Surgery for Cerebral Stroke最新文献

{"title":"Protocol Improves Safety of Carotid Endarterectomy","authors":"Masanori Yoshino, T. Mizutani, R. Yuyama, T. Hara, T. Ota","doi":"10.2335/SCS.39.257","DOIUrl":"https://doi.org/10.2335/SCS.39.257","url":null,"abstract":"Carotid endarterectomy remains an effective procedure despite the introduction of carotid artery stenting. We have established a simple but sophisticated protocol for surgery, management of patients, and education of surgeons to prevent perioperative complications. Using our treatment strategy and education system, we performed 422 CEAs on 372 patients as the first-line choice for carotid artery stenosis between 2002 and 2009. Four experienced surgeons performed 121 procedures, and 15 inexperienced surgeons performed 301 procedures. Surgical morbidity and mortality rates within 1 month were 1.6% and 0%, respectively, for the experienced surgeons, and 1.4% and 0.2%, respectively, for the inexperienced surgeons. Our results are acceptable compared with other clinical studies. The defined procedural protocol, including thorough systemic control, especially prevention of ischemic heart disease, and an education system reduce surgical morbidity and mortality rates, even for inexperienced surgeons.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"273 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116069189","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":"Retrograde injection and suction methodが再開通治療に有効であった頚部内頚動脈完全閉塞症の１例","authors":"司 久保田, 麓 健太朗, 大輔 森, 幹雄 西谷, 友昭 寺田","doi":"10.2335/SCS.39.284","DOIUrl":"https://doi.org/10.2335/SCS.39.284","url":null,"abstract":"We planned carotid artery stenting (CAS) with “seat belt and air bag” technique for a patient of symptomatic post-radiation pseudo-occlusion of the right cervical internal carotid artery (ICA) in the chronic stage because of an artery-to-artery embolic episode in the sub-acute phase. During the CAS procedure, the right ICA was found to be totally occluded. Neither the left ICAG nor the left vertebral angiogram (VAG) could demonstrate the retrograde opacification of the right ICA below the C2 portion. A 4Fr. catheter was navigated to the cervical C1 vertebral level beyond the occlusion point, where arterial blood was aspirated. However, contrast injection from the catheter seemed risky because a large thrombus may have existed in the ICA above the C1 vertebral level. Left VAG with simultaneous aspiration from the catheter placed in the right ICA under flow reverse condition (named “retrograde injection and suction method”) retrogradely depicted a clean right ICA from its cavernous to cervical portion. This information confirmed us to pass the guidewire across the long occluded lesion safely, leading to a successful CAS of a totally occluded ICA.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132929023","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":"内頚動脈系閉塞性脳血管病変に対するSTA-MCA bypass術後の急性期画像評価","authors":"英徳 遠藤, 幹 藤村, 敬 井上, 宏明 清水, 悌二 冨永","doi":"10.2335/SCS.39.163","DOIUrl":"https://doi.org/10.2335/SCS.39.163","url":null,"abstract":"Superficial temporal artery-middle cerebral artery (STA-MCA) bypass for steno-occlusive cerebrovascular disease prevents future ischemic stroke by improving cerebral blood flow (CBF). Cerebral ischemia and hyperperfusion are potential complications of this procedure during the early postoperative period. We designed this study to investigate the efficacy of neuroradiological evaluation during early postoperative period after revascularization to detect postoperative pathological conditions of the brain and to avoid these complications. Eight consecutive patients (7 men and 1 woman; mean age 62.6 years) suffering from cerebral ischemia due to occlusive cerebrovascular disease with hemodynamic compromise were enrolled in this study. The underlying pathological condition was internal carotid artery (ICA) or MCA occlusion in 7 cases and MCA severe stenosis in 1 case. The standard STA-MCA bypass was performed for all cases. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed on the day after surgery, and single photon emission computed tomography (SPECT) was performed 1 and 7 days after surgery. Postoperative MRA on Day 1 showed patency of the bypass in all cases. Postoperative MRI on Day 1 revealed no ischemic or hemorrhagic complications in any of the cases. Postoperative SPECT showed transient focal intense increase in CBF around the sites of anastomosis in all 8 cases. Intensive blood pressure control was performed to prevent symptomatic hyperperfusion. All cases were discharged without perioperative complications with an average of 19.8 days of postoperative hospital stay. Neuroradiological evaluation during the early postoperative period enables safe perioperative management by revealing underlying pathological conditions of the brain following revascularization surgery.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"130 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116034267","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":"中学生に対する脳卒中啓発活動：Act FAST","authors":"達雄 天野, 千晶 横田, 裕也 重畠, 泰輝 井上, 康宏 冨井, 隆朗 萩原, 史生 宮下, 一夫 峰松","doi":"10.2335/SCS.39.204","DOIUrl":"https://doi.org/10.2335/SCS.39.204","url":null,"abstract":"Early recognition of stroke signs and symptoms is essential for early treatment and improvement of clinical outcomes. We performed a stroke education program for junior high school students and their parents. In February 2010, 79 students in 2 classes of the 1st grade of a junior high school and their parents were enrolled. Subjects were divided into 2 groups: an intervention class (39 students) and a control class (40 students). Students in the intervention class received a 45-minute lesson about stroke signs and symptoms. This group was taught the FAST message (Facial droop, Arm weakness, Speech disturbance, Time to call 119), and stroke risk factors. School items consisting of a pen, file, magnet, sticky note with the FAST message, and stroke pamphlets were also distributed to students in the intervention class. Parents of the intervention class were educated indirectly through the stroke pamphlets and items. For all subjects, questionnaires on stroke knowledge were examined at the baseline and immediate post-lesson time-points and 3 months after the stroke lesson. In students, the percentages of correct answers did not differ significantly between the 2 classes at the baseline. Three months after the stroke lesson, students in the intervention class answered more correctly than in the control class to the questions of facial palsy (97% in the intervention class vs. 55% in the control class; P<0.0001), speech disturbance (100% vs. 83%; P=0.006), calling 119 for stroke (90% vs. 55%; P=0.001), smoking (87% vs. 63%; P=0.012), hypertension (92% vs. 73%; P=0.021) and the FAST message (97% vs. 13%; P<0.0001). Parents of the intervention group also answered more correctly the question of the FAST message (82% vs. 19%; P<0.0001) than did the control group 3 months after the stroke lesson. We demonstrated that the stroke education program for junior high school students and their parents improved their stroke knowledge, especially of the FAST message.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"246 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115003592","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":"Result and Complications of Unruptured Cerebral Aneurysms Treated by a Clip-coil Combined Team: Problems to Be Overcome","authors":"Michiyasu Suzuki, H. Sadahiro, S. Kato, H. Ishihara, H. Yoneda, H. Goto, S. Shirao, H. Koizumi, Hiroya Imoto, S. Nomura, M. Fujii, K. Kajiwara","doi":"10.2335/SCS.39.182","DOIUrl":"https://doi.org/10.2335/SCS.39.182","url":null,"abstract":"Definite indications for the treatment of unruptured cerebral aneurysm (uAN) are very difficult to establish because the risk of rupture for any individual aneurysm still cannot be estimated. Furthermore, the criteria for evaluation of the prognosis and potential complications remain unclear, so no risk-benefit analysis can be performed. Recently, prevention of adverse effects to improve patient safety and satisfaction have become more important in the field of neurosurgery. We analyzed the occurrence and nature of adverse effects in 156 consecutive patients treated for uAN in our institute. The patients were treated with endovascular coil embolization for mainly paraclinoid or basilar apex aneurysms in 17 men and 38 women aged 35–81 years (mean 62.1±10.0 years) or surgical clipping for other aneurysms in 23 men and 78 women aged 35–77 years (mean 58.4±9.9 years). Anterior cerebral, anterior communicating, and middle cerebral artery aneurysms were significantly more common in the clipping group, whereas internal carotid and vertebrobasilar artery aneurysms were significantly more common in the coil group. Selection and treatment of uAN by our team showed generally good results in the short term. However, long-term observation to detect such complications as recurrence is required. Serious adverse events occurred in 17 of all 156 patients (10.9%), including mortality in 1 patient (0.6%), major morbidity (less than modified Rankin scale score 2) in 1 patient (0.6%), minor morbidity in 3 patients (1.9%), and transient neurological deficits in 12 patients (7.7%). The incidence of serious adverse events was similar in the coil and clipping groups, but all events including minor,","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"342 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122755700","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":"Non-aneurysmal Subarachnoid Hemorrhage and Consequent Diffuse Cerebral Vasospasm in Eclampsia Related to Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report","authors":"Hiroki Sato, M. Takayama, M. Hojo","doi":"10.2335/SCS.39.138","DOIUrl":"https://doi.org/10.2335/SCS.39.138","url":null,"abstract":"We report a case of posterior reversible encephalopathy syndrome (PRES) with subarachnoid hemorrhage in eclampsia. A 31-year-old female presented with a sudden severe headache and generalized convulsive seizure 6 days after delivery. Initial blood pressure was 198/100 (mean 133). Moderate disturbance of consciousness was observed. A brain CT scan was performed by her gynecologist and revealed subarachnoid hemorrhage. Therefore she was referred to our neurosurgery department. A 3D-CTA and MRA were performed on the day of admission, and no ruptured aneurysm and only very mild segmental vasoconstrictions at the vertebral artery and posterior cerebral artery were shown. A FLAIR image revealed multiple vasogenic edema in the cerebellar hemisphere, cerebral cortices and basal ganglia bilaterally. PRES was the most likely diagnosis. The sedative Propofol was administered for 3 days, and the patient recovered clinically. A follow-up MRI and MRA were performed 3, 10, and 21 days and 1 and 2 months after admission. Although a continuous reduction of the vasogenic edemas was shown by a follow-up FLAIR image, the severest diffuse vasoconstrictions in multiple cerebral arteries appeared 3 days after admission. Vasoconstrictions gradually improved during 2 months of follow-up. Concerning the clinical cause of vasogenic edema in PRES, Bertynski mentioned 2 theories in his review. One theory is “Injury of the endothelium caused by altered autoregulation of cerebral arteries following excessive hypertension results in vasogenic edema,” and the other is “Vasogenic edema caused by the cerebral infarction after vasoconstriction.” In the present case, an elevated initial blood pressure was shown, but the mean arterial pressure did not seem high enough to injure the endothelium. Besides, the severest vasoconstriction of cerebral arteries did not occur until 3 days after the peak of the vasogenic edema. This means vasoconstriction did not precede vasogenic edema. Both theories are still controversial, and our case does not correspond to either theory. We conclude that the present case shows a new theory for the clinical cause of vasogenic edema in PRES should be considered.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"49 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":"131032129","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":"Tailor-made keyhole clipping術による安全な未破裂脳動脈瘤の治療","authors":"森 健太郎, 拓史 山本, 保秋 中尾, 孝徳 江崎","doi":"10.2335/SCS.39.89","DOIUrl":"https://doi.org/10.2335/SCS.39.89","url":null,"abstract":"","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"18 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":"131594453","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":"Narrow Window CTによる超急性期脳虚血所見","authors":"隆充 内沢, 慶行 今田, 孝篤 鎌田, 都子 佐々木, 典文 目時, 譲士 萩井, 尚孝 前田, 俊太 舘山, 光昭 畑中","doi":"10.2335/SCS.39.127","DOIUrl":"https://doi.org/10.2335/SCS.39.127","url":null,"abstract":"We report a new computed tomographic (CT) finding of hyperacute ischemic stroke. We examined the CT findings of patients with acute ischemic stroke within 3 h of onset by using a very narrow CT window width. The CT number (Hounsfield unit, HU) of the ischemic area was decreased by only 1 or 2 units. The areas of decreased CT number were larger than the hyperintense areas observed in magnetic resonance imaging diffusion-weighted images (MRI-DWI). These areas were not detected as so called “early CT signs” of acute ischemia on conventional CT. We examined 3 patients of hyperacute stroke, and treated them with tissue-plasminogen activator within 3 h of onset. Their narrow-window CT examination revealed low-density areas that were not detected in the conventional study. After arterial recanalization and resolution of ischemic symptoms, these low-density areas reduced and the CT number was normalized. When recanalization did not occur, these areas showed signs of infarction. A low-density area in a narrow-window CT study may be a hypo-perfused area and include reversible ischemic area (or penumbra).","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"27 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":"116149281","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":"Laser Speckle Flowgraphyを用いた網脈絡膜血流測定によるCEAの眼虚血改善効果の検討","authors":"整 芳賀, 寛 江内田, 赤木 洋二郎, 愛 宇賀, 禎久 庄野, 康弘 濱田, 眞治 詠田","doi":"10.2335/SCS.39.103","DOIUrl":"https://doi.org/10.2335/SCS.39.103","url":null,"abstract":"We examined improvement of ocular ischemia in patients with carotid endarterectomy (CEA) with chorioretinal blood flow measurements using laser speckle flowgraphy (LSFG). LSFG allowed the quantitative measurement of chorioretinal blood flow. Five CEA patients, 4 men and 1 women ranging in age from 59 to 79 years, with carotid stenosis were examined. Three patients were symptomatic, and 2 patients were asymptomatic. The ratio of carotid stenosis was 68% to 98%. None of the patients presented delayed arm-to-retina circulation by fluorescein angiography. Four of 5 patients presented a mean increase in chorioretinal blood flow. The mean increase ratio of blood flow was 7.84%. LSFG was useful to evaluate peripheral blood flow in CEA patients and revealed that CEA may improve ocular ischemia.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"7 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":"121954949","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":"中大脳動脈本幹（M1部）の上向き動脈瘤の外科的治療","authors":"範和 波多野, 路弘 栗本, 一憲 新帯, 恒介 青木, 諭 椎名, 高須 俊太郎, 隆生 小島, 行雄 関","doi":"10.2335/SCS.39.109","DOIUrl":"https://doi.org/10.2335/SCS.39.109","url":null,"abstract":"Surgical treatment for the cerebral aneurysms of the proximal (M1) segment of the middle cerebral artery, especially those that project superiorly, carries a high risk of infarct caused by damage of perforating arteries. Between January 2004 and November 2009, of 114 patients with MCA aneurysms treated surgically in our hospital, 11 patients with aneurysms of the proximal MCA were diagnosed on the basis of angiographic or surgical findings. Among them, 8 patients had aneurysms projected superiorly. All patients underwent surgery via fronto-temporal craniotomy and trans-sylvian approach. Four patients with ruptured aneurysms underwent emergency surgery within 72 hours of the insult. Motor evoked potential (MEP) was monitored during surgery in the latest 2 patients. We reviewed retrospectively 8 patients with such aneurysms treated by direct surgery. The average age in our patient population was 64.3 years (range, 56-81 yr). There were 2 men and 6 women. The average size of aneurysms was 8.1 mm (range, 3-25 mm). Four patients had ruptured aneurysms. Intracerebral hematoma was recognized on computer tomographic (CT) scan in 2 patients with ruptured aneurysms. Neck clipping was performed in 7 patients and wrapping in 1 patient. STA-MCA bypass was performed for the patient with giant aneurysm. Temporary occlusion of the M1 segment was required in 2 patients, including the patient with giant aneurysm. CT scans after surgery revealed cerebral infarction in the territories of the perforating artery from the M1 segment in 3 patients, and aphasia remains in 1 of the 3 patients. At 3 months after surgery, 5 patients made a good recovery (GR), 2 had a moderate disability (MD), and 1 a severe disability (SD), according to Glasgow Outcome Scale (GOS). All of the unruptured aneurysms made GR, though 1 patient presented with cerebral infarction. The aneurysms of the M1, which project superiorly, represent one of the most complicated aneurysms. Understanding the relationship between the perforating arteries arising from the M1 segment and the aneurysm neck should allow surgeons to avoid many postoperative ischemic complications.","PeriodicalId":131030,"journal":{"name":"Surgery for Cerebral Stroke","volume":"36 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":"125356639","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}