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DOI： 10.1016/j.jstrokecerebrovasdis.2022.106573

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DOI： 10.1016/j.clnu.2021.07.009

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DOI： 10.1016/j.clnu.2021.01.040

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Neurosurgical Society  

DOI： 10.2176/nmc.oa.2020-0350

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Other Link： https://search.jamas.or.jp/link/ui/2022000704

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

INTRODUCTION: Although arteriovenous fistulas(AVFs)are typically located within the cranium, there are several published reports documenting rare cases of extracranial AVFs between the ascending pharyngeal artery(APA)and the internal jugular vein(IJV). Herein, we report the case of a patient with APA-IJV AVFs who presented with symptoms of lower cranial nerve palsy that was treated with transvenous embolization(TVE). CASE: A 53-year-old man presented with chief complaints of numbness in the left oral cavity and a temple headache. Magnetic resonance angiography showed an abnormal signal in the left jugular bulb. An AVF was suspected; digital subtraction angiography revealed the presence of a shunt from the jugular branch of the APA to the jugular bulb which was accompanied by regurgitation into the inferior petrosal sinus(IPS)and sigmoid sinus(SS). Numbness in the oral cavity was diagnosed as lower cranial nerve palsy associated with increased pressure within the jugular foramen. As the nature of the AVF(single or multi-hole)was uncertain, a therapeutic TVE was planned. Microcatheters were guided into the IPS and SS, and TVE was performed using a double-catheter technique. Regurgitation into the IPS resolved; embolization via the APA was not performed, and symptoms improved postoperatively. CONCLUSIONS: AVFs involving the APA and IJV are identified infrequently and there are only a few published case reports describing this vascular anomaly. Most reported cases were single-hole AVF and were treated with trans-arterial embolization via the APA. As noted in the present case, APA-IJV AVF can also be treated by TVE.

DOI： 10.11477/mf.1436204376

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Language：English   Publisher：The Japanese Society for Neuroendovascular Therapy  

OBJECTIVE: To elucidate the current state of in-hospital acute ischemic stroke under the introduction of acute-phase mechanical thrombectomy. METHODS: The study included 18 consecutive patients with in-hospital cerebral infarction who underwent thrombectomy between April 2014 and March 2020 at St. Marianna University School of Medicine Yokohama City Seibu Hospital. We analyzed the primary disease, department responsible for treatment, modified Rankin Scale (mRS) scores before onset and on discharge, status of onset, treatment course, and so on. RESULTS: The mean age was 79.9 (66-93) years. There were nine females. The admission methods included scheduled admission in 5 patients and non-scheduled admission in 13 patients. The primary diseases consisted of malignant tumors in five patients and heart disease in four patients. The departments responsible for treatment consisted of the Department of Digestive Surgery for six patients and Department of Cardiology for three patients. The mRS score before admission was evaluated as 0-2 in 15 patients and 3-5 in 3 patients. The embolism was evaluated as cardiogenic in 14 patients. Antithrombotic therapy was discontinued before the onset of cerebral infarction in three patients. The mean interval from onset or last well known (LWK) until CT/MRI and puncture was 88.4 and 157.6 minutes. The median Alberta stroke program early CT score (ASPECTS; minimum-maximum) was 8 (2-10). Tissue plasminogen activator (t-PA) was administered to five patients. Concerning the degree of recanalization, the thrombolysis in cerebral infarction (TICI) grade was evaluated as 1 to 2a in 2 patients and 2b to 3 in 16. In the latter, the mean interval from onset or final onset-free confirmation until recanalization was 197.7 minutes. mRS score on discharge was evaluated as 0-2 in four patients, 3-5 in nine, and 6 in five patients. The mortality was related to a primary disease requiring admission in three patients. CONCLUSION: In-hospital onset cerebral infarction was markedly influenced by the primary disease requiring admission. Even when favorable recanalization was achieved, the number of patients with a favorable outcome was small.

DOI： 10.5797/jnet.oa.2020-0171

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Other Link： https://www.jstage.jst.go.jp/article/jnet/15/12/15_oa.2020-0171/_pdf

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Congress of Neurological Surgeons  

DOI： 10.7887/jcns.30.741

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Other Link： https://search.jamas.or.jp/link/ui/2022010668

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

Background and Purpose: The natural history and therapeutic management of patients with unruptured vertebral dissections presenting with headache remains unclear. We retrospectively assessed 41 consecutive patients treated for unruptured vertebral dissections that presented with headaches.

Methods: We identified 41 patients diagnosed with vertebral artery dissection through magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and angiography between April 2008 to March 2017 and who experienced only headache at the time of onset. All patients underwent MRI, MRA, or three-dimensional computed tomography (CT) every 1-4 weeks for 3 months, every 1-3 months between 3 and 6 months, every 3-6 months 6 months post-onset, or more often depending on the situation. Clinical characteristics, morphological changes, and treatments were analyzed.

Results: Headaches were posteriorly located in 39 cases, however, there were no specific findings other than location. Primary radiographic investigations showed dilatation in 13 cases, pearl and string signs in 20 cases, and stenosis or occlusion in 8 cases. Following the initial conservative treatment, morphologic changes were improved in 27 cases, dilated and occluded in 8 cases, and remained unchanged in 6 cases. The most morphological changes were seen within 3 months for 35 cases, with a mean time of 1.6 months, however, for 6 cases the mean time was 11.2 months. These 6 patients showed dilation and occlusion as morphological changes. Five of these 6 patients' dissection sites enlarged and 3 underwent surgical treatment at a mean of 7.7 months post-onset. The remaining 2 patients were treated conservatively; their dissection sites healed and decreased. None of the patients experienced bleeding or neurological deficits during follow-up.

Conclusion: Clinicians should monitor patients with unruptured vertebral dissections who present with headache to prevent stroke development. It should be noted that even if the dissection site enlarges without new symptoms, acute intervention is not always required and patients should be treated with careful radiographic follow-up.

DOI： 10.2335/scs.49.42

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Other Link： https://search.jamas.or.jp/link/ui/2021211368

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DOI： 10.1016/j.nut.2021.111407

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Language：Japanese   Publisher：The Japan Society of Neurotraumatology  

<i>Objectives:</i> As the incidence of stepladder related fall injury (sLRFI) is increasing in Japan, we retrospectively analyzed our own previous sLRFI cases to investigate the clinical characteristics of sLRFI and to give information about the awareness of stepladder safety and pre­cautions.

<i>Materials and Methods:</i> From April 2009 to March 2019, we treated 8 sLRFI cases at our institution. The frequency of sLRFI cases in acute head trauma, patient’s age, sex, cause of injury, Glasgow Coma Scale (GCS) on admission, type of head injury, extracranial lesions, neurosurgical treatment method and outcomes in each patient were retrospectively reviewed.

<i>Results:</i> During the same period, we treated 989 patients with acute head trauma, and determined the sLRFI frequency to be 0.8%. Patients evaluated in the current analysis included 7 males and 1 female, with ages ranging from 52 to 86 years (mean age of 76 years). Mean GCS on admission was 12 points. Cause of injury were non–occupational falls in 7 patients and occupational in 1. Seven out of 8 patients fell from the top of the stepladders or during straddling the stepladders. Type of head injury included acute epidural hema­toma in 3, acute subdural hematoma in 3, cerebral contusion in 3, traumatic intracerebral hematoma in 1, traumatic subarachnoid hemor­rhage in 5, chronic subdural hematoma in 2, pneumocephalus in 1 and skull fracture in 3. Extracranial lesions included clavicular fracture in 1 patient, rib fracture in 2, hemopneumothorax in 2. Neurosurgical procedures were performed in 6 patients. Evacuation of hematoma via craniotomy was carried out in 4 patient, irrigation of hematoma through a burr hole in 2. At the time of discharge, outcomes based on the Glasgow outcome scale were good recovery in 3, moderately disabled in 3, severely disabled in 1, with death occurring in 1.

<i>Conclusions:</i> Clinical characteristics of sLRFI were evaluated based on our previous cases. The typical patients of sLRFI were male, elderly and non–occupational users. As the trend of stepladder falls has been increasing, preventative strategies should be established to support stepladder safety usage.

DOI： 10.32187/neurotraumatology.43.2_70

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Language：Japanese   Publisher：The Japanese Society for Spine Surgery and Related Research  

We reviewed the surgical outcomes of spinal meningioma. A total of 8 patients (follow-up duration: 1-10 years) with spinal meningioma were treated surgically in our institute over the past 10 years. The localisation of all meningiomas was thoracic. The surgeries consisted of posterior midline skin incision; removal of the meningioma via bilateral laminoplasty (5 cases); hemilaminectomy (2 cases); and bilateral laminectomy, pediculectomy, and facetectomy with posterior fixation (1 case). All meningiomas were completely removed (Simpson grade II). No patients showed neurological deterioration or recurrence. The surgical routes are important in the complete removal of spinal meningiomas.

DOI： 10.34371/jspineres.2020-0702

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Language：Japanese   Publisher：The Japan Society of Neurotraumatology  

<i>Objectives:</i> As traumatic basal ganglia hemorrhage (TBGH) is uncom­mon, we retrospectively analyzed our own previous TBGH cases in order to investigate the clinical characteristics of this rare hemorrhagic lesion.

<i>Materials and methods:</i> From January 2012 to June 2018, we treated 6 TBGH cases at our institution. We reviewed the frequency of TBGH cases in acute head trauma, patient’s age, sex, cause of injury, Glasgow coma scale at the time of admission, TBGH site, associated intracranial lesions, treatment method and outcomes in each patient.

<i>Results:</i> During the same period, we treated 214 patients with acute head trauma, and determined the TBGH frequency to be 2.8%. Patients evaluated in the current analysis included 5 males and 1 female, with ages ranging from 17 to 86 years, (mean age of 43.8 years). Cause of injury included traffic accidents in 3, falls in 2, and falling downstairs in 1 patient. Glasgow coma scale at the time of admission was 15 in 1, and less than 8 in the other 5 patients. TBGH sites included the putamen in 3 and the globus pallidus in 3 patients. Computed tomography detected associated intracranial lesions in all cases, with acute subdural hematoma (aSDH) found in 3, traumatic subarachnoid hemorrhage in 2, skull fracture in 2, and corpus callosum injury in 1 patient. With the exception of 1 case, surgical procedures were performed in all patients. Evacuation of TBGH via craniotomy was carried out in 1 patient, and evacuation of aSDH in 3 patients, and placement of external ventricular drainage and intracranial pressure monitoring in 1 patient. At the time of discharge, outcomes based on the Glasgow outcome scale were moderately disabled in 1, and severely disabled in 3, with death occurring in 2 patients.

<i>Conclusions:</i> Clinical characteristics of TBGH were evaluated based on our previous cases. Although TBGH is uncommon, medical staff need to have a basic knowledge of this traumatic injury.

DOI： 10.32187/neurotraumatology.43.1_23

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Language：Japanese   Publisher：Japanese Society for Clinical Nutrition and Metabolism  

<b>Aim:</b> To investigate the optimal acute-phase nutrition protocol by using different enteral formulas in patients with stroke.

<b>Subjects and methods:</b> This single-center retrospective analysis included 51 acute stroke patients who received enteral nutrition according to an early enteral feeding protocol from August 2015 to April 2017. The patients were classified into two groups: the 1.0 kcal group who received a standard 1.0 kcal/mL formula (n = 28 patients) and the 1.5 kcal group who received a 1.5 kcal/mL formula (a high protein peptide-based formula followed by a liquid diet [1.5 kcal/mL] and later switched to partially hydrolyzed guar gum (PHGG]-containing liquid diet; n = 23). Clinical progress and outcomes were retrospectively compared between the groups.

<b>Results:</b> Baseline characteristics were similar between both groups. Compared with the 1.0 kcal group, the 1.5 kcal group had a lower protocol incompletion rate owing to gastrointestinal symptoms and fewer number of days needed to complete the protocol. The 1.5 kcal group also had a lower rate of weight loss. Blood biochemistry results showed improvement in nutritional status and inflammatory status.

<b>Conclusion:</b> The nutritional protocol using a 1.5 kcal/mL high protein peptide-based formula and a 1.5 kcal/mL PHGG-containing liquid diet was more beneficial than that using a 1.0 kcal/mL standard formula in acute stroke patients.

DOI： 10.11244/ejspen.2.2_103

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Language：Japanese   Publisher：The Japanese Society of Spinal Surgery  

A 63-year-old woman presented with a rare case of both intraspinal and orbital inflammatory pseudotumors (IPT). The former IPT manifested as progressive dysesthesia and pain in her left leg. MRI revealed a mass at L5/S1 with extradural and intradural components, showing low signal on T1 and T2-weighted images and strong homogeneous enhancement on gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). Intraoperatively, an extradural granulomatous lesion that was slightly adhesive to the dura mater was found and removed. Histological examination of the resected lesions revealed the presence of excessive collagen fibers infiltrated with polyclonal lymphocytes, plasma cells macrophages, and giant cells. Only a small number of IgG4-positive cells were observed. Immunostaining for the epithelial membrane antigen was negative. No malignant cells were detected. The diagnosis was consistent with IPT. Two months after surgery, orbital IPT developed. She was treated with steroids. After one year, no aggravation was observed.

  IPTs usually occur in the lung and the orbit, but rarely in the spine. Although spinal IPTs are typically solitary lesions, we present a case of a patient with multiple IPTs and review the literature.

DOI： 10.2531/spinalsurg.34.302

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Other Link： https://search.jamas.or.jp/link/ui/2021131286

Language：Japanese   Publisher：Japanese Society for Clinical Nutrition and Metabolism  

DOI： 10.11244/ejspen.2.2_158

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DOI： 10.1016/j.brainres.2019.05.034

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-19K15752/

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OBJECTIVES: Intracranial chordomas are thought to arise from remnants of the notochord and usually occur at the parasellar region. We present a case of a primary intrasellar chondroid chordoma in a patient who was initially diagnosed with a pituitary adenoma. CASE: A 77-year-old woman had a history of two surgeries for a tumor in the sella turcica(17 months after the 1st surgery). On initial MRI, the intrasellar mass showed low signal intensity on T1WI, very high signal intensity on T2WI, and inhomogeneous enhancement. On bone reconstructive CT, the sellar floor was thin, and no abnormalities were observed at the top of the clivus. Transsphenoidal surgery was performed. The pathological diagnosis was pituitary adenoma in both cases. Seventy-two months after the 1st(31 months after the 2nd)surgery, she developed right-sided oculomotor and abducent nerve palsies again. Since recurrence occurred during the relatively short period, the surgical specimens obtained from the 1st and 2nd surgeries were reexamined. Reexamination of the previously obtained specimen demonstrated areas of chondroid tissue that were embedded in a mucoid stroma and tumor cells that were composed of round or pleomorphic nuclei with vacuolated cytoplasm(physaliphorus cells)that were compatible with chondroid chordoma. The third surgery was performed. Postoperatively, her symptoms improved, and cyber knife therapy was administered for the residual part of the tumor. CONCLUSIONS: Although intrasellar chondroid chordomas are extremely rare, they should be considered in the differential diagnosis of tumors located in the sella turcica.

DOI： 10.11477/mf.1436204042

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Language：Japanese   Publisher：Japanese Society for Parenteral and Enteral Nutrition  

DOI： 10.11244/jspen.34.237

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Other Link： http://id.ndl.go.jp/bib/030077137

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Neurosurgical Society  

DOI： 10.2176/nmc.oa.2018-0023

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Other Link： https://search.jamas.or.jp/link/ui/2019301726

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OBJECTIVES: Primary meningiomas arising outside the intracranial component are rather rare and have been termed primary extradural meningiomas(PEMs). We present a case of an intraosseous-type PEM occurring at a high convexity location and discuss the clinical characteristics of PEMs. CASE: An 80-year-old woman presented with a soft and painless subcutaneous mass of approximately 10 cm in diameter in the right parietal region, which had appeared 1 year previously. Mild cognitive dysfunction and left hemiparesis were observed upon admission. A skull radiograph and a bone window computed tomography scan revealed an osteolytic lesion at the above-mentioned site. Magnetic resonance imaging indicated that the mass was inhomogeneously enhanced and seemed to extend through the skull defect both intra- and extra-cranially. The preoperative diagnosis was a metastatic skull bone tumor due to the patient's history of breast cancer. During surgery, the tumor was found to be solid and had expanded through both the inner and outer tables of the skull, destroyed the inner table at one location, and perforated into the subdural space via the thinned, but not infiltrated, dura mater. The tumor was removed along with a wide margin of surrounding healthy bone and a cranioplasty was performed using a titanium plate. The histopathological diagnosis was atypical meningioma(World Health Organization grade II). Postoperatively, no adjuvant therapies(radiation and/or chemotherapy)were administered and the patient was reported to be well at 8 months post-surgery with no evidence of tumor recurrence. CONCLUSIONS: Although PEMs are rather rare, clinicians should consider the differential diagnosis of osteolytic skull vault tumors.

DOI： 10.11477/mf.1436203762

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DOI： 10.4103/sni.sni_220_17

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Language：Japanese   Publisher：Japan Society of Neurosurgical Emergency  

In 228 aneurysm cases, we assessed the relation of ischemic and hemorrhagic complications with age, sex, location, size, ruptured vs. unruptured status, WFNS (World Federation of Neurological Surgeons Committee) grade of ruptured cases and use of neck plasty. Of these 228 cases, 10 had ischemic complications (4.3%) and six had hemorrhagic complications (2.6%). Cases with ischemic complications were significantly correlated with those involving neck plasty. However, no permanent complications were identified. All hemorrhagic complications occurred in cases with ruptured aneurysms. In two cases with hemorrhagic complications, bleeding occurred at the end of coil insertion and the bleeding was stopped with the dilation of the balloon alone, which resulted in good prognosis. Excluding these cases, hemorrhage‒complicated cases tended to have a serious prognosis. Administering argatroban and performing high‒quality endovascular surgery is important for reducing complications. Improvements are also required for reducing the ischemic complications caused by neck plasty. There may be a need to administer dual antiplatelet therapy or perform reinforced heparinization.

DOI： 10.24723/jsne.23.1_45

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Other Link： http://id.ndl.go.jp/bib/029203952

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OBJECTIVE: Previously, cavernous angiomas(CAs)have been thought to be only congenital in origin. Recently, however, a few cases of de novo CAs have been reported in the literature. We present a case of a de novo CA and discuss the etiology of the newly appeared CA. CASE REPORT: A 29-year-old man was presented to a local clinic because of hypersomnia. MRI demonstrated a heterogeneous mass peripherally located, which was in contact with a developmental venous anomaly(DVA)at the left thalamus. Six years before the presentation, he visited the same clinic because of faintness, and MRI results indicated no abnormality except for the DVA. Three weeks later, he suddenly experienced difficulty in speech, and the MRI revealed an increase in the size of the mass. Subsequently, he was admitted at our institution, and neurological examination revealed aphasia and right hemiparesis. A left carotid angiogram on venous phase showed a narrowing of the DVA, which was seen as it entered the internal cerebral vein. The diagnosis of a de novo CA was made. The mass was completely resected through the transcallosal transventricular approach to avoid injuring the DVA. The DVA could not be found during surgery. The pathological diagnosis was in line with the findings of CA. Postoperatively, the patient continued having difficulty in speech and was transferred to another institution for speech rehabilitation. CONCLUSIONS: Although the association of CA and DVA has been described with increasing frequencies recently, the etiology of de novo CA in the case of this association has been a matter of debate. In the present case, it was speculated that a narrowing of the DVA resulted in increased venous pressure and caused the development of de novo CA.

DOI： 10.11477/mf.1436203503

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DOI： 10.1016/j.bbrc.2016.10.154

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-15K15104/

Language：Japanese   Publisher：The Japan Stroke Society  

A 45-year-old woman was presented to our hospital for severe pharyngalgia and neck pain with fever. The CT angiography revealed the presence of the giant extracranial internal carotid artery (ICA) aneurysm at the time of admission. The MRI revealed abnormal intensity suggestive of abscess formation in the pharyngeal area. Endovascular parent artery occlusion was performed on Day 2. Postoperative evaluation was performed by transoral carotid ultrasonography (TOCU) to obtain image guidance for puncture and drainage the abscess. The ICA and the giant aneurysm were completely thrombosed, and the drainage of abscess was performed with high safety on the basis of the TOCU findings. Although endovascular treatment for extracranial infectious ICA aneurysm has not been well established, our case suggests that the treatment with guidance of TOCU appears effective.

DOI： 10.3995/jstroke.10443

DOI： 10.2301/neurosonology.31.134_references_DOI_4Rom7tMM0CIrVGIhspGAzv0vn82

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

To determine the predictors of medical complications in aneurysmal subarachnoid hemorrhage during the vasospasm stage, we reviewed the medical complications of 92 patients treated for ruptured cerebral aneurysm at our institutions between January 2010 and December 2014.<br>The 92 patients were divided into medical and non-medical complication groups. Their clinical characteristics were compared, including age, sex, World Federation of Neurological Surgeons (WFNS) grade, vasospasm, medical condition, creatinine (Cr) level, estimated glomerular filtration rate (eGFR), glycemia, cardiothoracic ratio at admission, albumin level, natrium level at onset of medical complication, Cr level 3 days after admission (first period), Cr level at onset of medical complication (second period), eGFR at 3 days after admission (first period), eGFR at onset of medical complication (second period), average intake volume for 3 days (first period), and onset of medical complication (days; second period) after admission by using the Mann-Whitney <i>U</i> test or Fisher test. Univariate and multiple logistic regression analyses were used to determine factors associated with risk of medical complication.<br>The overall rate of medical complication was 26.1% (24/92). The most common medical complication was pulmonary cardiac complication. The Mann-Whitney <i>U</i> test and univariate analyses showed WFNS grade and eGFR (second period) to be significantly higher in the medical complication group than in the non-medical complication group. The independent risk factors of medical complications that were identified in the multiple analyses were WFNS grade and eGFR (second period; odds ratio, 95% confidence interval: 4.9577, 1.6557-15.0264 and 6.6759, 2.2421-19.8780, respectively).<br>We identified WFNS grade and eGFR (second period) as independent risk factors. Under the wrong WFNS grade at admission, extensive care should be taken in the management of the disease. When eGFR is less than that at admission during the vasospasm stage, it may play a predictive role for medical complications.

DOI： 10.2335/scs.45.389

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Other Link： https://search.jamas.or.jp/link/ui/2018027220

Language：Japanese   Publisher：The Japan Stroke Society  

A 25-year-old woman with a right neck swelling visited her local hospital, where paravertebral arteriovenous fistula (PAVF) was diagnosed. The PAVF was fed mainly by the ascending cervical artery and also by the subcutaneous cervical, external cervical, and vertebral arteries, and it drained via multiple fistulas and a varix into the paravertebral venous plexus. Ligation of the main feeding artery and transarterial embolization were performed, but the PAVF recurred, so the patient was referred to our hospital, where angiography revealed multiple high-flow feeding arteries, fistulas, and draining veins. We adopted a bidirectional treatment strategy, combining transarterial and transvenous catheterization and coil embolization. The fistulas were obliterated, and 1-year follow-up angiography showed no signs of recurrence. PAVF is a rare condition involving spinal vascular malformations and for which there is no established treatment strategy. Simultaneous transarterial and transvenous embolization should be considered for PAVF with a complex angioarchitecture.

DOI： 10.3995/jstroke.10421

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Other Link： https://search.jamas.or.jp/link/ui/2017188271

Language：Japanese   Publisher：The Japan Stroke Society  

Purpose: The aim of this study was to examine the relationship between stress index (SI) calculated by dividing blood sugar (BS) concentration by serum potassium (K) level at the time of initial examination and both severity and outcome of subarachnoid hemorrhage (SAH). Methods: We retrospectively analyzed 108 patients with SAH. Severity of SAH was assessed using the World Federation of Neurosurgical Societies (WFNS) classification system. The moderate group included patients with WFNS grade I–III, with all other patients classified into the severe group. Outcomes at the time of discharge were assessed using the Glasgow Outcome Scale. Good outcome group included patients with good recovery or moderate disability, while others were classified to the poor outcome group. Biochemical factors evaluated at the initial examination included K, BS, and SI. Results: BS and SI were significantly higher in the severe group than in the moderate group (p<0.001). These indicators were also significantly higher in the poor outcome group than in the good outcome group (p<0.001). Some patients in the moderate group fell into the poor outcome group. In those patients, SI was significantly high. Conclusion: SI was significantly high in patients with severe SAH and in patients with poor outcome. Patients with high SI who are classified into the moderate group might show poor clinical outcomes.

DOI： 10.3995/jstroke.10406

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Language：Japanese   Publisher：The Japan Society of Neurotraumatology  

<i>Objective:</i> We retrospectively analyzed our own cases of subacute subdural hematoma (SSH) to investigate the clinical characteristics of SSH.

<i>Materials & Methods:</i> From January 2011 to October 2015 we experienced 5 cases with SSH at our institution. Frequency, age, gender, clinical course, radiological find­ings, operative findings and outcomes were reviewed.

<i>Results:</i> During the same period we treated 85 patients with acute subdural hematoma, thus frequency of SSH accounted for 5.9％. The patient’s ages ranged from 45 to 89 years with a mean age of 72 years. There were 2 men and 3 women. The cause of injury was fall on the same level in 4 patients, fall in 1. Glasgow coma scale score on admission was 15 in 4 patients, 14 in 1. Initial comput­erized tomography (CT) scans revealed mixed density subdural hematoma in 2 patients, homogenously high density in 3. The mean maximal thickness of hematoma was 10 mm. Time intervals to worsening were 5 to 13 post­traumatic days with a mean time interval of 9.6 days. Symptomatologically all patients developed contralateral hemiparesis. CT scans on worsening revealed mixed den­sity in 2 patients, iso in 2, low in 1. The mean maximal thickness of hematoma was 13 mm and revealed mass sign and mild midline shift. Magnetic resonance imaging was obtained only in case 3 and demonstrated high signal intensity on T1 weighted images, low signal intensity on T2 weighted images, high signal intensity with the low intensity rim close to the brain surface on diffusion weighted images. All patients underwent craniotomy to evacuate hematoma. Postoperatively 4 patients recovered fully and 1 patient died of pulmonary failure.

<i>Conclusions:</i> Even though subdural hematoma is treated conservatively at acute stage, it should be kept in mind that it may develop at subacute stage and cause neurological deterioration.

DOI： 10.32187/neurotraumatology.39.2_118

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Other Link： http://id.ndl.go.jp/bib/027865199

Language：Japanese   Publisher：The Japan Society of Neurotraumatology  

<i>Background and purposes:</i> We retrospectively reviewed clinical features of chronic subdural hematomas in the patients with hematological diseases.

<i>Methods:</i> A total of 410 patients with chronic subdural hematoma(s) admitted to St. Marianna University Yokohama City Seibu Hospital between 2008 and 2015 were reviewed. Among these patients, 9 corresponding cases were collected.

<i>Results:</i> The average age of the patients was 65.5 years. In three out of 9 patients, preceding head injury was found in the past history. Based on complete blood counts on admission, blood transfusion was needed prior to surgical treatment in order to correct bleeding tendency mostly due to platelets deficiency. Because of cerebral her­niation signs, emergency surgery was necessary in three patients. All under­went common burr hole aspiration surgery under local anesthesia. No surgical complication including postoperative hemorrhages was encountered. Neurological deficits were disappeared immediately after the surgery. However, another surgical treatment was added in 4 patients because of recurrent accumulation of subdural bloody fluid. Although nearly a half of the patients showed good prognosis, coexisting hematological disorders pro­gressed to death within six months after the surgery in four out of 9 patients.

<i>Conclusion:</i> Chronic subdural hematomas are generally recognized as a benign disease having good outcome when appropriate treatments were given. However, as the patients concomitantly having hematological diseases, their prognosis might be pessimistic.

DOI： 10.32187/neurotraumatology.39.2_89

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DOI： 10.1186/s13256-016-1007-3

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<i>Introduction:</i> We retrospectively analyzed surgically treated “talk and deteriorate (T&D)” patients at our institution to find an appropriate management of this potentially preventable poor outcome head injury.

<i>Materials and Methods:</i> From January 1996 to November 2014, a total of 468 patients with mild head injuries (GCS≧13) were admitted to our institution. Among these, 16 patients were identified as T&D. We defined T&D as a patient who utters comprehensible speech at some time after head injury and then deteriorates to a severe state (GCS score 8 or less) within 24 hours after injury. Clinical characteristics of these patients were analyzed.

<i>Results:</i> Of the 16 T&D patients, 10 were men, and 6 were women, aged 16–89 years (mean ± standard deviation (SD) = 65 ± 19). Thirteen patients were injured in non high energy trauma. All deterioration was due to intra-cranial hematomas, mostly acute subdural hematoma. Time interval from accident to deterioration was 1–15 hours (mean ± SD ＝ 4.4 ± 4.0). All patients underwent craniotomy, two of these craniectoy and 5 indwelled intracranial pressure monitoring. Two died and 6 were left in moderate disability or severe disability status. The remaining 8 patients had good outcome.

<i>Conclusion:</i> The most important factors in saving these patients are rapid diagnosis and immediate surgical decompression before irreversible brain damage sets in.

DOI： 10.32187/neurotraumatology.39.1_27

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DOI： 10.11477/mf.1436203283

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DOI： 10.2176/nmc.oa.2015-0201

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Other Link： https://search.jamas.or.jp/link/ui/2016275717

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Dural arteriovenous fistulas (DAVFs) are generally present in the transverse-sigmoid sinus as well as the cavernous sinus. To date, endovascular surgery has been mainstream; however, direct surgical treatment seems to be primarily limited to anterior skull base DAVFs. We herein report two cases of non-sinus-type DAVF located in the middle cranial fossa that were successfully treated with direct surgery. Both were symptomatic and angiographically classified as Cognard type IV. The first case was referred to our institution because of recurrence of a left middle fossa DAVF seven years after initial treatment with transarterial coil embolization (TAE). Drainer obliteration was performed using the subtemporal approach. The second case had severe headache with prominent clinical features similar to those of a carotid cavernous sinus fistula. TAE was applied to the branches of the right external carotid artery to reduce the flow rate. Drainer obliteration was performed without difficulty using the conventional frontotemporal approach.<br>The cortical vein-draining DAVF, classified as Cognard type III or type IV, presents a high risk of intracranial hemorrhage. When diagnosed, they should be treated completely, as early as possible. The aforementioned drainer obliteration appeared to be the best way to cure the DAVF. Endovascular surgery before direct surgical treatment was effective to reduce shunt flow and to enable an easy access to the shunt point.

DOI： 10.2335/scs.44.151

DOI： 10.5797/jnet.cr.2021-0021_references_DOI_aOeqscrzwocyUBmlupsoSG4zcAP

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DOI： 10.1136/neurintsurg-2013-011006.rep

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We here tried to comprehensively elucidate the effects of edaravone on human brain microvascular endothelial cells (HBMECs) by Two Dimensional Fluorescence Difference Gel Electrophoresis (2D-DIGE). We found 17 proteins, the intensity of which was significantly altered more or less than 1.3 folds on average (p<0.05) by the treatment with edaravone after 4 hours. Functionally, 4 out of the 17 proteins were cytoskeleton proteins themselves or a cytoskeleton-regulating protein. Thus, we next investigated the change of size and shape of the cells, actin network, and the tight junction of HBMEC by immunocytochemistry. We found data would provide fundamental and useful information in the clinical use of edaravone in patients with cerebral vascular diseases.

DOI： 10.3995/jstroke.10300

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Congress of Neurological Surgeons  

DOI： 10.7887/jcns.24.713

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Other Link： https://search.jamas.or.jp/link/ui/2015406169

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DOI： 10.7887/jcns.24.246

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DOI： 10.4103/2152-7806.157795

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DOI： 10.4103/2152-7806.153705

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DOI： 10.2176/nmc.tn2012-0296

DOI： 10.1007/s10143-016-0759-y_references_DOI_M1AE5VuUOJwDQDKbUrpYOQX3JwJ

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DOI： 10.1136/bcr-2013-011006

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DOI： 10.7887/jcns.23.909

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DOI： 10.1016/j.brainres.2013.08.019

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-24790563/

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DOI： 10.1007/978-3-7091-1434-6_41

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DOI： 10.1016/j.brainres.2012.03.061

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DOI： 10.3109/02688697.2011.581771

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Neurosurgical Society  

DOI： 10.2176/nmc.52.216

DOI： 10.3109/14397595.2015.1021950_references_DOI_FV6kbbCxGUQG2r7CIW04vjLyEI2

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Object: In order to predict the technical difficulties of coil embolization for paraclinoid aneurysms (PC-an), we retrospectively analized our clinical experience. Method: We analyzed 34 patients with 35 PC-an treated with endovascular techniques between 2001 and 2010. These aneurysms were classified into 4 groups on the basis of their projections visualized on angiograms as follows: ventral, 17 ; medial, 7 ; dorsal, 8 and lateral, 3. The size of the aneurysms and the angle of carotid siphon were measured on angiograms for each group. The levels of those aneurysm necks were classified as supraclinoid, clinoid and infraclinoid according to their relation to the anterior clinoid process. Angiographic outcome, volume embolization ratio (VER), number of microcatheters and microguidewires used and duration of endovascular procedure were evaluated for each group. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). Result: The mean size of the aneurysms in the ventral, medial, dorsal and lateral groups was 4.1, 5.6, 6.7 and 8.4 mm, respectively. The mean angle of carotid siphon was more acute in the dorsal and lateral groups. The neck level was supraclinoid in 10, clinoid in 14 and infraclinoid in 11. The percentage of dorsal and lateral groups was larger in the supraclinoid level. Endovascular treatment was successfully performed in 91.4% cases with treatment complications including 3 ischemic events. The number of patients with clinical outcomes classified according to the GOS was as follows: good recovery, 31 ; moderately disabled, 2 ; severely disabled, 1 ; vegetative state, 0 and dead, 1. Complete obliteration was achieved in 70.6%, 57.1%, 32.5% and 0% patients in the ventral, medial, dorsal and lateral groups, respectively, and the corresponding VER was 37.6%, 32.3%, 24.8% and 16.4%. The number of microcatheters and microguidewires used was higher in the dorsal and lateral groups than that used in the other 2 groups. The duration of the procedures was also longer in the dorsal and lateral groups. Conclusion: Endovascular treatment is a safe and effective therapeutic alternative for PC-an. However, in dorsal and lateral PC-an, this treatment entails additional difficulties of handling microcatheters and microguidewires because of their anatomical specificity. Therefore, endovascular treatment for these aneurysms is occasionally associated with lower rates of complete obliteration and lower VER than those of ventral and medial PC-an.

DOI： 10.7887/jcns.21.481

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DOI： 10.7887/jcns.21.931

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The pterional approach is arguably the most popular surgical approach for neurosurgeons. Therefore, we should understand and experience this approach properly. The other surgical approaches can be learned readily once this approach is mastered. The principle aspect of the pterional approach is an appropriate exposure of the parasellar area without damaging the brain and vessels. There are various surgical options based on the primary disease and patterns of the sylvian veins. We will discuss about methods for widening the pterional approach, including manipulation of the sylvian vein and sphenoparietal sinus, the temporopolar approach, optic unroofing, anterior clinoidectomy, resection of the tuberculum sellae, and section of the dural ring.

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DOI： 10.3109/02688697.2011.568641

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We report a case of sylvian hematoma enlarging 3 days after neck clipping for a ruptured anterior communicating artery aneurysm, in the contralateral sylvian fissure to the operative approach.<br> This 65-year-old man was admitted with sudden loss of consciousness by ambulance. Angiography revealed a saccular aneurysm at the anterior communicating artery complex, measuring 2.3×2.4 mm and pointing inferiorly. The aneurysmal neck was successfully clipped by using the right pterional approach. To minimize predictable vasospasm, the hematoma in the left sylvian stem was removed. Postoperative CT scan showed a considerable decrease in hematoma in the basal cistern, but a slight decrease in the vertical portion of the left sylvian fissure. The patient’s consciousness gradually recovered, but deteriorated again 3 days after the operation. CT scan showed a large high-density area in the sylvian fissure suggesting unexpected enlargement of sylvian hematoma. A left fronto-temporal craniotomy was performed. When the subpial hematoma around the sylvial fissure was removed, a large amount of bloody cerebrospinal fluid (CSF) flowed out. The cavity containing bloody fluid was located in the temporal lobe. Postoperative course was uneventful. He recovered well, but moderate sensory aphasia remained.<br> Sylvian hematoma is rarely associated with ruptured anterior communicating artery aneurysms. Furthermore, there has been no report describing delayed onset sylvian hematoma as far as we are aware. The following mechanism was considered to explain this very rare condition. Removal of subarachnoid hematoma in the left sylvian fissure made a recovery of CSF flow up to the limen insulae, but CSF appeared to be blocked from entering the distal sylvian fissure by the thick subpial sylvian hematoma. Instead of normal CSF flow route, CSF may enter into the weakened subpial space to allow accumulation of bloody CSF in the temporal lobe. Subpial hematoma may act as a one-way valve. <br>

DOI： 10.2335/scs.38.119

DOI： 10.2176/nmc.cr2013-0025_references_DOI_OH1oPU7vPo4IBYCTMjkzCDCMhky

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Congress of Neurological Surgeons  

DOI： 10.7887/jcns.19.727

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DOI： 10.7887/jcns.18.56_1

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Other Link： https://search.jamas.or.jp/link/ui/2009113188

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society for Neuroendovascular Therapy  

DOI： 10.5797/jnet.2.238

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Other Link： https://search.jamas.or.jp/link/ui/2009159151

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DOI： 10.7887/jcns.13.711

DOI： 10.2335/scs.38.52_references_DOI_BZxDfl4psqSAVwvx6wOMXR5gV3I

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