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

Whether the lenticulostriate artery (LSA) can branch from the M2 inferior trunk of the middle cerebral artery (MCA) remains unclear. However, although rare, some branches from the M2 inferior trunk have been observed to run along the LSA from the MCA M1 segment or M2 superior trunk. In addition, these branches could be clinical problems by running across the MCA bifurcation. Therefore, we investigated whether these branches were truly LSAs using cadaveric heads, and assessed their clinical significance. We examined 32 hemispheres of 16 cadaveric heads using microscopy to evaluate the branches from the M2 inferior trunk and their relationships with other arteries, including the M1 segment, M2 branches, and LSAs. Among the 32 hemispheres, four exhibited branches from the M2 inferior trunk running along the LSA. However, these branches terminated at the limen insulae and did not run in the Sylvian cistern and did not reach the anterior perforated substance. Therefore, they were not truly LSAs. We defined these branches from the M2 inferior trunk as "insular branches from the M2 inferior trunk resembling LSA". In some clinical cases, such as "MCA bifurcation aneurysm" and "insular glioma", these branches could be surgical problems by running across the MCA bifurcation. Moreover, in these four hemispheres, the LSAs were observed to branch from the M2 superior trunk. Although this variation is infrequent, awareness of this variation would be useful for the safer operations, particularly in cases that the LSAs branch from the M2 superior trunk.

DOI： 10.1007/s10143-025-03614-x

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Intraventricular haemorrhage (IVH) is a key prognostic factor for subarachnoid haemorrhage (SAH). However, no simple or rapid scoring method for its evaluation exists. We aimed to modify and validate a simple scale for rapid IVH grading. We engaged two study groups to generate scores and examine their utility. Study 1 identified prognostic factors in poor-grade SAH and developed a prognostic scoring system. Study 2 evaluated the utility of the score by analysing data from a multicentre patient registry, including all severity levels, and confirmed its generalisability. Outcomes were defined using the modified Rankin scale (score ≥ 3: poor outcome). Study 1 (including 110 patients with poor-grade SAH) created a simple IVH score (IVHAge) based on two slices of computed tomography images and confirmed that it was as predictive as the modified Graeb score (area under the curve: IVHAge score, 0.815; modified Graeb score, 0.752). Study 2 examined 493 patients and found that for each 1-unit increase in the IVHAge score, the odds of a poor outcome increased by 37% (unit odds ratio, 1.37; 95% confidence interval 1.10-1.70; P = 0.005). The IVHAge score, which comprises a simplified IVH score and age-related factors, has prognostic value and is suitable for rapid clinical application.

DOI： 10.1038/s41598-025-99132-3

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BACKGROUND: The standard approach for transvenous embolization (TVE) of a cavernous sinus (CS) dural arteriovenous fistula (DAVF) involves the inferior petrosal sinus (IPS). However, the IPS is often obstructed in many cases. In some cases, the IPS is not connected to the internal jugular vein, making access to the CS via the IPS difficult. The inferior petroclival vein (IPCV) runs through the extracranial petroclival fissures. Although only one case series has reported on the treatment of a CS DAVF via the IPCV, no detailed technical tips have been provided. OBSERVATIONS: A 76-year-old female presented with right abducens nerve palsy and left ptosis. Angiography revealed a right CS DAVF with bilateral IPS obstructions. Preoperative contrast-enhanced MRI confirmed the IPCV, connecting caudally to the anterior condylar confluence (ACC) and cranially to the internal carotid artery venous plexus of Rektorzik. Intraoperative venography of the ACC revealed the IPCV, allowing easy access to the CS. The patient's symptoms resolved after TVE. LESSONS: The IPCV is rarely used due to its low anatomical recognition and narrow, tortuous structure compared to the IPS. However, understanding the course of the IPCV through preoperative contrast-enhanced MRI and visualizing the IPCV using intraoperative ACC venography can facilitate the IPCV approach. https://thejns.org/doi/10.3171/CASE24574.

DOI： 10.3171/CASE24574

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BACKGROUND: A vein of Galen aneurysmal malformation (VGAM) is a rare vascular lesion that often requires treatment in the neonatal period or infancy. Neonates and infants have limited catheter access, and the treatment of VGAM often requires multiple procedures. When standard access routes are unavailable, alternative vascular access becomes essential. OBSERVATIONS: A female infant born at 35 weeks 6 days of gestation with a prenatal diagnosis of VGAM developed severe heart failure and anuria after birth. Urgent transarterial glue embolization was performed on days 0 and 1. Three months later, follow-up MRI showed shunt worsening and venous congestion. With no remaining access routes available, the brachial artery was utilized as an alternative, as both femoral arteries were occluded and direct internal carotid artery puncture was unsafe due to the short neck and enlarged jugular vein. After this approach, treatment improved venous congestion and reduced the VGAM shunt without complications, preserving blood flow in the brachial artery. LESSONS: In neonates, maintaining umbilical artery access is crucial to preserving the femoral arteries for future use. However, if these routes are lost due to multiple procedures, the brachial artery can serve as an effective alternative for vascular access. https://thejns.org/doi/10.3171/CASE24861.

DOI： 10.3171/CASE24861

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Background: An aspiration catheter needs to attach to a thrombus in order to achieve first-pass recanalization by mechanical thrombectomy (MT) for acute ischemic stroke (AIS), particularly that using a direct aspiration first pass technique. The meniscus sign, which is defined as meniscoid contrast opacification indicating the proximal edge of a thrombus, has been suggested to contribute to successful recanalization. In some cases, the meniscus sign is not detected following an injection of contrast medium through a guiding catheter. To precisely identify the location of a thrombus, we use "the microcatheter contrast injection (MCI) technique," which accurately shows the proximal edge of a thrombus. We herein introduce this novel technique and discuss its efficacy in MT. Methods: In cases without the meniscus sign, a microcatheter was advanced to the distal end of contrast opacification, and contrast medium was injected through the microcatheter to detect the meniscus sign. An aspiration catheter was then advanced to the thrombus indicated by the meniscus sign and slowly withdrawn under aspiration. Results: 29 patients underwent MT for AIS using the MCI technique. Even in cases without the meniscus sign on initial angiography, the MCI technique accurately revealed the proximal edge of the thrombus. Moreover, middle cerebral artery occlusion due to atherosclerotic stenosis and displacement of the aspiration catheter and thrombus axis were detected using this technique. Conclusions: The MCI technique may effectively reveal the exact site of a thrombus and increase the success rate of first-pass recanalization.

DOI： 10.1177/19714009231224427

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<p>Introduction: Surgical extirpation of a cholesterol granuloma in the petrous apex, located dorsal to the petrous part of the internal carotid artery (ICA), is challenging. Herein, we report a pediatric case of a cholesterol granuloma of the petrous apex treated using the endoscopic contralateral transmaxillary (CTM) approach. Case Presentation: A 13-year-old boy presented with a left-sided headache, slight hypoesthesia in the left V1 area, and severe neuralgia of the left auriculotemporal nerve. Magnetic resonance imaging (MRI) revealed a high-intensity mass without gadolinium enhancement. The patient's headache was unresponsive to various medications. After careful evaluation, an endoscopic CTM approach was selected for the extirpation of the granuloma. Postoperatively, the patient did not experience headache or associated neurological complications. MRI at 46 months revealed no recurrence. Conclusion: The endoscopic CTM approach can be used for excising cholesterol granulomas of the petrous apex located posterior to the petrous part of the ICA without causing severe complications. This approach can be considered useful for pediatric cases in which granulomas are not accessible via the transnasal endoscopic transsphenoidal approach. </p>.

DOI： 10.1159/000546531

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

Traumatic brain injury is a world-leading cause of disability. Current treatments are not sufficient to promote neurological recovery. Intracerebral transplantation of allogeneic mesenchymal stem cells, specifically SB623, has shown promise in achieving better neurological recovery compared with a sham surgery group in the STEMTRA trial. However, the optimal location for cell transplantation remains unclear, as transplanted lesions vary between patients. This study aimed to explore the relationship between functional recovery and the location of transplanted lesions. This study included all Japanese subjects from the STEMTRA trial who were assigned to the cell transplantation group. Functional recovery was assessed by the difference in Fugl-Meyer Motor Scale (FMMS) scores between the screening period and 24 or 48 weeks post-transplantation. An FMMS score improvement of >8 was defined as an improved group. Lesions responsible for motor deficits were categorized into three groups: motor cortex (Cortex), deep white matter (DWM), or both (Cortex and DWM). Data on the 15 transplanted sites per patient were obtained from surgical navigation software, and the distance from the damaged area to the transplanted sites was calculated. Twelve patients were included in this post-hoc analysis. No patients in the 2.5 × 106 cells group showed improvement and were therefore excluded from further analysis. Five patients were categorized into the Cortex group and four into the DWM group. The distance between the transplanted site and the injury point ranged from 0 to 39 mm. A moderate to strong trend of correlations was observed, suggesting that a shorter distance is preferable for the motor cortex group, while a greater distance is preferable for the DWM group. The optimal site for stem cell transplantation may be different from the damaged site of the patient; however, a further large number cohort is necessary to elucidate this hypothesis.

DOI： 10.1089/neur.2024.0130

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AIM: To evaluate the prognostic factors in severe head trauma patients (Glasgow Coma Score (GCS) ≤ 8) with all trauma, including those with trunk injury as well as single severe head trauma (abbreviated injury scale (AIS) ≥ 3). METHODS: We included 152 consecutive patients with head trauma (AIS ≥ 3) and consciousness disorders (GCS ≤ 8) who were transported to our institute from January 2017 to October 2022. Data on the patients' background, vital signs at presentation, multiple trauma (AIS ≥ 3 in two or more locations), surgical intervention, and hematological findings were examined; a retrospective analysis was conducted with the modified Rankin Scale score after 3 months assigned as the primary outcome. RESULTS: The patients' mean age was 57.6 ± 23.4 years (0-89), 49 patients (32.2%) had multiple trauma, and 25 patients (16.4%) had accompanying shock vital signs. In the multivariate analysis of prognosis, age (p = 0.0007) and D-dimer levels (p = 0.0007) were independent poor prognostic factors. On the contrary, patients with multiple trauma (p = 0.027) and shock vital signs at presentation (p = 0.037) had a significantly better prognosis. In the non-shock group, 97.6% (41/42) of patients aged ≥50 years and with D-dimer level of 40 μg/mL or higher had a poor prognosis after 3 months. CONCLUSION: Advanced age and high D-dimer levels are important independent associated factors in patients with severe consciousness disorder associated with head trauma; meanwhile, the prognosis is more favorable in patients whose consciousness disorders are associated with multiple trauma or circulatory failure, indicating that rapid improvement of circulatory failure may lead to better outcomes.

DOI： 10.1002/ams2.70058

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Head trauma accompanied by circulatory failure is a rare but severe condition, and few reports regarding its prognosis or initial treatment strategies have been published. We aimed to evaluate the prognostic factors and treatment strategies for patients with head trauma and vital signs of shock. We included 415 consecutive patients with head trauma (Abbreviated Injury Scale [AIS] score ≥3) who were transported to our institution from January 2017 to December 2023. These patients were divided into shock and non-shock groups. Data on their background, vital signs at presentation, trunk injury status, surgical intervention, and hematological findings were examined. A retrospective analysis was conducted with the modified Rankin Scale score after 3 months as the primary outcome. The patients' mean age was 53.9 ± 24.4 years, 304 (73.3%) were male, 265 (63.9%) experienced severe trauma (injury severity score ≥16), 124 (29.9%) had multiple trauma (AIS score ≥3 at two or more locations), and 59 (14.2%) had accompanying vital signs of shock (shock index >1). Multivariable analysis revealed that older age (p < 0.0001), a lower Glasgow Coma Scale (GCS) score (p < 0.0001), elevated D-dimer levels (p = 0.0077), and pupillary abnormalities (p = 0.038) were independently associated with a poor prognosis in the non-shock group. In the shock group, older age (p = 0.0037) and neurosurgical intervention (p = 0.012) were independent prognostic factors. In contrast to those in the non-shock group, the GCS score and D-dimer levels were not useful prognostic factors in the shock group. The optimal cut-off age for prognosis was 64 years (area under the receiver operating characteristic curve: 0.752; sensitivity: 0.670, specificity: 0.777). The prognosis was significantly worse in the shock group when neurosurgery was required, suggesting that developing a treatment strategy aimed at more rapidly reducing intracranial pressure is essential, especially for patients under 64 years old with circulatory failure.

DOI： 10.1089/neur.2024.0167

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Background and purpose The risk of rupture increases with advancing age. However, the risk-benefit of coil embolization for elderly patients with unruptured aneurysms is controversial. This study aimed to identify factors associated with treatment primary outcomes, including risk factors for complications and aneurysm recurrence requiring re-treatment in the endovascular treatment of unruptured aneurysms in elderly patients. In addition, deterioration of the modified Rankin Scale (mRS) was examined as a secondary outcome. Materials and methods This retrospective three-center study examined 112 cases of coiled unruptured aneurysms in patients aged ≥ 60 years using endovascular registry data from January 2018 to March 2022. We examined patient background, aneurysm characteristics, adjuvant technique, symptomatic complications, and mRS scores. Results The average age of the patients was 72.5±6.9 years, and 83 cases (74.1%) were female. During the postoperative follow-up period (six to 36 months), no deaths occurred, one case of postoperative rupture was observed, and nine patients (5.4%) were re-treated. Notably, age, underlying disease, aneurysm location, and re-treatment were not associated with complications. In the multivariate logistic analysis for re-treatment, symptomatic complications [odds ratio (OR) 11.01; 95% confidence interval (CI), 3.68-52.5; p < 0.001] and re-treatment (OR 3.25; 95% CI, 1.04-10.7; p = 0.039) were independently associated with mRS score deterioration. The risk factors for re-treatment were maximum aneurysm diameter and aneurysm neck diameter; aneurysms with neck diameters and maximum diameters > 5.0 mm and > 9.0 mm, respectively, had a higher rate of need for re-treatment (33%) and mRS score deterioration (33%) due to re-enlargement of the aneurysm. Conclusion In this study, complications did not increase with age in those aged 60 and older. However, prioritizing the avoidance of complications in elderly patients is important. Elderly patients with aneurysms larger than 9 mm have a poor prognosis and require additional attention for re-treatment.

DOI： 10.7759/cureus.75759

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Publishing type：Research paper (scientific journal)   Publisher：Mary Ann Liebert Inc  

DOI： 10.1089/neur.2024.0133

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Other Link： https://www.liebertpub.com/doi/pdf/10.1089/neur.2024.0133

Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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INTRODUCTION: The use of anti-epileptic drugs (AEDs) in degenerative dementia (DD) remains uncertain. We aimed to evaluate the association of early AED administration with subsequent DD occurrence. METHODS: Using a large nationwide database, we enrolled patients newly diagnosed with epilepsy from 2014 to 2019 (n = 104,225), and using propensity score matching, we divided them into treatment (those prescribed AEDs in 2014) and control groups. The primary outcome was subsequent DD occurrence in 2019. RESULTS: Overall, 4489 pairs of patients (2156 women) were matched. The odds ratio (treatment/control) for DD occurrence was 0.533 (95% confidence interval: 0.459-0.617). The DD proportions significantly differed between the treatment (340/4489 = 0.076) and control (577/4489 = 0.129) groups. DISCUSSION: Among patients newly diagnosed with epilepsy, compared to non-use, early AED use was associated with a lower occurrence of subsequent DD. Further investigations into and optimization of early intervention for epilepsy in DD are warranted. HIGHLIGHTS: Anti-epileptic drug (AED) use before epilepsy diagnosis was linked with a lower subsequent degenerative dementia (DD) occurrence.Identifying the epileptic phenotype was crucial for justifying early AED use in DD.AED use with an epilepsy diagnosis did not pose an additional risk of DD.The potential contribution of combination drug therapy to the strategy was noted.

DOI： 10.1002/trc2.70001

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OBJECTIVES: The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. METHODS: This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. RESULTS: A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). CONCLUSION: The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

DOI： 10.5797/jnet.oa.2023-0083

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BACKGROUND: Vertebral artery (VA) stenosis can be caused by several factors, including arteriosclerosis, arterial dissection, and mechanical compression. Symptomatic vertebrobasilar insufficiency caused by VA stenosis due to mechanical compression associated with head rotation is well-known as Bow Hunter's syndrome. However, an accurate diagnosis of asymptomatic osteophyte compression-induced nonrotational VA stenosis is difficult. We report a case of left posterior inferior cerebellar artery aneurysm with severe left VA stenosis, treated with stent-assisted coil embolization following appropriate diagnosis. CASE DESCRIPTION: A 72-year-old female patient was found to have severe asymptomatic VA stenosis at the V2 segment (C4-5 level of the cervical spine) on cerebral angiography. Osteophyte compression-induced VA stenosis was suspected, which was confirmed by cone-beam computed tomography. The VA stenosis improved by flexing the neck and fixing the head position, following which the endovascular treatment was successfully completed. CONCLUSION: The site of the VA stenosis is critical in determining the etiology. Atherosclerotic VA stenosis often occurs at the origin of the artery or V4 segment, whereas bony compression-induced stenosis is more likely to occur at the V2 segment. Diagnosis and appropriate management of VA stenosis is based on determining the site.

DOI： 10.25259/SNI_772_2024

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Isolated abducens nerve palsy (IANP), caused by secondary communicating hydrocephalus, has been rarely documented; in addition, its mechanism and appropriate treatment are not understood well. This study presents a case of bilateral IANP with hydrocephalus in a 62-year-old man who was successfully treated with cerebrospinal fluid (CSF) diversion to correct an enlarged retroclival space during the follow-up of recurrent brain tumor in the right parieto-occipital lobe. The patient was treated with three resections, temozolomide, and irradiation before developing IANP. Magnetic resonance imaging (MRI) revealed a recurrent tumor and ventriculomegaly with an expanded retroclival cisternal space. The patient underwent subtotal tumor resection and external ventricular drain placement in the anterior horn of the lateral ventricle. His bilateral IANP persisted for 4 days after surgery but gradually improved and disappeared by Day 7. Four weeks later, the patient underwent ventriculoperitoneal (VP) shunt surgery to establish a permanent CSF diversion that continued to control the symptoms. Retrospective MRI review revealed the distance between the clivus and pontomedullary junction on the sagittal section (retroclival-pontomedullary distance; RPD) of 9.0, 12.8, 10.7, and 10.6 mm before IANP, on IANP onset, on postoperative Day 4, and post VP shunt surgery, respectively. In conclusion, VP shunt surgery was an appropriate approach for IANP with communicating hydrocephalus to correct the enlarged retroclival cisternal space. RPD thus may be used as one of possible evaluation methods for IANP with hydrocephalus, which can be caused by various factors.

DOI： 10.2176/jns-nmc.2024-0092

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

BACKGROUND AND OBJECTIVES: Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS: Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS: A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION: Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.

DOI： 10.1227/ons.0000000000000879

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本脳神経血管内治療学会  

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

BACKGROUND: Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous sinus (CS), are rare. Targeting embolization of an intraosseous clival AVF is challenging because of its complex venous and skull base anatomy; therefore, a therapeutic strategy based on detailed preoperative radiological findings is required to achieve a favorable outcome. Here, the authors report the successful targeted embolization of an intraosseous clival AVF using an ingenious access route. OBSERVATIONS: A 74-year-old woman presented with left-sided visual impairment, oculomotor nerve palsy, and right facial pain. A fusion image of three-dimensional rotational angiography and cone-beam computed tomography revealed a left CS dural AVF and a right intraosseous clival AVF. The shunt flow of the clival AVF drained extracranially from the posterior and anterior condylar veins via the intraosseous venous route. Transvenous embolization was performed by devising suboccipital, posterior condylar, and intraosseous access routes. The symptoms resolved after the bilateral AVFs were treated. LESSONS: Accurate diagnosis and proper transvenous access based on detailed intraosseous and craniocervical venous information obtained from advanced imaging modalities are key to resolving intraosseous clival AVF.

DOI： 10.3171/CASE23492

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PURPOSE: The 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors uses an integrated approach involving histopathology and molecular profiling. Since majority of adult malignant brain tumors are gliomas and primary central nervous system lymphomas (PCNSL), rapid differentiation of these diseases is required for therapeutic decisions. Additionally, diffuse gliomas require molecular information on single nucleotide variants (SNV), such as IDH1/2. Here, we report an intraoperative integrated diagnostic (i-ID) system to classify CNS malignant tumors, which updates legacy frozen section (FS) diagnosis through incorporation of a quantitative polymerase chain reaction (qPCR)-based genotyping assay. EXPERIMENTAL DESIGN: FS evaluation, including GFAP and CD20 rapid immunohistochemistry, was performed on adult malignant CNS tumors. PCNSL was diagnosed through positive CD20 and negative GFAP immunostaining. For suspected glioma, genotyping for IDH1/2, TERT SNV, and CDKN2A copy number alteration was routinely performed, whereas H3F3A and BRAF SNV were assessed for selected cases. i-ID was determined based on the 2021 WHO classification and compared with the permanent integrated diagnosis (p-ID) to assess its reliability. RESULTS: After retrospectively analyzing 153 cases, 101 cases were prospectively examined using the i-ID system. Assessment of IDH1/2, TERT, H3F3AK27M, BRAFV600E, and CDKN2A alterations with i-ID and permanent genomic analysis was concordant in 100%, 100%, 100%, 100%, and 96.4%, respectively. Combination with FS and intraoperative genotyping assay improved diagnostic accuracy in gliomas. Overall, i-ID matched with p-ID in 80/82 (97.6%) patientswith glioma and 18/19 (94.7%) with PCNSL. CONCLUSIONS: The i-ID system provides reliable integrated diagnosis of adult malignant CNS tumors.

DOI： 10.1158/1078-0432.CCR-23-1660

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

OBJECTIVES: Carotid artery stenting is sometimes adapted for some at-risk cases; however, appropriate treatment timing with stroke onset is controversial. This study aims to identify factors that have an impact on complications and outcomes, especially in patients at high risk. MATERIALS AND METHODS: We examined the characteristics of 152 consecutive patients treated by carotid artery stenting between January 2018 and March 2022 and retrospectively analyzed the risk factors for complications and poor outcomes (modified-Rankin-Scale deterioration), such as patient background, carotid artery stenting risks (access route tortuosity, severe calcification, vulnerable plaque, estimated glomerular filtration rate <30 mL/min/1.73 m2, etc.), characteristics of the stenosis, details of treatment, and treatment timing. RESULTS: The average North American Symptomatic Carotid Endarterectomy Trial criteria score was 68.3% and the lesion length was 20.5±9.7mm. Among patients, 107 (70.4%) had a carotid artery stenting risk. In high-risk carotid artery stenting cases, symptomatic complications occurred in 32 (30.0%), and the 90-day modified Rankin scale score deteriorated in 15 cases (14.0%). Multivariate analysis showed that cases with triple antithrombotic therapy (p=0.003), stenting within 7 days (p=0.0032), and after 28+ days (p=0.0035) of stroke onset were independently associated factors for complications. CONCLUSIONS: This study showed that among risk factors, triple antithrombotic therapy in particular was a risk factor for perioperative complications. Carotid artery stenting for patients with stroke after 28 days of onset affects the prognosis. Therefore, although further study is warranted, waiting more than one month for treatment in patients requiring carotid artery stenting is a potential risk.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107329

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Biphenotypic sinonasal sarcoma is a newly established tumor entity that is associated with distinct clinicopathological findings. Biphenotypic sinonasal sarcoma is a rare, low-grade spindle cell sarcoma that arises in middle-aged females, exclusively in the sinonasal tract. A fusion gene involving PAX3 is detected in most biphenotypic sinonasal sarcomas, which aids in its diagnosis. Here, we report a case of biphenotypic sinonasal sarcoma with its cytological findings. The patient was a 73-year-old woman who presented with purulent nasal discharge and dull pain in the left cheek area. Computed tomography showed a mass extending from the left nasal cavity to the left ethmoid sinus, the left frontal sinus, and the frontal skull base. She underwent a combined transcranial and endoscopic approach for en bloc resection with a safety margin. Histologically, spindle-shaped tumor cells have been thought to proliferate mainly in the subepithelial stroma. Here, nasal mucosal epithelial hyperplasia was noted, and the tumor had invaded the bone tissue accompanying the epithelial cells. Fluorescence in situ hybridization (FISH) analysis showed a PAX3 rearrangement, and next-generation sequencing identified a PAX3::MAML3 fusion. Based on FISH, split signals were observed not in respiratory cells but in stromal cells. This indicated that respiratory cells were non-neoplastic. In the diagnosis of biphenotypic sinonasal sarcoma, the inverted growth of the respiratory epithelium can be a diagnostic pitfall. FISH analysis using a PAX3 break-apart probe is helpful not only for an accurate diagnosis but also for detecting the true neoplastic cells.

DOI： 10.1177/10668969231152577

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

PURPOSE: There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19. METHODS: Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings. RESULTS: Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa. CONCLUSION: Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.

DOI： 10.7759/cureus.34229

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Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1227/neuopn.0000000000000019

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000525229

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

BACKGROUND: The use of mechanical thrombectomy (MT) for treatment of acute large vessel occlusion has recently increased. Prompt and timely guiding catheter (GC) induction is necessary to improve prognosis of MT and reduce the time for recanalization. However, difficulties in GC induction are encountered in some patients. This GC induction depends mainly on the aortic arch structure. Therefore, this study focused on assessing presence of tracheal shift on chest X-ray images as pre-treatment evaluation method for GC induction due to its wide availability as an indicator for status of the mediastinum. METHODS: We retrospectively examined 33 patients who underwent MT at our facilities between April 2017 and March 2021. The patients were divided into two groups according to presence or absence of tracheal shift on chest X-ray images. Background characteristics and treatment courses in these two groups were compared. RESULTS: Among 33 patients, tracheal shift was observed on the chest X-ray images of 14 patients. Furthermore, tracheal shift was positively correlated with the time of GC induction (32.9 min vs. 11.6 min, [p < 0.05]) and the female sex (p = 0.03). Additionally, tracheal shift exhibited correlations with multiple risk factors of atherosclerosis (p = 0.04). CONCLUSIONS: In patients with tracheal shift, GC induction could be expectedly difficult. Therefore, advanced disinfection of the right upper arm and affected side of the neck during MT in preparation for changing an approach route is required.

DOI： 10.1177/19714009221084237

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：English  

Background: It is not well-known that contralateral vertebral artery dissecting aneurysms (VADA) may be newly revealed after parental artery occlusion for unilateral VADA. However, the optimal treatment strategies and perioperative management have not been established. In this report, we present the case of a patient who required reconstructive embolization in the subacute stage for contralateral VADA developed after endovascular internal trapping of the ruptured VADA. Case Description: A 61-year-old man developed subsequent disturbance of consciousness. Head CT showed a diffuse and symmetrical SAH. 3DCT revealed a fusiform aneurysm of the left intracranial vertebral artery with bleb formation. We performed emergency endovascular parent artery occlusion of the left vertebral artery. A digital subtraction angiography on postoperative day 16 showed continued occlusion of the left VA, and a fusiform aneurysm was noted at the right VA. We performed reconstructive embolization and the patient eventually recovered with minimal persistent symptoms. Conclusion: Since the outcomes of contralateral VAD complicated by infarction or hemorrhage are poor, and most cases develop within 7-14 days after endovascular internal trapping for unilateral VAD, performing bilateral radiographic reinspection within this time frame is recommended for early detection and preventive treatment of possible contralateral VADs.

DOI： 10.25259/SNI_19_2022

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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BACKGROUND: The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. METHODS: The procedure is shown through an illustrative video of surgery and cadaver. Five cadavers were analyzed for their arachnoid structures and the surgical procedures via the OTA, in strict compliance with legal and ethical requirements. RESULTS: All cadavers showed a 2-layered arachnoid structure-one belonging to the occipital lobe, and the other to the cerebellum. According to our cadaveric analysis, the arachnoid attachment of the tentorial apex can be peeled bluntly, with an average distance of 10.2 mm. For our clinical presentation, a pineal tumor with hydrocephalus was detected in a 14-year-old boy. While using the OTA and expanding the deep surgical field, we detached the membrane from the tentorial apex and bluntly peeled it to reveal the deep veins. Finally, gross total removal of the tumor was achieved. CONCLUSIONS: A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.

DOI： 10.1016/j.wneu.2021.04.041

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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J-GLOBAL

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03582&link_issn=&doc_id=20210514370019&doc_link_id=%2Fdp2sport%2F2021%2F002902%2F019%2F0211-0219%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdp2sport%2F2021%2F002902%2F019%2F0211-0219%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Primary central nervous system lymphoma (PCNSL) is an isolated type of lymphoma of the central nervous system and has a dismal prognosis despite intensive chemotherapy. Recent genomic analyses have identified highly recurrent mutations of MYD88 and CD79B in immunocompetent PCNSL, whereas LMP1 activation is commonly observed in Epstein-Barr virus (EBV)-positive PCNSL. However, a lack of clinically representative preclinical models has hampered our understanding of the pathogenic mechanisms by which genetic aberrations drive PCNSL disease phenotypes. Here, we establish a panel of 12 orthotopic, patient-derived xenograft (PDX) models from both immunocompetent and EBV-positive PCNSL and secondary CNSL biopsy specimens. PDXs faithfully retained their phenotypic, metabolic, and genetic features, with 100% concordance of MYD88 and CD79B mutations present in PCNSL in immunocompetent patients. These models revealed a convergent functional dependency upon a deregulated RelA/p65-hexokinase 2 signaling axis, codriven by either mutated MYD88/CD79B or LMP1 with Pin1 overactivation in immunocompetent PCNSL and EBV-positive PCNSL, respectively. Notably, distinct molecular alterations used by immunocompetent and EBV-positive PCNSL converged to deregulate RelA/p65 expression and to drive glycolysis, which is critical for intracerebral tumor progression and FDG-PET imaging characteristics. Genetic and pharmacologic inhibition of this key signaling axis potently suppressed PCNSL growth in vitro and in vivo. These patient-derived models offer a platform for predicting clinical chemotherapeutics efficacy and provide critical insights into PCNSL pathogenic mechanisms, accelerating therapeutic discovery for this aggressive disease. SIGNIFICANCE: A set of clinically relevant CNSL xenografts identifies a hyperactive RelA/p65-hexokinase 2 signaling axis as a driver of progression and potential therapeutic target for treatment and provides a foundational preclinical platform. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/23/5330/F1.large.jpg.

DOI： 10.1158/0008-5472.CAN-20-2425

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00650&link_issn=&doc_id=20210115260006&doc_link_id=%2Fco2socie%2F2020%2F004504%2F006%2F0358-0364%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2020%2F004504%2F006%2F0358-0364%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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BACKGROUND: Cerebral bypass surgery, such as the STA-MCA bypass, is one of the essential procedures for cerebral revascularization. However, very narrow or thin blood vessels increase the risk of anastomotic problems, as seen in Moyamoya disease. For such vessels, we have devised the "lifting method" in the recipient arteriotomy. Here, we introduce this novel optional technique and evaluate its effects. METHODS: The "lifting method" is a procedure of lifting the incision edge in a linear incision on the recipient vessel to widen the ostium. We attempted the "lifting method" in 23 consecutive cases (41 arteries) and, as a historical control, compared it with the conventional method of 25 consecutive cases (37 arteries) for the previous 3 years. We compared patient age, years of surgical experience, recipient vessel diameter, anastomotic events and final patency. As a sub-analysis, the same evaluations were done for Moyamoya disease cases. Furthermore, the time required for the lifting procedure was measured retrospectively. RESULTS: The incidence of anastomotic events in the conventional method was 13.5% overall and 19% in Moyamoya disease. No events occurred with the "lifting method" (P <0.05). There was no significant difference in other factors including final patency between the two groups. The time required for lifting procedure averaged at 1 minute 15 seconds. CONCLUSIONS: The "lifting method" widens and secures the ostium in a recipient vessel and greatly facilitates operability. This is a foolproof method enabling safe and reliable anastomosis even in conditions of narrow or thin vessels.

DOI： 10.1016/j.wneu.2020.06.077

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Thiel's embalming method provides natural coloration, flexibility, and tissue plasticity, and is used widely to prepare specimens for cadaver surgical training. However, this method causes brain softening, thereby restricting the cadaver surgical training of intra-cranial procedures. In this study, three cadavers were embalmed using formalin fixation, Thiel's embalming method, and Thiel's embalming method with additional intra-cerebral ventricular formalin injection, respectively. We also established rat models of the three embalming methods to develop and determine the best method for retaining adequate brain elasticity. The intra-ventricular formalin injection in the cadaver was performed through the Kocher's point, as in the classical external ventricular drain procedure. Both, the cadaver brains and rat models yielded consistent shear wave measurements and brain surface stiffness data. Notably, the Thiel's embalming method with additional intra-cerebral ventricular formalin injection yielded suitable elasticity for brain cadaver surgical training in terms of brain mobilization and surgical field deployment, and also discharged formaldehyde in undetectable quantities. To our knowledge, this is the first report in which a fixed quality, namely, brain elasticity for the performance of head and brain cadaver surgical training, has been evaluated in a cadaver subjected to the Thiel's embalming method with immersion fixation in the cerebrospinal fluid space. We conclude that the Thiel's embalming method with additional intra-cerebral ventricular formalin injection can maintain the brain elasticity, and may therefore improve the quality of head and brain cadaver surgical training safely and easily.

DOI： 10.1007/s12565-020-00545-z

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Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

症例は31歳男性で、発熱を主訴に外来を受診した。僧帽弁に疣贅を認め、血液培養からα-hemolytic Streptococcusが検出され、感染性心内膜炎と診断され入院となった。入院翌日に心臓血管外科で僧帽弁置換術を施行され、頭部MRIで左後大脳動脈末端に紡錘状の動脈瘤を認めた。抗生剤投与にもかかわらず動脈瘤が消退しないため血管内治療となった。全身麻酔下に視覚誘発電位(VEP)の術中モニタリングを行い、バルーンを拡張、造影を行うと後頭葉の造影欠損を認め、直後から左後頭葉のVEP振幅が低下し始めた。そこで、left parieto-occipital arteryを温存しつつleft calcarine arteryの起始拡張部をコイル塞栓することにした。術後はアスピリン100mg/日とクロピドグレル300mg/日の内服を開始し、クロピドグレルは75mg/日で維持を行った。MRAで動脈瘤は消失し、MRI拡散強調画像で新規梗塞はなかった。視野欠損なく独歩で退院した。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02079&link_issn=&doc_id=20200527210009&doc_link_id=%2Fcp4strok%2F2020%2F004802%2F009%2F0134-0138%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2020%2F004802%2F009%2F0134-0138%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：横浜市立大学医学会  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01499&link_issn=&doc_id=20200622220007&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001859%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001859%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

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The adult mammalian central nervous system (CNS) rarely recovers from injury. Myelin fragments contain axonal growth inhibitors that limit axonal regeneration, thus playing a major role in determining neural recovery. Nogo receptor-1 (NgR1) and its ligands are among the inhibitors that limit axonal regeneration. It has been previously shown that the endogenous protein, lateral olfactory tract usher substance (LOTUS), antagonizes NgR1-mediated signaling and accelerates neuronal plasticity after spinal cord injury and cerebral ischemia in mice. However, it remained unclear whether LOTUS-mediated reorganization of descending motor pathways in the adult brain is physiologically functional and contributes to functional recovery. Here, we generated LOTUS-overexpressing transgenic (LOTUS-Tg) rats to investigate the role of LOTUS in neuronal function after damage. After unilateral pyramidotomy, motor function in LOTUS-Tg rats recovered significantly compared to that in wild-type animals. In a retrograde tracing study, labeled axons spanning from the impaired side of the cervical spinal cord to the unlesioned hemisphere of the red nucleus and sensorimotor cortex were increased in LOTUS-Tg rats. Anterograde tracing from the unlesioned cortex also revealed enhanced ipsilateral connectivity to the impaired side of the cervical spinal cord in LOTUS-Tg rats. Moreover, electrophysiological analysis showed that contralesional cortex stimulation significantly increased ipsilateral forelimb movement in LOTUS-Tg rats, which was consistent with the histological findings. According to these data, LOTUS overexpression accelerates ipsilateral projection from the unlesioned cortex and promotes functional recovery after unilateral pyramidotomy. LOTUS could be a future therapeutic option for CNS injury.

DOI： 10.1016/j.expneurol.2019.113068

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Language：Japanese   Publisher：The Japanese Society on Surgery for Cerebral Stroke  

<p>Introduction: Magnetic resonance imaging (MRI) and spinal digital subtraction angiography (DSA) are considered the gold standard for the screening and diagnosis of spinal dural arteriovenous fistula (SPDAVF). However, the flow-void signals of abnormal vessels are not always reported, even when spinal cord edema is detected with the MRI, rendering the diagnosis in such cases difficult. Similarly, although selective spinal DSA is useful for the definite diagnosis of SPDAVF, it can be a lengthy procedure requiring technical proficiency. Here, we introduce an effective diagnostic procedure with MRI (3T MRI 3D T2 Cube), followed by reconstruction of the 3D-CTA (64 row multistring detector CT).</p><p>Material and Methods: A total of 15 consecutive cases of SPDAVF present in the departmental database from April 2006 to June 2017 were reviewed in this study. Of these, we enrolled 5 patients who conducted the 3T MRI 3D T2 Cube and/or 3D-CTA with the analysis application VINCENT®.</p><p>Result: Of the 5 SPDAVF cases analyzed, 4 showed flow-void signals around the spinal cord in the 1.5T MRI T2WI. In contrast, all cases showed engorged vessels around the spinal cord with the 3D-CTA reconstructed VINCENT® image. The entry point of the influx vessels can be easily identified, resulting in simple and efficient selective spinal DSA. Furthermore, the 3D-CTA reconstructed image was helpful as a surgical simulation tool.</p><p>Conclusion: The diagnostic procedure of the 3T MRI 3D T2 Cube followed by the reconstructed 3D-CTA image markedly contributes to the diagnosis of SPDAVF and the identification of the entry point of the influx vessels and is helpful for both efficient spinal DSA and surgical simulation.</p>

DOI： 10.2335/scs.48.42

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本臨床神経生理学会  

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DOI： 10.1038/s41598-019-50073-8

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DOI： 10.2176/nmc.tn.2018-0299

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Language：Japanese   Publisher：(一社)日本小児神経外科学会  

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DOI： 10.11477/mf.1436203773

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DOI： 10.1080/02688697.2018.1485877

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(株)医学書院  

60歳女性。左顔面痙攣を主訴とした。頭部単純MRI/MRAにて左後下小脳動脈(左PICA)による左顔面神経の圧迫所見を認めたため、治療目的に入院となった。左顔面痙攣に対し、異常筋反応モニタリング(AMR)併用下に動脈刺激筋反応モニタリング(AWS-EMG)を行い、術中に異常波形を確認し、微小血管減圧術を施行した。術後AMR、AWS-EMGの異常波形は消失し、顔面痙攣も改善が得られた。

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DOI： 10.11477/mf.1436203487

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-16K10765/

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DOI： 10.1016/j.expneurol.2015.03.021

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DOI： 10.1016/j.expneurol.2015.03.017

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DOI： 10.1038/nrneurol.2014.207

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DOI： 10.1016/j.pneurobio.2014.06.002

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DOI： 10.1007/s10143-014-0531-0

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DOI： 10.3174/ajnr.A3679

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File： Austin J 論文ajns-v1-id1013 suenaga manuscript final version.pdf

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DOI： 10.1186/1471-2121-14-12

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DOI： 10.2176/nmc.51.434

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DOI： 10.3171/2010.9.JNS10354

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DOI： 10.1159/000323543

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Language：Japanese   Publisher：The Japanese Society on Surgery for Cerebral Stroke  

We retrospectively studied 15 patients, 9 men and 6 women aged 17 to 52 years (mean 28.1 years), who developed cyst formation following gamma knife radiosurgery (GKS) at our hospital for cerebral arteriovenous malformation (AVM). The mean nidus volume was 11 cm³ (0.1-26.7 cm³), and the mean prescription dose at the nidus margin was 20.0 Gy (18-28 Gy). Nidus obliteration was obtained in 9 patients, partial obliteration in 5, and no change in 1. Cyst formation was detected from 2.5 to 13.5 years (mean 6.4 years) after GKS. Three patients underwent craniotomy, and 2 received placement of an Ommaya reservoir. Spontaneous regression of cyst was observed in 2 patients. The outcome of the cyst was unknown in 2 patients, because of no response from the neurosurgeon the patients were referred to. Serial magnetic resonance imaging was performed in the other 6 patients because the cyst size was stable or asymptomatic. These findings suggest that cyst formation following GKS is not a "late complication." <br> Placement of an Ommaya reservoir or cyst-peritoneal shunt is recommended for cysts with obliterated nidus. Craniotomy should be considered if the nidus is not completely obliterated or the cyst is associated with an expanding hematoma. Serial follow-up imaging is recommended for asymptomatic patients.<br>

DOI： 10.2335/scs.38.228

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Other Link： http://search.jamas.or.jp/link/ui/2010317891

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DOI： 10.1007/s11060-010-0170-4

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DOI： 10.2176/nmc.50.107

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DOI： 10.1007/s00441-006-0164-x

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DOI： 10.1016/j.modgep.2004.12.002

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Language：Japanese   Publisher：(一社)日本臨床神経生理学会  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06751&link_issn=&doc_id=20190513310006&doc_link_id=%2Fcf5nokec%2F2019%2F000402%2F006%2F0090-0094%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2019%2F000402%2F006%2F0090-0094%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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診断・治療を行った中枢神経系原発悪性リンパ腫(PCNSL)は78例で、大量シタラビン、シスプラチン、エトポシド、メチルプレドニゾロンを用いた化学療法(ESHAP療法)を施行したものは35例であった。そのなかで大量メトトレキサート(HD-MTX)療法を行ったが進行・再発し、二次化学療法としてESHAP療法を施行した18例(28〜77歳)を対象とした。全生存期間は3.9〜124.9ヵ月、PCNSL発症時のKarnofsky Performance Statusは30〜100に対して、ESHAP療法施行時は50〜100であった。ESHAP療法1クール目終了時のRRは77.8%で、CRを6例に認めた。ESHAP療法は1〜8クール施行し、最終クール後のRRは61.1%で、CRを4例に認めた。HD-MTX療法においてPDであった早期進行症例についても、ESHAP療法の最終クールにおけるRRは77.8%で、CRを3例に認めた。ESHAP療法における、Grade 3以上の副作用は66.7%に認め、全症例が骨髄抑制による好中球減少、あるいは血小板減少であった。

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Language：Japanese   Publisher：一般社団法人 日本脳卒中の外科学会  

We report herein five cases of symptomatic brainstem cavernous malformations (CM). Specific surgical approaches were designed to directly access each lesion. Neuronavigation and intraoperative monitoring were used. Four lesions underwent gross total resection, and one was subtotally partially removed. None of the patients developed new neurological deficits and all cases showed an improvement based on the modified Rankin Scale and the Karnofsky Performance Status. Although brainstem CM have a relatively high rate of re-bleeding, thus adversely affecting the neurological status of the patient, recent reports have demonstrated favorable outcomes after their resection. Hence, surgical removal can be recommended for cases of symptomatic brainstem CM, particularly those with re-bleeding. An optimal surgical approach, providing direct access to the lesion, is critical for successfully resecting brainstem CM.

DOI： 10.2335/scs.46.58

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Language：Japanese  

DOI： 10.2335/scs.46.58

J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

症例1(52歳女性)。右後頭葉AVMに対するガンマナイフ(GKS)10年後に左下肢の筋力低下が出現し、血管腫様病変の診断に至った。頭部造影MRIでは右後頭葉に強い周辺脳浮腫を伴う増強効果の著しい腫瘤が認められた。そこで、右後頭開頭による全摘出術を行ったところ、術後、神経症状、脳浮腫は速やかに改善した。症例2(20歳女性)。脳室内出血で発症した左後頭葉AVMに対するGKS後11年経過で頭痛が出現し、診断に至った。頭部造影MRIでは左後頭葉に強い周辺脳浮腫を伴う増強効果の著しい腫瘤、ならびに脳室内嚢胞性病変が認められ、腹臥位にて後頭葉半球間裂経由で摘出し、術後、頭痛と脳浮腫は速やかに改善した。症例3(31歳女性)。AVMに対するGKS後9年経過で右上下肢の筋力低下が出現し、診断に至った。頭部MRIでは左半球間裂に腫瘤が認められ、T2では強い周辺脳浮腫がみられた。そこで、経半球裂アプローチにて全摘出したところ、術後に一過性の右片麻痺が生じたが、運動麻痺は1週間後にはほぼ回復し、脳浮腫も術後1ヵ月以内に消失した。

DOI： 10.2335/scs.39.347

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Language：Japanese  

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Language：Japanese   Publisher：(株)メディカ出版  

穿頭血腫ドレナージ術を施行した109例のうち再発した11例(男8例、女3例、年齢51〜91歳)を対象に、再発に影響を及ぼす因子について多変量解析を用いて検討した。11例中6例に先行する頭部打撲があり、抗血栓・凝固薬使用では抗凝固薬1例、高血圧あり2例、糖尿病あり2例であった。その結果、「手術翌日の残存空気が1/4(25%)以上」と「1週間後の脳の膨張率が悪い」のみが有意な因子であった。年齢、性別、先行する頭部打撲、抗血栓・凝固療法の有無、高血圧・糖尿病の既往については再発因子としては有意ではなかった。また、手術翌日に残存空気が25%以上ある群は、残存空気が少ない群と比較して優位に1週間後の脳の膨張率が悪い結果となった。

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Language：Japanese   Publisher：(株)癌と化学療法社  

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Language：Japanese   Publisher：The Japanese Congress of Neurological Surgeons  

We retrospectively studied 43 patients with pediatric cerebral arteriovenous malformation, 15 boys and 28 girls aged 4 to 15 years (mean 11.7 years), who underwent gamma knife radiosurgery (GKS) at our hospital. The mean nidus volume was 4.5 ml(0.1〜17 ml), and the mean prescription dose at the nidus margin was 19.9 Gy(12〜25 Gy). The actuarial obliteration rate was 50.0% at 3 years and 80.0% at 5 years, based on angiography in 24 patients and magnetic resonance (MR) imaging in 4 patients. The delivered peripheral dose tended to be correlated with obliteration rate (p=0.09). Fourteen of the 43 patients developed radiation-induced change in the brain tissue on follow-up MR imaging, and 4 of these 14 patients were symptomatic. Eight of the 14 patients with edema of the brain tissue required steroid therapy. None suffered permanent neurological complication. Three of the 43 patients suffered postradiosurgical hemorrhage. No patient developed long-term complication such as cyst formation or chronic encapsulated expanding hematoma. These findings suggest that GKS is effective for the treatment of pediatric cerebral arteriovenous malformation, especially if located in deep or eloquent areas. In contrast, we recommend direct surgery for cerebral arteriovenous malformation in surgical accessible regions because of the relatively high rate of radiation-induced change of brain tissue on follow-up MR imaging.

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