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OBJECTIVE: The purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs). METHODS: Data from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed. RESULTS: Spinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7-546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of ≥ 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02). CONCLUSIONS: Based on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.

DOI： 10.3171/2020.6.SPINE20309

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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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OBJECTIVE: Spinal arteriovenous shunts are rare vascular lesions and are classified into 4 types (types I-IV). Due to rapid advances in neuroimaging, spinal epidural AVFs (edAVFs), which are similar to type I spinal dural AVFs (dAVFs), have recently been increasingly reported. These 2 entities have several important differences that influence the treatment strategy selected. The purposes of the present study were to compare angiographic and clinical differences between edAVFs and dAVFs and to provide treatment strategies for edAVFs based on a multicenter cohort. METHODS: A total of 280 consecutive patients with thoracic and lumbosacral spinal dural arteriovenous fistulas (dAVFs) and edAVFs with intradural venous drainage were collected from 19 centers. After angiographic and clinical comparisons, the treatment failure rate by procedure, risk factors for treatment failure, and neurological outcomes were statistically analyzed in edAVF cases. RESULTS: Final diagnoses after an angiographic review included 199 dAVFs and 81 edAVFs. At individual centers, 29 patients (36%) with edAVFs were misdiagnosed with dAVFs. Spinal edAVFs were commonly fed by multiple feeding arteries (54%) shunted into a single or multiple intradural vein(s) (91% and 9%) through a dilated epidural venous plexus. Preoperative modified Rankin Scale (mRS) and Aminoff-Logue gait and micturition grades were worse in patients with edAVFs than in those with dAVFs. Among the microsurgical (n = 42), endovascular (n = 36), and combined (n = 3) treatment groups of edAVFs, the treatment failure rate was significantly higher in the index endovascular treatment group (7.5%, 31%, and 0%, respectively). Endovascular treatment was found to be associated with significantly higher odds of initial treatment failure (OR 5.72, 95% CI 1.45-22.6). In edAVFs, the independent risk factor for treatment failure after microsurgery was the number of intradural draining veins (OR 17.9, 95% CI 1.56-207), while that for treatment failure after the endovascular treatment was the number of feeders (OR 4.11, 95% CI 1.23-13.8). Postoperatively, mRS score and Aminoff-Logue gait and micturition grades significantly improved in edAVFs with a median follow-up of 31 months. CONCLUSIONS: Spinal epidural AVFs with intradural venous drainage are a distinct entity and may be classified as type V spinal vascular malformations. Based on the largest multicenter cohort, this study showed that primary microsurgery was superior to endovascular treatment for initial treatment success in patients with spinal edAVFs.

DOI： 10.3171/2020.2.SPINE191432

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

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).

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®.

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.

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.

DOI： 10.2335/scs.48.42

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The suction decompression (SD) method, which proactively aspirates the blood flowing into the aneurysm and reduces the internal pressure of the aneurysm, is useful for clipping surgery of large and giant cerebral aneurysm. However, there has been little discussion on re-utilization of blood aspirated during SD. This study aimed to examine the safety, convenience, and usefulness of autologous transfusion of aspirated blood using a transfusion bag. At the time of craniotomy, the cervical carotid artery is fully exposed. An angiocatheter sheath was inserted into the carotid artery and placed in the internal carotid artery. In SD, blood was aspirated from the sheath at a constant speed and quickly stored in a blood transfusion storage bag. Blood aspiration was repeated with a new syringe; once the transfusion bag was full, the blood was re-administered to the patient. Changes in vital sign and hemoglobin/hematocrit values before and after SD were examined in five cases performed in this procedure. The aspirated blood volumes of five cases ranged from 130 to 400 mL, and all aspirated blood was successfully re-transfused. There was no critical change in vital sign, and no significant decrease in the hemoglobin/hematocrit value. No findings suggestive of complications of thrombus formation, infection, and hemolysis were noted. Re-transfusion of aspirated blood during SD using a transfusion bag is a simple and safe method, which can minimize potential risk of re-utilizing aspirated blood, and enables the safe and easy execution of SD regardless of aspirated blood volume.

DOI： 10.2176/nmc.tn.2018-0299

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PURPOSE: Oligodendroglioma has a relatively favorable prognosis, however, often undergoes malignant progression. We hypothesized that preclinical models of oligodendroglioma could facilitate identification of therapeutic targets in progressive oligodendroglioma. We established multiple oligodendroglioma xenografts to determine if the PI3K/AKT/mTOR signaling pathway drives tumor progression. EXPERIMENTAL DESIGN: Two anatomically distinct tumor samples from a patient who developed progressive anaplastic oligodendroglioma (AOD) were collected for orthotopic transplantation in mice. We additionally implanted 13 tumors to investigate the relationship between PI3K/AKT/mTOR pathway alterations and oligodendroglioma xenograft formation. Pharmacologic vulnerabilities were tested in newly developed AOD models in vitro and in vivo. RESULTS: A specimen from the tumor site that subsequently manifested rapid clinical progression contained a PIK3CA mutation E542K, and yielded propagating xenografts that retained the OD/AOD-defining genomic alterations (IDH1 R132H and 1p/19q codeletion) and PIK3CA E542K, and displayed characteristic sensitivity to alkylating chemotherapeutic agents. In contrast, a xenograft did not engraft from the region that was clinically stable and had wild-type PIK3CA. In our panel of OD/AOD xenografts, the presence of activating mutations in the PI3K/AKT/mTOR pathway was consistently associated with xenograft establishment (6/6, 100%). OD/AOD that failed to generate xenografts did not have activating PI3K/AKT/mTOR alterations (0/9, P < 0.0001). Importantly, mutant PIK3CA oligodendroglioma xenografts were vulnerable to PI3K/AKT/mTOR pathway inhibitors in vitro and in vivo-evidence that mutant PIK3CA is a tumorigenic driver in oligodendroglioma. CONCLUSIONS: Activation of the PI3K/AKT/mTOR pathway is an oncogenic driver and is associated with xenograft formation in oligodendrogliomas. These findings have implications for therapeutic targeting of PI3K/AKT/mTOR pathway activation in progressive oligodendrogliomas.

DOI： 10.1158/1078-0432.CCR-18-4144

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Language：Japanese   Publisher：The Japanese Society of Spinal Surgery  

DOI： 10.2531/spinalsurg.33.198

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OBJECTIVE: Erythropoietin (EPO) is a clinically available hematopoietic cytokine. EPO has shown beneficial effects in the context of spinal cord injury and other neurological conditions. The aim of this study was to evaluate the effect of EPO on a rat model of spinal cord compression-induced cervical myelopathy and to explore the possibility of its use as a pharmacological treatment. METHODS: To develop the compression-induced cervical myelopathy model, an expandable polymer was implanted under the C5-C6 laminae of rats. EPO administration was started 8 weeks after implantation of a polymer. Motor function of rotarod performance and grip strength was measured after surgery, and motor neurons were evaluated with H-E, NeuN and choline acetyltransferase staining. Apoptotic cell death was assessed with TUNEL and Caspase-3 staining. The 5HT, GAP-43 and synaptophysin were evaluated to investigate the protection and plasticity of axons. Amyloid beta precursor protein (APP) was assessed to evaluate axonal injury. To assess transfer of EPO into spinal cord tissue, the EPO levels in spinal cord tissue were measured with an ELISA for each group after subcutaneous injection of EPO. RESULTS: High-dose EPO maintained motor function in the compression groups. EPO significantly prevented the loss of motor neurons and significantly decreased neuronal apoptotic cells. Expression of 5HT and synaptophysin was significantly preserved in the EPO group. APP expression was partly reduced in the EPO group. The EPO levels in spinal cord tissue were significantly higher in the high-dose EPO group than other groups. CONCLUSION: EPO improved motor function in rats with compression-induced cervical myelopathy. EPO suppressed neuronal cell apoptosis, protected motor neurons, and induced axonal protection and plasticity. The neuroprotective effects were produced following transfer of EPO into the spinal cord tissue. These findings suggest that EPO has high potential as a treatment for degenerative cervical myelopathy.

DOI： 10.1371/journal.pone.0214351

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OBJECTIVE: Postoperative C5 palsy is a well-known complication after cervical decompression with either a posterior or an anterior approach. Its cause has been discussed more regarding the posterior approach. The main hypothesis is that postoperative spinal cord shift causes root traction and palsy. However, the pathogenesis in anterior cases has not been fully described. Therefore, the purpose of this study was to clarify the risk factors for C5 palsy in the anterior approach through our C5 palsy cases. METHODS: A total of 149 surgical patients with an anterior cervical lesion were treated by a specific spinal surgeon under consistent same treatment strategy. Of these patients, 88 who satisfied the evaluation criteria were enrolled. Postoperative C5 palsy was defined as postoperative weakness of the deltoid with or without weakness of the biceps brachii. Risk factors of C5 palsy were extracted from clinical backgrounds, surgical approaches, and radiologic findings from patients with palsy. RESULTS: Four sides of 3 individuals (4.6%) who underwent multiple corpectomy developed C5 palsy. All paralyses became evident several days after the surgery and recovered. Older age, multiple corpectomy, postoperative spinal cord shift, and foraminal stenosis of C4-5 and C5-6 were statistically extracted as causative factor of C5 palsy. In the patients with palsy, distortion of the anterior nerve root as a result of a residual vertebral spur was observed with anterior spinal cord shift after anterior corpectomy. CONCLUSIONS: Multiple corpectomy for patients with longer anterior lesions and locally developed kyphosis is related to a larger postoperative cord shift, which can cause the occurrence of C5 palsy. Moreover, C4-5 or C5-6 foraminal stenosis can accelerate tethering of the C5 or C6 nerve root. Older patients undergoing multiple corpectomy are susceptible to these risks of palsy. Appropriate patient selection and sufficient additional foraminotomy should be considered for extensive anterior lesions and locally developed kyphosis to avoid postoperative C5 palsy.

DOI： 10.1016/j.wneu.2018.08.240

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BACKGROUND: Bow hunter's syndrome (BHS) is rare and typically induced by mechanical compression of the dominant vertebral artery (VA) during head rotation. We report a case of BHS induced by nondominant VA compression in which contralateral VA patency was preserved. Definite diagnosis of BHS is not often feasible because of transient symptoms and nonspecific clinical features, such as vertigo or dizziness, especially in nondominant VA compression. We discuss the diagnostic clues of BHS and clinical features of BHS caused by nondominant VA compression through a literature review. CASE DESCRIPTION: A 65-year-old man suffered repeated bouts of dizziness whenever his head was rotated to the left. This dizziness was consistently accompanied by downbeat nystagmus (DBN). Radiography revealed left VA compression by a lateral osteophyte at the C3-C4 level only during left head rotation. In contrast, patency of the right VA, which was almost equivalent in size to the left VA, was preserved during head rotation. The distinctive clinical finding of head rotation-induced DBN, which is usually associated with lesions involving the caudal midline cerebellum, was observed. Symptoms disappeared immediately after left VA decompression with osteophytectomy and C3-C4 fusion. CONCLUSIONS: Despite excellent flow through the contralateral VA, occlusion of the nondominant VA occasionally induces BHS. According to a review of the literature, BHS cases do not always depend on the VA on one side for blood supply. Head rotation-induced DBN can be useful for diagnosis of BHS, even in cases of nondominant VA compression.

DOI： 10.1016/j.wneu.2017.12.167

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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   Publisher：The Japanese Society of Spinal Surgery  

DOI： 10.2531/spinalsurg.30.198

DOI： 10.2531/spinalsurg.36.132_references_DOI_LjKaBIarZxHMsgwvQNApuv3KTtN

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The basic procedure of carotid endarterectomy (CEA) has been almost established. However, beginners sometimes have difficulty dissecting the plaque at the same plane and treating the distal end of the plaque, even in typical cases. A simple, safe, and standardized procedure is important for beginners. We use the internal shunt in all cases to secure adequate blood flow and take advantage of the shunt tube as the tool for plaque dissection at the distal end.<br>We introduce our surgical technique and review our procedure from a beginner's point of view. We tack up the skin, muscle, and carotid sheath by using sutures to make wide and shallow operative fields without retractors. We insert the internal shunt tube after arteriotomy. Beginners need to rehearse the tube insertion before the procedure. At the proximal side of the plaque, we connect both sides of the dissection plane across the shunt to secure the same plane.<br>The distal end of the intima of the internal carotid artery (ICA) is fastened by using a shunt tube and tourniquet. The plaque can be easily cut off at the position of the tourniquet. If the plaque remains, we can peel off the plaque remnant like peeling onion skin. A shunt tube is used as the template of the ICA lumen in the distal end.<br>Beginners can easily master these procedures, which can be performed safely without distress, even in high-positioned stenosis. These procedures enable the beginners to accomplish CEA securely.

DOI： 10.2335/scs.44.352

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Adequate operative field and preservation of perforating arteries is necessary for successful, safe clipping of cerebral aneurysm. However, it is often difficult to avoid multiple perforators adjacent or dorsal to the aneurysm even if they could be separated from the aneurysm. Here, we used a polyglactin mesh (Vicryl mesh®) for aneurysmal clipping surgery. The polyglactin mesh is made of glycolic-lactic acid polyester and can be hydrolyzed within a living body. It is very thin, about 0.1 mm, without being fuzzy, and can be cut freely into any size and shape. Because of its consistency, it can hold dissected perforators off the aneurysm while clipping the neck, thus facilitating safe and successful maneuvers. It can also be retrieved safely and easily because it does not adhere to the surrounding structures. We used them in 45 cases of aneurysm. We could clip the cerebral aneurysms safely while avoiding perforators, other critical arteries, and cranial nerves around the aneurysm. No complications like vasospasm and perforator injuries were noted. Eighty-seven percent of the clipping procedures were accomplished by junior neurosurgeons under the guidance of senior instructors using the polyglactin mesh. This procedure is useful and safe in preserving critical arteries and structures like perforators and cranial nerves around the cerebral aneurysm.

DOI： 10.2335/scs.44.81

DOI： 10.2531/spinalsurg.36.132_references_DOI_NAFnZTeLNip9HR7BLq3k68ZfNe8

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DOI： 10.2531/spinalsurg.29.211

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PURPOSE: Semiquantitative analysis of thallium-201 chloride single photon emission computed tomography (201Tl SPECT) was evaluated for the discrimination between recurrent brain tumor and delayed radiation necrosis after gamma knife surgery (GKS) for metastatic brain tumors and high-grade gliomas. METHODS AND MATERIALS: The medical records were reviewed of 75 patients, including 48 patients with metastatic brain tumor and 27 patients with high-grade glioma who underwent GKS in our institution, and had suspected tumor recurrence or radiation necrosis on follow-up neuroimaging and deteriorating clinical status after GKS. Analysis of 201Tl SPECT data used the early ratio (ER) and the delayed ratio (DR) calculated as tumor/normal average counts on the early and delayed images, and the retention index (RI) as the ratio of DR to ER. RESULTS: A total of 107 tumors were analyzed with 201Tl SPECT. Nineteen lesions were removed surgically and histological diagnoses established, and the other lesions were evaluated with follow-up clinical and neuroimaging examinations after GKS. The final diagnosis was considered to be recurrent tumor in 65 lesions and radiation necrosis in 42 lesions. Semiquantitative analysis demonstrated significant differences in DR (P=.002) and RI (P<.0001), but not in ER (P=.372), between the tumor recurrence and radiation necrosis groups, and no significant differences between metastatic brain tumors and high-grade gliomas in all indices (P=.926 for ER, P=.263 for DR, and P=.826 for RI). Receiver operating characteristics analysis indicated that RI was the most informative index with the optimum threshold of 0.775, which provided 82.8% sensitivity, 83.7% specificity, and 82.8% accuracy. CONCLUSIONS: Semiquantitative analysis of 201Tl SPECT provides useful information for the differentiation between tumor recurrence and radiation necrosis in metastatic brain tumors and high-grade gliomas after GKS, and the RI may be the most valuable index for this purpose.

DOI： 10.1016/j.ijrobp.2012.03.008

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<b>Purpose</b> : Fibrocartilaginous embolism (FCE) causing spinal cord ischemia is poorly understood. Although rare, its clinical impact is significant due to rapid progression of motor paralysis despite minor trauma. Here we report a case of FCE. <b>Case Presentation</b> : A 23-year-old man without a significant prior medical history experienced lower-limb numbness and lumbar pain 15min after falling on his buttocks, with paraplegia and bladder and rectal dysfunction developing 1 h later. Proprioception was retained. Intramedullary high-intensity signals within the spinal cord from T8 to the conus medullaris were detected on T2-weighted magnetic resonance imaging (MRI). Suspecting spinal cord ischemia in the anterior spinal artery area, we initiated treatment with steroids, edaravone, aspirin, and hyperbaric oxygen therapy, considering the possibility of myelitis and demyelinating diseases. Subsequently, aortic dissection and other vascular abnormalities were ruled out by contrast computed tomography, and coagulation abnormalities, vasculitis, immune and demyelinating diseases were ruled out by blood tests and cerebrospinal fluid analysis. Intramedullary high-intensity signals on diffusion-weighted imaging and low signal changes on apparent diffusion coefficient MRI were observed. On contrast-enhanced MRI, no contrast-enhanced lesions were observed. The patient was able to walk with a cane at 37 days post-injury, and the neurological deficits disappeared after 3 months. <b>Discussion</b> : Although veterinary medical literature has reported more cases in various animals, it is difficult to make a histological diagnosis of FCE in humans because it requires a spinal cord biopsy. Therefore, it is necessary to make a diagnosis primarily through the exclusion of conditions such as infection, myelitis, vasculitis, coagulation disorders, and demyelinating diseases based on the characteristic clinical course, neurological symptoms in the anterior spinal artery area, and abnormal findings consistent with vascular distribution mainly on axial MRI. The pathophysiological mechanism involves intervertebral disc components entering the spinal cord microcirculation due to increased intradiscal pressure, then retrogradely flowing into the radicular arteries, causing embolization in the anterior spinal artery area. Treatment methods are lacking, and prognostic reports are inconsistent. It is important to be aware of the possibility of FCE and accumulate further case studies in the future.

DOI： 10.2531/spinalsurg.37.272

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2006年5月～2013年4月の間に施行した頸椎前方除圧手術のうち、椎間板切除固定または椎体亜全摘固定にて初回外科治療を施行した頸椎変性疾患、または後縦靱帯骨化症例を対象に「C5麻痺発生における脊髄移動の関与」について検討した。対象は椎体レベルの一部、または全体がC3～C6の間に存在し、所定画像検査の基準を満たし、かつ術後6ヵ月以上の追跡可能であった65例(男性38例、女性27例)であった。その結果、1)術後C5麻痺は3例(うち1例は両側性)に認められ、いずれも遅発性発症(術後2～4日)であった。患者の年齢中央値は発症群74歳、非発症群53歳で、発症群の疾患は全例が頸椎症性脊髄症、椎間板ヘルニアの症例で、術式は多椎体切除であった。2)MRI上の術後脊髄移動距離の中央値は発症群で3.4mm、非発症群で0.4mmであった。一方、発症時の徒手筋力テストのスコア中央値は3.5であった。3)診断後は全例でデキサメタゾン点滴静注とビタミンB12内服による保存療法が行われた。4)頸椎前方固定術後の遅発性C5麻痺は高齢者の多椎体切除例において発症リスクが高い傾向がみられたほか、除圧による脊髄前方移動、椎間孔狭窄の関与が示唆された。このことからも多椎体切除例における脊髄前方移動は完全な回避は困難であり、多椎体切除のように大きな脊髄移動を伴う手術では術後遅発性C5麻痺が生じやすいと考えられた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J02943&link_issn=&doc_id=20150901350018&doc_link_id=10.2531%2Fspinalsurg.29.211&url=https%3A%2F%2Fdoi.org%2F10.2531%2Fspinalsurg.29.211&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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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：日本定位放射線治療学会  

脳動静脈奇形に対するガンマナイフ施行後(1.1～13.5年後)に嚢胞形成が認められた25例(男15例、女10例、平均29.6歳)について報告した。造影MRI所見は、嚢胞壁の一部に結節状の増強効果を呈する病変を認め周囲脳に浮腫を伴わないものが15例、均一な増強効果を呈しmass effectと強い脳浮腫を伴うものが6例、増強効果を示す病変のないものが1例であった。治療は開頭術を12例に行い、嚢胞内容物はキサントクロミーで高蛋白であったが、血性のものもあり、一部の症例では画像上明らかな嚢胞への出血が認められた。嚢胞内腔面は褐色を呈し、白色の変性したナイダスと共に赤色の軟らかい結節性病変を認め、これを摘出した。2例はOmmaya貯留槽設置で嚢胞サイズの制御が得られ、1例は自然縮小した。定期的経過観察9例のうち、5例は嚢胞サイズ不変、1例は増大や縮小を繰り返し、3例は増大傾向であるが無症候性または深部に存在するため無治療としている。

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Language：Japanese   Publisher：(一社)日本神経学会  

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