Curriculum Vitaes
Profile Information
- Affiliation
- Professor, School of Medicine Faculty of Medicine, Fujita Health University
- Degree
- 医学博士
- J-GLOBAL ID
- 200901073226457742
- researchmap Member ID
- 1000289360
Research Areas
2Research History
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May, 2023 - Present
Papers
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AJNR. American journal of neuroradiology, Jan 30, 2024BACKGROUND AND PURPOSE: Tumor embolization through the meningohypophyseal trunk and inferolateral trunk is known to be effective in skull-based tumors; however, microcatheter cannulation into these arteries is difficult, and the number of cases that can be safely embolized is limited. In this study, we present a novel embolization procedure for meningohypophyseal trunk and inferolateral trunk using the distal balloon protection technique and detail its clinical efficacy and complication risks. We developed this procedure to allow safe embolization in patients who cannot be adequately cannulated with microcatheters into these arteries. MATERIALS AND METHODS: Patients who underwent meningohypophyseal trunk or inferolateral trunk embolization using the distal balloon protection technique for skull-based tumors at our institution between 2010 and 2023 were included. In this procedure, the ICA was temporarily occluded with a balloon at the ophthalmic artery bifurcation, the microcatheter was guided to the meningohypophyseal trunk or inferolateral trunk vicinity, and embolic particles were injected into the arteries. The balloon was deflated after the embolic particles, that had refluxed into the ICA, were aspirated. RESULTS: A total of 25 meningohypophyseal trunks and inferolateral trunks were embolized during 21 surgeries. Of these 25 arteries, only nine (36.0%) were successfully cannulated with microcatheters. Nevertheless, effective embolization was achieved in all cases. Permanent complications occurred in only one case (4.8%), in which the central retinal artery was occluded during inferolateral trunk embolization, resulting in a visual field defect. No permanent complications resulting from the embolic cerebral infarction were observed. Of 16 cases that underwent MRI within a week after embolization, however, 11 (68.8%) demonstrated embolic cerebral infarctions. CONCLUSIONS: In patients with skull-based tumors with meningohypophyseal trunk or inferolateal trunk feeders that cannot be catheterized directly, embolization using the distal balloon protection technique for tumor supply can be considered as a salvage technique. ABBREVIATIONS: MHT = meningohypophyseal trunk; ILT = inferolateral trunk; GC = guide catheter; AC = aspiration catheter; FR = flow reverse.
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Acta neurochirurgica, 166(1) 44-44, Jan 29, 2024BACKGROUND: In intraventricular surgery using a flexible endoscope, the lesion is usually aspirated via the working channel. However, the surgical view during aspiration is extremely poor because the objective lens is located adjacent to the working channel. METHOD: To address this issue, we developed a novel surgical procedure using an angiographic catheter. In this procedure, the catheter is inserted into the working channel, and the lesion is aspirated through the catheter. Besides, continuous intraventricular irrigation is performed via the gap between the catheter and the working channel. CONCLUSION: This procedure maintains a clear view during surgery and reduces complications.
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Japanese Journal of Stroke, 2024
Misc.
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JNET: Journal of Neuroendovascular Therapy, 5(4) 138-138, Nov, 2011
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JNET: Journal of Neuroendovascular Therapy, 5(4) 150-150, Nov, 2011
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JNET: Journal of Neuroendovascular Therapy, 5(4) 197-197, Nov, 2011
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JNET: Journal of Neuroendovascular Therapy, 5(4) 292-292, Nov, 2011
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NEUROSURGERY, 69(4) 843-851, Oct, 2011 Peer-reviewedBACKGROUND: In ruptured cerebral aneurysms (RCAs), identification of the rupture point of a cerebral aneurysm is useful for treatment planning. In unruptured cerebral aneurysms (URCAs), detection of the risk of aneurysmal rupture is also useful for patient management. OBJECTIVE: Electrocardiographic (ECG)-gated 3D-CT angiography was performed for patients with RCAs and URCAs using 320-row area detector CT (ADCT) to detect pulsation of the cerebral aneurysms. The clinical usefulness of this method was then evaluated. METHODS: Twelve patients had 12 RCAs, and 39 patients had 53 URCAs. A 320-row ADCT system was used to scan. ECG-gated reconstruction was then performed with the R-R interval divided into 20 phases. RESULTS: Pulsation was observed in 10 of the 12 RCAs. The bleeding site was considered to correspond to the area of pulsation. Pulsation was observed in 14 of 53 URCAs. Thirteen patients with 18 URCAs were followed. Of the 11 URCAs in which pulsation was not observed, 1 showed a change in shape. Of the 7 URCAs in which pulsation was observed, 3 showed a change in shape. URCAs in which pulsation was observed were more likely to show a change in shape (P = .082). CONCLUSION: The area of pulsation was found to correspond to the bleeding site in many RCAs. This information would be extremely useful for treatment planning. The detection of pulsation in an URCA is therefore considered to provide useful information for patient management.
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JOURNAL OF NEUROSURGERY, 115(2) A436-A436, Aug, 2011
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Neuroradiology Journal, 24(1) 48-58, 2011The objectives of the study were to quantitatively assess whole-brain CT Perfusion (CTP) data using an automatic region of interest (ROI) analysis program in order to distinguish between the degree of ischemia in the ischemic core and that in the penumbra and to assess the relationship between expansion of the area of infarction. The subjects were 20 patients with acute cerebral infarction. Whole-brain CTP was performed for all subjects using a 320-row area detector CT scanner. The penumbra* is defined as the region in which the CBV value is 2 mL/100 g or more and the ischemic core* is defined as the region in which the CBV value is less than 2 mL/100 g. The quantitative values of CTP parameters were automatically measured using the automatic ROIs analysis program. The Mann-Whitney U test was applied to differentiate between the ischemic core* and the penumbra*. The reduction in perfusion pressure in the penumbra* was smaller in the group with expansion of the area of infarction than in the group without expansion of the area of infarction. The difference in the median values between the penumbra* and the ischemic core* was larger in the group with expansion of the area of infarction than the group without expansion of the area of infarction. It is considered that the quantitative analysis method using whole-brain CTP may be useful for more accurately distinguishing between the ischemic core and the penumbra and for evaluating the risk of expansion of the ischemic core into the penumbra.
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脳神経外科速報, 20(11) 1303-1308, Nov, 201061歳男。運転中に突然のめまい感を自覚し持続したため近医を受診した。脳梗塞の診断で抗血小板薬を内服し軽快したが、退院後2ヵ月に同様のめまいを自覚したため紹介入院となった。MRI拡散強調像で右小脳半球と左後頭葉領域に高信号を認め、3次元CT撮像で、右内頸動脈から分岐し、脳底動脈を形成する遺残動脈を認めた。遺残動脈は舌下神経管を通過し脳底動脈に合流しており、Persistent primitive hypoglossal artery(PPHA)と考えられた。両側椎骨動脈は低形成でPPHA分岐部近傍に高度狭窄を認め、多発性閉塞症を生じたと判断した。小径のバルーンカテーテルでPTAを施行したが拡張が得られず、径を大きくして再PTAを行ったが、短時間でrecoilを認めたためステントを留置後に拡張を行った。術後CTで良好な拡張と内腔の開存を確認し、MRIで塞栓症は認めず経過良好で退院し、6ヵ月後のDSA、CTでも再狭窄は認めていない。
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JNET: Journal of Neuroendovascular Therapy, 4(4) 332-332, Nov, 2010
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Japanese Journal of Radiology, 28(Suppl.I) 31-31, Jul, 2010
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映像情報Medical, 42(6) 650-651, Jun, 201037歳女。Ehlers-Danlos症候群の遺伝子診断中に突然の左耳鳴が出現した。頭部MRI、MRA上CCFを指摘され紹介受診した。3DCTAを施行し左ICA近傍からのdirectCCFを確認した。頸動静脈の間欠的用手圧迫による保存的療法にて症状は一時的に改善するも、再び増悪した。頭蓋内への著明なcortical refluxに伴う高次機能障害出現のため、全身麻酔下にSOVからのアプローチにて経静脈的塞栓術を施行した。術後失語、耳鳴は2週間ほどで完全に消失し、mRS0にて退院した。術後の評価はMRDSAにて行い、増悪は認めていない。
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INNERVISION, 25(3) 78-82, Feb, 2010320列面検出器(Area Detector:AD)CT(Aquilion ONE:東芝社製)では、0.5mm×320列の検出器を用いて、ヘリカルスキャンを行うことなく1度に16cm幅を撮影することが可能である。そのため、1回転で全脳の解剖学的情報(形態画像)を得ることが可能で、複数回転させれば、全脳のCT perfusion(CTP)やダイナミック3D-CTDSA(digital subtraction angiography)などの生理学的情報(機能画像)を得ることが可能である。このように、320列ADCTでは、得られる情報量が多く有益である反面、CTの撮影方法自体も多様化しているため、不適切な撮影を行えば不要な被ばくを生じることとなる。したがって、検査適応をよく考え、診断に必要十分な撮影方法を用いることが重要である。本稿では、脳神経領域における320列ADCTの検査適応、撮影方法についてまず概説し、臨床的意義について実際の臨床画像を提示しながら述べる。(著者抄録)
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Minim Invasive Neurosurg, 53(5-6) 243-249, 2010 Peer-reviewed
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分子脳血管病, 9(1) 15-21, 2010100列以上の検出器をもった面検出器CTはもはや単なるCTではなくなった。ワンショットスキャンは単純レントゲン写真を撮影するかのごとくCTが撮影できる。また、撮影のプログラムを組んだシーケンシャルスキャンでは検査目的に応じた最適な撮影が可能となった。CT Perfusionでは脳血流だけでなく同じデータより3D-CTAの再構成が可能であり、動脈相だけでなく、あらゆる時相の再構成が可能である。AVMでは連続撮影により時間分解の良好は4D imageの取得が可能である。また心電同期再構成はヘリカルCTより画質が向上している。しかしながら、診療目的にあった適切な検査方法と画像処理をおこなわなければ、適切な結果がでないことを忘れてはならない。(著者抄録)
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JNET: Journal of Neuroendovascular Therapy, 3(4) 123-123, Nov, 2009
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JNET: Journal of Neuroendovascular Therapy, 3(4) 147-147, Nov, 2009
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JNET: Journal of Neuroendovascular Therapy, 3(4) 171-171, Nov, 2009
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JNET: Journal of Neuroendovascular Therapy, 3(4) 253-253, Nov, 2009
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JNET: Journal of Neuroendovascular Therapy, 3(4) 296-296, Nov, 2009
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中部リウマチ, 40(1) 36-37, Oct, 200950歳男性。患者は41歳時に関節リウマチを発症し、以前より左膝痛、両足痛があった。今回、右膝痛が出現し増強を認めたため、著者らの施設へ受診となった。所見では右膝の伸展は-5度、屈曲120度、JOA score 39点で、X腺およびCT、MRIでは右脛骨内顆部後方に骨折線がみられた。そこで、FTA 193度で右下肢免荷として外固定したところ、左膝は伸展-25度、屈曲135度、JOA score 39点となった。だが、X線では大腿骨外顆に低形成が認められ、またFTA 168度と左下肢の荷重は困難であり、車椅子の生活となった。一方、両足趾変形と痛みについては、X線で外反母趾とMPの亜脱臼が確認され、患者希望で両膝人工膝関節置換術(TKA)と両足趾形成術が行なわれ、手術から1週経過でリハビリを開始、歩行訓練はワイヤー抜去後の術後4週から足底板を付けて開始された。その結果、術後5週半で杖歩行が可能となり退院、術後6ヵ月経過で両膝のROMは進展0度、屈曲135度、JOA score 95点で独歩が可能となった。
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JOURNAL OF THE NEUROLOGICAL SCIENCES, 285 S85-S85, Oct, 2009
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The Mt. Fuji Workshop on CVD, 27 28-31, Jul, 2009著者らは破裂前交通動脈瘤(AcomA)64例を、開頭クリッピング術(A群)31例、コイル塞栓術(B群)33例に分け、治療成績を比較検討した。術前のHunt and Hess gradeでgrade I、II、IIIの軽症例はA群が58%、B群が25%、IV、Vの重症例はA群が42%、B群が75%であった。その結果、退院時GOSにてGR、MDはA群65%、B群44%、SD、VS、DeadはA群35%、B群56%であった。65歳以上の症例に限るとGR、MDはA群で50%、B群では63%であった。症候性脳血管攣縮の発現頻度はA群16%、B群15%であった。コイル塞栓術直後の塞栓率はcomplete occlusionで81%、neck remnantで15%、dome fillingで4%であった。また、術後5～26ヵ月の経過観察で、再開通は4例(12%)で認められ、いずれも術直後は完全閉塞例であり、うち1例はclipping、2例は再塞栓、1例は経過観察とした。治療による合併症はA群ではHeunbner artery閉塞による脳梗塞、不完全clipによるSAHを各1例に確認された。一方、B群では1例で術中にガイドワイヤー穿孔によるminor bleeding、頸部に血栓形成が認められた。以上より、コイル塞栓術は直達術に比べ高齢者、重症くも膜下出血、攣縮期のAcomAに対して有用であることが考えられた。
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Japanese Journal of Radiology, 27(Suppl.) 29-29, Apr, 2009
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日本脳神経外科救急学会プログラム・抄録集, 14回 38-38, Jan, 2009
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日本脳神経外科救急学会プログラム・抄録集, 14回 44-44, Jan, 2009
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The Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec), 2009 _2A1-K05_1-_2A1-K05_4, 2009Technologies to develop scaffolds with controlled diameter and high porosity have great significance in tissue engineering. We have fabricated biodegradable 2D and 3D scaffolds with ordered array of pores by casting polymer on self-assembled d-fructose (sugar) microspheres. First, ferrite microparticles were encapsulated in sugar spheres to make them become magnetized. After sieving magnetic sugar particles, those diameter-controlled particles were attracted by a magnet to form a self-assembled template for polymer casting. After removal of sugar particles, ordered array of pores were generated on the surface of scaffolds. Elastic modulus of a sheet-like scaffold, which was fabricated by using magnetic sugar particles, was measured and it was reasonably lower than that of a nonporous sheet.
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The Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec), 2009 _1A2-K05_1-_1A2-K05_2, 2009We have proposed a novel method to produce biological models using polyurethane elastomer, which has high photoelastic coefficient. And a method to analyze stress states on the model by circular polarized light method. In this paper, we propose stress measurement on biological model by image reconstruction which is a stress measurement method using photoelastic effect. With this method, the cross section of the model was reconstructed accurately by the image reconstruction processing. And, each pixel stress states of not only principal shear stress, but also each stress difference and shear stress can be measured. Consequently, it should be valuable for various applications not only surgical simulations but also hemodynamic studies and pathological studies.
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Surgery for Cerebral Stroke, 37(3) 156-161, 2009Giant aneurysms have a dismal natural history, thus necessitating early management. These pose a great challenge to the vascular neurosurgeon. The complexity of their anatomy, parent vessels or branches and perforators warrants additional measures for maintaining distal perfusion. Here we try to define the minimally invasive management of these aneurysms. This study compares reconstruction and bypass.<br> This study covers 40 large and 5 giant cases of aneurysms treated in our institute. Giant aneurysms are those with a dome diameter 25 mm or more. 3D CT scan and DSA were the primary investigative procedures, and 3D CT scan was especially useful in thrombosed aneurysms. Aneurysms that had involved a major portion of the parent wall were reconstructed, thus avoiding bypass.<br> Based on our experience, not only basic technique of trapping and evacuation and clipping of the aneurysm neck but also reconstruction of the artery bearing the aneurysm is vital for good postoperative results. Different clipping methods are also used to reconstruct the parent artery. Bypass techniques are also gaining importance in the management of giant aneurysms in difficult cases. However, we feel that bypass procedures are too extensive and are associated with attendant complications. Acute graft occlusion is one of the commonest complications. Aneurysmal rupture is one more complication of bypass procedures. Prolonged occlusion can also cause neurological deficits. <br> Considering the difficulties with bypass and our experience in parent vessel reconstruction with multiple clipping, we feel bypass should be considered only in exceptional cases.<br>
Books and Other Publications
4Presentations
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第43回日本脳卒中の外科学会学術集会(STROKE2014), Mar 13, 2014
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Geriatr Gerontol Int, Nov 8, 2013
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Congress of Neurological Surgeons 2013 / 63rd Annual Meeting (e-poster), Oct 19, 2013
Professional Memberships
5Research Projects
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Grants-in-Aid for Scientific Research, Japan Society for the Promotion of Science, Apr, 2022 - Mar, 2026
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Grants-in-Aid for Scientific Research, Japan Society for the Promotion of Science, Apr, 2015 - Mar, 2017