respectively). Overall, marked shrinkage was achieved in 27%, moderate shrinkage in 20%, stabilization in 47%, enlargement in 7%, and favorable outcome in 71%. Maximum flow reduction strategy for BA aneurysms tended to show higher shrinking efficacy than endovascular trapping for VA and BA aneurysms (P = 0.08). CONCLUSION: For aneurysms at nonbranching sites, endovascular trapping may be effective, although its shrinking efficacy may be moderate. For the most formidable BA aneurysms at branching sites, maximum flow reduction may cause marked shrinkage, even of aggressive lesions.
• 血行再建術後過灌流 もやもや病の直接バイパス術後におけるSTA流速の経時的変化と術後過灌流の予測

  舟木 健史; 高橋 淳; 飯原 弘二; 佐藤 徹; 森 久恵; 岡崎 貴仁; 佐藤 公俊; 宮本 享

  日本脳神経外科学会総会CD-ROM抄録集 67回 3B - 06 (一社)日本脳神経外科学会 2008年10月 [査読有り]
  
• 三叉神経痛に対するガンマナイフ治療

  森 久恵; 宮本 享; 飯原 弘二; 高橋 淳; 佐藤 徹; 岡崎 貴仁; 佐藤 公俊; 舟木 健史

  日本脳神経外科学会総会CD-ROM抄録集 67回 2J - 02 (一社)日本脳神経外科学会 2008年10月 [査読有り]
  
• [Management of intracranial arteriovenous malformations].

  Susumu Miyamoto; Jun C Takahashi

  Brain and nerve = Shinkei kenkyu no shinpo 60 10 1103 - 13 2008年10月 

  Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into (1) presurgical embolization in large AVMs to occlude deep arterial feeding vessels and (2) embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon.
• 【頭蓋内血行再建のすべて】前方循環に対する血行再建(STA-MCA bypass)

  飯原 弘二; 江頭 裕介; 舟木 健史; 中嶌 教夫; 高橋 淳; 宮本 享

  脳神経外科ジャーナル 17 8 579 - 586 日本脳神経外科コングレス 2008年08月 [査読有り]
   

  前方循環における血行再建術であるSTA-MCA bypass術の適応,手技のスタンダードについて概説した.STA-MCA bypass術は,現在の脳血管障害の手術において最も基本的な手技であり,主な適応は最近の症候性の内頸動脈系の閉塞性疾患である。適応の決定は,PETまたはSPECTによる貧困灌流の証明された例であり,JET studyの登録基準に合致した例にのみ,明らかな手術適応がある.また複雑な脳動脈瘤の治療においても,STA-MCA bypass術は重要な手技であり,確実な結果が最も要求される手技である.ラボでのトレーニングが,基本手技の獲得に必須である.
• Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study.

  Kazunori Toyoda; Masahiro Yasaka; Kazunori Iwade; Ken Nagata; Yukihiro Koretsune; Tomohiro Sakamoto; Shinichiro Uchiyama; Jun Gotoh; Takehiko Nagao; Masahiro Yamamoto; Jun C Takahashi; Kazuo Minematsu

  Stroke 39 6 1740 - 5 2008年06月 [査読有り]
   

  BACKGROUND AND PURPOSE: We sought to determine the incidence and severity of bleeding events in patients with stroke and cardiovascular diseases who were taking oral antithrombotic agents in Japan, where the incidence of hemorrhagic stroke is higher than in Western countries. METHODS: A prospective, multicenter, observational study was conducted; 4009 patients who were taking oral antithrombotic agents for stroke and cardiovascular diseases were enrolled. The patients were classified into 4 groups according to their antithrombotic treatment: the single antiplatelet agent group (47.2%); the dual antiplatelet agent group (8.7%); the warfarin group (32.4%); and the warfarin plus antiplatelet agent group (11.7%). The primary end point was life-threatening or major bleeding according to the MATCH trial definition. RESULTS: During a median follow-up of 19 months, there were 57 life-threatening and 51 major bleeding events, including 31 intracranial hemorrhages. The annual incidence of the primary end point was 1.21% in the single antiplatelet agent group, 2.00% in the dual antiplatelet agent group, 2.06% in the warfarin group, and 3.56% in the warfarin plus antiplatelet agent group (P<0.001). After adjustment for baseline characteristics, adding an antiplatelet agent to warfarin increased the risk of the primary end point (relative risk=1.76; 95% CI, 1.05 to 2.95), and adding another antiplatelet agent to single antiplatelet agent therapy increased the secondary end point of any bleeding, including minor events (relative risk=1.37; 95% CI, 1.07 to 1.76). CONCLUSIONS: The incidence of bleeding events during antithrombotic therapy in Japan was similar to that reported for Western countries, although the trials used different study designs. Dual antithrombotic therapy was independently related to an increased risk of bleeding events.
• 内頸動脈海綿静脈洞部大型・巨大動脈瘤の中長期治療成績

  舟木 健史; 高橋 淳; 飯原 弘二; 毛利 正直; 佐藤 徹; 森 久恵; 高田 英和; 菱川 朋人; 中嶌 教夫; 永田 泉; 宮本 享

  日本脳神経外科学会総会CD-ROM抄録集 66回 1K - 3 (一社)日本脳神経外科学会 2007年10月 [査読有り]
  
• Successful "blind-alley" formation with bypass surgery for a partially thrombosed giant basilar artery tip aneurysm refractory to upper basilar artery obliteration. Case report.

  Jun C Takahashi; Kenichi Murao; Koji Iihara; Yuko Nonaka; Junya Taki; Izumi Nagata; Susumu Miyamoto

  Journal of neurosurgery 106 3 484 - 7 2007年03月 [査読有り]
   

  Partially thrombosed giant aneurysms that are located at the basilar artery (BA) bifurcation and are not amenable to clip application are among the most challenging lesions for neurosurgeons. They compress vital structures such as the brainstem and the thalamus, and the prognosis is extremely poor when they are left untreated. Although obliteration of the upper BA is a promising approach for these aneurysms, some lesions are refractory to this treatment, and effective additional strategies have not been clearly established. The authors report a case treated by placement of clips in the unilateral posterior cerebral artery (PCA) and posterior communicating artery as well as by superficial temporal artery-PCA bypass after unsuccessful upper BA obliteration. Complete thrombosis and dramatic shrinkage of the aneurysm were obtained.
• [Therapeutic strategy for isolated dissecting aneurysms of the posterior inferior cerebellar artery: report of three cases and review of literature].

  Hidenori Seyama; Takeo Nishida; Munetaka Yamamoto; Hisae Mori; Tetsu Satow; Jun Yamada; Norio Nakajima; Jun C Takahashi; Koji Iihara; Kenichi Murao; Susumu Miyamoto

  No shinkei geka. Neurological surgery 34 10 1001 - 6 2006年10月 [査読有り]
   

  Dissecting aneurysm of the posterior inferior cerebellar artery (PICA) is a relatively rare disease and its treatment has not been well established. The authors analyzed the clinical and anatomical features of 38 reported lesions and three of our cases to clarify the "best therapeutic modality". The average age was 45.0 years old and 27 patients were male. Left-sided predominance (26 cases) was noted. As to the mode of onset, 23 cases were subarachnoid hemorrhage, 16 were ischemia, and 6 were Wallenberg's syndrome. Anatomically, the sites of dissection were located in the proximal segment of PICA in 31 lesions (75.6%). Review of the cases show that 30 (75%) patients underwent surgical therapy, and 7 (17.5%) patients underwent endovascular treatment. Twenty six patients who took surgical therapy and 5 patients who took endovascular treatment had excellent or good outcome. The critical point in therapeutic procedure is the preservation of perforating branches arising from PICA, therefore surgical trapping with the revascularization of PICA (usually extracranial-PICA anastomosis), in which these tiny branches are secured under microscopic manipulation, has the advantage in principle.
• The stenting to internal carotid artery stenosis (ICS) in Petrous portion - The evaluation of plaque figures in magnetic resonance image

  K Hayashi; H Seyama; N Yamada; K Murao; K Iihara; JC Takahashi; N Nakajima; T Sayama; M Morimoto; H Mori; M Yamamoto; T Hishikawa; Y Nonaka; J Ayabe; T Kikuchi; M Hyuga; M Ookawa; T Kudo; S Miyamoto

  INTERVENTIONAL NEURORADIOLOGY 12 SUPPL. 1 193 - 196 2006年01月 [査読有り]
   

  In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque. We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI. By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.
• Unruptured paraclinoid aneurysms: a management strategy.

  Koji Iihara; Kenichi Murao; Nobuyuki Sakai; Atsushi Shindo; Hideki Sakai; Toshio Higashi; Shuji Kogure; Jun C Takahashi; Katsuhiko Hayashi; Toshihiro Ishibashi; Izumi Nagata

  Journal of neurosurgery 99 2 241 - 7 2003年08月 [査読有り]
   

  OBJECT: To elucidate an optimal managenent strategy for unruptured paraclinoid aneurysms, the authors retrospectively reviewed their experience in the treatment of 100 patients who underwent 112 procedures for111 paraclinoid aneurysms performed using direct surgery and/or endovascular treatment. METHODS: Between 1997 and 2002, 111 unruptured paraclinoid aneurysms categorized according to a modified al-Rodhan classification (Group la, 30 anterior wall lesions; Group lb, 25 ventral paraclinoid lesions; Group IL 18 true ophthalmic artery lesions; Group III, 37 carotid cave lesions; and Group IV, one transitional lesion) were treated by direct surgery (35 lesions) and/or endovascular treatment (77 lesions) (one aneurysm was treated by both procedures). In lesions in Groups Ia, Ib, II, and III that were treated by endovascular treatment, complete aneurysm obliteration was achieved in 50, 65, 50, and 78%, respectively, and the combined transient and permanent morbidity rates due to cerebral embolic events were 20, 25, 20, and 13.9%, respectively. Overall, the transient morbidity rate after endovascular treatment was 14.3% and the permanent morbidity rate was 6.5%. Notably, permanent visual deficits caused by retinal embolism occurred after endovascular treatment in two patients with Group II aneurysms. Direct surgery was mainly performed in Groups Ia (20 lesions), Ib (five lesions), and II (eight lesions), with complete neck clip occlusion achieved in 80, 80, and 71.4%, respectively; the transient and permanent morbidity rates associated with aneurysms treated by surgery were 8.6 and 2.9%, respectively. CONCLUSIONS: Endovascular therapy for superiorly projecting paraclinoid aneurysms (Groups Ia and II) is associated with lower rates of complete obliteration than direct surgery, and with rates of cerebral embolic events comparable to those of endovascular treatment in the other groups. Furthermore, endovascular treatment for Group II aneurysms entails additional risks of retinal embolism. Therefore, direct surgery is recommended for the treatment of paraclinoid aneurysms projecting superiorly. For other groups, especially for Group III, endovascular treatment is the acceptable first line of therapy.
• [Restenosis after CEA: pathogenesis and treatment].

  Shuji Kogure; Nobuyuki Sakai; Kenichi Murao; Koji Iihara; Hideki Sakai; Toshio Higashi; Jun Takahashi; Katsuhiko Hayashi; Chikao Yutani; Hatsue Ueda; Izumi Nagata

  No shinkei geka. Neurological surgery 30 12 1303 - 12 2002年12月 

  This study examined the incidence and mechanism of restenosis after carotid endarterectomy (CEA) in Japanese patients. To determine the optimal management for carotid restenosis, we retrospectively compared re-CEA with stent placement. One hundred and twenty-six patients who had received 135 CEA with primary suture were studied with angiography or duplex ultra-sonography as a follow-up study to detect restenosis (> 50% diameter reduction). Data was collected regarding demographics of the patients suffering restenosis, including age, sex, other risk factors. Recurrent carotid stenosis (more than 50% stenosis) developed in 9 CEA sites (6.7%) during a mean follow-up interval of 11.0 months (4.7-46.7 months). Recurrent carotid stenosis occurred to a significantly higher degree in women (p = 0.015). There was no significant difference in other risk factors. All patients who developed carotid restenosis were asymptomatic. Re-do CEA and carotid stenting were used to treat restenosis in 3 and 5 patients, respectively. No operative procedure was performed in the remaining one patient with milder restenosis (55%). The 30-day stroke morbidity-mortality rate was 33.3% in CEA and 0% in stent placement. In only one of 4 early restenosis patients, there was a bright lesion in diffusion weighted MR images after stent placement. To treat restenosis after CEA, stent placement is indicated because of a lower risk of distal emboli and there being no need to dissect the previous wound. To prevent restenosis, through plaque removal is necessary and patch closure may be needed especially in females.
• Cerebral hemodynamics and metabolism in patients with cerebral arteriovenous malformations: an evaluation using positron emission tomography scanning.

  Toru Iwama; Kohei Hayashida; Jun C Takahashi; Izumi Nagata; Nobuo Hashimoto

  Journal of neurosurgery 97 6 1314 - 21 2002年12月 [査読有り]
   

  OBJECT: The purpose of this study was to evaluate cerebral hemodynamic and metabolic features in patients with arteriovenous malformations (AVMs) by using positron emission tomography (PET) scanning. METHODS: Twenty-four patients with supratentorial cerebral AVMs participated in PET studies in which 15O inhalation steady-state methods were used. The authors recorded the values of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), the regional oxygen extraction fraction (rOEF), and the regional cerebral metabolic rate of O2 (rCMRO2) at three designated regions of interest (ROIs) in each patient. These ROIs included perilesional (ROI-p), ipsilateral remote (ROI-i), and contralateral symmetrical (ROI-c) brain regions. To identify the factors that exert a direct effect on the hemodynamics of brains affected by AVM, we also separated the lesions according to their size and flow type shown on angiograms, and grouped the patients according to the presence or absence of progressive neurological deficits. We then compared the PET parameters at different ROIs in individual patients and evaluated the mean values obtained for all 24 patients according to AVM flow type and size, and the presence or absence of progressive neurological deficits. CONCLUSIONS: Overall, mean rCBV and rOEF values were significantly higher in ROI-p than in ROI-c (p = 0.00046 and p = 0.015, respectively). No significant differences were seen between the ROI-i and ROI-c with respect to rCBF, rCBV, and rOEF. Mean rCMRO2 values were similar in the three ROIs; however, the mean rCBF was significantly lower in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.019), large AVMs (p = 0.017), and progressive neurological deficits (p = 0.021). Furthermore, the mean rOEF values were significantly higher in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.005), large AVMs (p = 0.019), and progressive neurological deficits (p = 0.017). The PET studies revealed hemodynamic impairment characterized by decreased rCBF and increased rOEF and rCBV values in the ROI-p of patients with large, high-flow AVMs regardless of whether they exhibited progressive neurological deficits.
• Dissecting aneurysms of the vertebral artery: a management strategy.

  Koji Iihara; Nobuyuki Sakai; Kenichi Murao; Hideki Sakai; Toshio Higashi; Shuji Kogure; Jun C Takahashi; Izumi Nagata

  Journal of neurosurgery 97 2 259 - 67 2002年08月 [査読有り]
   

  OBJECT: The authors present a retrospective analysis of their experience in the treatment of vertebral artery (VA) dissecting aneurysms and propose a management strategy for such aneurysms, with special emphasis on the most formidable VA dissecting aneurysms, which involve the origin of the posterior inferior cerebellar artery (PICA). METHODS: Since 1998, 18 patients with VA dissecting aneurysms, 11 of whom presented with subarachnoid hemorrhage (SAH), have been treated by endovascular surgery at the authors' institution. Obliteration of the entire segment of the dissected site with coils (internal trapping) was performed for aneurysms without involvement of the origin of the PICA (12 cases; among these the treatment-related morbidity rate was 16.7%). The treatment strategy applied to PICA-involved VA dissecting aneurysms presenting with SAH (three cases) included proximal occlusion of the parent artery followed by internal trapping of the aneurysm (one case), proximal occlusion of the parent artery followed by occipital artery (OA)-PICA bypass (one case), and two-staged internal trapping of the aneurysm involving double PICAs (one case). For PICA-involved VA dissecting aneurysms that were not associated with SAH at presentation (three cases), OA-PICA bypass was performed and followed by internal trapping of the aneurysm (two cases). In the remaining case in which a fetal-type posterior communicating artery was present, internal trapping was performed following successful balloon test occlusion (BTO). Overall, there was no sign of infarction in the PICA territory, despite complete occlusion of aneurysms involving the PICA. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. The overall treatment-related morbidity rate for the VA dissecting aneurysms involving the PICA was 16.7%. CONCLUSIONS: Dissecting VA aneurysms that do not involve the PICA can be safely treated by internal trapping. For those lesions that do involve the PICA, a decision-making algorithm is advocated to maximize the efficacy of the treatment as well as to minimize the risks of treatment-related morbidity based on BTO.
• Multiple supra-aortic stenting for Takayasu arteritis: extensive revascularization and two-year follow-up.

  Jun C Takahashi; Nobuyuki Sakai; Hiroshi Manaka; Koji Iihara; Hideki Sakai; Hiroshi Sakaida; Toshio Higashi; Toshihiro Ishibashi; Izumi Nagata

  AJNR. American journal of neuroradiology 23 5 790 - 3 2002年05月 [査読有り]
   

  A patient with Takayasu arteritis with multiple supra-aortic lesions underwent successful treatment with two-staged stent implantation. Stenotic bilateral common carotid, innominate, and left subclavian arteries were dilated, and no restenosis was observed during the follow-up period of 2 years despite recurrent inflammation. Stenting for supra-aortic vessels in cases of Takayasu arteritis has rarely been reported, and to our knowledge, this is the first report of multiple stent placement for all the supra-aortic branches involved.
• [Embolic complications associated with neurovascular intervention: prospective evaluation by use of diffusion-weighted MR imaging].

  Hideki Sakai; Nobuyuki Sakai; Toshio Higashi; Koji Iihara; Jun Takahashi; Shuji Kogure; Ryogo Anei; Naoaki Yamada; Satoshi Imakita; Izumi Nagata

  No shinkei geka. Neurological surgery 30 1 43 - 9 2002年01月 

  The most serious complication of neurovascular interventions is distal cerebral embolism. Diffusion-weighted MR imaging (DWI) appears to be the most sensitive technique for detecting early and small ischemic lesions. To evaluate the incidence and radiological features of embolic events associated with neuro-intervention, we applied DWI to screening for procedure-related ischemic lesions including silent embolisms. One hundred and thirty-seven patients who have received 154 neuro-interventional procedures were studied with DWI before and within 5 days after treatment. Imaging was performed, using single-shot echo-planar imaging with b value of 1000-1100 sec/mm2. DWI findings were classified into 5 groups by size and location of lesions: type 0 (n = 71), no lesions; I (n = 33), lesions in border-zone regions only; II (n = 9), lesions at perforator territories mainly; III (n = 29), small territorial lesions (< 5 mm); IV (n = 12), large territorial lesions (> or = 5 mm). DWI detected procedure-related lesions in 83 of 154 procedures (53.9%), 36 of which demonstrated new neurological symptoms during and/or after procedures. The parent artery occlusion for cerebral aneurysms had a higher incidence of symptomatic embolisms than other procedures. In 71 of 154 procedures (46.1%), DWI detected no lesions (type 0). Although type I was the most frequent pattern presented, it included few neurological symptoms. Type III often resulted in transient symptoms, and type II and IV tended to induce strokes. Because ischemic lesions detected by DWI were likely to arise in border-zone territories by parent artery occlusions, we considered that hypoperfusion as well as emboli were involved in the evolution of cerebral infarctions. Thus, DWI is a useful method to detect silent embolisms, and to determine the safety of neuro-intervention and the mechanism of embolic ischemia.
• Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa. Case report.

  Jun C Takahashi; Nobuyuki Sakai; Koji Iihara; Hideki Sakai; Toshio Higashi; Shuji Kogure; Ayumi Taniguchi; Hatsue I Ueda; Izumi Nagata

  Journal of neurosurgery 96 1 132 - 4 2002年01月 [査読有り]
   

  Polyarteritis nodosa (PAN) is a rare systemic necrotizing arteritis that involves small- and medium-sized arteries in various organs. Although aneurysm formation in visceral arteries is a typical finding in PAN, intracranial aneurysms are much less common, and only a few cases of aneurysm rupture associated with this disease have been documented. In this paper, the authors report on a ruptured PAN aneurysm of the anterior cerebral artery; the lesion was trapped and resected. On histological examination, extensive fibrinoid necrosis and an inflammatory infiltration of leukocytes were seen in the aneurysm wall. To the authors' knowledge this is the first report of subarachnoid hemorrhage from a histologically confirmed PAN aneurysm.
• 無症候性未破裂脳動脈瘤の治療成績・術後合併症

  間中 浩; 坂井 信幸; 永田 泉; 中原 一郎; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 太田 元; 石澤 錠二; 森実 飛鳥; 安粂 良悟; 新堂.敦; 川端 康弘; 菊池 晴彦

  脳卒中の外科 29 6 414 - 419 日本脳卒中の外科学会 2001年11月 

  Many asymptomatic non-ruptured intracranial aneurysms are detected by non-invasive radiological examinations. On the other hand, the question has arisen whether surgical treatment of them is justifiable or not because their natural history is not clear. Therefore, we should discuss with patients the possible risk of surgical treatment when they decide to undergo surgery. We retrospectively investigated treatment results and surgical complications involving asymptomatic non-ruptured intracranial aneurysms. From Jan. 1998 to Dec. 1999, we treated 151 patients (56 male, 95 female) aged 22-77 (mean 58.4), with 201 non-ruptured asymptomatic intracranial saccular aneurysms, excluding multiple aneurysms combined with subarachnoidal hemorrhage, within 6 months of onset. Our policy was that surgical treatment was indicated if the aneurismal size was over 3-4 mm, the patient's age was under 70, and their general condition was satisfactory. Neck clipping was the first choice of the surgical treatment. Direct surgery was difficult for such aneurysms as internal carotid artery aneurysm arising near the dural ring, those involving posterior circulation and those of a large-size. Such aneurysms were treated with intravascular embolization if possible. We evaluated the surgical risk by the number of the operations (169 cases). Permanent morbidity resulted in 7 cases of the 112 direct surgery (6.3%) and 3 cases of the 56 cases of intravascular embolization (5.6%). No deaths resulted. The causes for the morbidity were brain damage or cranial nerve injury at the approach, a perforating artery injury or occlusion of the parent artery at the clipping in the direct surgery, and distal embolism and perforating artery occlusion in the intravascular embolization. The risk factor of the patients with postoperative neurological deficits was the aneurismal size (>10mm, p<0.05) with no relation to the age over 70, preoperative ischemic complication of the brain, the triple major risk factors for arteriosclerosis (hypertension, diabetes mellitus, hyperlipidemia) or aneurysmal location. Transient or minor surgical complications were found in 58 cases (34.3%). The prognosis of severe subarachnoidal hemorrhage caused by the rupture of the aneurysm is poor, and surgical therapy for non-ruptured aneurysm over 10 mm in size is difficult. We have, therefore, decided not to change our treatment policy. However, even for transient or minor complications, surgical risk is accompanied with the treatment of cerebral aneurysm. We should seek to reduce such surgical complications by analyzing their causes.
• 脳虚血の治療 Carotid Stenting時のDistal Protection Systemの有用性 Protection時に採取したcarotid plaque debrisの検討

  大田 元; 東 登志夫; 坂井 信幸; 中原 一郎; 酒井 秀樹; 阪井田 博司; 飯原 弘二; 木暮 修治; 高橋 淳; 長嶺 知明; 新堂 敦; 安栄 良吾; 副田 明男; 谷口 歩; 永田 泉; 菊池 晴彦

  The Mt. Fuji Workshop on CVD 19 178 - 180 (株)にゅーろん社 2001年07月 

  頸部内頸動脈(ICA)狭窄症の24例25病変を対象とした.本研究よりprotection手技中,回収した血液からcarotid plaque debrisが検出できdistal embolismは高頻度で起こるという認識が必要である.又,頸部ICA狭窄に対するステント留置術中,特に拡張時にdistal protection systemは必須であり有効と思われた
• 頸部頸動脈狭窄に対するstenting

  中原 一郎; 坂井 信幸; 永田 泉; 柳本 広二; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 名村 尚武; 高橋 淳; 大田 元; 石澤 錠二; 間中 浩; 森実 飛鳥; 川端 康弘; 新堂 敦; 安榮 良悟; 菊池 晴彦

  脳神経外科ジャーナル 10 7 445 - 453 日本脳神経外科コングレス 2001年07月 

  87例の症候性或いは無症候性の高度狭窄病変に対するstentingの手技成功率は97.7%で,ステントが留置できた症例においてはいずれも十分な拡張が得られた.合併症はいずれも血栓塞栓症に起因しており,永続性2.3%,一過性8.0%であった.適応決定における頸部エコー上のプラーク性状評価の重視,distal protective balloonの導入,形態上の完全拡張を企図しない,等の配慮に加え,又,主義の習熟と共に合併症率の低減が得られた
• 感染を契機に痴呆症状を発症したmultiple dural arteriovenous fistulasの1例

  川端 康弘; 下鶴 哲郎; 坂井 信幸; 中原 一郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 石澤 錠二; 間中 浩

  北野病院紀要 45 3〜4 209 - 215 (公財)田附興風会医学研究所北野病院 2000年12月 [査読有り]
  
• 頭頸部主幹動脈狭窄におけるステント留置

  中原 一郎; 坂井 信幸; 柳本 広二; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 名村 尚武; 高橋 淳; 大田 元; 石澤 錠二; 間中 浩; 森実 飛鳥; 川端 康弘; 永田 泉; 菊池 晴彦

  脈管学 40 11 881 - 886 (一社)日本脈管学会 2000年11月 

  頭頸部主幹動脈狭窄にステント留置を行った115例を対象に,手技上の特徴,注意点,頭頸部特有の問題点について検討した.手技成功率は高く,留置できた症例では良好な開存が得られた.合併症としては,頸部頸動脈狭窄における血管塞栓症が主であった.頸部頸動脈では後半の症例にprotective balloon systemを導入したところ,症候群合併症を認めなかった
• Embolic complications of endovascular surgery for cerebrovascular diseases - Evaluation with diffusion-weighted MR imaging

  H Sakai; N Sakai; Nakahara, I; T Shimozuru; T Higashi; JC Takahashi; H Ohta; J Kokuzawa; H Manaka; A Morizane; Y Kawabata; Nagata, I; H Kikuchi

  INTERVENTIONAL NEURORADIOLOGY 6 SUPPL. 1 223 - 226 2000年11月 [査読有り]
   

  The purpose of this study was to evaluate asymptomatic embolisms during cerebral endovascular surgery for cerebrovascular diseases with diffusion-weighted magnetic resonance imaging (DWI) which allowed sensitive and early detection of cerebral ischemic lesions. 71 patients who underwent a total of 74 cerebral endovascular procedures were subjected to DWI screening Study. MR imaging was performed on a 1.5T system by using single-shot SE echo-planar imaging (EPI) with b value of 1100 seconds per mm(2) in pre- and post-treatment periods (between day 2 and 5 after procedures). In 38 (51.3%) of 74 procedures, new high intensify lesions, as recent infarctions related to procedures, were detected on post-procedural DWI. In 18 Of the patients (47.4%), symptomatic infarctions occurred and resulted in TIAs (n = 4), RINDs (n = 8), minor strokes (n = 6) and no major strokes and MO death. 20 (52.6%) of the recent infarctions detected by DWI were asymptomatic lesions. Most of the asymptomatic ischemic lesions were likely to be distributed in watershed border areas On the other hand, symptomatic lesions tended to be distributed in cortical and/or perforator regions and to be multiple. Thus, DWI is a useful method that can detect neurologically silent and asymptomatic ischemic lesions. It can be used to help to evaluate the safety and efficacy of neurovascular intervention.
• Carotid stenting時のdistal protection systemの有用性 protection時に採取したplaque debrisの検討

  大田 元; 東 登志夫; 坂井 信幸; 中原 一郎; 酒井 秀樹; 高橋 淳; 新堂 敦; 安栄 良悟; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 100 - 100 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• 頸部頸動脈狭窄症に対する血行再建術 ステント留置術開始後の成績

  坂井 信幸; 永田 泉; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 安榮 良悟; 新堂 敦; 中原 一郎; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 116 - 116 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• ステント併用血管形成術における再治療の適応と実際

  東 登志夫; 坂井 信幸; 中原 一郎; 酒井 秀樹; 高橋 淳; 大田 元; 安栄 良悟; 新堂 敦; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 330 - 330 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• 脳動脈瘤GDC塞栓術後の再開通と再治療に関する検討

  副田 明男; 坂井 信幸; 中原 一郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 新堂 敦; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 100 - 100 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• 血管内手術と直達手術を併用した脳動脈瘤の治療

  新堂 敦; 坂井 信幸; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 安榮 良悟; 中原 一郎; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 178 - 178 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• Large & giant BA-top aneurysmに対する血管内治療

  坂井 信幸; 滝 和郎; 中原 一郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 村尾 健一; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 328 - 328 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• 脳動脈瘤GDC塞栓術におけるadjunct techniqueの実際

  東 登志夫; 坂井 信幸; 中原 一郎; 酒井 秀樹; 高橋 淳; 大田 元; 新堂 敦; 安栄 良悟; 永田 泉; 菊池 晴彦

  日本脳神経外科学会総会抄録集 59回 329 - 329 (一社)日本脳神経外科学会 2000年10月 [査読有り]
  
• SPECTで貧困灌流はどこまでdetectできるか

  高橋 淳; 中原 一郎; 坂井 信幸; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 大田 元; 石澤 錠二; 間中 浩; 新堂 敦

  脳循環代謝 12 3 198 - 198 (一社)日本脳循環代謝学会 2000年09月 [査読有り]
  
• Brain Attack最前線 直達手術か血管内手術か(2) 急性期破裂脳動脈瘤塞栓術の治療成績

  坂井 信幸; 滝 和郎; 中原 一郎; 村尾 健一; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 石澤 錠二; 間中 浩; 森実 飛鳥; 川端 康弘; 永田 泉; 菊池 晴彦

  The Mt. Fuji Workshop on CVD 18 156 - 159 (株)にゅーろん社 2000年07月 

  1)離脱型コイル(主にGDC)を用いた急性期破裂脳動脈瘤塞栓術を,重症例(高齢者,全身状態,重症)や直達手術困難例(部位,大きさ)57例に行った.完全閉塞は瘤内塞栓術の70.5%にとどまり,特に大型動脈瘤の完全閉塞は困難でcoil compactionによる再開通が生じうるが,再増大はなかった.2)手技に起因する合併症は,出血3例,塞栓症5例,分枝閉塞1例で,予後不良につながったものは3例であった.3)症候性脳血管攣縮期の発生率は18.4%,うち予後悪化につながったものは6.1%であった.同時期の直達手術では,症候性脳血管攣縮期の発生率は37.5%,うち予後悪化につながったもの14.0%で,血管内手術の方がやや少ない傾向があったが,統計学的有意差はなかった.4)症候性脳血管攣縮を呈して入院した症例に対する脳動脈瘤塞栓術と攣縮血管拡張術の同時治療は血管内手術のよい適応となりうる
• 頸部頸動脈狭窄症に対するステント留置術における血管内超音波検査の意義

  石澤 錠二; 坂井 信幸; 中原 一郎; 酒井 秀樹; 高橋 淳; 東 登志夫; 大田 元; 永田 泉; 菊池 晴彦

  Neurosonology 13 増刊 36 - 36 (一社)日本脳神経超音波学会 2000年06月 [査読有り]
  
• 血管内治療直後の経頭蓋超音波ドップラー法によるHITSの検出について 術後後療法の効果の確認として

  大田 元; 酒井 秀樹; 中原 一郎; 坂井 信幸; 下鶴 哲郎; 東 登志夫; 高橋 淳; 石澤 錠二; 間中 浩; 新堂 敦

  Neurosonology 13 増刊 54 - 54 (一社)日本脳神経超音波学会 2000年06月 [査読有り]
  
• Adenovirus-mediated gene transfer of basic fibroblast growth factor promotes the survival of primary-cultured rat neuronal cells

  Norihiro Matsuoka; Shin-Ichi Miyatake; Hiroyuki Yukawa; Jun C. Takahashi; Masaaki Saiki; Hisae Mori; Kazuhiro Ishii; Masayuki Akimoto; Hirofumi Hamada; Nobuo Hashimoto

  NeuroReport 11 9 2001 - 2006 2000年06月 [査読有り]
  
• Adenoviral gene transfer of basic fibroblast growth factor promotes angiogenesis in rat brain

  YUKAWA H

  Gene Ther 7 11 942 - 949 2000年06月 [査読有り]
  
• 無症候性頸動脈狭窄症に対する血行再建術 : Stentingの現状をCEAと対比して(<特集>無症候性頸動脈狭窄症に対する外科治療)

  坂井 信幸; 永田 泉; 秋山 義典; 中原 一郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 石澤 錠二; 間中 浩; 林 直樹; 森実 飛鳥; 橋本 信夫; 菊池 晴彦

  脳卒中の外科 28 3 184 - 187 日本脳卒中の外科学会 2000年05月 

  Several large randomized multicenter trials have demonstrated the beneficial effects of carotid endarterectomy (CEA) for prevention of strokes in patients with severe symptomatic or asymptomatic carotid artery stenosis. On the other hand, endovascular treatments are rapidly evolving as alternatives to CEA, but indication for endovascular treatment remain uncertain and long-term results have not yet been established. We experienced 59 consecutive patients with asymptomatic carotid artery stenosis treated with CEA in 5 recent years, and 14 patients with asymptomatic carotid artery stenosis treated with stenting since 1997. One minor stroke (1.7%, hemiparesis and aphasia) and 1 transient neurological event occurred after CEA, and one major stroke (7.1%, hemiplegia) occurred during stenting by distal embolic occlusion of MCA and ACA. There were no neurological events after either CEA or stenting, but distal embolic signals were detected in all patients with TCD during stenting, and embolic lesions were detected in more than half the patients with MRI/DWI after stenting. We consider that cerebral protection by means of balloon is mandatory to eliminate embolic complication in the endovascular treatment of carotid artery stenosis. Stenting for asymptomatic carotid artery stenosis can now be indicated only for surgically high-risk patients who are very old, have severe heart or pulmonary disease, contraindication to general anesthesia, high-positioned stenosis, restenosis after CEA or PTA, or radiation-induced stenosis.
• 脳血管外科におけるdecision-making 頸部頸動脈狭窄に対するstentingの適応

  中原 一郎; 坂井 信幸; 柳本 広二; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 名村 尚武; 高橋 淳; 大田 元; 石澤 錠二

  脳神経外科ジャーナル 9 4 272 - 272 日本脳神経外科コングレス 2000年04月 [査読有り]
  
• A case of endovascular embolization of BA-SCA saccular aneurysm associated with SCA fusiform aneurysm

  H. Manaka; H. Sakai; I. Nakahara; N. Sakai; H. Yanamoto; Y. Akiyama; T. Higashi; J. C. Takahashi; J. Kokuzawa; N. Hayashi; A. Morizane; I. Nagata; H. Kikuchi

  Japanese Journal of Neurosurgery 9 11 738 - 742 2000年 [査読有り]
   

  A 52-year-old male who complained of a headache was admitted to our hospital. A left basilar artery-superior cerebral artery (BA-SCA) saccular aneurysm and a left distal SCA fusiform aneurysm were detected. As the high position BA-SCA aneurysm was difficult to treat with direct surgery, coil embolization was selected. By inserting a microcatheter into the left SCA, we were able to examine the collateral flows of the distal SCA (occlusion test). After the occlusion test, the BA-SCA aneurysm was totally embolized with detachable coils including the orifice of the left SCA. Using these strategies, we were able to safely treat both aneurysms after the collateral flow of the distal SCA was evaluated by endovascular surgery.
• 研修医のためのクリニカルカンファレンス 頸動脈病変のステント留置における超音波診断の意義

  石澤 錠二; 中原 一郎; 坂井 信幸; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 間中 浩; 森実 飛鳥; 新堂 敦; 川端 康弘; 永田 泉; 山上 宏; 菊池 晴彦

  脳神経外科速報 9 12 1023 - 1029 (株)メディカ出版 1999年12月
• ステント手術最近の進歩 頭頸部主幹動脈狭窄におけるステント留置

  中原 一郎; 坂井 信幸; 柳本 広二; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 名村 尚武; 高橋 淳; 大田 元; 石澤 錠二

  脈管学 39 10 616 - 616 (一社)日本脈管学会 1999年10月 [査読有り]
  
• [Endovascular surgery for untreated ruptured aneurysm with symptomatic vasospasm]

  Morizane A; Nakahara I; Sakai N; Yanamoto H; Akiyama Y; Sakai H; Higashi T; Namura S; Takahashi J; Nishizaki J; Kokuzawa J; Manaka H; Hayashi N; Nagata I; Kikuchi H

  NEUROLOGICAL SURGERY 27 10 941 - 946 1999年10月 [査読有り]
   

  It is difficult to treat ruptured aneurysms with symptomatic vasospasm. Although direct surgery for such cases is associated with poor outcomes, conservative therapy has the risk of both rerupture and infarction. In two cases of ruptured aneurysms with symptomatic vasospasm, we performed aneurysmal coil embolization with Guglielmi electrodetatchable coils (GDC). At the same time we performed percutaneous transluminal angioplasty (PTA) with papaverine infusion. In both cases, rerupture did nor occur and PTA was effective angiographically. A good outcome was achieved in case 1. However, broad cerebral infarction occurred in case 2, in which the patient had shown severe symptomatic vasospasm on admission. In advanced cases, such as in case 2, the outcome is poor. The aneurysm may not be able to be approached before PTA because of severe vasospasm. In such cases, PTA must be performed carefully to avoid aneurysmal rerupture. Intraarterial papaverine infusion is safer than PTA for severe spasm in distal vessels. However the efficacy of papaverine is known to be transient in many cases. It is often difficult to determine the exact relationship between branches and the aneurysm in the presence of vasospasm. In such cases, we recommend that the rupture point be packed and that the aneurysmal neck remain unpacked. After vasospasm is cured and good general condition has been recovered, direct surgery can be performed. In summary, endovascular surgery is an effective option for treatment of ruptured aneurysm with symptomatic vasospasm.
• Adenovirus-mediated gene transfer of a truncated form of fibroblast growth factor receptor inhibits growth of glioma cells both in vitro and in vivo.

  Masaaki Saiki; Tatsuo Mima; Jun C. Takahashi; Shoichi Tani; Hiroyuki Yukawa; Hikaru Ueno; Takashi Mikawa; Nobuyuki Itoh; Haruhiko Kikuchi; Nobuo Hashimoto; Shin-Ichi Miyatake

  Journal of Neuro-Oncology 44 3 195 - 203 1999年 [査読有り]
  
• Nitric oxide synthase immunoreactivity related to cold-induced brain edema

  Kazuo Gotoh; Haruhiko Kikuchi; Hideo Kataoka; Izumi Nagata; Kazuhiko Nozaki; Jun Takahashi; Fumitada Hazama

  Neurological Research 20 7 637 - 642 1998年10月 [査読有り]
  
• In vitro growth suppression of vascular smooth muscle cells using adenovirus-mediated gene transfer of a truncated form of fibroblast growth factor receptor

  Hiroyuki Yukawa; Shin-Ichi Miyatake; Masaaki Saiki; Jun C Takahashi; Tatsuo Mima; Hikaru Ueno; Izumi Nagata; Haruhiko Kikuchi; Nobuo Hashimoto

  Atherosclerosis 141 1 125 - 132 1998年10月 [査読有り]
  
• Adenovirus-mediated gene transfer of basic fibroblast growth factor induces in vitro angiogenesis

  J Takahashi

  Atherosclerosis 132 2 199 - 205 1997年07月 [査読有り]
  
• Altered nitric oxide synthase immunoreactivity in the brain of stroke-prone spontaneously hypertensive rats

  Kazuo Gotoh; Haruhiko Kikuchi; Hideo Kataoka; Izumi Nagata; Kazuhiko Nozaki; Jun C. Takahashi; F. Hazama

  Acta Neuropathologica 92 2 123 - 129 1996年07月 [査読有り]
  

MISC

• High Systolic Blood Pressure Variability After Successful Reperfusion Therapy in Acute Ischemic Stroke Predicts Unfavorable Outcomes

  Satoshi Hosoki; Kaori Miwa; Takeshi Yoshimoto; Kanta Tanaka; Hajime Ikenouchi; Tadataka Mizoguchi; Shunsuke Kimura; Tetsuya Chiba; Tetsu Satow; Jun C. Takahashi; Kazunori Toyoda; Masafumi Ihara; Masatoshi Koga STROKE 51 2020年02月
• 頸部血管エコーが治療判断に有用であった頭蓋外椎骨動脈解離による脳底動脈閉塞の1例

  千葉哲矢; 千葉哲矢; 高下純平; 吉村壮平; 吉本武史; 田中寛大; 田中寛大; 山口枝里子; 山口枝里子; 佐藤徹; 西村真樹; 西村真樹; 高橋淳; 豊田一則; 古賀政利 日本脳神経超音波学会総会プログラム・抄録集 39th 2020年
• 【脳神経外科救急医療】急性期脳梗塞に対する血栓回収療法の現状と近未来

  山上 宏; 田中 寛大; 吉本 武史; 佐藤 徹; 高橋 淳; 井上 学; 古賀 政利; 猪原 匡史; 豊田 一則 脳神経外科ジャーナル 28 (9) 552 -560 2019年09月
• 小児もやもや病の手術法と長期成績 小児もやもや病における成人後出血転化例の脳血管撮影の特徴

  舟木 健史; 高橋 淳; 宮本 享 小児の脳神経 44 (2) 147 -147 2019年04月 [査読有り]
  
• 小児もやもや病に対する前・後大脳動脈領域への直接血行再建 周術期および中期治療成績の検証

  舟木 健史; 高橋 淳; 宮本 享 小児の脳神経 44 (1) 16 -22 2019年03月 [査読有り]
  
• 【出血性脳血管障害】出血型もやもや病治療の新たな展開

  舟木 健史; 高橋 淳; 宮本 享; JAM Trial Group 脳神経外科ジャーナル 28 (3) 149 -155 2019年03月 [査読有り]
  
• 小児もやもや病診断・治療の進歩と長期予後 小児もやもや病の成人後の遅発性脳血管イベントおよび社会的予後

  舟木 健史; 高橋 淳; 宮本 享 The Mt. Fuji Workshop on CVD 36 13 -19 2018年07月 [査読有り]
  
• 小児出血発症もやもや病に対する直接血行再建

  舟木 健史; 高橋 淳; 宮本 享 小児の脳神経 43 (2) 251 -251 2018年04月 [査読有り]
  
• 内胸動脈グラフトCABG後の鎖骨下動脈狭窄症に対するstentingの有効性

  橋村 直樹; 佐藤 徹; 丸山 大輔; 伊藤 嘉朗; 濱野 栄佳; 田中 俊一; 築家 秀和; 石黒 太一; 松原 博文; 小野 功朗; 高橋 淳 脳血管内治療 2 (Suppl.) S331 -S331 2017年11月
• 未破裂脳動脈瘤コイル塞栓術の長期治療成績

  小柳 正臣; 石井 暁; 今村 博敏; 佐藤 徹; 吉田 和道; 長谷川 仁; 菊池 隆幸; 武信 洋平; 高橋 淳; 中原 一郎; 坂井 信幸; 宮本 享 脳血管内治療 2 (Suppl.) S14 -S14 2017年11月
• 最終未発症から6時間以降の前方循環系脳主幹動脈閉塞症に対する再開通療法 発症形式による治療成績の比較

  伊藤 嘉朗; 佐藤 徹; 山上 宏; 濱野 栄佳; 築家 秀和; 石黒 太一; 園田 和隆; 松原 博文; 小野 功朗; 豊田 一則; 猪原 匡史; 高橋 淳 脳血管内治療 2 (Suppl.) S130 -S130 2017年11月
• OnyxとNBCAの相補的使用によるAVM塞栓術での有用性と安全性の両立

  佐藤 徹; 濱野 栄佳; 伊藤 嘉朗; 松原 博文; 石黒 太一; 築家 秀和; 橋村 直樹; 小野 功朗; 森 久恵; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S32 -S32 2017年11月
• ステント導入後における未破裂脳動脈瘤コイル塞栓術後の長期治療成績と再発因子についての検討

  小野 功朗; 佐藤 徹; 石黒 太一; 築家 秀和; 濱野 栄佳; 伊藤 嘉朗; 森 久恵; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S90 -S90 2017年11月
• 高齢者くも膜下出血における塞栓術の特徴と治療選択に関する検討

  濱野 栄佳; 佐藤 徹; 伊藤 嘉朗; 石黒 太一; 築家 秀和; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S91 -S91 2017年11月
• 硬膜動静脈瘻に対する単回根治を目指した血管内治療の成績

  石黒 太一; 佐藤 徹; 濱野 栄佳; 松原 博文; 伊藤 嘉朗; 丸山 大輔; 田中 俊一; 築家 秀和; 橋村 直樹; 小野 功朗; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S100 -S100 2017年11月
• 未破裂脳動脈瘤塞栓術における術中血栓症とその対策

  佐藤 徹; 松原 博文; 伊藤 嘉朗; 濱野 栄佳; 石黒 太一; 築家 秀和; 橋村 直樹; 小野 功朗; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S130 -S130 2017年11月
• 破裂脳動脈瘤塞栓術における術中血栓形成の相関因子と対処法

  松原 博文; 佐藤 徹; 伊藤 嘉朗; 丸山 大輔; 濱野 栄佳; 田中 俊一; 石黒 太一; 築家 秀和; 橋村 直樹; 小野 功朗; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S139 -S139 2017年11月
• 中大脳動脈開存を伴う軽症急性内頸動脈閉塞症に対する血管内治療

  築家 秀和; 佐藤 徹; 山上 宏; 伊藤 嘉朗; 濱野 栄佳; 石黒 太一; 園田 和隆; 片岡 大治; 猪原 匡史; 豊田 一則; 高橋 淳 脳血管内治療 2 (Suppl.) S176 -S176 2017年11月
• 頭部外傷に伴い発生した中頭蓋窩動静脈瘻の1例

  小磯 隆雄; 伊藤 嘉朗; 佐藤 徹; 石黒 太一; 築家 秀和; 濱野 栄佳; 森 久恵; 片岡 大治; 高橋 淳 脳血管内治療 2 (Suppl.) S253 -S253 2017年11月
• もやもや病を究める もやもや病の手術成績 中長期予後へのインパクト

  高橋 淳; 濱野 栄佳; 片岡 大治; 舟木 健史; 宮本 享 脳循環代謝 29 (1) 147 -147 2017年11月
• 小児もやもや病の手術法 小児もやもや病に対する直接血行再建 特に前・後大脳動脈領域への直接血行再建手技について

  舟木 健史; 高橋 淳; 宮本 享 小児の脳神経 42 (2) 190 -190 2017年04月 [査読有り]
  
• 急性期脳主幹動脈閉塞に対する血管内治療後の転帰良好例における早期症候改善についての検討

  船津奈保子; 船津奈保子; 早川幹人; 山上宏; 吉本武史; 園田和隆; 佐藤徹; 高橋淳; 長束一行; 豊田一則 脳循環代謝(Web) 28 (2) 257 -263 2017年
• 急性期脳主幹動脈閉塞に対する血管内治療後の症状改善時期に関する検討

  船津 奈保子; 早川 幹人; 山上 宏; 吉本 武史; 園田 和隆; 佐藤 徹; 高橋 淳; 長束 一行; 豊田 一則 脳循環代謝 28 (1) 183 -183 2016年11月
• Stent retrieverによる血栓回収術後のくも膜下出血に関する検討

  早川 幹人; 山上 宏; 船津 奈保子; 園田 和隆; 吉本 武史; 塩澤 真之; 日野 天祐; 奥野 善教; 佐藤 徹; 高橋 淳; 長束 一行; 豊田 一則 脳血管内治療 1 (Suppl.) S76 -S76 2016年11月
• 症候性のBorden type I硬膜動静脈瘻は経過観察でよいか?

  江口 盛一郎; 佐藤 徹; 濱野 栄佳; 丸山 大輔; 伊藤 嘉朗; 織田 祥至; 田中 俊一; 松原 博文; 福本 博順; 片岡 大治; 高橋 淳 脳血管内治療 1 (Suppl.) S23 -S23 2016年11月
• Terminal type動脈瘤に対するstent非使用コイル塞栓術の成績

  松原 博文; 佐藤 徹; 丸山 大輔; 伊藤 嘉朗; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 田中 俊一; 福本 博順; 片岡 大治; 高橋 淳 脳血管内治療 1 (Suppl.) S240 -S240 2016年11月
• 瘤内塞栓を行わずに血管内治療で根治し得た椎骨動脈部分血栓化巨大動脈瘤の1例

  佐藤 徹; 植松 幸大; 江口 盛一郎; 丸山 大輔; 濱野 栄佳; 織田 祥至; 伊藤 嘉朗; 田中 俊一; 松原 博文; 片岡 大治; 高橋 淳 脳血管内治療 1 (Suppl.) S39 -S39 2016年11月
• 発症または最終未発症時刻から6時間以上の血行再建術の治療成績

  伊藤 嘉朗; 佐藤 徹; 早川 幹人; 山上 宏; 丸山 大輔; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 田中 俊一; 片岡 大治; 豊田 一則; 高橋 淳 脳血管内治療 1 (Suppl.) S76 -S76 2016年11月
• 破裂椎骨動脈解離性動脈瘤に対する母血管閉塞を主軸とした治療戦略の有用性

  織田 祥至; 佐藤 徹; 丸山 大輔; 伊藤 嘉朗; 濱野 栄佳; 江口 盛一郎; 田中 俊一; 松原 博文; 福本 博順; 片岡 大治; 高橋 淳 脳血管内治療 1 (Suppl.) S83 -S83 2016年11月
• MRAによるステント支援下脳動脈瘤塞栓術後評価の検討

  田中 俊一; 佐藤 徹; 濱野 栄佳; 丸山 大輔; 織田 祥至; 江口 盛一郎; 伊藤 嘉朗; 松原 博文; 福本 博順; 片岡 大治; 高橋 淳 脳血管内治療 1 (Suppl.) S127 -S127 2016年11月
• ハイブリッド手術室を用いた脳動脈瘤複合治療 バイパス術支援下コイル塞栓術

  濱野 栄佳; 佐藤 徹; 丸山 大輔; 伊藤 嘉朗; 織田 祥至; 江口 盛一郎; 田中 俊一; 片岡 大治; 飯原 弘二; 高橋 淳 脳血管内治療 1 (Suppl.) S214 -S214 2016年11月
• 皮質静脈逆流を伴う硬膜動静脈瘻における脳血液量補正を改良した15O標識ガス吸入PET検査による新たな周術期脳循環代謝評価

  丸山 大輔; 佐藤 徹; 伊藤 嘉朗; 濱野 栄佳; 織田 祥至; 江口 盛一郎; 田中 俊一; 片岡 大治; 中川原 譲二; 高橋 淳 脳血管内治療 1 (Suppl.) S262 -S262 2016年11月
• 頸動脈内膜剥離術(CEA)術後における経口腔頸動脈超音波検査(TOCU)の有用性

  木下 直人; 斎藤 こずえ; 山上 宏; 吉本 武史; 和田 晋一; 古賀 政利; 片岡 大治; 高橋 淳; 豊田 一則; 長束 一行 Neurosonology 29 (増刊) 98 -98 2016年06月
• Correlation Between Collateral Circulations, Cerebral Metabolisms and Posterior Cerebral Artery Stenoses or Occlusions in Moyamoya Disease.

  Seiichiro Eguchi; Jyoji Nakagawara; Sei Sugata; Daisuke Maruyama; Eika Hamano; Yoji Orita; Tetsu Satow; Hiroharu Kataoka; Jun Takahashi STROKE 47 2016年02月
• Selection and Outcomes of Multimodality Interventional Treatment for Unruptured Arteriovenous Malformations in a Single Institution

  Daisuke Maruyama; Hisae Mori; Tetsu Satow; Hiroharu Kataoka; Sei Sugata; Eika Hamano; Yoji Orita; Seiichiro Eguchi; Jun Takahashi STROKE 47 2016年02月
• The Clinical Utility of Contrast Enhanced Ultrasound Detecting Disrupted Carotid Plaques

  Shuichi Tonomura; Kozue Saito; Hatsue Ishibashi-Ueda; Soichiro Abe; Kota Mori; Rie Motoyama; Hiroshi Yamagami; Hiroharu Kataoka; Jun C. Takahashi; Koji Iihara; Kazunori Toyoda; Kazuyuki Nagatsuka STROKE 47 2016年02月
• Cerebrovascular Accidents in Patients With a Left Ventricular Assist Device

  Yuichi Miyazaki; Osamu Seguchi; Tomotaka Tanaka; Hiroki Hata; Mikito Hayakawa; Katsufumi Kajimoto; Hiroshi Yamagami; Masanobu Yanase; Kazuyuki Nagatuka; Jun C. Takahashi; Tomoyuki Fujita; Takeshi Nakatani; Kazuo Minematsu; Kazunori Toyoda STROKE 47 2016年02月
• 再灌流療法後の急性期中大脳動脈閉塞例におけるMRI3次元Arterial Spin Labeling灌流イメージング法による脳血流評価

  吉本武史; 岡崎周平; 岡崎周平; 梶本勝文; 山上宏; 早川幹人; 佐藤徹; 高橋淳; 豊田一則; 長束一行 脳血管内治療(Web) 1 (Supplement) 2016年
• ADAPTを第一選択とした急性期再開通療法の検討

  織田 祥至; 佐藤 徹; 山上 宏; 早川 幹人; 菅田 真生; 丸山 大輔; 濱野 栄佳; 江口 盛一郎; 片岡 大治; 長束 一行; 豊田 一則; 高橋 淳 JNET: Journal of Neuroendovascular Therapy 9 (6) S242 -S242 2015年11月
• 血小板凝集能評価とプラークイメージングによる頸動脈ステント留置術周術期塞栓性合併症のリスク評価

  丸山 大輔; 佐藤 徹; 江口 盛一郎; 織田 祥至; 濱野 栄佳; 菅田 真生; 早川 幹人; 山上 宏; 片岡 大治; 飯原 弘二; 高橋 淳 JNET: Journal of Neuroendovascular Therapy 9 (6) S261 -S261 2015年11月
• Asymptomatic moyamoya disease: Literature review and ongoing AMORE study

  Satoshi Kuroda; AMORE Study Group; Clinical Coordinating Center; Data Management Center; Norihiro Sato; Kuniaki Ogasawara; Koji Iihara; Ken-Ichiro Kikuta; Kiyohiro Houkin; Toshiaki Osato; Teiji Tominaga; Nobuhito Saito; Yoshikazu Okada; Shigeru Nogawa; Tadashi Nariai; Jun-Ichi Ono; Kimitoshi Sato; Kazuo Yamada; Susumu Miyamoto; Susumu Miyamoto; Jun Takahashi; Jyoji Nakagawara; Manabu Sakaguchi; Isao Date; Isao Date; Izumi Nagata Neurologia Medico-Chirurgica 55 (3) 194 -198 2015年02月
• Periprocedural Elevation of Von Willebrand Factor is Associated With Thromboembolic Events in Coil Embolization of Unruptured Intracranial Aneurysms Under Dual Antiplatelet Therapy

  Minoru Ideguchi; Tetsu Satow; Shigeki Takada; Sei Sugata; Daizo Ishii; Daisuke Maruyama; Eika Hamano; Masataka Hayashi; Hideki Kanamaru; Hiroharu Kataoka; Koji Iihara; Jun Takahashi STROKE 46 2015年02月
• Contrast-Enhanced Ultrasound is Useful for Detection of Vulnerable Plaques

  Rie Motoyama; Kozue Saito; Shuichi Tonomura; Hatsue I. Ueda; Hiroharu Kataoka; Koji Iihara; Jun C. Takahashi; Kazunori Toyoda; Kazuyuki Nagatsuka STROKE 46 2015年02月
• 梗塞巣内のFLAIR高信号病変は血管内治療による急性再開通療法後の頭蓋内出血に関連する

  吉本武史; 山上宏; 関賢太; 早川幹人; 宮崎雄一; 佐藤徹; 高橋淳; 豊田一則; 長束一行 Journal of Neuroendovascular Therapy 9 (6) S202 -S202 2015年
• CHADS(2) and CHA(2)DS(2)-VASc Scores as Bleeding Risk Indices for Patients Having Atrial Fibrillation: The Bleeding with Antithrombotic Therapy (BAT) Study

  Kazunori Toyoda; Masahiro Yasaka; Shinichiro Uchiyama; Kazunori Iwade; Yukihiro Koretsune; Ken Nagata; Tomohiro Sakamoto; Takehiko Nagao; Masahiro Yamamoto; Jun Gotoh; Jun C. Takahashi; Kazuo Minematsu CEREBROVASCULAR DISEASES 34 58 -59 2012年
• 両側の血行再建を行った内頸動脈狭窄症 : 頸動脈ステント留置の活用

  川端 康弘; 永田 泉; 坂井 信幸; 中原 一郎; 下鶴 哲郎; 酒井 秀樹; 東 登志夫; 高橋 淳; 大田 元; 菊池 晴彦; Yasuhiro KAWABATA; Izumi NAGATA; Nobuyuki SAKAI; Ichiro NAKAHARA; Tetsuro SHIMOZURU; Hideki SAKAI; Toshio HIGASHI; Jun TAKAHASHI; Hajime OHTA; Haruhiko KIKUCHI; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; 国立循環器病センター脳神経外科; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center; Department of Neurosurgery National Cardio-vascular Center 脳卒中の外科 = Surgery for cerebral stroke 29 (5) 339 -344 2001年09月
• 内頸動脈-眼動脈分岐部未破裂脳動脈瘤コイル塞栓術後に網膜動脈分枝閉塞症をきたした1例

  間中 浩; 酒井 秀樹; 中原 一郎; 坂井 信幸; 下鶴 哲郎; 柳本 広二; 東 登志夫; 名村 尚武; 高橋 淳; 大田 元; 石澤 錠二; 森実 飛鳥; 川端 康弘; 永田 泉; 菊池 晴彦 脳神経外科ジャーナル = Japanese journal of neurosurgery 9 (5) 389 -391 2000年05月
• 2.頚部頚動脈狭窄に対するstentingの適応

  中原 一郎; 石澤 錠二; 間中 浩; 森実 飛鳥; 川端 康弘; 新堂 敦; 安榮 良悟; 明田 秀太; 永田 泉; 菊池 晴彦; 坂井 信幸; 柳本 広二; 下鶴 哲郎; 酒井 秀樹; 東登 志夫; 名村 尚武; 高橋 淳; 大田 元; 紺野 広; 小笠原 邦昭; 鈴木 倫保; 小川 彰 脳神経外科ジャーナル 9 (4) 272 -272 2000年
• Adenovirally expressed basic fibroblast growth factor rescues photoreceptor cells in RCS rats

  M Akimoto; SI Miyatake; JI Kogishi; M Hangai; K Okazaki; JC Takahashi; M Saiki; M Iwaki; Y Honda INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE 40 (2) 273 -279 1999年02月
• 頚部頚動脈狭窄病変に対する外科治療のトピックス ＣＥＡとＳｔｅｎｔｉｎｇの選択:CEAとStentingの選択

  秋山 義典; 坂井 信幸; 中原 一郎; 酒井 秀樹; 石澤 錠二; 間中 浩; 森実 飛鳥; 林 直樹; 高橋 淳; 永田 泉 脳卒中 21 (4) 469 -469 1999年

共同研究・競争的資金等の研究課題

• 広領域循環シミュレータによる脳血管血行再建術支援のための血流制御機構の解明

  日本学術振興会：科学研究費助成事業

  研究期間 : 2015年04月 -2018年03月 

  代表者 : 片岡 大治; 八木 高伸; 中村 匡徳; 宮本 享; 梅津 光生; 高橋 淳; 樋口 隆弘; 飯田 秀博

   

  脳血行再建術は、脳動脈瘤や虚血性脳血管障害に対する確立された外科治療であるが、術後の血行動態を予測することが困難であるという問題点がある。本研究では位相コントラストMRI（PC-MRI）による脳血管血流計測、PET/SPECTによる脳組織血流計測、数値流体力学（Computational Fluid Dynamics）によるシミュレーション技術を統合して、脳血行再建術後の局所における調節機構と脳全体の血流再配分機構のメカニズムの一端を解明した。本研究の成果は術後の血行動態を再現する広領域脳血流シミュレータの開発に結びつくもので、脳血行再建術の治療成績の向上に貢献するものである。
• 小児もやもや病の多施設コホート研究：成人後のQOLの解明と関連要因の探索

  日本学術振興会：科学研究費助成事業

  研究期間 : 2014年04月 -2018年03月 

  代表者 : 舟木 健史; 宮本 享; 高橋 淳; 高木 康志

   

  もやもや病は原因不明の脳血管疾患であり、小児例では主に脳虚血症状で発症する。本研究の目的は、小児もやもや病の成人後の予後を調査するとともに、それに影響すると思われる小児期の認知障害特性とその要因、効果的介入法を明らかにすることである。成人後の課題として遅発性脳出血（出血転化）と社会適応困難の2つが浮き彫りとなり、特に社会適応困難は10~20％の患者にみられ、脳梗塞や慢性的前頭葉血流不足がその要因として疑われた。脳梗塞を認めた患児では作業記憶、同時・継時処理、注意等の認知処理機能低下が認められ、成人後のQOL低下を予防するための、小児期の作業療法的・脳神経外科的介入の有効性検証が今後望まれる。
• 頭蓋内主幹動脈閉塞性疾患における分子メカニズムの解明

  日本学術振興会：科学研究費助成事業

  研究期間 : 2012年04月 -2015年03月 

  代表者 : 宮本 享; 高木 康志; 高橋 淳

   

  1. 家族性もやもや病におきてRNF213遺伝子に変異が認められた家系の患者の皮膚より、繊維芽細胞を採取し、iPS細胞を作成した。計3系統のiPS細胞が樹立され、筋肉や内皮細胞へ分化に異常が認められた 2. もやもや病患者から中大脳動脈片を採取し、病理学的に解析した。小児例、成人例ともに中大脳動脈内皮と中膜に異常が認められ、この病変において頭蓋内血管も障害されていることが示された。

その他のリンク

researchmap

https://researchmap.jp/juntak