Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 12 de 12
Filter
Add more filters










Publication year range
1.
World Neurosurg ; 186: 95-96, 2024 06.
Article in English | MEDLINE | ID: mdl-38537787

ABSTRACT

A 50-year-old man presented with mild unconsciousness after a fall-induced head injury. Initial imaging revealed a left-sided acute subdural hematoma. After transportation to our hospital, his condition deteriorated, leading to the discovery of a new hemorrhage and an anterior falcine artery aneurysm upon further examination. The patient underwent successful decompressive craniectomy and endovascular occlusion. This case, the first reported of a traumatic anterior falcine artery aneurysm, suggests the initial injury caused both the hematoma and aneurysm. The aneurysm's specific location near the crista galli likely contributed to the formation of the traumatic aneurysm, and the compression of the left frontal lobe by the acute subdural hematoma caused the subsequent hemorrhage. This case highlights the importance of considering traumatic aneurysms in atypical postinjury hemorrhages and adds to the understanding of traumatic intracranial aneurysms' mechanisms.


Subject(s)
Intracranial Aneurysm , Humans , Male , Middle Aged , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/surgery , Hematoma, Subdural, Acute/diagnostic imaging , Decompressive Craniectomy/methods , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/diagnostic imaging , Intracranial Hemorrhages/surgery
2.
Clin Neurol Neurosurg ; 227: 107667, 2023 04.
Article in English | MEDLINE | ID: mdl-36934635

ABSTRACT

Cerebral hyperperfusion syndrome (CHS) is one of the complications of cerebral revascularization. The main pathophysiology of CHS was considered to be cerebral autoregulation impairment due to long-standing cerebral hypoperfusion. Herein, we describe the case of a 40-year-old man with symptomatic intracranial arterial dissection (IAD) related to internal carotid artery stenosis. The patient underwent intracranial stenting 11 days after onset due to severe cerebral hypoperfusion presenting with neurological symptoms, and CHS presenting with intracerebral hemorrhage, post-operatively. The present case indicated not only the potential risk of CHS after intracranial stenting in IAD-related stenosis but also that cerebral hypoperfusion-even in a short period-might lead to CHS.


Subject(s)
Carotid Artery, Internal, Dissection , Carotid Stenosis , Male , Humans , Adult , Carotid Artery, Internal, Dissection/diagnostic imaging , Carotid Artery, Internal, Dissection/surgery , Carotid Artery, Internal, Dissection/complications , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Carotid Stenosis/complications , Vascular Surgical Procedures , Cerebral Hemorrhage/etiology
3.
Stem Cells Transl Med ; 11(7): 767-777, 2022 07 20.
Article in English | MEDLINE | ID: mdl-35605097

ABSTRACT

The therapeutic effect of a cell replacement therapy for Parkinson's disease (PD) depends on the proper maturation of grafted dopaminergic (DA) neurons and their functional innervation in the host brain. In the brain, laminin, an extracellular matrix protein, regulates signaling pathways for the survival and development of neurons by interacting with integrins. The heparan sulfate (HS) chain binds mildly to various neurotrophic factors and regulates their intracellular signaling. Perlecan-conjugated laminin 511/521-E8 fragments (p511/p521) were designed to contain an integrin-binding site and HS chains. Here we examined the effect of treating DA progenitors with p511/p521 prior to transplantation in rodent PD models. In vitro and in vivo experiments showed that p511/p521 treatment enhanced the maturation and neurite extension of the grafted DA progenitors by activating RAS-ERK1/2 signaling. This strategy will contribute to an efficient cell replacement therapy for PD in the future.


Subject(s)
Laminin , Parkinson Disease , Animals , Dopamine/metabolism , Dopaminergic Neurons/metabolism , Extracellular Matrix Proteins/metabolism , Heparan Sulfate Proteoglycans , Heparitin Sulfate , Humans , Parkinson Disease/therapy
4.
World Neurosurg ; 131: e593-e598, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31404688

ABSTRACT

OBJECTIVE: The greatest advantage of local anesthesia (LA) in endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) is that direct neurologic evaluation can be performed during the procedure, unlike with general anesthesia. However, the usefulness of such direct evaluation has not been established. In this study, we attempted to assess the effects of direct neurologic evaluation by identifying the causes, management, and outcomes of clinical symptoms during the procedure and procedure-related events during EVT under LA. METHODS: We retrospectively evaluated the medical and radiologic data of 1000 patients (1015 UIAs) who had undergone coil embolization under LA from 2008 to 2016. RESULTS: Clinical symptoms were identified in 62 patients (6.2%) during the procedure. The symptoms improved during the procedure in 27 of these patients (44%) and after the procedure in another 28 (45%). One month after the procedure, 55 patients (89%) had good outcomes and 7 (11%) had poor outcomes. Procedure-related events occurred in 67 patients (6.7%); of these 67 events, 39 were symptomatic and 28 were asymptomatic. Thirty-five of the 39 symptomatic events (90%) [13 of 13 (100%) ruptures, 6 of 10 (60%) thrombus formations, and 16 of 16 (100%) thromboembolisms] were detected on the basis of clinical symptoms before angiographic changes were identified, and they were managed promptly. All 28 patients with asymptomatic events were managed safely without further complications before symptoms developed. CONCLUSIONS: We demonstrated that appropriate management of clinical symptoms and procedure-related events under LA led to favorable outcomes of EVT of UIAs.


Subject(s)
Anesthesia, Local , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Neurologic Examination/methods , Aged , Female , Humans , Intraoperative Care , Male , Middle Aged , Retrospective Studies
5.
World Neurosurg ; 128: e461-e467, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31042599

ABSTRACT

BACKGROUND: Although endovascular coiling of unruptured aneurysms is widely accepted, the endovascular treatment of wide-neck bifurcation aneurysms remains one of the most challenging morphologies. Our purpose was to describe our experience with 24-month follow-up for the treatment of unruptured intracranial bifurcation aneurysms using the PulseRider (Cerenovus, New Brunswick, NJ). METHODS: This study is a single-center, single-arm registry performed under institutional review board control to evaluate efficacy and safety of the PulseRider. Patients with bifurcation aneurysms were identified and enrolled prospectively. Angiography immediately after treatment and at 6 months, and magnetic resonance imaging and magnetic resonance angiography at 12- and 24-month follow-up were retrospectively analyzed. A modified Rankin score was obtained prior to procedure, at discharge, and at 6-, 12- and 24-month follow-up visits. RESULTS: Eight patients with a mean age of 66 years were treated with the PulseRider. All patients had bifurcation aneurysms (2 anterior communicating, 2 carotid terminus, and 4 basilar apex). The aneurysm diameters ranged from 4.6 to 13.6 mm (mean 7.4 mm) with dome/neck ratio ranging from 1.4 to 2.2 (mean 1.6). In all cases, the PulseRider was successfully deployed. Complete occlusion was demonstrated at 6-month follow-up on 6 of 8 (75%), near complete occlusion in 1 of 8 (12.5%), and residual aneurysm in 1 of 8 (12.5%) patients. There was no change or recurrence on magnetic resonance angiography, nor clinical complication after the procedure through 24-month follow-up. CONCLUSIONS: Our experience with 24-month follow-up demonstrated favorable efficacy in the treatment of intracranial wide-neck bifurcation aneurysms using the PulseRider.


Subject(s)
Embolization, Therapeutic/instrumentation , Intracranial Aneurysm/therapy , Adult , Aged , Embolization, Therapeutic/methods , Endovascular Procedures , Female , Follow-Up Studies , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged
6.
J Neurointerv Surg ; 11(3): 296-299, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30262657

ABSTRACT

OBJECTIVE: To describe our initial experience with the Versi Retriever for mechanical thrombectomy in patients with acute ischemic stroke. METHODS: This study is a single-center, single-arm, first-in-man registry under institutional review board control to evaluate the efficacy and safety of the new stent retriever, the Versi Retriever. Patients with acute ischemic stroke were consecutively enrolled between September and November 2017. The clinical and procedural data were retrospectively analyzed. The angiographic result after the procedure was self-graded based on the Thrombolysis in Cerebral Infarction (TICI) scale by each operator. RESULTS: Eleven patients with a mean age of 69.4 years were treated with the Versi Retriever. Median National Institutes of Health Stroke Scale score on admission was 16 (IQR 10-34). The occluded vessel was located in the anterior circulation in 81.8%. Revascularization rates of TICI 2b-3 and TICI 3 at final angiogram were achieved in 100% and 63.6%, respectively. A favorable functional outcome (modified Rankin Scale 0-2) at 90 days was obtained in 72.7%. No symptomatic intracranial hemorrhage occurred and no procedure-related complication was observed. CONCLUSIONS: Our initial experience suggests that the Versi Retriever is a safe and effective stent retriever for mechanical thrombectomy in patients with acute ischemic stroke. CLINICAL TRIAL REGISTRATION: NCT03366818.


Subject(s)
Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , Drug-Eluting Stents , Stroke/diagnostic imaging , Stroke/surgery , Thrombectomy/methods , Adult , Aged , Aged, 80 and over , Alloys/administration & dosage , Angiography/methods , Female , Humans , Male , Middle Aged , Registries , Retrospective Studies , Thrombectomy/instrumentation , Treatment Outcome , Young Adult
7.
J Neurosurg ; : 1-7, 2018 Nov 16.
Article in English | MEDLINE | ID: mdl-30497173

ABSTRACT

OBJECTIVE: The authors sought to compare methods of measurement for venous phase delay (VPD) or mean stump pressure (MSTP) to rank their potential to predict ischemic tolerance during balloon test occlusion in the internal carotid artery, exploring a more correlative and convenient way to measure cerebral blood flow (CBF) that could be utilized even in the acute phase or in institutions not adequately equipped to measure CBF during the test. METHODS: X-ray angiography perfusion analysis using diagnostic digital subtraction angiography (DSA) equipment enables 1-step examination (without any room-to-room transfer of patients) to measure CBF, VPD, and MSTP completely simultaneously, which has not been accomplished by any previous perfusion studies. RESULTS: This analysis was applied to 17 patients and resulted in successful estimation of all 3 parameters in each case. The average VPD of several cortical veins had a strong correlation with relative CBF (rCBF) between bilateral hemispheres with a correlation coefficient of 0.89443, a correlation as strong as that (0.90357) of the "approximate VPD," which is interpreted based on the trend line of the scatterplot of the time to peak contrast opacification in cortical veins and their spatial positioning from the median sagittal plane. MSTP and classic visual determination of VPD have weaker correlation coefficients with rCBF (0.56119 and 0.70048, respectively). Overall, subjective visual determination in combination with the calculation of the trend line to estimate VPD provided a considerably strong correlation with rCBF (R = 0.86660) without any dedicated software or hardware. CONCLUSIONS: VPD has a stronger correlation with rCBF than MSTP. rCBF could be successfully predicted on common DSA equipment, even by visual determination without expensive software, if the trend line is adopted for processing to estimate VPD.

8.
World Neurosurg ; 118: 162-167, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30030186

ABSTRACT

BACKGROUND: Bone metastases from endometrial cancer are rare. To our knowledge, only 2 cases of solitary vertebral metastases from endometrial cancer presenting with osseous and/or neurologic symptoms before the diagnosis of the primary endometrial cancer have been reported; however, in both cases, the metastases were thoracic. Thus, cervical vertebral metastases are extremely rare. CASE DESCRIPTION: We describe the case of a 55-year-old woman who presented with right C6 radicular and neck pain. Neurologic imaging showed destruction of the C6 vertebral body by an extradural mass with kyphotic changes in the cervical spine. Fluorodeoxyglucose positron emission tomography showed increased uptake in the enlarged body of the uterus as well as the C6 vertebral body. Additional pelvic magnetic resonance images and endometrial biopsy confirmed endometrial cancer. The patient underwent excision of the cervical tumor with anterior reconstruction and posterior fixation followed 1 month later by semiradical hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymph node dissection. The cervical and endometrial histopathologic findings were similar, and the final diagnosis made was cervical metastatic adenocarcinoma originating from an endometrial cancer. CONCLUSIONS: We describe an extremely rare case of a precocious solitary cervical metastasis from an endometrial cancer presenting as cervical radicular pain. In our review of published reports, we found that solitary spinal metastases are significantly associated with longer overall survival than are multiple lesions. Resection of the spinal lesion with rigid spinal reconstruction followed by radical hysterectomy may be beneficial in such patients.


Subject(s)
Carcinoma/surgery , Endometrial Neoplasms/surgery , Pain/surgery , Uterine Cervical Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Carcinoma/secondary , Endometrial Neoplasms/diagnosis , Female , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Magnetic Resonance Imaging/methods , Middle Aged , Positron-Emission Tomography/methods , Uterine Cervical Neoplasms/diagnosis
9.
No Shinkei Geka ; 45(7): 599-606, 2017 Jul.
Article in Japanese | MEDLINE | ID: mdl-28720742

ABSTRACT

Two cases of ruptured blood blister-like internal carotid artery aneurysms for which low flow bypass was sufficient to attain successful treatment of trapping are reported. In the acute stage of rupture, it is troublesome to perform accurate examinations of tolerance to ischemia like balloon occlusion test(BOT)for estimating the required amount of bypass flow. In our cases, X-ray angiography perfusion(XAP)analysis was introduced, which could be performed in a couple dozen seconds without room-to-room transfer of patients, following the ordinary examination of diagnostic digital subtraction angiography. The perfusion index(PI)ratio measured in this analysis is equivalent to the laterality of cerebral blood flow between the right and left hemispheres. The PI ratio of 0.85 approximately corresponds to the mean stump pressure(MSTP)of 40mmHg, on the basis of the correlation diagram between the PI ratio and MSTP(approximate straight line:PI ratio%=0.6×MSTP+60). Even though the PI ratio of the cases was superior to this threshold of tolerance for parent artery occlusion, complementary low flow bypass was added in the acute case for the overwhelming succeeding vasospasm and for securing the flow to peripheral perforators, which resulted in a successful treatment without any ischemic events.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Intracranial Aneurysm/diagnostic imaging , Adult , Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Cerebral Angiography , Humans , Intracranial Aneurysm/surgery , Male , Middle Aged , Tomography, X-Ray Computed
10.
World Neurosurg ; 105: 591-598, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28624563

ABSTRACT

BACKGROUND: Preoperative endovascular embolization of intracranial meningiomas denatures the tumor tissue, reduces intraoperative blood loss, and facilitates surgical removal. However, as most meningiomas are surgically removed within a few days after embolization, the effect of long-term volume reduction of the tumor due to the endovascular embolization remains unknown. METHODS: Five patients with intracranial meningioma underwent endovascular embolization between January 2006 and December 2014 and were followed without surgical resection for >14 days. The reduction in tumor and peritumoral edema volumes on sequential head magnetic resonance imaging, along with the clinical symptoms, were retrospectively reviewed. RESULTS: All the tumors indicated a 10%-30% volume reduction 30 days after embolization, which continued thereafter; no meningioma regrowth was observed for >90 days in 2 of 5 cases. Moreover, the peritumoral edema volume was reduced by 30%-70% at 30 days after embolization, and no subsequent increase was observed for >60 days in 4 of 5 cases. The neurologic symptoms related to the tumor mass effect improved after embolization. CONCLUSIONS: Endovascular embolization of intracranial meningiomas with n-butyl cyanoacrylate reduced the tumor and peritumoral edema volumes by 10%-30% and 30%-70%, respectively, within 30 days. Volume and edema reduction effect of embolization may last longer than expected, beyond the timing when most meningiomas are resected after embolization. In this study, we described our preliminary results of the volume reduction of intracranial meningiomas that were embolized using n-butyl cyanoacrylate and monitored without any surgical resection for >14 days. We believe that our study makes a significant contribution to the literature because we showed that volume and edema reduction effect of embolization may last longer than expected, beyond the timing when most meningiomas are resected after embolization.


Subject(s)
Embolization, Therapeutic/methods , Endovascular Procedures/methods , Meningeal Neoplasms/surgery , Meningioma/surgery , Tumor Burden , Aged , Embolization, Therapeutic/trends , Endovascular Procedures/trends , Female , Follow-Up Studies , Humans , Male , Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Middle Aged
11.
Neurol Med Chir (Tokyo) ; 56(8): 485-92, 2016 Aug 15.
Article in English | MEDLINE | ID: mdl-27021642

ABSTRACT

Instrumented spinal fixation is ordinarily required in patients who present with myelopathy or cauda equina syndrome secondary to vertebral collapse following osteoporotic thoracolumbar fracture. Posterior spinal fixation is a major surgical option, and partial vertebral osteotomy (PVO) through a posterior approach is occasionally reasonable for achievement of complete neural decompression and improvement of excessive local kyphosis. However, the indications and need for PVO remain unclear. The objectives of this retrospective study were to determine the efficacy and safety of posterior spinal fixation with or without PVO for osteoporotic thoracolumbar vertebral collapse and identify patients who require neural decompression and alignment correction by PVO. We retrospectively reviewed the clinical records of 20 patients (13 females, 7 males; mean age, 67.1 years) who underwent instrumented posterior fixation for osteoporotic thoracolumbar vertebral fracture. Clinical outcomes were assessed by the Japanese Orthopedic Association score and visual analog scale scores in the lumbar and leg areas. PVO was added with posterior spinal fixation in eight patients because neural decompression was incomplete after laminectomy as indicated by intraoperative echo imaging. Neurological and functional recovery significantly improved during follow-up. Clinical outcomes in patients who underwent PVO were similar to those in patients who did not undergo PVO. However, correction of the local kyphotic angle and improvement of spinal canal compromise after surgery was significant in patients who underwent PVO. The patients who required PVO had a less local kyphotic angle in the supine position and higher occupation rate of the fractured fragment in the spinal canal in the preoperative examination.


Subject(s)
Fracture Fixation, Internal , Lumbar Vertebrae/injuries , Osteoporotic Fractures/surgery , Osteotomy , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies
12.
J Physiol Sci ; 58(4): 291-5, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18647443

ABSTRACT

Incremental exercise testing to a symptom-limited maximum has been used to measure the ratio of the increase in ventilation (V.E) to the increase in CO(2) output (V.CO(2)) during exercise (V.E/V.CO(2) slope), a valuable index reflecting the severity of the ventilation-perfusion mismatch in heart failure. Here we studied whether this same value for the slope of V.E/V.CO(2) could be determined from a short constant work-rate exercise test of moderate intensity. Twenty-three patients with a previous myocardial infarction underwent moderate-intensity (69+/-15 W) constant work-rate exercise for 6 min and an incremental work-rate exercise test to the max. The V.E/V.CO(2) slope was calculated from the incremental exercise test from the start of increasing the work-rate to the ventilatory compensation point. The V.E/V.CO(2) slope was similarly calculated from the start of constant work-rate exercise until the 4th minute, when V.E and V.CO(2) changed minimally. The V.E/V.CO(2) slope determined from incremental exercise was 33.8+/-5.9, ranging from 20.9 to 42.8. The slope obtained from constant work-rate exercise was 32.9+/-5.7. The V.E/V.CO(2) slopes obtained from the two exercise tests did not differ significantly. The slope obtained from constant work-rate exercise was significantly positively correlated with the slope obtained from the incremental exercise (r=0.84, p<0.0001). The V.E/V.CO(2) slope can be determined from constant work-rate exercise at a moderate intensity. This indicates that the relationship between ventilation and CO(2) output is consistent and independent of the mode of exercise testing.


Subject(s)
Carbon Dioxide/metabolism , Exercise Test , Exercise Tolerance , Heart Failure/physiopathology , Myocardial Infarction/physiopathology , Pulmonary Gas Exchange , Pulmonary Ventilation , Adult , Female , Heart Failure/metabolism , Humans , Male , Middle Aged , Models, Cardiovascular , Myocardial Infarction/metabolism , Reproducibility of Results , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...