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

DOI： 10.1016/j.jphs.2025.12.004

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report stentless reconstructive embolization of a high-flow vertebrovertebral arteriovenous fistula using a double-balloon jailing technique with microsnare-guided retrograde exchange. A 70-year-old woman had pulsatile tinnitus and a cervical bruit. Angiography demonstrated a V3-to-suboccipital cavernous sinus fistula with a single short tract, draining into vertebral venous plexuses and via the posterior condylar vein to the sigmoid sinus, without cortical reflux. Targeted embolization was planned by jailing an embolization microcatheter within the tract using arterial and venous balloon microcatheters. Direct transvenous navigation was prevented by septations and high shunt flow; therefore, an arterial microcatheter was advanced antegrade into the internal jugular vein, where it was captured with a microsnare introduced from the venous side, then drawn back as a coupled system to secure venous access. Subsequent inflation of both balloon microcatheters immobilized the embolization microcatheter and enabled dense coil packing. Angiography confirmed complete obliteration which persisted after balloon deflation. Tinnitus resolved immediately, and imaging showed durable occlusion with no recurrence at 5 years. This approach enables reconstructive obliteration of selected high-flow vertebrovertebral arteriovenous fistulas (VVAVFs) without stent implantation, potentially reducing antiplatelet exposure while preserving bailout options. Microsnare-guided retrograde exchange facilitates device delivery in cases of challenging transvenous navigation.

DOI： 10.7461/jcen.2026.E2025.10.008

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Oral squamous cell carcinoma cell (OSCC) comprises malignant neoplasms arising within the oral cavity. Early-stage detection is associated with favorable prognosis, whereas progression to advanced stages with lymph node metastasis significantly worsens outcomes. We previously reported that the prostaglandin E₂ (PGE₂) receptor EP4 regulates OSCC migration. RNA sequencing reanalysis suggested that EP4 stimulation is strongly associated with cell migration and adhesion, with interleukin-6 (IL-6) emerging as a central mediator of these processes. In OSCC cells, ONO-AE1-437 (EP4 agonist) increased IL-6 mRNA expression and protein secretion. EP4-overexpressing cells showed increased IL-6 expression without stimulation, further enhanced by ONO-AE1-437 or PGE₂. xCELLigence demonstrated that PGE₂ promoted cell adhesion, which was suppressed by ONO-AE3-208 (EP4 antagonist) and Tocilizumab (IL-6 inhibitor). Scratch and transwell assays revealed enhanced migration under PGE₂ and ONO-AE1-437, blocked by IL-6 inhibition. These results suggest that EP4 promotes cell adhesion and migration through IL-6 in OSCC cells. (147 words).

DOI： 10.1016/j.jphyss.2026.100057

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) following carotid artery stenting (CAS) is unclear. Therefore, this study aimed to compare outcomes across four centers with differing DAPT strategies-3-month versus extended duration-to assess safety and efficacy. METHODS: We retrospectively evaluated 347 patients who underwent CAS between 2010 and 2022. Patients were categorized into two groups according to DAPT duration:3 months or >3 months. We compared patient backgrounds, postoperative stroke events, and DAPT-related hemorrhagic complications. Propensity score matching was performed, and 80 matched pairs were analyzed. RESULTS: In the matched cohort of 80 pairs, the incidence of ischemic events, including cerebral infarction and transient ischemic attack, was four and 10 in the 3-month DAPT and >3-month DAPT groups, respectively. Intracranial and extracranial hemorrhagic events occurred in two and seven cases in the 3-month and >3-month groups, respectively. Log-rank testing showed a statistically significant association between >3-month DAPT and higher incidence of hemorrhagic complications (including intracranial and extracranial hemorrhage) (hazard ratio [HR]: 6.21, 95 % confidence interval [CI] 1.23-31.4, p=0.014), whereas no significant difference was observed in ischemic event rates (HR 2.90, 95 % CI 0.89-9.46, p=0.077). CONCLUSION: In our series of CAS patients treated with DAPT, a 3-month regimen before transitioning to SAPT was associated with similar efficacy and a lower incidence of hemorrhages compared to longer DAPT regimens. High-risk ischemic cases should be considered individually; however, routine extension of DAPT beyond 3 months may not be necessary.

DOI： 10.1016/j.jstrokecerebrovasdis.2025.108452

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1038/s41598-025-99132-3

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.3171/CASE24574

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.3171/CASE24861

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1177/19714009231224427

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.7759/cureus.75759

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The increasing prevalence of heated tobacco products (HTPs) has heightened concerns regarding their potential health risks. Previous studies have demonstrated the toxicity of cigarette smoke extract (CSE) from traditional tobacco's mainstream smoke, even after the removal of nicotine and tar. Our study aimed to investigate the cytotoxicity of CSE derived from HTPs and traditional tobacco, with a particular focus on the role of reactive oxygen species (ROS) and intracellular Ca2+. METHODS: A human oral squamous cell carcinoma (OSCC) cell line, HSC-3 was utilized. To prepare CSE, aerosols from HTPs (IQOS) and traditional tobacco products (1R6F reference cigarette) were collected into cell culture media. A cell viability assay, apoptosis assay, western blotting, and Fluo-4 assay were conducted. Changes in ROS levels were measured using electron spin resonance spectroscopy and the high-sensitivity 2',7'-dichlorofluorescein diacetate assay. We performed a knockdown of calcium/calmodulin-dependent protein kinase kinase 2 (CaMKK2) by shRNA lentivirus in OSCC cells. RESULTS: CSE from both HTPs and traditional tobacco exhibited cytotoxic effects in OSCC cells. Exposure to CSE from both sources led to an increase in intracellular Ca2+ concentration and induced p38 phosphorylation. Additionally, these extracts prompted cell apoptosis and heightened ROS levels. N-acetylcysteine (NAC) mitigated the cytotoxic effects and p38 phosphorylation. Furthermore, the knockdown of CaMKK2 in HSC-3 cells reduced cytotoxicity, ROS production, and p38 phosphorylation in response to CSE. CONCLUSION: Our findings suggest that the CSE from both HTPs and traditional tobacco induce cytotoxicity. This toxicity is mediated by ROS, which are regulated through Ca2+ signaling and CaMKK2 pathways.

DOI： 10.1186/s12576-024-00928-1

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction Preoperative embolization can potentially facilitate surgical resection of challenging tumors in the intracranial and facial regions; however, its clinical efficacy remains controversial, mainly due to potential morbidity risks. We explored negative factors of the combined treatment of preoperative embolization and tumor resection that affect neurological prognosis. Method This retrospective study used clinical data from 132 consecutive tumors that underwent combined treatment at multiple facilities between January 2016 and May 2021. Basic patient information, tumor characteristics, and treatment details were assessed to identify predictors of deterioration as measured using the modified Rankin scale (mRS) score at three months post-treatment. Results Among the 126 eligible combined treatments, a deterioration in the postoperative mRS score was observed in 19/126 (15.1%). Complications related to embolization and tumor resection occurred in 8/126 (6.3%) and 19/125 (15.2%) of procedures, respectively. Multivariate analyses indicated significant associations between migration of embolic material (adjusted odds ratio 13.80; 95% confidence interval 1.25-152.52; p=0.03), elevated intraoperative blood loss (p=0.04), and deterioration of postoperative mRS score. Embolic material migration was identified as the primary prognostic factor for the deterioration of score. An analysis of 192 procedures, excluding those that exclusively used coils, identified embolization targeting the accessory meningeal artery (p=0.046) and the third segment of the internal maxillary artery (p=0.03) as a risk factor for embolic material migration. Conclusions Embolic material migration is the predominant factor associated with declining neurological outcome that persists into the chronic phase after combined treatment. Given that preoperative embolization is a supplementary treatment option, a thorough understanding of vascular anatomy and striving safe procedure are critical.

DOI： 10.7759/cureus.57315

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.5797/jnet.oa.2023-0083

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.25259/SNI_772_2024

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.3171/CASE23492

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107329

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.inat.2022.101678

Scopus

researchmap

記述言語：英語  

DOI： 10.1136/neurintsurg-2022-019080

PubMed

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data. METHODS: This retrospective multicenter cohort study aimed to identify the prognostic factors after CAS using real-world data from the stroke registry of Yokohama (STrOke Registry of Yokohama; STORY) from January 1, 2018 to May 31, 2021. Patient characteristics, procedural factors, complications, and prognoses were collected using medical records. RESULTS: Data from 107 patients were enrolled in this study after excluding those with insufficient data (2 cases). The mean participant age was 74.9±8.2 years, and 66 patients (61.7%) were symptomatic. Symptomatic lesions were a significant prognostic factor in the overall analysis (p=0.003). A multivariate analysis showed that the estimated glomerular filtration rate (eGFR) (odds ratio: 1.11, p=0.003) and staged CAS (odds ratio: 38.9, p=0.04) were independent prognostic factors. The odds ratio and relative risk of mRS deterioration when eGFR was under 49 mL/min/1.73 m2 compared with when eGFR was above 49 mL/min/1.73 m2 were 5.2 and 3.74, respectively. CONCLUSIONS: In this real-world multicenter study, we established independent prognostic factors for CAS using high totality data. For patients with symptomatic lesions and low eGFR (≤49 mL/min/1.73 m2), indication for treatment should be considered strictly.

DOI： 10.1016/j.jstrokecerebrovasdis.2021.106269

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Eagle syndrome is a rare condition induced by an elongated styloid process. A 51‐year‐old man became aware of weakness and numbness of the right upper extremity. Magnetic resonance images and angiography revealed fresh multiple infarctions in the left cerebrum, and stenosis and dilatation of the left internal carotid artery. Angiography, cone‐beam computed tomography, and contrast‐enhanced computed tomography demonstrated dissection of the left internal carotid artery and an elongated styloid process close to the internal carotid artery. These findings indicated that cerebral infarction due to internal carotid artery dissection resulted from mechanical compression by an elongated styloid process. The patient was treated by carotid artery stenting on the 7th day. His symptoms induced by cerebral infarction gradually improved. Follow‐up MRI on the 29th day showed patency of the left internal carotid artery. Although the incidence of internal carotid artery dissection due to Eagle syndrome is low, the possibility of this rare condition should be taken into consideration as an etiology of cerebral infarction.

DOI： 10.1111/ncn3.12555

researchmap

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ncn3.12555

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report a case of developmental venous anomaly (DVA) with venous congestion caused by stenosis of the collecting vein that presented with intracerebral hemorrhage (ICH). A 74-year-old woman was referred to our hospital a few days after the onset of motor aphasia. Computed tomography (CT) and magnetic resonance imaging (MRI) showed ICH in the left frontal lobe. Angiography revealed DVA in the left frontal lobe in the late venous phase. Stenosis of the collecting vein of DVA at the entrance to the superior sagittal sinus was detected and accompanied by cavernous malformation (CM) beside DVA. Cone-beam CT revealed the absence of the left septal vein and hypoplastic transverse caudate veins. The patient was treated by blood pressure management and no additional neurological symptoms were detected. DVA develops to compensate for the absence of pial or deep venous systems, and generally benign and clinically asymptomatic. However, the outflow restriction of DVA causes chronic venous hypertension and the formation of CM. These abnormalities are considered to occur during post-natal life and may result in ICH. The risk of hemorrhage needs to be considered in cases of DVA with restricted venous outflow or CM.

DOI： 10.1080/02688697.2021.1940859

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Background

Dissection of a fenestration of the vertebral artery is extremely rare.

CASE REPORTS

A 55‐year‐old man presented with severe headache. Radiological examinations revealed a fenestration of the intracranial vertebral artery, and both limbs of the fenestration showed stenosis and dilatation. Three‐dimensional‐T1 fat suppression‐weighted images of magnetic resonance imaging (MRI) showed an intramural thrombus. These findings indicated that dissection occurred in both limbs of the fenestrated vertebral artery. Since no hemorrhage or infarction was observed, the patient was conservatively treated with an anti‐hypertensive drug. His symptom gradually improved and finally disappeared. Follow‐up MRI in the 2nd month showed a decreased intramural thrombus and smoothened vertebral artery.

Discussion

Detection of an intramural thrombus on MRI is useful for the diagnosis of dissection of a vertebral artery fenestration. Treatment of this rare condition might be the same as that for a non‐fenestrated vertebral artery.

DOI： 10.1111/ncn3.12510

researchmap

その他リンク： https://pericles-gcp.literatumonline.com/doi/full-xml/10.1111/ncn3.12510

担当区分：筆頭著者,　責任著者   記述言語：英語  

We report a rare case of an aneurysm originating from the penetrating artery of the distal middle cerebral artery (MCA). A 76-year-old man without a notable past history presented with sudden-onset severe headache, left hemiparesis, and a decreased level of consciousness. Computed tomography (CT) revealed subarachnoid hemorrhage (SAH) with intracerebral hemorrhage (ICH) in the right temporal lobe extending into the ventricle. Contrast-enhanced CT (CE-CT) demonstrated a focus of contrast enhancement (CE) adjacent to the hematoma in the right frontal lobe. An aneurysm fed by a penetrating artery branching off from the right distal MCA was found on angiography. The patient underwent emergency resection of the aneurysm and hematoma evacuation. Histological analysis revealed that arterial dissection may be an associated factor in the pathogenesis of this peripheral aneurysm formation. A focus of CE within or adjacent to the hematoma may be useful for diagnosing this peripheral aneurysm. ICH can result in a life-threatening situation. Therefore, microsurgery may be the first treatment choice for aneurysms in this location.

DOI： 10.2176/nmccrj.cr.2020-0004

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語  

BACKGROUND: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. CASE DESCRIPTION: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. CONCLUSION: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

DOI： 10.25259/SNI_564_2020

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intracranial aneurysm. Most aneurysms associated with duplicated middle cerebral artery are located at the origin of the duplicated middle cerebral artery. An aneurysm located at the distal middle cerebral artery is not common. CASE PRESENTATION: We encountered a 62-year-old Asian man with duplicated middle cerebral artery associated with aneurysms at the M1/M2 junction of the duplicated middle cerebral artery and top of the internal carotid artery. CONCLUSIONS: In cases of duplicated middle cerebral artery, association with a distal aneurysm on the duplicated middle cerebral artery is rare. However, the aneurysm may be formed on the thicker middle cerebral artery due to hemodynamic stress.

DOI： 10.1186/s13256-018-1824-7

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Although diagnosis of dissection in the anterior cerebral artery (ACA) has increased, cerebral infarction in frontal lobe due to contralateral ACA dissection is rare. A 52‐year‐old woman developed headache and motor weakness in the left hemibody. Magnetic resonance images demonstrated a fresh cerebral infarction in the right frontal lobe and thin right ACA. The initial diagnosis was a cerebral infarction in the right frontal lobe due to right ACA stenosis. Angiography performed nine days after onset showed dilatation and stenosis of the left ACA, and a small diameter of the right ACA. An intramural thrombus in the left ACA was demonstrated on MRI. The diagnosis was a cerebral infarction in the right frontal lobe due to dissection of the contralateral left A2 and A3 of ACA. There is a possibility that cerebral infarction in frontal lobe is induced by the contralateral ACA abnormality in a case with bihemispheric ACA.

DOI： 10.1111/ncn3.12228

researchmap

その他リンク： https://pericles-gcp.literatumonline.com/doi/full-xml/10.1111/ncn3.12228

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

DOI： 10.1016/j.wneu.2017.12.167

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms. Patients and methods From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation. The aneurysms were located at the anterior communicating artery and basilar artery in two patients each, and on the internal carotid artery at the bifurcation of the anterior choroidal artery (AChoA) in one. In these patients, the clinical course, radiological findings, and management were retrospectively reviewed. Results Thrombus formation was observed in the posterior cerebral artery, anterior cerebral artery (A2), AChoA, and middle cerebral artery. The timing of thrombus formation was during coil delivery in four cases, and guiding catheter advancement in one. As for thrombus management, for all patients, administrations of heparin and antiplatelet agents were performed. For four patients, urokinase injection into the affected arteries was added after the completion of embolization. Cerebral infarction was postoperatively identified in two patients, but no hemorrhage was noted. Conclusion Administrations of heparin and antiplatelet drugs should be performed appropriately during procedures, and close observation of the arterial condition on angiography is necessary. Once thromboembolism occurs during the endovascular embolization of ruptured cerebral aneurysms, adequate heparinization, and antiplatelet therapy should first be performed.

DOI： 10.1177/1591019917739448

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 28-year-old man without a significant medical history visited our hospital complaining of a headache. Computed tomography (CT) demonstrated thick, calcified vertebral artery (VA) and basilar artery (BA), despite the patient being young. Magnetic resonance angiography demonstrated the absence of the left internal carotid artery (ICA). The right ICA, the bilateral VA, and the BA were well developed and dolichoectatic. CT revealed the absence of the carotid canal on the left side. The condition was diagnosed as congenital agenesis of the left ICA with dolichoectatic changes in 3 other arteries. In a young patient with thick, calcified intracranial arteries, close examination is necessary, because vascular anomalies such as ICA agenesis may exist.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.021

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society for Neuroendovascular Therapy  

DOI： 10.5797/jnet.ai.2017-0087

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objective Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is a procedure to reconstruct cerebral blood flow in the MCA territory. In some cases, the STA wall is thickened and the size discrepancy between STA and MCA is apparent. In such a situation, STA-MCA bypass is challenging. We present two patients who underwent STA-MCA bypass using STA in which a thickened intima was removed. We discuss the usefulness of this rescue technique. Patients and Results A patient with an atherosclerotic MCA occlusion and another with an occluded internal carotid artery are included. Endarterectomy of STA was performed before or during anastomosis, and the intima-resected STA was anastomosed to MCA. In both cases, the STA was thick and hard, and it was difficult to anastomose the STA as it was to the MCA. Patency of the bypass was confirmed by postoperative angiography. Conclusion Endarterectomy of a thickened STA might be an effective rescue technique in cases with severely atherosclerotic STA in STA-MCA bypass.

DOI： 10.1055/s-0037-1598050

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語  

We report the rare case of a right aortic arch associated with agenesis of the left internal carotid artery. A 75-year-old woman with a medical history of tetralogy of Fallot presented with dizziness. Magnetic resonance angiography revealed agenesis of the left internal carotid artery in addition to a previously diagnosed right aortic arch. The left common carotid artery was present, but it was thin. Computed tomography showed the absence of the left carotid canal. The left anterior cerebral artery was fed via the anterior communicating artery. The left middle cerebral artery was fed via a thickened posterior communicating artery originating from the left posterior cerebral artery. Although a right aortic arch and agenesis of the internal carotid artery are both very rare, association of the two conditions may occur. Both anomalies depend on the abnormal regression of the dorsal aorta during embryonic development. In such a situation, the presence of other anomalies in the cardiac or central nervous system should be taken into consideration.

DOI： 10.2176/nmccrj.cr.2016-0240

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.

DOI： 10.1177/1971400916684667

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a patient with a traumatic middle cerebral artery dissection, which showed hyperperfusion in the territory supplied by the left middle cerebral artery. A 45-year-old man experienced speech disturbance and motor weakness in his right hemibody on the day following mild head trauma. His symptoms worsened on the fourth day. Magnetic resonance imaging showed narrowing in the left M1 portion of the middle cerebral artery. Angiography showed narrowing and dilatation in the left middle cerebral artery trunk. The lesion was diagnosed as a dissection of the middle cerebral artery. Arterial spin labelling of magnetic resonance imaging and single photon emission computed tomography showed increased cerebral blood flow in the left temporal region compared with the right. The patient was treated conservatively and the symptoms gradually improved. The hyperperfusion observed on arterial spin labelling and single photon emission computed tomography gradually improved and disappeared on the 25th day. This is the first reported case of traumatic middle cerebral artery dissection, which showed post-ischaemic hyperperfusion in the territory of the affected artery. To detect hyperperfusion in the brain, arterial spin labelling is a useful technique.

DOI： 10.1177/1971400916665370

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語  

Intraorbital schwannoma is a rare tumor which accounts for about 1-2% of all neoplasms of the orbit. Orbital schwannomas most commonly arise from the sensory branches of the trigeminal nerve. On the other hand, intraorbital abducens nerve schwannomas are extremely rare, with a search of the English literature identifying only four cases of intraorbital abducens nerve schwannoma. This is the 5th reported case of an orbital schwannoma arising from the terminal branch of the abducens nerve to the lateral rectus muscle. We report a case of an intraorbital abducens nerve schwannoma in a 51-year-old man with no signs of neurofibromatosis. The tumor was totally excised with functional preservation of the nerve by a zygomatic approach with lateral orbitotomy. With knowledge of these anatomic features, total removal of the tumor with preservation of the abducens nerve function might be possible.

DOI： 10.2176/nmccrj.cr.2015-0259

PubMed

researchmap

記述言語：英語  

Cavernous sinus (CS) dural arteriovenous fistula (dAVF) patients presenting with only headache as an initial symptom are not common. Patients with CS-dAVF commonly present with symptoms related to their eyes. In all three patients, headache was the initial symptom. Other symptoms related to the eyes developed 1 - 7 months after headache. In one patient, headache was controlled by sumatriptan succinate, but not diclofenac sodium or loxoprofen sodium. In another patient, headache was controlled by loxoprofen sodium. In the third patient, headache was improved by stellate ganglion block. In all patients, magnetic resonance angiography (MRA) in the early stage of the clinical course showed abnormal blood flow in the CS. However, reflux to the superior ophthalmic vein (SOV) was not detected. As treatment, transarterial and transvenous embolizations were necessary for one patient, and transvenous embolization was performed for another patient with significant blood flow to the SOV and cortical veins. On the other hand, manual compression of the bilateral carotid arteries at the neck resulted in disappearance of the fistula in the third patient. In all patients, the symptoms improved after the disappearance of blood reflux to the CS. The refluxed blood to the CS might cause elevation of the CS pressure and stimulate the trigeminal nerve in the dural membrane, resulting in headache before developing reflux in an anterior direction. CS-dAVF could induce both migraine and common headache. In cases with blood reflux to the CS on magnetic resonance imaging and/or MRA even without eye symptoms, a differential diagnosis of CS-dAVF should be taken into consideration.

DOI： 10.14740/jocmr2489w

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

DOI： 10.14740/jnr371w

researchmap

記述言語：英語  

BACKGROUND: An aneurysm originating from the junction of the A1 segment of the anterior cerebral artery and accessory middle cerebral artery (Acc-MCA) is markedly rare. We report a rare case of an Acc-MCA aneurysm, and discuss the clinical course and management of this rare condition. CASE DESCRIPTION: A 64-year-old man with a past history of cerebral infarction was revealed to have a left Acc-MCA and an aneurysm at its origin. The aneurysm was clipped via a transsylvian approach. Due to its location and projectile direction, the neck of the aneurysm was left partially unclipped. CONCLUSION: Although an Acc-MCA aneurysm is very rare, it has a potential risk of rupture. Therefore, radical treatment is necessary for such aneurysms.

DOI： 10.4103/2152-7806.166179

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A duplicated middle cerebral artery (DMCA) is a rare vessel anomaly. Aneurysms at the origin of DMCA have been reported. CASE DESCRIPTION: We report 2 cases of aneurysms at the origin of DMCA accompanied by aneurysms at different sites. Each case of ruptured and unruptured aneurysm at the DMCA origin was associated with an unruptured aneurysm at the ipsilateral internal carotid artery and a ruptured one at the ipsilateral MCA, respectively. The aneurysms were clipped successfully in both patients. CONCLUSION: In cases of DMCA aneurysm associated with an aneurysm at another site, either aneurysm has a high risk of rupture. In such a case, radical treatment is necessary.

DOI： 10.4103/2152-7806.168069

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：SAH  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：日本メディカルイラストレーション学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本メディカルイラストレーション学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本老年脳神経外科学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本神経治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

J-GLOBAL

researchmap