記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To investigate the relationship between body weight loss and activities of daily living (ADL) 3 months after stroke onset. MATERIALS AND METHODS: This retrospective cohort study included 81 patients at a rehabilitation hospital after receiving acute treatment at our hospital (mean age 70.7 years). Patients were divided into two groups, namely independent and non-independent, based on their ADL 3 months after stroke. Receiver operating characteristic (ROC) curves were constructed with the ADL independence possibility as the objective variable and body weight change rate (%) at 3 months as the explanatory variable. Patients were classified using the weight change rate calculated from the ROC curve and the NIHSS cut-off values, and the ADL independence percentage was compared. RESULTS: The ADL-independent group had significantly lesser body weight loss than the non-independent group (median rate of body weight change: -2.7% vs. -7.2%; p<0.001). The area under the ROC curve was 0.76. The cut-off value was -5.6% for the body weight change rate. When participants with NIHSS ≤ 8 points were selected, the ADL-independent participants' proportion was significantly higher in the body weight loss ≤ -5.6% group than in the > -5.6% group (56.0% vs. 15.4%, p=0.016). However, there was no significant difference in the ADL-independent participants' proportion when those with NIHSS >8 points were selected (p=0.19). CONCLUSIONS: Our findings indicate that weight loss after stroke onset is associated with non-independent ADL at 3 months. Weight maintenance from the onset is important for ADL independence, especially in patients with mild to moderate stroke.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106573

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記述言語：英語  

DOI： 10.1016/j.clnu.2021.07.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.clnu.2021.01.040

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

Infection is a common complication of stroke and is associated with unfavorable outcomes. Although nutritional intervention reduces the risk of postoperative infection, the impact of specific nutritional products remains unclear. From a hospital management perspective, we aimed to determine whether the provision of specific types of enteral nutrition in acute stroke patients affects infection control and hospital costs. In all, 45 acute hemorrhagic stroke patients receiving enteral nutrition in a single center (April 2017-March 2019) were retrospectively assessed. Patients were divided into two groups according to nutritional interventions: the 1.0-group with general nutrition (1.0 kcal/mL) (24 patients) and the 1.5+α-group with an initial high-protein, whey peptide-digested liquid diet (1.5 kcal/mL), followed by a highly fermentable fiber-containing liquid diet (1.5 kcal/mL initiated after 4 days) (21 patients). Changes in body mass index (BMI), duration of antibiotic use, incidence of postoperative infection, and medical cost were evaluated. Baseline patient characteristics were similar between groups. The mean BMI change was lower in the 1.5+α-group than in the 1.0-group, and the mean duration of antibiotic use throughout hospitalization was 12.8 and 18.3 days, respectively. Antibiotic use in the 1.5+α-group was lesser than that in Japanese patients from other hospitals. The incidence of postoperative infections was lower in the 1.5+α-group. Injection costs for the 1.5+α group (615 USD/patient) were lower than those for the 1.0-group. Enteral nutrition provided to acute stroke patients reduced the risk of hospital infection and medical costs.

DOI： 10.2176/nmc.oa.2020-0350

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その他リンク： https://search.jamas.or.jp/link/ui/2022000704

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   出版者・発行元：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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その他リンク： https://www.jstage.jst.go.jp/article/jnet/15/12/15_oa.2020-0171/_pdf

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

カーニー複合は, 皮膚色素沈着, 心臓粘液腫, 内分泌腫瘍を主要徴候とする遺伝性疾患である. 症例は20歳女性で, カーニー複合の責任遺伝子である<i>PRKAR1A</i>の変異を認めた. 上下口唇に色素性病変がみられ, 血糖負荷では成長ホルモン値は抑制されなかった. MRIのT2強調画像では高信号域の微小な腫瘤が下垂体内部にみられた. 経蝶形骨洞手術により, 灰白色の腫瘤を摘出した. 病理学的には腫瘍細胞はGH陽性で<i>PRKAR1A</i>遺伝子の消失を認めた. 術後の負荷試験ではGH値は抑制され, 経過観察中である. カーニー複合は一般の脳神経外科医にはなじみが少ないと思われ, 本例を提示して本疾患の基本的事項を報告する.

DOI： 10.7887/jcns.30.741

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その他リンク： https://search.jamas.or.jp/link/ui/2022010668

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

DOI： 10.2335/scs.49.42

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その他リンク： https://search.jamas.or.jp/link/ui/2021211368

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to examine the effects of protein intake on physical performance in critically ill adult patients admitted to the intensive care unit (ICU). METHODS: This was a retrospective cohort study of adult patients mechanically ventilated over 48 h in the ICU who were classified into two groups based on the amount of protein intake: >1.0 g/kg/d (high-protein group) or <1.0 g/kg/d (low-protein group). After adjustment for possible confounding factors with propensity score matching, we compared muscle strength at the time of ICU discharge and the rate of recovery to independent walking between the two groups. RESULTS: One-to-one propensity score matching created 20 pairs. The high-protein group had significantly higher muscle strength than the low-protein group at the time of discharge from the ICU. In addition, the rate of recovery to independent walking before hospital discharge was higher in the high-protein group than the low-protein group (16 of 20 patients [80%] vs. 8 of 20 patients [40%]; P = 0.032). CONCLUSIONS: Our findings indicate that a sufficient amount of protein intake may lead to a higher rate of recovery to independent walking before discharge from the hospital in critically ill patients admitted to the ICU. This finding is likely related to preserved muscle strength at the time of ICU discharge.

DOI： 10.1016/j.nut.2021.111407

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳神経外傷学会  

DOI： 10.32187/neurotraumatology.43.2_70

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記述言語：日本語   出版者・発行元：一般社団法人 日本脊椎脊髄病学会  

脊髄髄膜腫の手術成績より摘出におけるアプローチについて報告する．対象は8例，観察期間は1～10年である．アプローチは，5例は両側，2例は片側，1例は両側椎弓・椎間関節・椎弓根切除＋後方固定で，全例で完全に摘出でき，SimpsonIIで終了した．合併症は片側椎弓切除の1例に棘突起骨折を認め，全例で再発はない．脊髄髄膜腫の治療の主体は手術であり，腫瘍を確実に摘出でき硬膜の処置が可能な適切なアプローチの選択が重要である．

DOI： 10.34371/jspineres.2020-0702

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳神経外傷学会  

DOI： 10.32187/neurotraumatology.43.1_23

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.34.302

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その他リンク： https://search.jamas.or.jp/link/ui/2021131286

記述言語：日本語   出版者・発行元：一般社団法人 日本臨床栄養代謝学会  

【目的/方法】2011年国際栄養調査で，本邦ICUの栄養療法における環境体制や実施状況の遅れが示唆された．2011年以降，それらに関する調査は殆どなく，神奈川県内ICUでの栄養療法の実態や栄養チーム内での栄養療法に対する見解を明確にする目的でオンライン質問票を用いた横断研究を行った．【結果】神奈川県内12施設13ICUから回答が得られ，経腸栄養プロトコール使用が54％，ICU常在管理栄養士が31％，ICU常在リハビリテーションスタッフが54％と以前と比し高水準であった．一方，エネルギー・たんぱく質の目標投与量に関し『わからない』と答えた施設が39％を占めた．【結論】ICUにおける栄養療法の環境体制は，以前と比し整えられてきている．一方，栄養チーム内での栄養療法の目標に対する共通見解にばらつきがある可能性が考えられた．今後，栄養チーム内での栄養療法の目標に関する共通見解を深めていく必要がある．

DOI： 10.11244/ejspen.2.2_158

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記述言語：日本語   出版者・発行元：一般社団法人 日本臨床栄養代謝学会  

【目的】脳卒中患者における急性期至適栄養プロトコールを経腸栄養剤の違いから検討した．【対象および方法】急性期脳卒中患者のうち，早期経腸栄養プロトコールで栄養管理が行われた患者51例を対象とした．1.0kcal/mLの標準組成栄養剤を用いた1.0kcal群28例と1.5kcal/mLの2種類の栄養剤（高たんぱく消化態栄養剤およびPHGG配合栄養剤）を用いた1.5kcal群23例について経過およびアウトカムを調査し，後方視的に比較検討した．【結果】1.0kcal群と比較して1.5kcal群で，消化管トラブルによるプロトコール停滞率が低く，プロトコール完遂までの日数も短縮された．1.5kcal群は，体重減少率が低く，血液生化学所見における栄養炎症の指標も改善していた．【結論】脳卒中患者の急性期栄養管理に対する1.5kcal/mLの高たんぱく消化態栄養剤およびPHGG配合栄養剤を使用した栄養プロトコールは，1.0kcal/mL栄養剤の場合と比較し有益であることが示唆された．

DOI： 10.11244/ejspen.2.2_103

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.brainres.2019.05.034

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その他リンク： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-19K15752/

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：一般社団法人 日本静脈経腸栄養学会  

急性期病床では、専門的かつ高度な疾患治療が行われる一方で、退院を目指したマネジメントも入院早期から行われる。急性期において栄養サポートチーム（nutrition support team; 以下、NSTと略）は、栄養障害に対する介入やリスクマネジメントに加え、必要に応じて慢性期以降の栄養管理継続に関する情報共有を行う。急性期病床では在院日数が短期間の場合が多く、限られた時間で有効な栄養サポートを行う必要がある。今後、更なる高齢化の進行が見込まれる日本では、栄養管理上の問題に遭遇する機会の増加が予想され、特に急性期病床において臨床的アウトカム、経済的アウトカムおよび患者立脚アウトカムのいずれにおいても、改善には多くの困難が生じる恐れがある。NSTによる早期からの栄養サポートは、推奨される栄養管理の遵守につながり、結果として栄養障害が引き起こす疾患の治癒遷延や身体機能低下、生活機能障害などに対して予防や改善といった効果をもたらす。

DOI： 10.11244/jspen.34.237

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その他リンク： http://id.ndl.go.jp/bib/030077137

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

This study sought to analyze the incidence of contralateral microembolic infarctions (MIs) on diffusion-weighted imaging (DWI) following protected carotid artery stenting (CAS) and compared the difference of risk factors between ipsilateral and contralateral lesions. From April 2010 to March 2017, 147 CASs in 140 patients were performed. All the patients underwent DWI within 1 week before and 24 hrs after the procedures. CAS was successfully completed in 145 (98.6%) of the 147 procedures. Forty-nine (33.8%) patients with new MIs revealed on postprocedural DWI were enrolled. They were divided into ipsilateral and contralateral groups based on the side of the CAS and MIs. The ipsilateral group indicates patients with MIs exclusively on the side of CAS. The contralateral group includes patients with MIs on the opposite side of the CAS or both sides. Patients with MIs at vertebrobasilar territory were excluded. Patient characteristics, morphology of the carotid artery and aortic arch, and procedural data were retrospectively assessed and compared between the two groups. Twenty-two (15.2%) and 14 (9.7%) patients were assigned to the ipsilateral and contralateral groups, respectively. Advanced age, left-sided stenosis, severe aortic arch calcification (AAC) on chest X-ray and contralateral carotid occlusion significantly increased the occurrence of contralateral MIs. On multivariable logistic regression analysis, severe AAC was statistically more frequent in the contralateral group. In the present study, the incidences of contralateral MIs after CAS is relatively not low. Advanced aortic atherosclerosis is statistically predictive for contralateral MIs. AAC on chest X-ray is a useful finding for estimating aortic atherosclerosis in candidates for CAS.

DOI： 10.2176/nmc.oa.2018-0023

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その他リンク： https://search.jamas.or.jp/link/ui/2019301726

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A tailor-made treatment is often required in arteriovenous malformations (AVMs) depending on the individual situation. In most cases, treatment strategy is usually determined according to the patient's Spetzler-Martin grade. However, in the present case, we were not able to treat the patient following the usual guidelines because of neurological symptoms and pregnancy. CASE DESCRIPTION: We describe a rare case of a 31-year-old woman in the 15th week of gestation who presented with an AVM in the anterior perforated substance (APS). She suffered a sudden coma and hemiplegia. A computed tomographic scan showed an enhanced mass and a huge hematoma in the basal ganglia and temporal lobe. The hematoma was successfully evacuated in an endoscopic procedure. Angiography showed that a 25-mm nidus in the APS was fed by the anterior choroidal arteries (AChAs) and the lenticulostriate arteries (LSAs). Therefore, we attempted to remove the nidus because the patient became alert with mild aphasia and hemiparesis 10 days after hemorrhage. The feeding arteries were cut under motor evoked potential (MEP) monitoring, and the nidus was totally resected leaving two of four AChAs and a single artery with several LSAs. The postoperative course was uneventful, and she gave birth to a healthy baby by caesarian delivery 122 days after the hemorrhage with only minor sequelae. CONCLUSIONS: Surgical strategy with a device-administered anesthesia are suitable for removing large AVMs even in pregnant women and for the successful outcome of their pregnancies. Even after recovering from a coma and hemiplegia, MEP monitoring is effective for removing large AVMs even when located in the APS.

DOI： 10.4103/sni.sni_220_17

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本脳神経外科救急学会 Neurosurgical Emergency  

動脈瘤塞栓術を行った228例を年齢，性別，部位，大きさ，破裂の有無，重症度，ネック形成バルーンの拡張の有無と合併症との関連性を検討した．虚血性合併症は10例（4.3%）で出血性合併症は６例（2.6%）であった．虚血性合併症はバルーン使用例で有意に多く永続的合併症は認めなかった．出血性合併症は全例破裂例に生じ死亡と永続的合併症を１例ずつ生じた．フィニッシングコイル挿入時に出血した２例はネック形成用バルーンの拡張のみで止血し良好な転帰であった．全体の合併症は少なく要因としてアルガトロバンの投与や慎重な手術操作が挙げられるが出血性合併症の転帰は不良でありさらなる手術手技の向上が望ましい．バルーン拡張例では抗血小板薬やヘパリン化の強化などを行うべきと考えられた．

DOI： 10.24723/jsne.23.1_45

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その他リンク： http://id.ndl.go.jp/bib/029203952

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.bbrc.2016.10.154

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その他リンク： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-15K15104/

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中学会  

症例は45 歳女性．頸部痛，咽頭痛を主訴に当院に紹介となり，咽頭部膿瘍の疑いで入院となった．入院時造影CT にて巨大右頭蓋外内頸動脈瘤をみとめ，第2 病日内頸動脈母血管コイル閉塞術を施行した．第5 病日，腫瘤周囲の培養検査および排膿目的に経口腔的な穿刺が予定されており，動脈瘤内部の状況を詳細に把握するため経口腔超音波検査（transoral carotid ultrasonography，TOCU）を施行した．コイル塞栓された内頸動脈は血栓化し完全閉塞しており，内部が高輝度，外周が低輝度の二層となる形で血栓化されていた．周囲の外頸動脈系血管との位置関係と瘤内部に血流がないことを確認したうえで安全に腫瘤周囲を穿刺することができた．頭蓋外感染性内頸動脈瘤は稀であり確立された治療はないが，本症例は母血管コイル閉塞術にて良好な転帰を得た．またTOCU は血管内治療術後の評価と排膿穿刺術に有用であった．

DOI： 10.3995/jstroke.10443

DOI： 10.2301/neurosonology.31.134_references_DOI_4Rom7tMM0CIrVGIhspGAzv0vn82

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その他リンク： https://search.jamas.or.jp/link/ui/2017264193

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

DOI： 10.2335/scs.45.389

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その他リンク： https://search.jamas.or.jp/link/ui/2018027220

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中学会  

25 歳女性．右頸部腫瘤を主訴に他院を受診し皮下頸部動脈や椎骨動脈，外頸動脈からの多数の流入血管を有し，複数の瘻孔から皮下静脈瘤を経由して傍脊椎静脈叢へ流出する傍脊椎動静脈瘻（PAVF）を指摘された．主たる流入路の上行頸動脈を頸部切開で結紮したが側副血行のため根治せず，経動脈的塞栓術を行うも再発し当科紹介となった．多数の流入血管と瘻孔からなる複雑な血管構築のため，全ての血管を網羅するように動脈と静脈双方にカテーテルを誘導しコイルで塞栓した．瘻孔は消失し1 年後の血管撮影でも再発は認めない．PAVF はまれな脊髄シャント性疾患であり確立された治療法はない．血行動態が複雑なPAVF に対する経動脈的および経静脈的な同時塞栓は試みるべき有効な治療法の一つである．

DOI： 10.3995/jstroke.10421

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その他リンク： https://search.jamas.or.jp/link/ui/2017188271

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中学会  

【目的】くも膜下出血（SAH）において，初診時に，カテコラミン推移と相関するとされるstress index［SI；血糖（BS）値をカリウム（K）値で除した値］と重症度，転帰との関係を検討すること．【方法】過去4 年間のSAH 108 例を後方視的に検証した．重症度はWFNS 分類で評価し，軽症例をModerate 群，重症例をSevere 群に分けた．転帰は退院・転院時のGOS で評価し，良転帰例をGood群，転帰不良例をPoor 群とした．初診時生化学的因子はK，BS，SI を検討した．【結果】WFNS 分類はSevere 群で，GOS ではPoor 群で有意にBS，SI が高値であった（p<0.001）．Moderate 群の中でもGOS がPoor 群となる症例があり，有意にSI が高値であった．【結論】SAH 重症例や転帰不良例はSIが有意に高値であった．軽症例でもSI 高値例は転帰不良となる可能性があり，注意が必要である．

DOI： 10.3995/jstroke.10406

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳神経外傷学会  

DOI： 10.32187/neurotraumatology.39.2_118

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その他リンク： http://id.ndl.go.jp/bib/027865199

記述言語：日本語   出版者・発行元：一般社団法人 日本脳神経外傷学会  

DOI： 10.32187/neurotraumatology.39.2_89

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その他リンク： http://id.ndl.go.jp/bib/027865011

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Dermoid cysts are non-neoplastic tumors that arise from defects in the separation of the neuroectoderm. Cyst rupture rarely occurs spontaneously and the most common symptom is headache, followed by seizure. Although many cases of ruptured dermoid cysts present with symptoms, reports of cases that are asymptomatic, or where symptoms disappear, are rare. CASE PRESENTATION: We report the case of a 66-year-old Asian man with a history of sudden onset headache who was found to have high amounts of fat material in the subarachnoid space and a fat suppression mass in the left cavernous sinus. He underwent oral steroid therapy. Five days after starting medication his headache symptoms disappeared. Routine neurological imaging was then performed without surgical procedure. Magnetic resonance imaging revealed evidence of the remains of a static lesion 6 months after his first visit. He has remained headache free for 10 months since the initial event. CONCLUSIONS: Although cases of ruptured dermoid cysts presenting with consistent symptoms have been commonly reported, until now there were few reports on asymptomatic cases or cases where symptoms disappeared. We believe that surgical intervention is unnecessary for ruptured dermoid cysts with minimal symptoms.

DOI： 10.1186/s13256-016-1007-3

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳神経外傷学会  

DOI： 10.32187/neurotraumatology.39.1_27

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その他リンク： http://id.ndl.go.jp/bib/027688538

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The formation of an intracranial pseudoaneurysm due to a ruptured saccular aneurysm is a rare condition that exhibits characteristic angiographic findings referred to as "ghost aneurysm" or "snowman's head". Currently, no detailed information about the treatment of this condition is available. Clipping has been reported to be more effective and better for removing massive hematomas than endovascular intervention. Moreover, endovascular coil embolization during the acute phase carries a high risk of repeated aneurysm rupture due to the fragility of the pseudoaneurysmal blood clot. Here, we describe three cases of pseudoaneurysm formation following the rupture of an anterior communicating artery aneurysm, and suggest the possibility that ruptured saccular aneurysms with pseudoaneurysm formation can be treated safely and effectively with endovascular coil embolization.

DOI： 10.11477/mf.1436203283

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掲載種別：研究論文（学術雑誌）  

Introduction: Edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one) of a free radical scavenger has been widely used in treatment of acute ischemic stroke. However, effects of edaravone on hypoxic astrocytes have not been fully understood. Therefore, we investigated the effects by proteomic analysis. Methods: We cultured human astrocytes under hypoxia and normoxia with or without edaravone. Then, we compared protein profiles of the astrocytes using 2-dimensional differential gel electrophoresis (2DDIGE). Further, we identified proteins affected by hypoxia and/or edaravone by mass spectrometry. Results: We detected 507 protein spots by 2D-DIGE. Among them, intensity of 22 spots showed more than 1.5-fold increase or less than 1/1.5-fold decrease with statistical significance (p<0.05) by hypoxia. We were able to identify 6 out of the 22 protein spots (increased: alpha-enolase (ENO1, from 2 spots) and ephrin-B2, decreased: adenosine triphosphate synthase subunit alpha (ATPA), mitochondrial heat shock 70 kDa protein 1A/1B, and ferritin light chain). In addition, in 61 out of the 507 spots, the spot intensity showed more than 1.3-fold increase or less than 1/1.3-fold decrease with statistical significance (p<0.05) by hypoxia. In 9 out of the 61 spots, the hypoxia-induced intensity alteration was suppressed by the simultaneous addition of edaravone. Three out of the 9 protein spots were identified (ENO1, ATPA, and rab-interacting lysosomal protein-like protein 1). Conclusion: Edaravone suppressed a part of molecular responses of human astrocytes to hypoxia. Our data would support use of edaravone in acute ischemic stroke.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

Anterior communicating artery (ACoA) aneurysms have a complex architecture and many variations, making endovascular therapy more difficult in some cases. The aim of this study was to investigate whether the neck position of an aneurysm was identifiable for determining the immediate angiographic success and procedural complications in the coiling of the ACoA aneurysms. We conducted a retrospective case review of 40 patients with ACoA aneurysms treated by endovascular therapy from 2008 to 2015. The mean age was 66.8 years. Thirty-five aneurysms were ruptured; five were unruptured. For the analysis, the patients were divided into two groups according to the neck position of aneurysms: the true ACoA group, 9 patients with the neck located on the ACoA itself; and the other ACoA group, 31 patients with the neck at the junction of the A1 and A2 portions of an anterior cerebral artery. Morphological characteristics (dome size, dome direction, rate of wide neck, and angulation of aneurysms in relation to the parent artery) were analyzed along with immediate angiographic results, volume embolization ratio (VER), and procedural complications. Small aneurysms with superior dome projection and acute angulation of the aneurysm direction occurred more often in the true ACoA group. The rates of complete obliteration, VER, and procedural complications were 33.3%, 32.3%, and 22.2% in the true ACoA group and 54.8%, 36.3%, and 6.5% in the other ACoA group, respectively. True ACoA aneurysms could present an anatomical difficulty in endovascular coiling. Aneurysmal neck position should be accurately assessed to achieve successful embolization of the ACoA aneurysms.

DOI： 10.2176/nmc.oa.2015-0201

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その他リンク： https://search.jamas.or.jp/link/ui/2016275717

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

DOI： 10.2335/scs.44.151

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

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その他リンク： https://search.jamas.or.jp/link/ui/2016212208

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 79-year-old woman presented with a subarachnoid hemorrhage. Angiography revealed pseudoaneurysm formation due to rupture of a true saccular anterior communicating artery aneurysm. Coil embolization, limited to the true aneurysm, was performed successfully with a favorable clinical outcome. This procedure can be considered as an alternative treatment option for similar aneurysms in cases where surgical clipping is contraindicated.

DOI： 10.1136/neurintsurg-2013-011006.rep

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中学会  

要旨：エダラボンによる脳血管内皮細胞への保護作用についてプロテオミクスを用い検討した．ヒト脳微小血管内皮細胞をエダラボン処理し，4 時間経過ののち二次元電気泳動展開した．コントロールに比し，発現量に有意差を認めた蛋白質スポットについて質量分析法により蛋白質を同定した．エダラボン添加により有意に1.3 倍以上増加もしくは –1.3 倍以下に減少した蛋白質スポットの同定を行い，17 個の蛋白質が同定された．同定された蛋白質は，細胞骨格に関連する蛋白質，糖代謝に関連する蛋白質，抗酸化作用に関与する蛋白質，翻訳に関連する蛋白質であった．さらにそれぞれの結果に対し，機能解析として検討を行い，バリアー効果の増強，エネルギー供給の変化を確認した．エダラボンによる発現量が変化した蛋白質が，ヒト脳微小血管内皮細胞に作用し保護作用に関与している可能性が示された．

DOI： 10.3995/jstroke.10300

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その他リンク： https://search.jamas.or.jp/link/ui/2016020038

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

症例は12歳男児で, 出血発症の左視床退形成性星細胞腫に対し手術および放射線化学療法を施行した. 周術期は脳室ドレーンを留置し, その後第三脳室底開窓術および脳室腹腔シャント術を施行した. 初回手術より5カ月後に, 頭皮下腫瘤がみられ摘出した. 病理所見は視床腫瘍と同様であり, 転移性頭皮下腫瘍と診断した. 経過中に頭蓋内転移もみられ, 9カ月の経過で死亡した. われわれが渉猟した範囲で頭皮下転移を生じた頭蓋内悪性腫瘍は28例あるが, 退形成性星細胞腫に限れば本例は2例目である. 頭皮下腫瘍は留置されていたドレーンの皮下経路にあり, 腫瘍容積倍加時間より逆算すると, 挿入時に径0.1mmの腫瘍細胞塊が同部に移植されたと推定される.

DOI： 10.7887/jcns.24.713

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その他リンク： https://search.jamas.or.jp/link/ui/2015406169

掲載種別：研究論文（学術雑誌）  

We report a case of infected subdural hematoma(ISH). We followed up an 81-year-old man with asymptomatic chronic subdural hematoma(CSDH). After half a year, he came to our hospital because of reduced activities of daily living and a high fever. Although his inflammatory markers were high, various cultures and imaging studies yielded negative results. Right hemiparesis developed 5 days later. Burr-hole surgery was performed to treat the CSDH. The hematoma proved to be mixed with pus, suggesting ISH. The ISH recurred twice despite antibiotic therapy and repeated irrigation. Finally, inflammatory parameters normalized and computed tomography disclosed an organized CSDH. ISH should be suspected in patients with CSDH presenting with high fever.

DOI： 10.7887/jcns.24.246

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endovascular treatment of wide-necked aneurysms with preservation of the parent artery remains a challenge. The authors describe a novel and simple technique to navigate a balloon or stent-delivery catheter across a wide-necked aneurysm in which previously existing methods could have failed to pass the catheter across the neck of the aneurysm, which we have named "temporary caging" technique. The technical results using this method are presented in 6 cases.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intracranial vascular complications following radiosurgery are extremely rare. CASE DESCRIPTION: We report a case of stenosis in the internal carotid artery 5 years after gamma knife radiosurgery for a recurrent pituitary adenoma. Percutaneous transluminal angioplasty was performed successfully with anatomical and functional improvement. CONCLUSION: These results suggested the importance of monitoring for arterial stenosis in the long-term follow-up. Moreover, this is the first case of endovascular treatment as an effective therapy for intracranial arterial stenosis due to radiotherapy.

DOI： 10.4103/2152-7806.157795

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The anterior interhemispheric approach provides wide exposure of the anatomy around the anterior communicating artery aneurysm. A disadvantage of this approach is that splitting the interhemispheric fissure is a complicated surgical maneuver. One solution is to hold the fissure horizontally in the operation field. Surgical procedures for bicoronal scalp incision and craniotomy are difficult in the horizontal head position. We developed a modified low anterior interhemispheric approach to minimize damage to the frontal lobe and olfactory nerve by rotating the head after opening the dura. METHODS: The head is fixed in a prerotated Sugita head holder in a neutral head position. Bicoronal scalp incision and frontal craniotomy are performed and the head holder is rotated 30 degrees clockwise to allow gravity to retract the right frontal lobe. The surgeon can then move to the right side of the patient to obtain a horizontal operation field parallel to the interhemispheric fissure. RESULTS: This method was used for 12 patients in the past 6 years. All aneurysms were successfully clipped without any complications related to the procedure. Damage to the frontal lobe was avoided and the olfactory nerve was preserved in all the patients. CONCLUSION: Intraoperative head rotation minimizes surgical damage to the neural structures in the anterior interhemispheric approach.

DOI： 10.4103/2152-7806.153705

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

Microvascular decompression (MVD) is a standard surgical procedure for treating vascular compression syndromes. There are two basic ways to perform MVD: interposition using a prosthesis and transposition. With the transposition technique, adhesions and granuloma around the decompression site are avoided, but the required operation is more complex than that for the interposition method. We describe a simple, quick MVD transposition procedure that uses a small "belt" cut from a sheet of 0.3-mm-thick expanded polytetrafluoroethylene membrane. The belt has a hole at the wide end and the other end tapered to a point. The belt is encircled around offending vessels by inserting the pointed end into the hole. The pointed end is then passed through a dural tunnel over the posterior wall of the petrous bone and is tied two or three times. This method avoids the risks involved in handling a surgical needle close to the cranial nerves and vessels.

DOI： 10.2176/nmc.tn2012-0296

DOI： 10.1007/s10143-016-0759-y_references_DOI_M1AE5VuUOJwDQDKbUrpYOQX3JwJ

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その他リンク： https://search.jamas.or.jp/link/ui/2015175787

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 79-year-old woman presented with a subarachnoid hemorrhage. Angiography revealed pseudoaneurysm formation due to rupture of a true saccular anterior communicating artery aneurysm. Coil embolization, limited to the true aneurysm, was performed successfully with a favorable clinical outcome. This procedure can be considered as an alternative treatment option for similar aneurysms in cases where surgical clipping is contraindicated.

DOI： 10.1136/bcr-2013-011006

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

一般的に血管攣縮は脳動脈瘤破裂によるくも膜下出血に高い頻度で認められる. 一方, 脳動静脈奇形によるくも膜下出血の程度は軽いため, 血管攣縮はまれとされている. われわれは高度の血管攣縮をきたした小児脳動静脈奇形の1例を経験したので報告する. <br> 症例は8歳の女児で, 小脳の脳動静脈奇形破裂による脳室内出血, くも膜下出血にて来院した. 開頭術を第5病日に行ったが, 第12病日に高度の血管攣縮を発症して脳梗塞に至った. 本例では動脈瘤破裂後のくも膜下出血による血管攣縮の臨床経過とは異なる点が多く, 両側脳室と第4脳室に残存した血腫が血管攣縮に強く影響した可能性がある. 脳室内血腫を伴う脳動静脈奇形破裂後に生じた血管攣縮の特徴的な臨床経過を考察する.

DOI： 10.7887/jcns.23.909

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.brainres.2013.08.019

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その他リンク： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-24790563/

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracranial pressure (ICP) monitoring has been used widely for patients with intracranial hypertension. However, the data of mean ICP do not reflect various brain conditions correctly. Therefore, we performed ICP -waveform analysis to assess brain compliance. Data for ICP -waveform analysis were obtained by stereotactic intraventricle puncture. ICP waveform is expressed as a three-phase wave. Analyzed differential waveforms in a water intoxication model and continuous infusion models were evaluated respectively. In the water intoxication models, the second wave (P2) known to reflect compliance is elevated. ICP waveform analysis will be valuable for the assessment of the pathological condition of the brain.

DOI： 10.1007/978-3-7091-1434-6_41

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 12-year-old boy had been known to have a small swelling in the left high vertex for several years. After a trivial head hit to the site of the swelling, the swelling enlarged gradually. A bone window CT scan showed a lesion having bubble-like lytic change in the left parietal bone. Similar changes, but small, were able to be pointed out in a CT scan taken seven years previously. In the following 13 months CT scans eventually revealed sequential increases to 3.5 cm in diameter. Surgical exploratory resection of the mass was performed. Intraoperatively, partial destruction of the outer skull table and a simple cyst with serous yellowish brown colored fluid were identified. There was no finding adherent to the diploic structure. The bone defect after excision was reconstructed by using a titanium plate. The patient was followed up for 2 years after the surgery. Bone window CT showed bony development of normal appearance. Histological examination showed the cyst wall consisted of fibrous connective tissue but there were neither epithelial nor endothelial cells. The histopathological diagnosis of SBC was most likely. SBC is relatively common in long bones, but rarely in flat bones. Only several cases of the SBC of cranial bone have been reported. Although a craniectomy for total excision followed by cranioplasty by resin was common, in cases of children, cyst removal with titanium plate application would be an alterative. SBC increasing in size after head injury is extremely rare, but clinicians may need to be aware of cystic skull bone tumors increasing in size after head injury.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diabetes mellitus in neurosurgical patients is known to be a disease with high risks and severe outcomes. However, the mechanism by which diabetes mellitus induces dysfunction of brain tissue is not well known. The hypothesis of this study was that the damage to brain microvasculature in diabetes mellitus results in impaired compliance of the brain. Pathological changes associated with type II diabetes were investigated using a rat model. Pathophysiological changes in diabetic brain tissue were also investigated to confirm cerebral compliance by analyzing intracranial pressure waveforms. Pathologic findings revealed thickening of the basement membrane and fibrous collagen infiltration into the inner basement membrane of the brain microvasculature in diabetes mellitus. Analysis of intracranial pressure waveforms revealed that the P2 portion increased in diabetic rats compared to the control and was increased further with the increase in intracranial pressure. Analysis of the differential pressure curve, with respect to time, demonstrated that intracranial elasticity showed a concomitant increase. Pathologic findings and intracranial pressure waveforms were consistent with changes in brain microvasculature in diabetes mellitus. The increase of elasticity of brain tissue in diabetes mellitus may exacerbate the damage of intracranial disease.

DOI： 10.1016/j.brainres.2012.03.061

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracerebral metastasis in osteosarcoma is extremely rare. A 14-year-old girl who had previously been operated upon for osteosarcoma of the femur presented with seizures and left hemiparesis. A right parietal lesion with calcification and brain oedema was found. After resection of the mass, pathology revealed an osteosarcoma metastasis.

DOI： 10.3109/02688697.2011.581771

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

傍突起部内頚動脈瘤のコイル塞栓術の治療成績向上を目的として自験例を分析した.動脈瘤を発育方向別に4群に分け,動脈瘤や内頚動脈サイホンの解剖学的な特徴,コイル塞栓術による治療成績,治療難易度を比較検討した.対象は34例の35病変で,腹側群17例,内側群7例,背側群8例,外側群3例の4群である.腹側および内側群は小さく,ワイドネックが多かった.背側および外側群の動脈瘤頚部はサイホン部以遠に多く,サイホンの屈曲角度はより鋭的であった.治療は32病変で完遂できた.治療効果と塞栓率は背側および外側群で劣る傾向があった.背側および外側群のサイホン屈曲角度はより急峻で,サイホンのより遠位に動脈瘤が多いことが,コイル塞栓術を困難にしていると考えられた.

DOI： 10.7887/jcns.21.481

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その他リンク： https://search.jamas.or.jp/link/ui/2012281702

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

髄膜腫手術の目標は, 合併症なしに腫瘍を全摘出し神経機能を改善させることである. 手術を成功させるには, 術前画像所見読影, 術前塞栓術, 術中モニタリング, 適切な体位・頭位・開頭の設定, そして手術アプローチと手術機器の選択など多段階のステップを着実に遂行する必要がある. 本稿では髄膜腫摘出の手技をステップアップさせることを目的に, 杉田式頭部固定枠と熊手型レトラクターをどのように利用するかを中心に解説する. 頭部固定枠は術中左右35度まで回旋可能で, 脳の自重を利用し脳損傷を軽減できる. 熊手型レトラクターは, 状況に応じたさまざまな使い分けで正常組織の損傷を最小限にとどめ迅速な摘出に寄与する.

DOI： 10.7887/jcns.21.931

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

A 22-year-old woman developed an unruptured fusiform aneurysm of the internal carotid artery 7 months after being diagnosed with Wagener's granulomatosis. Intracranial aneurysmal formation is an extremely rare complication of Wegener's granulomatosis. This rare case of intracranial aneurysm was treated by endovascular balloon occlusion.

DOI： 10.2176/nmc.52.216

DOI： 10.3109/14397595.2015.1021950_references_DOI_FV6kbbCxGUQG2r7CIW04vjLyEI2

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その他リンク： https://search.jamas.or.jp/link/ui/2013155946

記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

Pterional approachはトルコ鞍部周辺への到達法として頻繁に用いられ,脳神経外科医が最も習熟しておくべき手術アプローチである.このアプローチを完璧に習得すれば,他の手術アプローチを安全に行うための基本手技が速やかにマスターできる.本アプローチの原則は,脳と血管を損傷することなくトルコ鞍を中心とした頭蓋底部を必要十分露出することである.原疾患やシルビウス静脈の発達の程度によりDolenc approachをはじめとするさまざまな頭蓋内操作のバリエーションが存在する.シルビウス静脈やsphenoparietal sinusの処理,temporopolar approach,視神経管開放,前床突起切除,鞍結節切除,硬膜輪切開など,さまざまな術野拡大の技法がある.

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記述言語：英語   出版者・発行元：Informa UK Limited  

DOI： 10.3109/02688697.2011.568641

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

DOI： 10.2335/scs.38.119

DOI： 10.2176/nmc.cr2013-0025_references_DOI_OH1oPU7vPo4IBYCTMjkzCDCMhky

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

Pterional approachはトルコ鞍部周辺への到達法として頻繁に用いられ,脳神経外科医が最も習熟しておくべき手術アプローチである.このアプローチを完璧に習得すれば,他の手術アプローチを安全に行うための基本手技が速やかにマスターできる.本アプローチの原則は,脳と血管を損傷することなくトルコ鞍を中心とした頭蓋底部を必要十分露出することである.原疾患やシルビウス静脈の発達の程度によりDolenc approachをはじめとするさまざまな頭蓋内操作のバリエーションが存在する.シルビウス静脈やsphenoparietal sinusの処理,temporopolar approach,視神経管開放,前床突起切除,鞍結節切除,硬膜輪切開など,さまざまな術野拡大の技法がある.

DOI： 10.7887/jcns.19.727

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その他リンク： https://search.jamas.or.jp/link/ui/2011007571

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

ITP合併妊娠による胎児脳室内出血後水頭症の1例を報告する.胎生34週に母体超音波にて胎児脳室内出血と頭囲拡大がみられ,35週に帝王切開にて出生.出生時,児の血小板数は1.7×10^4/μlで,血小板輸血,ガンマグロブリン大量療法,ステロイド療法を行った.生後3日目に血小板数は7.6×10^4/μlに増加し,水頭症に対しOmmayaリザーバー留置術を施行したところ,再び脳室内出血をきたした.保存的治療にて良好に経過し,脳室-腹腔シャント術施行後,退院となった.新生児脳室内出血の報告は散見されるが,ITP合併妊娠による胎児期脳室内出血後水頭症の報告は非常にまれである.ITP合併妊娠による胎児および新生児の管理法について,脳神経外科医の視点から考察を行った.

DOI： 10.7887/jcns.18.56_1

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その他リンク： https://search.jamas.or.jp/link/ui/2009113188

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：特定非営利活動法人 日本脳神経血管内治療学会  

<b>【目的】</b>バルーンカテーテルの誘導，留置困難な広頸大型脳底動脈瘤の症例に対するcatheter exchange techniqueの有用性を報告する．<b>【症例】</b>くも膜下出血にて発症した71歳の女性．出血源である広頸脳底動脈瘤へのコイル塞栓術を施行した．瘤頸部は脳底動脈から左後大脳動脈に渡って広く存在するため，治療においてneck remodeling techniqueが必須であった．しかし，バルーンカテーテルの誘導は困難であったため，初回の血管内治療はtrialで終わった．２回目の治療時には，catheter exchange techniqueの併用によりバルーンカテーテルは留置可能となり，適切な塞栓術を行うことができた．<b>【結論】</b>バルーンカテーテルの誘導，および留置困難な症例に対し，catheter exchange techniqueは有用な手技であると考えられた．

DOI： 10.5797/jnet.2.238

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その他リンク： https://search.jamas.or.jp/link/ui/2009159151

記述言語：日本語  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: A rare case of ruptured kissing aneurysms on the right internal carotid-posterior communicating artery (ICPCA) and -anterior choroidal artery (ICAchA) is reported. CASE: A 47-year-old female was transferred to our hospital because of subarachnoid hemorrhage (SAH). Cerebral angiography revealed two aneurysms on the right ICPCA and ICAchA. Right frontotemporal craniotomy was performed to obliterate them on the day of admission. Despite the presence of angiographical cleavage, these two aneurysms were attached to each other tightly, and it was extremely difficult to dissect the space between them and premature rupture occurred. A Sugita long straight clip was inserted parallel to internal carotid artery to obliterate the body of ICAchA aneurysm and the neck of ICPCA aneurysm. Another straight clip was applied to the neck of the former aneurysm. Both PCA and AchA could be secured successfully. Postoperatively, although she developed symptomatic vasospasm on the 10th day, she discharged without any neurological deficits 40 days later. CONCLUSIONS: Because of the difficulty in dissection of aneurysms, the operation for kissing aneurysms has been recognized as hazardous and challenging since Jefferson. We emphasize that a clipping technique described above should be kept in mind as a safe value, though meticulous dissection of each aneurysmal neck followed by independent neck clipping is reasonable.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳神経外科コングレス  

36歳,女性で部分血栓化大型後大脳動脈瘤破裂によるクモ膜下出血後,興味ある経過をとった1例を報告した.本例は発症1カ月で親動脈を含んだ動脈瘤の自然血栓化後,発症2カ月後に親動脈,3カ月後に動脈瘤の自然再開通が認められた稀な症例である.治療として術前閉塞試験を行わずに血管内手術によるparent artery occlusion (PAO)を行い,非常に良好な予後が得られた.その原因として,後大脳動脈灌流域に認められる豊富な側副血行路が考えられた.

DOI： 10.7887/jcns.13.711

DOI： 10.2335/scs.38.52_references_DOI_BZxDfl4psqSAVwvx6wOMXR5gV3I

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その他リンク： https://search.jamas.or.jp/link/ui/2005019196