Surgery for Cerebral Stroke最新文献

{"title":"Angioguard XP を使用したステント留置術でのルーチン吸引法の有効性と限界","authors":"Takatoshi Sorimachi, Kazuhiko Nishino, Kenichi Morita, O. Sasaki, Tetsuo Koike, Yasushi Ito, Yukihiko Fujii","doi":"10.2335/SCS.39.121","DOIUrl":"https://doi.org/10.2335/SCS.39.121","url":null,"abstract":"We report the usefulness of a routine aspiration method, in which aspirations of blood column in the proximal internal carotid artery (ICA) to the filter are always performed regardless of the flow state on digital subtraction angiography immediately before the filter retrieval to prevent ischemic complications in filter protected carotid artery stenting (CAS). The purposes of the present study were to summarize the clinical results of patients undergoing CAS using the routine aspiration method and Angioguard XP, and to investigate limitations of this method and countermeasures to prevent ischemic complications. The routine aspiration method was performed in 71 consecutive CAS procedures using Angioguard XP between November 2008 and June 2010. Two patients suffered from stroke within 30 days of the procedures (2.8%). Cerebral infarction occurred during CAS in 1 patient, and cerebral hemorrhage by hyperperfusion syndrome occurred 2 days after CAS in another. In the cerebral infarction case, the ICA was kinking just distal to the stenosis, and the kink was extended by the CAS procedure. A large amount of debris was found in both the retrieved filter and the aspirated blood columns. Even in the routine aspiration method, ischemic complications can occur in a few cases. In cases of a kink in the ICA just distal to the stenosis, avoidance of the kink extension during CAS is recommended to prevent ischemic complications.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129790272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombosed Giant Aneurysm of the Basilar Artery that Developed from Dolichoectasia: A Case Report","authors":"H. Oyama, K. Hattori, A. Kito, Hideki Maki, Aichi Niwa","doi":"10.2335/SCS.39.133","DOIUrl":"https://doi.org/10.2335/SCS.39.133","url":null,"abstract":"A 66-year-old male patient suffered a lacunar infarction 7 years previously and was treated with 100 mg/day of cilostazol. The fluid attenuated inversion recovery (FLAIR) image of a follow-up magnetic resonance imaging (MRI) scan revealed dolichoectasia of the basilar artery with a small luminal thrombus. Thirteen months later, a left cerebellar infarction occurred. The size of the aneurysm and luminal thrombus had increased. The dosage of cilostazol was increased to 200 mg/day. Three weeks later, he suffered a left pontine infarction and 100 mg/day of aspirin was added to the treatment regimen. Seventeen months after the cerebellar infarction, the aneurysm enlarged further. Surgical treatment was performed using a flow reduction method. After anastomoses of the right superficial temporal artery-superior cerebellar artery and left superficial temporal artery-posterior cerebral artery were performed, the bilateral vertebral arteries were embolized using a coil. The patient became comatose 12 hours after the last procedure. Three-dimensional computed tomography angiography revealed the complete occlusion of the basilar artery. Four days later, recanalization of the basilar artery was achieved by using an intravenous urokinase infusion. Nevertheless, marked infarction occurred in the bilateral cerebellar hemispheres and brain stem. He died and an autopsy was performed. The aneurysm was found embedded in the brain stem at autopsy. A microscopic examination showed fragmentation of the internal elastic lamina with atrophy of the muscle layer and adventitia. Neoangiogenesis within the thickened intima may have caused intramural hemorrhage and thrombus formation. Furthermore, a new sickle-shaped clot located between the arterial wall and the old thrombus may have caused the hemodynamic expansion of the aneurysm. Antiplatelet drugs were used to treat ischemic events caused by perforator or branch occlusion. However, use of these drugs should be carefully considered with regards to the risk of potentiating the compression of the brain stem due to aneurysmal enlargement.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130131723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Wide Operative View Without Brain Retractors in a Pterional Approach to an Unruptuted Cerebral Aneurysm","authors":"K. Yokoyama, A. Kotani, T. Nishioka","doi":"10.2335/SCS.39.84","DOIUrl":"https://doi.org/10.2335/SCS.39.84","url":null,"abstract":"We report surgical techniques for gaining a wide operative view without brain retractors in a pterional approach to an unruptured aneurysm. In Summary, the techniques involve: 1) Head positioning with the chin slightly up (vertex down), allowing the frontal lobe to fall away from the orbital roof. 2) Wide arachnoidal dissection using a long strip of Bemsheets serving as brain retractors. 3) Further epidural removal of bone from the sphenoid ridge and the flattening of the orbital roof after gaining the appropriate subdural space. 4) Optic canal unroofing and anterior clinoidectomy resulting in mobilizing the internal carotid artery. A wide operative view without brain retractors contributes to the safe dissection and clipping of an unruptured aneurysm, preserving the parent arteries and their perforators.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127383461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"椎骨動脈解離性動脈瘤に対する血管内治療による母血管閉塞術 : 穿通枝閉塞による Wallenberg 症候群を防ぐために","authors":"齊木 雅章, 佐藤 岳史, 山田 茂樹, 石崎 竜司","doi":"10.2335/SCS.39.116","DOIUrl":"https://doi.org/10.2335/SCS.39.116","url":null,"abstract":"In this paper, we retrospectively analyze the factors related to infarction of the medulla oblongata causing Wallenberg syndrome after endovascular trapping for dissecting aneurysm of the vertebral artery (VA). Seven cases of dissecting aneurysm of the VA including 5 ruptured cases were treated with endovascular coil embolization between 2003 and 2009 in our hospital. The posterior inferior cerebellar arteries (PICA) originated proximal to the aneurysm in 1 case, at the site of the aneurysm in 1 case, distal in 2 cases, and from the basilar artery (BA) in 3 cases. Complete obliteration of the dissecting aneurysms preserving blood flow of the PICA and opposite VA could be obtained in all cases except 1 case in which the aneurysm involved the PICA. No rebleeding was experienced, but infarction of the lateral medulla occurred in all 3 cases in which the PICA originated from the BA. Though the outcome of the 3 cases was favorable (mRS 0-2; 100%), surgeons should be aware of the risk of the trapping of the VA if the PICA originate from the BA.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125082799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological Considerations for Ruptured and Fusiform Aneurysms at the Distal Posterior Inferior Cerebellar Artery : Two Case Reports","authors":"Shingo Yamashita, T. Ishikawa, H. Miyata, J. Moroi, A. Suzuki, N. Yasui","doi":"10.2335/SCS.39.58","DOIUrl":"https://doi.org/10.2335/SCS.39.58","url":null,"abstract":"Summary: We report 2 surgical cases of distal posterior inferior cerebellar artery (PICA) aneurysms and mainly discuss pathological findings. Seventy-one and 61-year-old women experienced a subarachnoid hemorrhage and were found to have fusiform aneurysms showing a pearl-and-string appearance at the distal PICA peripheral to the choroidal point. Both aneurysms were trapped and pathologically examined. The aneurysms show similar pathological findings. The aneurysm walls, which lost both the internal elastic lamina and the vascular smooth muscle layer, had an area of marked fibrous thickening as well as an area of thinning. Infiltration of inflammatory cells, primarily monocytes, was seen localized within the wall of the rupture area. There was no evidence of an acute dissecting aneurysm even though the radiological results are compatible with a dissecting aneurysm. Arteriosclerotic factors can also be excluded because no fat cells or degenerated cells were observed. In both aneurysms, we speculate, hemodynamic factors in areas where a congenital defect of the internal elastic lamina in the peripheral PICA may have led to aneurysm formation and rupturing.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133890096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"経時的3D-CTAによる，くも膜下出血後の脳血管攣縮の評価","authors":"幸一 沖山, 利生 町田, 厚 藤川, 修作 永野, 京子 青柳, 亮太 野村, 純一 小野","doi":"10.2335/SCS.39.7","DOIUrl":"https://doi.org/10.2335/SCS.39.7","url":null,"abstract":"We assess the usefulness of serial three-dimensional CT angiography (CTA) in the diagnosis of cerebral vasospasm (VS), and evaluate the contribution of VS to symptomatic vasospasm (SVS), cerebral infarction, and modified Rankin scale (mRS) in patients with aneurysmal subarachnoid hemorrhage (SAH). Within 3 hours after the onset of symptoms, CTA was performed in 48 patients with SAH. CTA was repeated on Day 5-8 (median 7) and Day 12-15 (median 14) to assess VS. Vasospasm was defined as ≥25% vascular narrowing, and rated with the following criteria (degree of VS): moderate spasm (25-50% decrease in vessel diameter), and severe spasm (≥50% decrease). Vasospasm was also categorized as follows (CTA grade): no VS, local VS, and diffuse VS. By local VS we mean an area of narrowing of the vessel in continuity with an aneurysm and not extending more than 2 cm to the aneurysm, or limited to the A-1, A-2 portion (≤2 cm). Diffuse VS means any stenosis affecting either a long segment of vessel or distal segments of cerebral arteries. Aggressive treatments for the VS including triple H therapy were started, when either SVS was revealed or Diffuse VS was detected on CTA. We statistically investigate correlations of Hunt and Kosnik grade, Fisher CT group, degree of VS, and CTA grade, with SVS, cerebral infarction, and mRS. Of the 48 patients, 32 (67%) showed VS and 19 (40%) revealed SVS by the 3rd CTA. Cerebral infarction on CT was detected in 13 (27%) patients. With logistic regression analysis, CTA grade significantly correlated with SVS and infarction, while Hunt and Kosnik grade and age of the patients significantly correlated with mRS. Prospective evaluation of CTA following SAH might allow early recognition of VS and promote aggressive treatment and improved neurological outcomes.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116587314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"脳卒中病院前救護の標準化PSLS（Prehospital Stroke Life Support）の位置付け","authors":"伸行 鈴木","doi":"10.2335/SCS.39.31","DOIUrl":"https://doi.org/10.2335/SCS.39.31","url":null,"abstract":"Although the introduction of t-PA (tissue plasminogen activator) was considered radical treatment for acute cerebral ischemic disease, the actual number of cases for such administration was limited in Japan for many reasons. One such reason was related to the ability of EMT (emergency medical technician) paramedics to transport patients to the proper hospital for treatment within 2 hours of onset. From this point of view, the Committee of the Prehospital Stroke Life Support (PSLS) of the Japanese Society for Emergency Medicine (JSEM) developed an original standard for prehospital treatment of stroke. In this paper, I provide an overview of PSLS and a half-day practical course, which has been widely disseminated over a short period of time.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127928220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Study of Cerebral Vasoparalysis During a Period of Cerebral Vasospasm after Subarachnoid Hemorrhage","authors":"Toshiichi Watanabe, Takehiko Sasaki, J. Nakagawara, T. Ogino, K. Kamiyama, Hideki Endo, K. Hara, K. Hayase, T. Kataoka, T. Osato, Y. Seo, Hirohiko Nakamura","doi":"10.2335/SCS.39.1","DOIUrl":"https://doi.org/10.2335/SCS.39.1","url":null,"abstract":"We employ the 123I-IMP SPECT dual table ARG method and stereotactic extraction estimation (SEE) analysis 7 or 8 days after subarachnoid hemorrhage (SAH) onset to predict cerebral vasospasm. We report new findings of cerebral vasoparalysis during a period of cerebral vasospasm after SAH. From January 1, 2005 to April 30, 2008, we encountered 330 cases of aneurysmal SAH, and treated 285 cases. Of these, 65 were excluded as unsuitable for this study, for reasons such as lack of SPECT data, external decompression, admission over 7 days from SAH onset. We studied 220 cases treated by microsurgical clipping (n＝178) or endovascular coil embolization (n＝42). Vasoparalysis was defined as a rise in resting CBF and a loss of vascular reserve on SEE analysis of CBF-SPECT. Vasoparalysis occurred in 15 cases (6.8%). Of these, 9 cases (60.0%) had cerebral hematoma, temporary clips had been used in the operation for 8 cases (53.3%), 9 cases (60.0%) experienced postoperative cerebral infarction, and 3 cases (20.0%) had postoperative convulsions. Vasoparalysis occurs in relation to perioperative cerebral damage. In terms of the loss of vascular reserve following SAH, vasoparalysis resembles hemodynamic cerebral ischemia, although the conditions are quite different. Differentiating between these 2 conditions is important, as different forms of management are required. Dual table ARG and SEE analysis are very useful for the evaluating these 2 conditions.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"24 139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116212051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Treatment Strategies for Cerebral AVMs","authors":"T. Yokoi, K. Takagi, N. Nitta, J. Jito, Tadateru Fukami, T. Nakazawa, K. Nozaki, N. Hashimoto","doi":"10.2335/SCS.39.24","DOIUrl":"https://doi.org/10.2335/SCS.39.24","url":null,"abstract":"脳動静脈奇形の治療の目的は,出血予防,痙攣コント ロール,進行性神経障害回避などであり,治療方針を決め るうえで最も重要視されるのは出血予防である.将来の出 血リスク軽減のためには,出血率の高い症例を選択して積 極的に治療すべきであるが,出血リスクの高い症例では治 療リスクも高いことがしばしばあり,その治療方針につい ては,現在定まった方針はない.一般には,SpetzlerMartin grading に基づいた外科治療の成績から,grade I, II,III については治療対象とし,grade IV,V について は治療対象外と考えることが多い.2001 年の AHA Scientific Statement に従えば,外科的摘出は SpetzlerMartin grade I,II について考慮すべきとし,SpetzlerMartin grade III については,術前塞栓術+摘出術がしば しば有効であり,Spetzler-Martin grade IV,V について 脳卒中の外科 39: 24 ~ 30,2011","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124071939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged therapyによりretrograde thrombosisを起こさず全摘出できた巨大なfeederをもつhigh-flow脳動静脈奇形の1例","authors":"Masashi Nakatsukasa, Takumi Kuramae, Joji Inamasu","doi":"10.2335/SCS.39.14","DOIUrl":"https://doi.org/10.2335/SCS.39.14","url":null,"abstract":"","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123296464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}