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Hattori Y, Tahara S, Ozawa H, Morita A, Ishii H. Transcriptomic Profiling of Lactotroph Pituitary Neuroendocrine Tumors via RNA Sequencing and Ingenuity Pathway Analysis. Neuroendocrinology 2024:000539017. [PMID: 38643763 DOI: 10.1159/000539017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Lactotroph pituitary neuroendocrine tumors (PitNETs) are common pituitary tumors, but their underlying molecular mechanisms remain unclear. This study aimed to investigate the transcriptomic landscape of lactotroph PitNETs and identify potential molecular mechanisms and therapeutic targets through RNA sequencing and ingenuity pathway analysis (IPA). METHODS Lactotroph PitNET tissues from five surgical cases without dopamine agonist treatment underwent RNA sequencing. Normal pituitary tissues from three patients served as controls. Differentially expressed genes (DEGs) were identified, and the functional pathways and gene networks were explored by IPA. RESULTS Transcriptome analysis revealed that lactotroph PitNETs had gene expression patterns that were distinct from normal pituitary tissues. We identified 1,172 upregulated DEGs, including nine long intergenic noncoding RNAs (lincRNAs) belonging to the top 30 DEGs. IPA of the upregulated DEGs showed that the estrogen receptor signaling, oxidative phosphorylation signaling, and EIF signaling were activated. In gene network analysis, key upstream regulators, such as EGR1, PRKACA, PITX2, CREB1, and JUND, may play critical roles in lactotroph PitNETs. CONCLUSION This study provides a comprehensive transcriptomic profile of lactotroph PitNETs and highlights the potential involvement of lincRNAs and specific signaling pathways in tumor pathogenesis. The identified upstream regulators may be potential therapeutic targets for future investigations.
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Nounaka Y, Murai Y, Kubota A, Tsukiyama A, Matano F, Koketsu K, Morita A. Pathological Findings of Donor Vessels in Bypass Surgery. J Clin Med 2024; 13:2125. [PMID: 38610890 PMCID: PMC11012859 DOI: 10.3390/jcm13072125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background Cerebral revascularization is necessary to treat intracranial arterial stenosis caused by moyamoya disease, atherosclerosis, or large complex aneurysms. Although various donor vascular harvesting methods have been reported safe, there are no reports on the histological evaluation of donor vessels for each disease, despite the variety of diseases wherein vascular anastomosis is required. (2) Methods Pathological findings of the superficial temporal artery (STA), radial artery (RA), occipital artery (OA), and saphenous vein (SV) harvested at the institution were analyzed. Patients classified according to aneurysm, atherosclerosis, and moyamoya disease were assessed for pathological abnormalities, medical history, age, sex, smoking, and postoperative anastomosis patency. (3) Results There were 38 cases of atherosclerosis, 15 cases of moyamoya disease, and 30 cases of aneurysm in 98 donor vessels (mean age 57.2) taken after 2006. Of the 84 STA, 11 RA, 2 OA, and 1 SV arteries that were harvested, 71.4% had atherosclerosis, 11.2% had dissection, and 10.2% had inflammation. There was no significant difference in the proportion of pathological findings according to the disease. A history of hypertension is associated with atherosclerosis in donor vessels. (4) Conclusions This is the first study to histologically evaluate the pathological findings of donor vessels according to disease. The proportion of dissection findings indicative of vascular damage due to surgical manipulation was not statistically different between the different conditions.
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Affiliation(s)
- Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki 211-8533, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusou Hospital, Inzai 270-1694, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
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Yamaguchi M, Kim K, Mizunari T, Umeoka K, Koketsu K, Isayama K, Morita A. Formation of a Large Fusiform Aneurysm near a Medullary Infarction Caused by Dissection of the Posterior Inferior Cerebellar Artery. J NIPPON MED SCH 2024; 91:129-133. [PMID: 36823119 DOI: 10.1272/jnms.jnms.2024_91-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Infarction of the posterior inferior cerebellar artery (PICA) can lead to ischemic stroke in the lateral medullary oblongata. PICA dissection can also elicit an ischemic event in this region, but its detection on radiological images is difficult because of the small diameter of the vessel. We report a case of Wallenberg syndrome due to PICA dissection in a 48-year-old man, which was difficult to diagnose on first admission. He reported sudden onset of sensory disturbance on the right side of his face, ataxic gait, and headache. Brain magnetic resonance imaging (MRI) revealed a fresh cerebral infarct in the right lateral medulla oblongata. Magnetic resonance angiography (MRA) performed at the time of his admission showed no cerebral vessel abnormalities. An MRI study 18 months after the event revealed a fusiform aneurysm on the lateral medullary segment of the PICA, which was extremely close to the cerebral infarct. We concluded that the infarct was due to PICA dissection because of the sudden onset of symptoms and because the infarcted territory of the occluded penetrating branch of the dissecting aneurysm was consistent with Wallenberg syndrome. The aneurysm was trapped and an occipital artery-PICA bypass was placed. At the latest follow-up, 1 year after the procedure, he had no neurological symptoms. Imaging findings at the time of his first admission indicated that the PICA was intact. However, 18 months later, MRI revealed enlargement of an aneurysm at the site of the dissection. A cerebral infarct with headache may indicate PICA dissection.
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Affiliation(s)
- Masahiro Yamaguchi
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Takayuki Mizunari
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Katsuya Umeoka
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Koshiro Isayama
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Yui K, Kanawaku Y, Morita A, Hirakawa K, Cui F. Time-frequency analysis reveals an association between the specific nuclear magnetic resonance (NMR) signal properties of serum samples and arteriosclerotic lesion progression in a diabetes mouse model. PLoS One 2024; 19:e0299641. [PMID: 38457384 PMCID: PMC10923453 DOI: 10.1371/journal.pone.0299641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/10/2024] [Indexed: 03/10/2024] Open
Abstract
Diabetes causes arteriosclerosis, primarily due to persistent hyperglycemia, subsequently leading to various cardiovascular events. No method has been established for directly detecting and evaluating arteriosclerotic lesions from blood samples of diabetic patients, as the mechanism of arteriosclerotic lesion formation, which involves complex molecular biological processes, has not been elucidated. "NMR modal analysis" is a technology that enables visualization of specific nuclear magnetic resonance (NMR) signal properties of blood samples. We hypothesized that this technique could be used to identify changes in blood status associated with the progression of arteriosclerotic lesions in the context of diabetes. The study aimed to assess the possibility of early detection and evaluation of arteriosclerotic lesions by NMR modal analysis of serum samples from diabetes model mice. Diabetes model mice (BKS.Cg db/db) were bred in a clean room and fed a normal diet. Blood samples were collected and centrifuged. Carotid arteries were collected for histological examination by hematoxylin and eosin staining on weeks 10, 14, 18, 22, and 26. The serum was separated and subjected to NMR modal analysis and biochemical examination. Mice typically show hyperglycemia at an early stage (8 weeks old), and pathological findings of a previous study showed that more than half of mice had atheromatous plaques at 18 weeks old, and severe arteriosclerotic lesions were observed in almost all mice after 22 weeks. Partial least squares regression analysis was performed, which showed that the mice were clearly classified into two groups with positive and negative score values within 18 weeks of age. The findings of this study revealed that NMR modal properties of serum are associated with arteriosclerotic lesions. Thus, it may be worth exploring the possibility that the risk of cardiovascular events in diabetic patients could be assessed using serum samples.
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Affiliation(s)
- Kanako Yui
- Division of Neurosurgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yoshimasa Kanawaku
- Department of Legal Medicine, Graduate School of Medicine, Nippon Medical School, Inzai, Chiba, Japan
| | - Akio Morita
- Geriatric Healthcare Center, Department of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Keiko Hirakawa
- Research Laboratory of Magnetic Resonance, Collaborative Research Center, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fanlai Cui
- Department of Legal Medicine, Graduate School of Medicine, Nippon Medical School, Inzai, Chiba, Japan
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Kim K, Shimizu J, Isu T, Morimoto D, Kubota A, Morita A, Murai Y. A clinicopathological study of low back pain due to middle cluneal nerve entrapment: case series. Eur Spine J 2024; 33:490-495. [PMID: 37924390 DOI: 10.1007/s00586-023-07944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE The middle cluneal nerve (MCN) is a pure sensory nerve around the middle buttock. Its entrapment between the iliac crest and the long posterior sacroiliac ligament elicits low back pain (LBP) that can be treated by MCN neurolysis or neurectomy. Because few studies examined the pathology of MCN entrapment (MCN-E) we subjected 7 neurectomized specimens from 6 LBP patients to pathologic study. METHODS We present 6 consecutive patients (7 sides) with intractable LBP who underwent successful MCN neurectomy. Their symptom duration ranged from 6 to 96 months (average 47.3 months); the follow-up period ranged from 6 to 17 months (average 11.7 months). The surgical outcomes were evaluated using the numerical rating scale (NRS) for LBP and the Roland-Morris Disability Questionnaire (RDQ) score. The resected MCNs underwent neuropathological analysis. RESULTS Postoperatively, all 6 patients reported immediate LBP amelioration; their NRS and RDQ scores were improved significantly. Pathological study of the 7 resected nerves showed that the myelinated fiber density was decreased in 6 nerves; we observed marked enlargement (n = 5), perineurial thickening and disruption (n = 6), intrafascicular fibrous changes (n = 5), myelinated fibers separated by fibrous cells under the perineurium (n = 4), and Renaut bodies (n = 3). The 7th nerve appeared normal with respect to the density and size of the myelinated fibers, however, the perineurium was slightly thickened. CONCLUSION We present pathological evidence at the MCN compression site of 7 nerves from 6 patients whose LBP was alleviated by MCN neurectomy, indicating that MCN entrapment can elicit LBP.
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Affiliation(s)
- Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School, Chiba Hokuso Hospital, 1715, Kamagari, Inzai-City, Chiba, Japan.
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
- Department of Rehabilitation, Tokyo University of Technology, Bunkyo-Ku, Tokyo, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro-City, Hokkaido, Japan
| | - Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
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Passeron T, Lim HW, Goh CL, Kang HY, Ly F, Morita A, Ocampo-Candiani J, Puig S, Schalka S, Wei L, Demessant AL, Le Floc'h C, Kerob D, Dreno B, Krutmann J. Do regrets of parents about sun overexposure impact preventive measures applied on their children? J Eur Acad Dermatol Venereol 2024; 38:e199-e203. [PMID: 37803519 DOI: 10.1111/jdv.19556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Affiliation(s)
- T Passeron
- Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France
- INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - H W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - C L Goh
- National Skin Centre, Singapore, Singapore
| | - H Y Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - F Ly
- Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - J Ocampo-Candiani
- Universidad Autonoma de Nuevo León, Facultad de Medicina, University Hospital "Dr. Jose E. González", Monterrey, Mexico
| | - S Puig
- Dermatology Department, Hospital Clinic de Barcelona, Barcelona University, Barcelona, Spain
| | - S Schalka
- Medecin Skin Research Center and Biochemistry Department, Chemistry Institute of Sao Paulo University, Sao Paulo, Brazil
| | - L Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| | - A L Demessant
- La Roche-Posay International, Levallois-Perret, France
| | - C Le Floc'h
- La Roche-Posay International, Levallois-Perret, France
| | - D Kerob
- La Roche-Posay International, Levallois-Perret, France
| | - B Dreno
- Nantes University, Université Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
| | - J Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Matano F, Murai Y, Nounaka Y, Higuchi T, Mihara R, Isayama K, Morita A. Experience Using Gentian Violet-Free Dyes for Tissue Visualization. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 37703915 DOI: 10.1055/a-2175-3295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. In this study, we compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and formation of microvascular thrombosis in anastomosis were compared. METHODS We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink. RESULTS The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4. CONCLUSION BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced when BV4 was used.
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Affiliation(s)
- Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Tadashi Higuchi
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Riku Mihara
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Koshiro Isayama
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Nakatogawa H, Hokamura K, Nomura R, Nakano K, Umemura K, Morita A, Homma Y, Tanaka T. Is oral Streptococcus mutans with collagen-binding protein a risk factor for intracranial aneurysm rupture or formation? Cerebrovasc Dis 2024:000536203. [PMID: 38219720 DOI: 10.1159/000536203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE Streptococcus mutans (SM) with the collagen-binding protein Cnm is a unique member of the oral resident flora because it causes hemorrhagic vascular disorders. In the multicenter study, we examined the relationship between Cnm-positive SM (CP-SM) and intracranial aneurysm (IA) rupture, which remains unknown. METHODS Between May 2013 and June 2018, we collected whole saliva samples from 431 patients with ruptured IAs (RIAs) and 470 patients with unruptured IAs (UIAs). Data were collected on age, sex, smoking and drinking habits, family history of subarachnoid hemorrhage, aneurysm size, number of teeth, and comorbidities of lifestyle disease. RESULTS There was no difference in the positivity rate of patients with CP-SM between the patients with RIAs (17.2%) and those with UIAs (19.4%). The rate of positivity for CP-SM was significantly higher in all IAs <5 mm than in those ≥10 mm in diameter (P=0.0304). In the entire cohort, the rate of positivity for CP-SM was lower in larger aneurysms than in smaller aneurysms (P=0.0393). CONCLUSIONS The rate of positivity for CP-SM was lower among patients with large UIAs. These findings are consistent with the hypothesis that CP-SM plays a role in the formation of vulnerable IAs that tend to rupture before becoming larger.
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Koketsu K, Kim K, Tajiri T, Isu T, Morimoto D, Kokubo R, Dan H, Morita A. Ganglia-Induced Tarsal Tunnel Syndrome. J NIPPON MED SCH 2024; 91:114-118. [PMID: 38462440 DOI: 10.1272/jnms.jnms.2024_91-203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. METHODS Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients. RESULTS The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes. CONCLUSIONS Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.
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Affiliation(s)
- Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | | | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | | | - Rinko Kokubo
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Hiroyuki Dan
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Suzuki K, Tahara S, Hattori Y, Teramoto S, Ishisaka E, Inomoto C, Osamura RY, Morita A, Murai Y. Lung adenocarcinoma metastasis within a pituitary neuroendocrine tumor: a case report with review of literature. Endocr J 2023:EJ23-0372. [PMID: 38171721 DOI: 10.1507/endocrj.ej23-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Collision tumors involving the metastasis of malignant neoplasms to pituitary neuroendocrine tumors (PitNETs) are extremely rare. We herein report a case involving a patient with lung adenocarcinoma metastasis within a PitNET who exhibited relatively rapid progression of neurological symptoms. A 75-year-old man who underwent tumor resection 36 and 18 years prior to presentation for bladder and colon cancer, respectively, without recurrence presented with bitemporal hemianopsia, ptosis, and diplopia of the right eye. Subsequent magnetic resonance imaging (MRI) revealed a tumor 3.2 cm in diameter that extended from the anterior pituitary gland to the suprasellar region. Gadolinium-enhanced MRI of the tumor showed heterogeneous contrast enhancement. Considering the relatively rapid progression of neurological symptoms, semi-emergency endoscopic endonasal transsphenoidal surgery was performed. Histopathological examination revealed a group of thyroid transcription factor-1- and napsin A-positive papillary proliferating cells intermingled with α-subunit- and steroidogenic factor-1-positive PitNET cells. Thus, the patient was diagnosed with lung adenocarcinoma metastasis within a gonadotroph PitNET. Genetic testing revealed the presence of an EGFR (Ex-19del) mutation, after which chemotherapy was initiated. Additional stereotactic radiotherapy was performed for the residual tumor in the sella turcica. With continued chemotherapy, good control of both the primary and metastatic tumors was noted after 24 months after surgery. Cases of malignant neoplasm metastasis within a PitNET are difficult to diagnose. In the case of a sella turcica tumor with relatively rapid progression of neurological symptoms, early surgical intervention is recommended given the possibility of a highly proliferative tumor and the need to obtain pathologic specimens.
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Affiliation(s)
- Koji Suzuki
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa 211-8233, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo 113-8431, Japan
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa 211-8233, Japan
| | - Chie Inomoto
- Department of Pathology, Tokai University School of Medicine, Kanagawa 259-1143, Japan
| | | | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
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Hattori Y, Tahara S, Aso S, Makito K, Matsui H, Fushimi K, Yasunaga H, Morita A. Comparison of prophylactic antibiotics for endonasal transsphenoidal surgery using a national inpatient database in Japan. J Antimicrob Chemother 2023; 78:2909-2914. [PMID: 37856687 DOI: 10.1093/jac/dkad329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The choice of prophylactic antibiotics for use in endonasal transsphenoidal surgery (ETSS) lacks universal standards. This study aimed to investigate the effectiveness of cefazolin, ampicillin and third-generation cephalosporins for preventing postoperative meningitis and secondary outcomes (in-hospital death and the combination of pneumonia and urinary tract infection) in patients who have undergone ETSS. METHODS The study used data from the Diagnosis Procedure Combination database in Japan. Data from 10 688 patients who underwent ETSS between April 2016 and March 2021 were included. Matching weight analysis based on propensity scores was conducted to compare the outcomes of patients receiving cefazolin, ampicillin or third-generation cephalosporins as prophylactic antibiotics. RESULTS Of the 10 688 patients, 9013, 102 and 1573 received cefazolin, ampicillin and third-generation cephalosporins, respectively. The incidence of postoperative meningitis did not significantly differ between the cefazolin group and the ampicillin group (OR, 1.02; 95% CI, 0.14-7.43) or third-generation cephalosporins group (OR, 0.81; 95% CI, 0.10-6.44). Similarly, in-hospital death and the composite incidence of pneumonia and urinary tract infection did not differ between the cefazolin group and the ampicillin or third-generation cephalosporins group. CONCLUSIONS Cefazolin, ampicillin and third-generation cephalosporins as perioperative prophylactic antibiotics for ETSS do not differ significantly in terms of preventing meningitis.
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Affiliation(s)
- Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Shotaro Aso
- Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kanako Makito
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
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Ishisaka E, Tahara S, Tsukiyama A, Nozaki T, Hattori Y, Morita A, Murai Y. Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: a technical case report. BMC Pediatr 2023; 23:604. [PMID: 38031015 PMCID: PMC10685644 DOI: 10.1186/s12887-023-04390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Spinal cord untethering by sectioning the filum terminale is commonly performed in tethered cord syndrome patients with minor abnormalities such as filar lipoma, thickened filum terminale, and low conus medullaris. Our endoscopic surgical technique, using the interlaminar approach, allows for sectioning the filum terminale through a very small skin incision. To our knowledge, this procedure has not been previously reported. This is the first case report involving a 1 cm skin incision. CASE PRESENTATION A 9-month-old male patient was referred to our neurosurgical department due to a coccygeal dimple. MRI revealed a thickened fatty filum. After considering the treatment options for this patient, the parents agreed to spinal cord untethering. A midline 1 cm skin incision was made at the L4/5 vertebral level. Untethering by sectioning the filum terminale was performed by full endoscopic surgery using the interlaminar approach. The procedure was uneventful and there were no postoperative complications. CONCLUSIONS In terms of visibility and minimizing invasiveness, our surgical technique of using the interlaminar approach with endoscopy allows for untethering by sectioning the filum terminale through a very small skin incision.
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Affiliation(s)
- Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki City, 211-8533, Kanagawa, Japan.
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki City, 211-8533, Kanagawa, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki City, 211-8533, Kanagawa, Japan
| | - Toshiki Nozaki
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki City, 211-8533, Kanagawa, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Endoscopic surgery versus craniotomy for spontaneous intracerebral hemorrhage in the late elderly patients. J Stroke Cerebrovasc Dis 2023; 32:107327. [PMID: 37677895 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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14
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Matsumoto Y, Nakae R, Matano F, Kubota A, Morita A, Murai Y, Yokobori S. A Case of Ruptured Carotid Traumatic Blood Blister-like Aneurysm. NMC Case Rep J 2023; 10:259-263. [PMID: 37869375 PMCID: PMC10584784 DOI: 10.2176/jns-nmc.2023-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023] Open
Abstract
Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.
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Affiliation(s)
- Yoshiyuki Matsumoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
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15
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Shibata A, Yamaguchi F, Sasaki K, Yokobori S, Morita A. Primary Central Nervous System Lymphoma in a Patient with Down Syndrome. J NIPPON MED SCH 2023; 90:346-350. [PMID: 35644559 DOI: 10.1272/jnms.jnms.2023_90-502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracranial tumors are rare in persons with Down syndrome. Although germ cell tumors and gliomas have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not. We report a case of PCNSL in a 48-year-old man with Down syndrome and no history of malignant tumors. He visited our hospital for evaluation of left hemiparesis and gait disturbance. A thorough examination revealed brain tumors, and analysis of a biopsy specimen of the tumor confirmed a diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether chromosomal abnormalities related to Down syndrome were involved in the development of PCNSL. Further molecular biological analysis may clarify the mechanism of combined Down syndrome and PCNSL.
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Affiliation(s)
- Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Fumio Yamaguchi
- Department of Neurosurgical Surgery, Nippon Medical School
- Department of Neurosurgery for Community Health, Nippon Medical School
| | - Kazuma Sasaki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akio Morita
- Department of Neurosurgical Surgery, Nippon Medical School
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16
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Nounaka Y, Murai Y, Shirokane K, Matano F, Koketsu K, Nakae R, Watanabe A, Mizunari T, Morita A. Spontaneous middle cerebral artery dissection: a series of six cases and literature review. Neurosurg Rev 2023; 46:229. [PMID: 37676338 DOI: 10.1007/s10143-023-02139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection-five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, the presence of an aneurysm, the presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area (p = 0.00) and were correlated with hemorrhage (p < 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.
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Affiliation(s)
- Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan.
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kazutaka Shirokane
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chibahokuso Hospital, Chiba, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Akira Watanabe
- Department of Neurological Surgery, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Takayuki Mizunari
- Department of Neurological Surgery, Nippon Medical School Chibahokuso Hospital, Chiba, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
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Ideguchi M, Kim K, Mizunari T, Koketsu K, Kominami S, Morita A. Distal Endovascular Occlusion for Incomplete Occlusion of Cavernous Carotid Aneurysms after High-flow Bypass and Cervical Internal Carotid Artery Ligation. Neurol Med Chir (Tokyo) 2023; 63:356-363. [PMID: 37286484 PMCID: PMC10482488 DOI: 10.2176/jns-nmc.2022-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/05/2023] [Indexed: 06/09/2023] Open
Abstract
Internal carotid artery (ICA) ligation for placing a high-flow extracranial-intracranial (EC-IC) bypass is used in patients with aneurysms on the cavernous portion of the ICA. Recanalization and rupture after proximal ICA ligation can occur. We present four patients who underwent endovascular distal ICA occlusion and report our surgical technique and treatment results. We ligated the ICA to place an EC-IC bypass using a radial artery (RA) graft. Failure to obtain spontaneous occlusion in the distal region required endovascular treatment an average of 219 days later. A guide catheter was placed in the common carotid artery, a guide or distal access catheter was introduced in the RA graft from the external carotid artery, and a microcatheter was navigated into the cavernous aneurysm through the RA graft. Using detachable coils, endovascular ICA occlusion was from just distal to the aneurysmal neck to a site proximal to the origin of the ophthalmic artery. Aneurysmal occlusion was completed by endovascular occlusion of the distal ICA. Complications were RA graft stenosis and transient consciousness disturbance due to local subarachnoid hemorrhage. Outpatient follow-up for a mean of 109.5 months revealed no recurrences. Distal occlusion of the ICA through the implanted RA graft is simple and presents a low risk for cerebral infarction due to thrombus formation during the procedure. To treat cavernous carotid aneurysms that do not disappear after placing the EC-IC bypass after ICA ligation at the aneurysmal neck, we offer our procedure as a treatment option.
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Affiliation(s)
- Minoru Ideguchi
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Takayuki Mizunari
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Kenta Koketsu
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Shushi Kominami
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Teramoto S, Tahara S, Hattori Y, Kondo A, Morita A. Assessment of anterior pituitary reserve capacity based on growth hormone response to growth hormone-releasing peptide-2 test in the elderly. Growth Horm IGF Res 2023; 71:101545. [PMID: 37295337 DOI: 10.1016/j.ghir.2023.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The growth hormone (GH)-releasing peptide-2 (GHRP-2) test is relatively safe among endocrine stimulation tests for the elderly. We investigated whether anterior pituitary function in elderly patients could be assessed on the basis of GH response to the GHRP-2 test. DESIGN Sixty-five elderly patients aged 65 years and older with non-functioning pituitary neuroendocrine tumor (PitNET) who underwent pituitary surgery and preoperative endocrine stimulation tests were classified into the "GH normal group" and "GH deficiency group" based on GH response to the GHRP-2 test. The baseline characteristics and anterior pituitary function were compared between the groups. RESULTS Thirty-two patients were assigned to the GH normal group and 33 to the GH deficiency group. The cortisol and adrenocorticotropic hormone (ACTH) results in the corticotropin-releasing hormone test were significantly higher in the GH normal group than in the GH deficiency group (p < 0.001). The relationship between the cortisol and ACTH results and the GH response revealed significant correlations (p < 0.001). In addition, receiver operating characteristic curve analysis identified that the optimal cut-off point for a peak GH level in the correlation between adrenocortical function and GH response to the GHRP-2 test was 8.08 ng/mL (specificity 0.868, sensitivity 0.852). CONCLUSION The present study indicated that adrenocortical function was significantly correlated with GH response to the GHRP-2 test in elderly patients before pituitary surgery. For elderly patients with non-functioning PitNET, GH response to the GHRP-2 test may support in diagnosing adrenocortical insufficiency.
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Affiliation(s)
- Shinichiro Teramoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan; Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan.
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Outcomes After Endoscopic Evacuation Versus Evacuation Using Craniotomy or Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage: Analysis Using a Japanese Nationwide Database. Neurocrit Care 2023; 38:667-675. [PMID: 36348138 DOI: 10.1007/s12028-022-01634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan. METHODS Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups. RESULTS Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011). CONCLUSIONS Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Teramoto S, Tahara S, Fukuda I, Hattori Y, Kondo A, Sugihara H, Morita A. Exploring endocrinological pitfalls in pituitary surgery in the elderly. Heliyon 2023; 9:e17060. [PMID: 37484278 PMCID: PMC10361224 DOI: 10.1016/j.heliyon.2023.e17060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
Background Endoscopic transsphenoidal surgery (ETSS) is performed more frequently in elderly patients. We investigated endocrinological pitfalls in pituitary surgery in the elderly by a comparative study focusing only on elderly patients. Methods Ninety-nine elderly patients aged 65 years and over with non-functioning pituitary adenoma (NFPA) who underwent ETSS were retrospectively examined and classified into the early (aged 65-74 years) and late (aged 75 years and over) elderly groups. The baseline characteristics and anterior pituitary function were compared between the groups. Results Seventy patients were assigned to the early elderly group and 29 to the late elderly group. Thyroid-stimulating hormone (TSH) response in preoperative and postoperative thyrotropin-releasing hormone (TRH) tests revealed a significant difference between the groups. Preoperative and postoperative TSH responses were significantly correlated in both groups. Residual analysis of the correlation between preoperative free triiodothyronine (T3) secretion quantity and preoperative TSH response in both groups, which was significant, indicated that preoperative TSH response was significantly normal when preoperative free T3 secretion quantity was normal in the early elderly group, but preoperative free T3 secretion quantity was significantly lower regardless of preoperative TSH response in the late elderly group. Conculsions The present study suggested that preoperative and postoperative TSH secretory capacity was presumed to be normal when preoperative free T3 levels were normal in the early elderly patients with NFPA. On the other hand, TSH secretory capacity in the late elderly patients could only be assessed by the TRH test, which should be taken into account.
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Affiliation(s)
- Shinichiro Teramoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Izumi Fukuda
- Department of Endocrinology, Diabetes and Metabolism, Nippon Medical School, Tokyo 113-8603, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Hitoshi Sugihara
- Department of Endocrinology, Diabetes and Metabolism, Nippon Medical School, Tokyo 113-8603, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo 113-8603, Japan
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Tahara S, Osamura RY, Hattori Y, Ishisaka E, Inomoto C, Sugihara H, Teramoto A, Morita A. Concurrent IgG4-related hypophysitis and clinically nonfunctioning gonadotroph pituitary neuroendocrine tumor. BMC Endocr Disord 2023; 23:96. [PMID: 37143052 PMCID: PMC10158217 DOI: 10.1186/s12902-023-01353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Some patients develop immunoglobulin G4 (IgG4)-related hypophysitis associated with systemic diseases. More than 30 cases of IgG4-related hypophysitis have been reported. However, biopsy has rarely been performed in these patients, and none have had an associated pituitary neuroendocrine tumor (PitNET). We present a case of concurrent IgG4-related hypophysitis and PitNET. CASE PRESENTATION A 56-year-old Japanese man arrived at the hospital with visual impairment, bitemporal hemianopia, and right abducens nerve palsy. Magnetic resonance imaging revealed pituitary body and stalk swelling as well as a small poorly enhanced right anterior lobe mass. Laboratory and loading test results suggested hypopituitarism. Because IgG4 level was elevated, a systemic examination was performed; multiple nodules were found in both lung fields. The diagnosis was based on an endoscopic transnasal biopsy of the pituitary gland. A histopathological examination revealed a marked infiltration of plasma cells into the pituitary gland, which was strongly positive for IgG4. The histological features of the resected tumor were consistent with those of gonadotroph PitNET, which was immunohistochemically positive for follicle-stimulating hormone-β and steroidogenic factor-1, and no plasma cell infiltration was observed. Based on the histopathological examination results, steroid therapy was initiated, which reduced pituitary gland size and serum IgG4 levels. DISCUSSION AND CONCLUSIONS This is the first reported case of IgG4-related hypophysitis with PitNET. Although no pathological findings indicating a relationship between the two conditions were found, we were able to preoperatively differentiate multiple lesions via detailed diagnostic imaging.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan.
| | | | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan
| | - Chie Inomoto
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
| | - Hitoshi Sugihara
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5Bunkyo-Ku, SendagiTokyo, 113-8603, Japan
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Hattori Y, Ishisaka E, Tahara S, Suzuki K, Teramoto S, Morita A. Creation of low cost, simple, and easy-to-use training kit for the dura mater suturing in endoscopic transnasal pituitary/skull base surgery. Sci Rep 2023; 13:6073. [PMID: 37055468 PMCID: PMC10101945 DOI: 10.1038/s41598-023-32311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 03/25/2023] [Indexed: 04/15/2023] Open
Abstract
Training kits for laparoscopes for deep suturing under endoscopes are commercially available; however, previously reported training kits for endoscopic transnasal transsphenoidal pituitary/skull base surgery (eTSS) were not available in the market. Moreover, the previously reported low cost, self-made kit has the drawback of being unrealistic. This study aimed to create a low cost training kit for eTSS dura mater suturing that was as close to real as possible. Most necessary items were obtained from the 100-yen store ($1 store) or from everyday supplies. As an alternative to the endoscope, a stick-type camera was used. Through the assembly of the materials, a simple and easy-to-use training kit was created, which is almost identical to the actual dural suturing situation. In eTSS, a simple and easy-to-use training kit for dural suturing was successfully created at a low cost. This kit is expected to be used for deep suture operations and the development of surgical instruments for training.
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Affiliation(s)
- Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Koji Suzuki
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Morimoto D, Kim K, Kokubo R, Kitamura T, Isu T, Morita A. Transarticular Fixation Using Bioabsorptive Screws for Cervical Lesions. Neurol Med Chir (Tokyo) 2023; 63:206-212. [PMID: 37019654 DOI: 10.2176/jns-nmc.2022-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Transarticular screw fixation is a method for posterior cervical fixation. It is ergonomic because neither connectors nor rods are needed. Biomechanical studies have shown that its fixation force is not inferior to that of lateral mass screws. More information is needed on the surgical outcome of procedures using bioabsorptive screws. We investigated the long-term surgical and radiological outcomes of posterior cervical decompression and fusion using bioabsorptive screws for transarticular fixation.Of 10 patients who underwent cervical spine transarticular fixation using bioabsorptive screws, nine presented with cervical degenerative spondylosis and one with a traumatic cervical spine injury. The mean postoperative follow-up period was 57.1 months. Transarticular screw fixation was successful in all 10 patients; no intraoperative complications were encountered. Bilateral screw breakage was discovered in a patient with cervical spine instability and associated dystonia due to cerebral palsy; there was no symptom deterioration, facet joint breakage, or instability exacerbation. Facet fusion was obtained in the nine other patients. At the patients' last visit, their clinical symptoms were significantly improved. Whole cervical spine alignment (-4.21 ± 7.2 to -5.2 ± 8.7) and the fused segment angle (mean, -0.1 ± 9.9 to -1.2 ± 13.7) did not significantly worsen postoperatively (mean: -0.1 ± 9.9 to -1.2 ± 13.7). Transarticular fixation using bioabsorptive screws is safe and associated with good long-term outcomes. In patients with exacerbation of local instability after posterior decompression, additional transarticular fixation using bioabsorbable screws is a treatment option.
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Affiliation(s)
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Rinko Kokubo
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Takao Kitamura
- Department of Neurological Surgery, Nippon Medical School
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Haemmerli J, Morel S, Georges M, Haidar F, Chebib FT, Morita A, Nozaki K, Tominaga T, Bervitskiy AV, Rzaev J, Schaller K, Bijlenga P. Characteristics and Distribution of Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease Compared with the General Population: A Meta-Analysis. Kidney360 2023; 4:e466-e475. [PMID: 36961086 PMCID: PMC10278849 DOI: 10.34067/kid.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/30/2023] [Indexed: 03/25/2023]
Abstract
Key Points IAs location distribution in patients with ADPKD differ from the ones in non-ADPKD patients IAs in patients with ADPKD are more commonly located in the anterior circulation and in large caliber arteries Because of IA multiplicity and singular IA distribution, patients with ADPKD represent a special population who need to be closely followed Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic condition associated with intracranial aneurysms (IAs). The associated pathophysiology remains unknown, but an association with wall shear stress is suspected. Cerebral arterial location is the principal factor influencing IA natural history. This study aims to compare IA location-specific distribution between ADPKD and non-ADPKD patients. Methods The ADPKD group comprised data from a systematic review of the literature (2016–2020, N =7) and three cohorts: integrated biomedical informatics for the management of cerebral aneurysms, Novosibirsk, and Unruptured Cerebral Aneurysms Study. The non-ADPKD group was formed from the integrated biomedical informatics for the management of cerebral aneurysms, Unruptured Cerebral Aneurysms Study, International Stroke Genetics Consortium, and the Finnish cohort from the literature. Patients and IAs characteristics were compared between ADPKD and non-ADPKD groups, and a meta-analysis for IA locations was performed. Results A total of 1184 IAs from patients with ADPKD were compared with 21,040 IAs from non-ADPKD patients. In total, 78.6% of patients with ADPKD had hypertension versus 39.2% of non-ADPKD patients. A total of 32.4% of patients with ADPKD were smokers versus 31.5% of non-ADPKD patients. In total, 30.1% of patients with ADPKD had a positive family history for IA versus 15.8% of the non-ADPKD patients. Patients with ADPKD showed a higher rate of IA multiplicity (33.2% versus 23.1%). IAs from patients with ADPKD showed a significant predominance across the internal carotid and middle cerebral arteries. Posterior communicating IAs were more frequently found in the non-ADPKD group. The meta-analysis confirmed a predominance of IAs in the patients with ADPKD across large caliber arteries (odds ratio [95% confidence interval]: internal carotid artery: 1.90 [1.10 to 3.29]; middle cerebral artery: 1.18 [1.02–1.36]). Small diameter arteries, such as the posterior communicating, were observed more in non-ADPKD patients (0.21 [0.11–0.88]). Conclusion This analysis shows that IAs diagnosed in patients with ADPKD are more often localized in large caliber arteries from the anterior circulation in comparison with IAs in non-ADPKD patients. It shows that primary cilia driven wall shear stress vessel remodeling to be more critical in cerebral anterior circulation large caliber arteries.
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Affiliation(s)
- Julien Haemmerli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marc Georges
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fadi Haidar
- Division of Nephrology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Transplantation, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Anatoliy V. Bervitskiy
- The “Federal Centre of Neurosurgery” of the Ministry of Health of the Russian Federation Novosibirsk, Novosibirsk Region, Novosibirsk, Russia
| | - Jamil Rzaev
- The “Federal Centre of Neurosurgery” of the Ministry of Health of the Russian Federation Novosibirsk, Novosibirsk Region, Novosibirsk, Russia
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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25
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Kokubo R, Kim K, Isu T, Morimoto D, Morita A. Patient Satisfaction with Surgery for Tarsal- and Carpal- Tunnel Syndrome - Comparative Study. Neurol Med Chir (Tokyo) 2023; 63:116-121. [PMID: 36682791 PMCID: PMC10072891 DOI: 10.2176/jns-nmc.2022-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We compared the treatment satisfaction of patients who had undergone surgery for tarsal tunnel syndrome (TTS) and carpal tunnel syndrome (CTS). We enrolled 44 patients in this study; 23 were operated for CTS and 21 for TTS. All patients had received surgery under a microscope and under local anesthesia. Using the numerical rating scale (NRS) for numbness/pain (range 0-10) we compared their preoperative outcome expectations with their satisfaction with our treatment 6 months after the operation. We also recorded their pre- and postoperative EuroQol 5-dimension 5-level (EQ-5D-5L) scale for their health-related quality of life (QOL). The subjective assessment of their QOL showed that it was significantly lower in TTS- than CTS patients both pre- and postoperatively. Six months after the operation, the NRS for symptoms and the (EQ-5D-5L) scale for the QOL were significantly improved in TTS- and CTS patients; however, these scores were significantly better after CTS- than TTS surgery. Also, the postoperative NRS was significantly lower in the CTS- than the TTS patients. Our comparison of the patients' expected- and actual surgical outcome showed that the result was better than expected after CTS- and TTS surgery; in CTS patients the difference was significant. Overall, CTS- were more satisfied than TTS patients with the treatment outcome. Satisfaction with the treatment was greater after CTS- than TTS surgery. TTS- experienced less symptom relief than CTS patients although the actual- exceeded the expected outcome in patients operated for TTS.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | | | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Ideguchi M, Kim K, Suzuki M, Kaneko J, Sato S, Shirokane K, Morita A. Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion. Neurol Med Chir (Tokyo) 2023; 63:73-79. [PMID: 36599429 PMCID: PMC9995149 DOI: 10.2176/jns-nmc.2022-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Mechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes of Health Stroke Scale score was 20.0 (range, 9-30), and the mean diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score on magnetic resonance images was 8.7 (range, 7-10). In six patients, MT of the CCA occlusion was successful, and the mean puncture-to-reperfusion time was 84 minutes (range, 39-211 minutes). In five patients, successful reperfusion was obtained. The mean total pass number was 4.1 (range, 2-7). Due to large thrombi, we performed balloon guide catheter (BGC) occlusion in three patients. Sheath occlusion occurred in two, and thrombus migration into the femoral artery around the sheath was observed in two patients. The mean modified Rankin Scale score 3 months post-stroke was 3.6 (range, 2-5). When the removal of a large CCA thrombus is attempted in a single step, catheter and sheath occlusion may occur, and this increases the risk for critical systemic artery occlusion. Therefore, we suggest that MT be combined with the BGC technique and propose the use of a large aspiration catheter to decrease the volume of the thrombus.
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Affiliation(s)
- Minoru Ideguchi
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | | | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Tamanagayama Hospital, Nippon Medical School
| | - Shin Sato
- Department of Emergency and Critical Care Medicine, Tamanagayama Hospital, Nippon Medical School
| | - Kazutaka Shirokane
- Department of Neurological Surgery, Tamanagayama Hospital, Nippon Medical School
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Dan H, Kim K, Kokubo R, Nomura R, Morimoto D, Morita A. Metastatic Spinal Tumor from Benign Pleomorphic Adenoma: Case Report and Literature Review. J NIPPON MED SCH 2023; 90:121-125. [PMID: 36908125 DOI: 10.1272/jnms.jnms.2023_90-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
PURPOSE Pleomorphic adenomas tend to arise in the salivary glands. They are rare and histologically benign but can result in distant metastasis, and their characteristics need further investigation. We report a case of locally recurring benign primary palatal pleomorphic adenoma that resulted in spinal metastases and review the relevant literature. CASE REPORT A 58-year-old woman had undergone surgery for a palatal pleomorphic adenoma 22 years earlier and 6 subsequent operations for local recurrences. During follow-up, metastases to multiple organs, including the spine, were diagnosed and 4 CyberKnife treatments were performed. She suffered right flank pain and slight paralysis of the right leg; radiological findings showed a growing metastatic spinal tumor. She underwent removal of a thoracic vertebral tumor and posterolateral fusion. Postoperatively, her symptoms improved. Histopathological analysis indicated a pleomorphic adenoma and no evidence of malignancy. Although there was no local recurrence, 23 months after surgery, a fifth CyberKnife procedure was performed for a growing salivary gland tumor and she is currently being followed up. CONCLUSION We described a rare case of benign pleomorphic adenoma that metastasized to the spine. Long-term follow-up for recurrence and metastasis is required for patients with benign pleomorphic adenoma.
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Affiliation(s)
- Hiroyuki Dan
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyongsong Kim
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Rinko Kokubo
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Ryutaro Nomura
- Department of Cyberknife Center, Chigasaki Central Hospital
| | | | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Horio K, Harada K, Muto J, Nakatomi H, Saito N, Morita A, Watanabe E, Mitsuishi M. Real-Time Suture Thread Detection with an Image Classifier. J Robot Mechatron 2022. [DOI: 10.20965/jrm.2022.p1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Micro-anastomosis is considered to be a difficult task even for skilled surgeons. Our group has developed a surgical robotic system to assist surgeons. Going further, the detection of surgically relevant objects in the microscopic view is indispensable for the automation or semi-automation of the system. This paper proposes a novel surgical thread detector inspired by an automatic crack detection method. The proposed method achieved a Dice score of 76.30% and an intersection over union (IOU) of 66.08% at 34.50 fps.
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Nakamura M, Magara T, Yoshimitsu M, Kano S, Matsubara A, Kato H, Morita A. 458 Tertiary lymphoid structures improve survival in virus-negative Merkel cell carcinoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Morita A, Okubo Y, Imafuku S, Tada Y, Yamanaka K, Yamaguchi Y, Yasuda M, Tsuchihashi H, Saitoh M, Okuyama R. 113 Flare frequency and patient characteristics in generalized pustular psoriasis (GPP) - A multicenter observational study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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31
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Kanayama Y, Ikumi K, Torii K, Enomoto Y, Yamamoto A, Morita A. 538 Bath-PUVA therapy changes inflammatory profiles for systemic effects beyond the skin. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Kim K, Kokubo R, Isu T, Morimoto D, Morita A. Patient satisfaction with cluneal nerve entrapment surgery. Acta Neurochir (Wien) 2022; 164:2667-2671. [PMID: 35972558 DOI: 10.1007/s00701-022-05344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Low back pain (LBP) from superior or middle cluneal nerve entrapment has been addressed surgically. We recorded patient satisfaction with this treatment. METHODS We included 22 consecutive patients who had undergone surgery for unilateral cluneal nerve entrapment (superior: n = 17, middle: n = 5). The numerical rating scale (NRS) for LBP, the Oswestry Disability Index (ODI) score, and the EuroQOL 5-dimension, 5-level (EQ-5D-5L) scale before and 6 months after the operation were compared. Using these scores, the treatment outcome was compared with the patients' preoperative expectations. RESULTS LBP was ameliorated in all 22 patients; their NRS, ODI, and EQ-5D-5L were significantly improved after surgery. Surgical satisfaction based on the postoperative NRS scores was recorded as 8.8 ± 1.1 (range 7-10). While the postoperative was significantly better than the expected NRS, the postoperative ODI was significantly higher than expected by the patients (both: p < 0.05). There was a moderate correlation between the postoperative NRS and ODI and postoperative patient satisfaction. CONCLUSION Patient satisfaction with the surgical result was rated as acceptable.
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Affiliation(s)
- Kyongsong Kim
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Kamagari, Inzai City, Chiba, 1715, Japan.
| | - Rinko Kokubo
- Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Kamagari, Inzai City, Chiba, 1715, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Murai Y, Matano F, Isayama K, Nounaka Y, Morita A. Evaluation of Ethyl Violet as an Alternative Dye to Crystal Violet to Visualize the Vessel Wall during Vascular Anastomosis. Neurol Med Chir (Tokyo) 2022; 62:530-534. [PMID: 36130905 DOI: 10.2176/jns-nmc.2022-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Crystal violet (CV) ink has been used as a skin marker worldwide. It has been reported to be useful for vessel wall visualization of microvascular anastomoses. Contrastingly, it has been found to be carcinogenic and inhibit migration and proliferation of venous cells. In some countries, its use in the medical field has been restricted. Therefore, it is necessary to consider alternatives to CV. In this present study, we compared the time required for the anastomosis of a 0.8-1 mm diameter vessel in the chicken wrist artery using CV and a CV-free dye (ethyl violet; EV). The surgeon, microscope, and anastomosis microsurgical tools were standardized for comparison. CV and EV were changed for each anastomosis. The same surgeon performed 30 anastomoses using each dye. No visually obvious differences were noted in the vascular transections with CV and EV. As per the results, no statistically significant difference was observed in the time required for anastomosis using CV and EV. EV conforming to California Proposition 65 may be an effective alternative to CV for vascular visualization of microvascular anastomoses. However, further studies on the effectiveness of the EV in clinical cases are needed.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Koshiro Isayama
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Tahara S, Hattori Y, Suzuki K, Ishisaka E, Teramoto S, Morita A. An Overview of Pituitary Incidentalomas: Diagnosis, Clinical Features, and Management. Cancers (Basel) 2022; 14:cancers14174324. [PMID: 36077858 PMCID: PMC9454484 DOI: 10.3390/cancers14174324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary A pituitary incidentaloma is a pituitary tumor or mass that is incidentally discovered in imaging studies which have been performed for reasons other than the symptoms of pituitary lesions. The majority of pituitary incidentalomas are pituitary neuroendocrine tumors (PitNETs) and Rathke cleft cysts. PitNETs have received attention because of their distinction from pituitary adenoma in the new World Health Organization (WHO) classification. The natural history of PitNETs is partially known, and the management of pituitary incidentalomas has been determined based on this history; however, the pathology of PitNETs has significantly changed with the new WHO classification, and studies with a high level of evidence are required to consider treatment guidelines for pituitary incidentalomas. Abstract Pituitary incidentalomas are tumors or mass lesions of the pituitary gland. These are incidentally discovered during imaging studies for symptoms that are not causally related to pituitary diseases. The most common symptom that triggers an examination is headache, and the most common type of pituitary incidentalomas are pituitary neuroendocrine tumors (PitNETs) and Rathke cleft cysts. The existing treatment strategy is controversial; however, surgical resection is recommended in cases of clinically non-functioning PitNETs with optic chiasm compression. In contrast, cystic lesions, such as Rathke cleft cysts, should be followed if the patients are asymptomatic. In this case, MRI and pituitary function tests are recommended every six months to one year; if there is no change, the follow-up period should be extended. The natural history of PitNET is partially known, and the management of pituitary incidentalomas is determined by this history. However, the pathogenesis of PitNET has significantly changed with the new World Health Organization classification, and follow-up is important based on this new classification. Therefore, a high level of evidence-based research is needed to consider treatment guidelines for pituitary incidentalomas in the future.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
- Correspondence:
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Koji Suzuki
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Shinichiro Teramoto
- Department of Neurosurgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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Tahara S, Hattori Y, Aso S, Uda K, Kumazawa R, Matsui H, Fushimi K, Yasunaga H, Morita A. Trends in surgical procedures for spontaneous intracerebral hemorrhage in Japan. J Stroke Cerebrovasc Dis 2022; 31:106664. [PMID: 35908346 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/01/2022] [Accepted: 07/17/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan. MATERIALS AND METHODS Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status. RESULTS We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group. CONCLUSIONS The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.
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Affiliation(s)
- Shigeyuki Tahara
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Yujiro Hattori
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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Ideguchi M, Kim K, Kominami S, Morita A. Brain arteriovenous malformation involving a persistent primitive olfactory artery. Nep J Neurosci 2022. [DOI: 10.3126/njn.v19i2.45417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The incidence of a persistent primitive olfactory artery is extremely rare. This anomaly may be involved in the development of aneurysms due to hemodynamic stress. We report a patient with a brain arteriovenous malformation mainly fed by a persistent primitive olfactory artery. A 40-year-old healthy man experienced transient numbness around the left side of his mouth. Magnetic resonance imaging incidentally disclosed flow voids inside and at the medial part of the pre-central gyrus of the left frontal lobe with dilation of the cortical veins. A left internal carotid artery angiogram revealed that a left persistent primitive olfactory artery with a proximal hair-pin turn fed an anterior component of the nidus. A right internal carotid artery angiogram showed that the right bihemispheric anterior cerebral artery fed a posterior component of the nidus. There was no aneurysm in the nidus or on the feeding vessel. The diagnosis was asymptomatic arteriovenous malformation (Spetzler-Martin grade 3). The patient developed systemic exanthema with facial edema after diagnostic angiography. We ruled out target embolization followed by stereotactic radiosurgery and placed him under close conservative outpatient observation. We suspect that the arteriovenous malformation was due to the presence of a pre-exiting persistent primitive olfactory artery. In patients with a persistent primitive olfactory artery, structural fragility and hemodynamic stress may elicit aneurysms at the apex of the hairpin curve of the persistent primitive olfactory artery.
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Ishikawa Y, Tanaka N, Asano Y, Kodera M, Shirai Y, Akahoshi M, Hasegawa M, Matsushita T, Kazuyoshi S, Motegi S, Yoshifuji H, Yoshizaki A, Kohmoto T, Takagi K, Oka A, Kanda M, Tanaka Y, Ito Y, Nakano K, Kasamatsu H, Utsunomiya A, Sekiguchi A, Niro H, Jinnin M, Makino K, Makino T, Ihn H, Yamamoto M, Suzuki C, Takahashi H, Nishida E, Morita A, Yamamoto T, Fujimoto M, Kondo Y, Goto D, Sumida T, Ayuzawa N, Yanagida H, Horita T, Atsumi T, Endo H, Shima Y, Kumanogoh A, Hirata J, Otomo N, Suetsugu H, Koike Y, Tomizuka K, Yoshino S, Liu X, Ito S, Hikino K, Suzuki A, Momozawa Y, Ikegawa S, Tanaka Y, Ishikawa O, Takehara K, Torii T, Sato S, Okada Y, Mimori T, Matsuda F, Matsuda K, Imoto I, Matsuo K, Kuwana M, Kawaguchi Y, Ohmura K, Terao C. OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGenome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.ObjectivesThe study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.MethodsA total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.ResultsWe identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.ConclusionOur study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.References[1]F. C. Arnett et al. Ann Rheum Dis, 2010.[2]T. R. Radstake et al. Nat Genet, 2010.[3]Y. Allanore et al. PLoS Genet, 2011.[4]O. Gorlova et al. PLoS Genet, 2011.[5]C. Terao et al. Ann Rheum Dis, 2017.[6]E. López-Isac et al. Nat Commun, 2019.[7]W. Pu et al. J Invest Dermatol, 2021.Disclosure of InterestsNone declared
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Teramoto S, Tahara S, Murai Y, Sato S, Hattori Y, Kondo A, Morita A. Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report. Front Surg 2022; 9:895233. [PMID: 35620195 PMCID: PMC9127310 DOI: 10.3389/fsurg.2022.895233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known. Case Presentation A 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful. Conclusion We believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.
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Affiliation(s)
- Shinichiro Teramoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
- Correspondence: Shinichiro Teramoto
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun Sato
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Morita A. [History of Skull Base Surgery]. No Shinkei Geka 2022; 50:496-507. [PMID: 35670162 DOI: 10.11477/mf.1436204580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Skull base surgery is a surgical field that involves the cooperation of multiple surgical and medical specialties, including neurosurgery, head-neck surgery, plastic-reconstructive surgery, radiation oncology, as well as multiple medical supporting teams. This field has been developed with the collaborative efforts of these medical specialties, and its history can be divided into five phases: Beginning of surgery(Prior to 1940); Early skull base surgery driven by the ENT-HN surgery group(1940-70); Conventional skull base surgery development based on anatomical, physiological knowledge and microsurgical equipment and technique(1970-90); Reflection and consolidation of the surgical dimension(1995-2005); and Evolution of endoscopic and new skull base surgical techniques(2005-). Several topics and advancements have improved this surgical field, such as access to the cavernous sinus, petrosal-temporal bone, and foramen magnum; concepts of minimally invasive surgical techniques; advanced endoscopic instruments; knowledge of biological assessments; and development of surgical robotics. To achieve a safe and effective surgery for cases of difficult cranial base lesions, clinicians must understand the origin of the surgical field, the detailed anatomy and physiology of the skull base, and the basic microsurgical techniques.
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Affiliation(s)
- Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Yamaguchi M, Kim K, Mizunari T, Ideguchi M, Koketsu K, Yokobori S, Morita A. External carotid artery-related adverse events at extra-intra cranial high flow bypass surgery using a radial artery graft. World Neurosurg 2022; 163:e655-e662. [DOI: 10.1016/j.wneu.2022.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
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Murai Y, Shirokane K, Sato S, Higuchi T, Kubota A, Ozeki T, Matano F, Sasakai K, Yamaguchi F, Morita A. Preliminary Clinical Surgical Experience with Temporary Simultaneous Use of an Endoscope during Exoscopic Neurosurgery: An Observational Study. J Clin Med 2022; 11:jcm11071753. [PMID: 35407363 PMCID: PMC8999258 DOI: 10.3390/jcm11071753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
The use of an endoscope in exoscopic transcranial neurosurgery for skull-base lesions has not yet been investigated. Thus, this study aimed to investigate the advantages, disadvantages, and safety of “simultaneous temporary use of an endoscope during exoscopic surgery” (exo-endoscopic surgery (EES)). Consecutive exo-endoscopic surgeries performed by experienced neurosurgeons and assistants were analyzed. Surgical complications and time were compared with previous consecutive microsurgeries performed by the same surgeon. A questionnaire survey was conducted on 16 neurosurgeons with experience in both “temporary simultaneous use of endoscope during microscopic surgery” (micro-endoscopic surgery (MES)) and EES. EES was performed in 18 of 76 exoscopic surgeries, including tumor removal (n = 10), aneurysm clipping (n = 5), and others (n = 3). There were no significant differences in operative time, anesthesia time, or complications from microsurgery by the same operator. According to the questionnaire survey results, compared with MES, EES had a wider field of view due to its lack of an eyepiece, was easier when loading and unloading instruments into and out of the surgical field, and was more suitable for the simultaneous observation of two fields of view. Overall, 79.2% of surgeons indicated that EES may be better suited than MES to simultaneously observe two fields of view.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
- Correspondence: ; Tel.: +81-3-3822-2131
| | - Kazutaka Shirokane
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Shun Sato
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Tadashi Higuchi
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Tomohiro Ozeki
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Kazuma Sasakai
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
| | - Fumio Yamaguchi
- Department of Neurosurgery for Community Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan;
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; (K.S.); (S.S.); (T.H.); (A.K.); (T.O.); (F.M.); (K.S.); (A.M.)
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Enomoto H, Iwata K, Matsumoto K, Otsuka M, Morita A, Ozawa H. Hypothalamic KNDy neuron expression in streptozotocin-induced diabetic female rats. J Endocrinol 2022; 253:39-51. [PMID: 35084363 PMCID: PMC8942341 DOI: 10.1530/joe-21-0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Abstract
Kisspeptin neurons, i.e. KNDy neurons, in the arcuate nucleus (ARC) coexpress neurokinin B and dynorphin and regulate gonadotropin-releasing hormone/luteinizing hormone (LH) pulses. Because it remains unclear whether these neurons are associated with reproductive dysfunction in diabetic females, we examined the expression of KNDy neurons detected by histochemistry in streptozotocin (STZ)-induced diabetic female rats 8 weeks after STZ injection. We also evaluated relevant metabolic parameters - glucose, 3-hydroxybutyrate, and non-esterified fatty acids - as indicators of diabetes progression. Severe diabetes with hyperglycemia and severe ketosis suppressed the mRNA expression of KNDy neurons, resulting in low plasma LH levels and persistent diestrus. In moderate diabetes with hyperglycemia and moderate ketosis, kisspeptin-immunoreactive cells and plasma LH levels were decreased, while the mRNA expression of KNDy neurons remained unchanged. Mild diabetes with hyperglycemia and slight ketosis did not affect KNDy neurons and plasma LH levels. The number of KNDy cells was strongly and negatively correlated with plasma 3-hydroxybutyrate levels. The vaginal smear analysis showed unclear proestrus in diabetic rats 3-5 days after STZ injection, and the mRNA expression of kisspeptin in the ARC was decreased 2 weeks after STZ injection in severely diabetic rats. Kisspeptin neurons in the anteroventral periventricular nucleus (AVPV), which induce an LH surge, were unaffected at 2 and 8 weeks after STZ injection regardless of the diabetes severity. These results suggest that diabetes mellitus progression in females may negatively affect ARC kisspeptin neurons but not AVPV kisspeptin neurons, implicating a potential role of ARC kisspeptin neurons in menstrual disorder and infertility.
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Affiliation(s)
- Hiroyuki Enomoto
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
- Department of Neurosurgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kinuyo Iwata
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
- Correspondence should be addressed to K Iwata:
| | - Keisuke Matsumoto
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Mai Otsuka
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akio Morita
- Department of Neurosurgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Hitoshi Ozawa
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Nounaka Y, Tenjin H, Okano Y, Morita A. Training Model for Brain Tumor Removal (Model TOM Meningioma). Neurosurgery Open 2022. [DOI: 10.1227/neuopn.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Murai Y, Sekine T, Ishisaka E, Tsukiyama A, Kubota A, Matano F, Ando T, Nakae R, Morita A. Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study. Neurosurgery 2022; 90:426-433. [PMID: 35064659 DOI: 10.1227/neu.0000000000001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maintaining the patency of extracranial-to-intracranial (EC-IC) bypass is critical for long-term stroke prevention. However, reports on the factors influencing long-term bypass patency and quantitative assessments of bypass patency are limited. OBJECTIVE To quantitatively evaluate blood flow in EC-IC bypass using four-dimensional (4D) flow magnetic resonance imaging (MRI) and investigate factors influencing the long-term patency of EC-IC bypass. METHODS Thirty-six adult Japanese patients who underwent EC-IC bypass for symptomatic internal carotid or middle cerebral artery occlusive disease were included. We examined the relationships between decreased superficial temporal artery (STA) blood flow volume and perioperative complications, long-term ischemic complications, patient background, and postoperative antithrombotic medications in patients for whom STA flow could be quantitatively assessed for at least 5 months using 4D flow MRI. RESULTS The mean follow-up time was 54.7 ± 6.1 months. One patient presented with a stroke during the acute postoperative period that affected postoperative outcomes. No recurrent strokes were recorded during long-term follow-up. Two patients died of malignant disease. Seven cases of reduced flow occurred in the STA, which were correlated with single bypass (P = .0294) and nonuse of cilostazol (P = .0294). STA occlusion was observed in 1 patient during the follow-up period. Hypertension, age, smoking, dyslipidemia, and diabetes mellitus were not correlated with reduced blood flow in the STA. CONCLUSION Double anastomoses and cilostazol resulted in long-term STA blood flow preservation. No recurrence of cerebral infarction was noted in either STA hypoperfusion or occlusion cases.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Musashi-Kosugi Hospital, Nippon Medical School, Kanagawa, Japan
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Zuurbier CCM, Molenberg R, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, Jääskeläinen JE, Koivisto T, Yamazaki T, Uyttenboogaart M, van Dijk JMC, Aalbers MW, Morita A, Tominari S, Arai H, Nozaki K, Murayama Y, Ishibashi T, Takao H, Gondar R, Bijlenga P, Rinkel GJE, Greving JP, Ruigrok YM. Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis. Stroke 2022; 53:362-369. [PMID: 34983236 PMCID: PMC8785514 DOI: 10.1161/strokeaha.121.035187] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. Methods: We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. Results: We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89–1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58–0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07–1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02–1.90). Conclusions: Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.
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Affiliation(s)
- Charlotte C M Zuurbier
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Liselore A Mensing
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Finland (S.J.)
| | - Antti E Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Juha E Jääskeläinen
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Timo Koivisto
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.)
| | - Maarten Uyttenboogaart
- Department of Neurology and Medical Imaging Center, University Medical Center Groningen, the Netherlands. (M.U.)
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Akio Morita
- Medical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.)
| | - Shinjiro Tominari
- Department of Health Informatics, School of Public Health, Kyoto University, Japan (S.T.)
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University- Medical School, Tokyo, Japan (H.A.)
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Japan (K.N.)
| | - Yuichi Murayama
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Toshihiro Ishibashi
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Hiroyuki Takao
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Renato Gondar
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Gabriel J E Rinkel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. (J.P.G.)
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
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Kanaya T, Murai Y, Yui K, Sato S, Morita A. Acoustic Neurinoma with Synchronous Ipsilateral Cerebellopontine Angle Lipoma: A Case Report and Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12010120. [PMID: 35054286 PMCID: PMC8775160 DOI: 10.3390/diagnostics12010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.
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Affiliation(s)
- Takahiro Kanaya
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya 343-8555, Saitama, Japan;
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan; (K.Y.); (S.S.); (A.M.)
- Correspondence:
| | - Kanako Yui
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan; (K.Y.); (S.S.); (A.M.)
| | - Shun Sato
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan; (K.Y.); (S.S.); (A.M.)
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Tokyo, Japan; (K.Y.); (S.S.); (A.M.)
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47
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Kokubo R, Kim K, Morimoto D, Isu T, Morita A. Paralysis immediately after surgical decompression for common peroneal nerve entrapment. J NIPPON MED SCH 2022. [DOI: 10.1272/jnms.jnms.2023_90-201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School
| | | | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School
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48
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Murai Y, Ishisaka E, Tsukiyama A, Kubota A, Yamaguchi M, Matano F, Tamaki T, Mizunari T, Morita A. Contest-style evaluation for the objective assessment of microsurgical techniques: an observational study. J NIPPON MED SCH 2022; 89:405-411. [DOI: 10.1272/jnms.jnms.2022_89-407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School Hospital
| | | | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Masahiro Yamaguchi
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Tomonori Tamaki
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Takayuki Mizunari
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
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Hackenberg KAM, Algra A, Al-Shahi Salman R, Frösen J, Hasan D, Juvela S, Langer D, Meyers P, Morita A, Rinkel G, Etminan N. Correction to: Definition and Prioritization of Data Elements for Cohort Studies and Clinical Trials on Patients with Unruptured Intracranial Aneurysms: Proposal of a Multidisciplinary Research Group. Neurocrit Care 2021; 35:924-926. [PMID: 34608597 DOI: 10.1007/s12028-021-01346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ale Algra
- Brain Center Rudolph Magnus, Department of Neurology and Neurosurgery, and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - David Hasan
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - David Langer
- Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, Lenox‑Hill Hospital, New York, NY, USA
| | - Philip Meyers
- Departments of Neurosurgery and Radiology, Columbia University Medical Center, New York, NY, USA
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo‑ku, Tokyo, Japan
| | - Gabriel Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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50
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Zuurbier CCM, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, Koivisto T, Jääskeläinen JE, Yamazaki T, Molenberg R, van Dijk JMC, Uyttenboogaart M, Aalbers M, Morita A, Tominari S, Arai H, Nozaki K, Murayama Y, Ishibashi T, Takao H, Rinkel GJE, Greving JP, Ruigrok YM. Difference in Rupture Risk Between Familial and Sporadic Intracranial Aneurysms: An Individual Patient Data Meta-analysis. Neurology 2021; 97:e2195-e2203. [PMID: 34670818 DOI: 10.1212/wnl.0000000000012885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We combined individual patient data (IPD) from prospective cohorts of patients with unruptured intracranial aneurysms (UIAs) to assess to what extent patients with familial UIA have a higher rupture risk than those with sporadic UIA. METHODS For this IPD meta-analysis, we performed an Embase and PubMed search for studies published up to December 1, 2020. We included studies that (1) had a prospective study design; (2) included 50 or more patients with UIA; (3) studied the natural course of UIA and risk factors for aneurysm rupture including family history for aneurysmal subarachnoid haemorrhage and UIA; and (4) had aneurysm rupture as an outcome. Cohorts with available IPD were included. All studies included patients with newly diagnosed UIA visiting one of the study centers. The primary outcome was aneurysmal rupture. Patients with polycystic kidney disease and moyamoya disease were excluded. We compared rupture rates of familial vs sporadic UIA using a Cox proportional hazard regression model adjusted for PHASES score and smoking. We performed 2 analyses: (1) only studies defining first-degree relatives as parents, children, and siblings and (2) all studies, including those in which first-degree relatives are defined as only parents and children, but not siblings. RESULTS We pooled IPD from 8 cohorts with a low and moderate risk of bias. First-degree relatives were defined as parents, siblings, and children in 6 cohorts (29% Dutch, 55% Finnish, 15% Japanese), totaling 2,297 patients (17% familial, 399 patients) with 3,089 UIAs and 7,301 person-years follow-up. Rupture occurred in 10 familial cases (rupture rate: 0.89%/person-year; 95% confidence interval [CI] 0.45-1.59) and 41 sporadic cases (0.66%/person-year; 95% CI 0.48-0.89); adjusted hazard ratio (HR) for familial cases 2.56 (95% CI 1.18-5.56). After adding the 2 cohorts excluding siblings as first-degree relatives, resulting in 9,511 patients, the adjusted HR was 1.44 (95% CI 0.86-2.40). DISCUSSION The risk of rupture of UIA is 2.5 times higher, with a range from a 1.2 to 5 times higher risk, in familial than in sporadic UIA. When assessing the risk of rupture in UIA, family history should be taken into account.
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Affiliation(s)
- Charlotte C M Zuurbier
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Liselore A Mensing
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Marieke J H Wermer
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Seppo Juvela
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Antti E Lindgren
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Timo Koivisto
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Juha E Jääskeläinen
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Tomosato Yamazaki
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Rob Molenberg
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - J Marc C van Dijk
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Maarten Uyttenboogaart
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Marlien Aalbers
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Akio Morita
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Shinjiro Tominari
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Hajime Arai
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Kazuhiko Nozaki
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Yuichi Murayama
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Toshihiro Ishibashi
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Hiroyuki Takao
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Gabriel J E Rinkel
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Jacoba P Greving
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Ynte M Ruigrok
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan.
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