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Kuwabara M, Ikawa F, Sakamoto S, Okazaki T, Ishii D, Hosogai M, Maeda Y, Chiku M, Kitamura N, Choppin A, Takamiya D, Shimahara Y, Nakayama T, Kurisu K, Horie N. Effectiveness of tuning an artificial intelligence algorithm for cerebral aneurysm diagnosis: a study of 10,000 consecutive cases. Sci Rep 2023; 13:16202. [PMID: 37758849 PMCID: PMC10533861 DOI: 10.1038/s41598-023-43418-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/23/2023] [Indexed: 09/29/2023] Open
Abstract
Diagnostic image analysis for unruptured cerebral aneurysms using artificial intelligence has a very high sensitivity. However, further improvement is needed because of a relatively high number of false positives. This study aimed to confirm the clinical utility of tuning an artificial intelligence algorithm for cerebral aneurysm diagnosis. We extracted 10,000 magnetic resonance imaging scans of participants who underwent brain screening using the "Brain Dock" system. The sensitivity and false positives/case for aneurysm detection were compared before and after tuning the algorithm. The initial diagnosis included only cases for which feedback to the algorithm was provided. In the primary analysis, the sensitivity of aneurysm diagnosis decreased from 96.5 to 90% and the false positives/case improved from 2.06 to 0.99 after tuning the algorithm (P < 0.001). In the secondary analysis, the sensitivity of aneurysm diagnosis decreased from 98.8 to 94.6% and the false positives/case improved from 1.99 to 1.03 after tuning the algorithm (P < 0.001). The false positives/case reduced without a significant decrease in sensitivity. Using large clinical datasets, we demonstrated that by tuning the algorithm, we could significantly reduce false positives with a minimal decline in sensitivity.
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Affiliation(s)
- Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Yuyo Maeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Masaaki Chiku
- Department of Neurosurgery, Medical Check Studio, Tokyo Ginza Clinic, 1-2-4 Ginza, Chuo-ku, Tokyo, 104-0061, Japan
| | - Naoyuki Kitamura
- Department of Diagnostic Radiology, Kasumi Clinic, 1-2-27 Shinonomehommachi, Minami-ku, Hiroshima, Hiroshima, 734-0023, Japan
| | - Antoine Choppin
- LPIXEL Inc., 1-6-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | | | - Yuki Shimahara
- LPIXEL Inc., 1-6-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoe, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan
| | - Kaoru Kurisu
- Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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Kuwabara M, Ikawa F, Michihata N, Sakamoto S, Okazaki T, Hosogai M, Maeda Y, Horie N, Kurisu K, Fushimi K, Yasunaga H. The 5-Factor Modified Frailty Index as a More Useful Associated Factor Than Chronological Age After Unruptured Cerebral Aneurysm Surgery: A Nationwide Registry Study. Neurosurgery 2023; 92:329-337. [PMID: 36331212 PMCID: PMC9815091 DOI: 10.1227/neu.0000000000002203] [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: 04/10/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although chronological age is associated with mortality and morbidity after surgery for unruptured cerebral aneurysms (UCAs), there is little evidence regarding an association between the simplified 5-factor modified frailty index (mFI-5) and postoperative outcomes based on age group. OBJECTIVE To investigate the association of the mFI-5 score with worse outcomes, mortality, and complications in patients after surgery for UCA by chronological age groups using a Japanese national database. METHODS This study included 32 902 patients with UCAs enrolled in a Japanese national database between 2011 and 2015. Age group (younger than 65 years, 65-74 years, and 75 years or older), sex, UCA location, treatment, medications, Barthel Index (BI), medical history, mFI-5 score, and in-hospital mortality and complications were evaluated. We identified risk factors for worsening BI score, in-hospital mortality, and overall postoperative complications in each age group. RESULTS In total, 14 465 patients were enrolled in this study. Multivariable analysis showed that elderly groups and patients with an mFI-5 score ≥2 items were associated with worsening BI scores (odds ratio 1.95; 95% CI 1.52-2.51) and in-hospital complications (odds ratio 1.79; CI 1.49-2.15), despite having no association with in-hospital mortality. Multivariable analysis by age groups showed that the mFI-5 score ≥2 items was associated with in-hospital complications in all age groups, unlike chronological age in patients younger than 74 years. CONCLUSION The mFI-5 score was a more useful associated factor of in-hospital complications than chronological age in patients younger than 74 years undergoing surgery for UCA.
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Affiliation(s)
- Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuyo Maeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
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Hidaka T, Ikawa F, Michihata N, Onishi S, Matsuda S, Ozono I, Oku S, Takayanagi S, Fushimi K, Yasunaga H, Kurisu K, Horie N. Perioperative Surgical Risks in Patients With Hemangioblastomas: A Retrospective Nationwide Review in Japan. World Neurosurg 2023; 170:e21-e27. [PMID: 36356840 DOI: 10.1016/j.wneu.2022.10.042] [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: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The perioperative risk of sporadic hemangioblastomas (HBs) and von Hippel-Lindau disease (VHL)-associated hemangioblastomas (VHL-associated HBs) remains unclear due to the rare prevalence of HB. Therefore, this study aimed to clarify risk factors for better surgical management of patients with HBs. METHODS A retrospective analysis of surgically treated HB patients registered in the Diagnosis Procedure Combination database of Japan, between 2010 and 2015, was performed. Age, sex, sporadic HBs or VHL-associated HBs, medical history, tumor location, hospital case load, postoperative complications, and Barthel index (BI) deterioration were assessed. We also evaluated the outcomes and factors of perioperative BI deterioration. RESULTS In total, 676 patients with 609 intracranial lesions, 64 spinal lesions, and 3 with both types were eligible. Among them, 618 and 58 patients had sporadic HBs and VHL-associated HBs, respectively. The rates of perioperative BI deterioration were 12.5% and 12.2% for sporadic HBs and VHL-associated HBs, respectively. Perioperative mortality was 1.8% and 0% for sporadic HBs and VHL-associated HBs, respectively. Male sex, old age, high hospital case load, and medical history of diabetes mellitus were significantly associated with perioperative BI deterioration in all cases and sporadic HBs. Only medical history of diabetes mellitus was a significant risk factor for perioperative BI deterioration in VHL-associated HBs. CONCLUSIONS No differences in perioperative BI deterioration rates between sporadic HBs and VHL-associated HBs were found. However, different risk factors for perioperative BI deterioration were identified. Consideration of these risk factors is recommended in all patients undergoing surgery for HB.
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Affiliation(s)
- Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shinichiro Oku
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, 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
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Kure, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Matsuda S, Ikawa F, Hidaka T, Yamaguchi S, Inagawa T, Horie N, Kurisu K, Akiyama Y, Goto Y, Nakayama T, Fukuda H, Ueba T, Sasaki M, Ishikawa T, Shimamura N, Ohkuma H. Recent Declining Trend of Incidence Rate of Subarachnoid Hemorrhage in Shimane, Japan: The Japan Incidence of Subarachnoid Hemorrhage (JIS) Study. Neurol Med Chir (Tokyo) 2022; 62:458-464. [PMID: 36130903 PMCID: PMC9637398 DOI: 10.2176/jns-nmc.2022-0067] [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] [Indexed: 11/30/2022] Open
Abstract
The “Izumo Study” revealed the incidence rate of subarachnoid hemorrhage (SAH) in Izumo City, Shimane Prefecture, Japan, from 1980 to 1998. However, no study has been published regarding the incidence of SAH in Shimane Prefecture after 1998. Most studies reporting the incidence of SAH in Japan have been conducted before 2000, although a few have been reported after 2000. This study aimed to assess the estimated age-adjusted incidence rate (AAIR) of SAH in Shimane Prefecture after 1998, following the Izumo Study. A retrospective study was conducted to identify the estimated AAIR of SAH in Shimane Prefecture, using the age-adjusted SAH mortality rate for this population from 1999 to 2017 and assuming that the case-fatality rate of SAH decreased by 0.7% annually from 45% in 1999 to 32.4% in 2017. We used linear regression analysis for trend to the estimated AAIR of SAH. Sensitivity analyses were also conducted by various case-fatality rates of SAH using assuming case-fatality rate based on previous reports. The estimated AAIR of SAH in Shimane Prefecture declined from 33.6 (95% confidence interval [CI]: 29.7-37.9) per 100,000 person-years in 1999, by 26.5%, to 24.7 (95% CI: 21.4-28.5) in 2017 (p < 0.01, r = 0.58). Declining trend of incidence rate of SAH in Shimane Prefecture from 1999 to 2017 was confirmed in this study.
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Affiliation(s)
- Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | | | | | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku Rosai Hospital
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine
| | - Yoshihito Goto
- Department of Clinical Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Masahiro Sasaki
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University Graduate School
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Imada Y, Mihara C, Kawamoto H, Kurisu K. Morphological Analysis of the Sylvian Fissure Stem to Guide a Safe Trans-sylvian Fissure Approach. Neurol Med Chir (Tokyo) 2022; 62:502-512. [PMID: 36130902 DOI: 10.2176/jns-nmc.2022-0064] [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
The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.
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Affiliation(s)
| | - Chie Mihara
- Department of Neurosurgery, Yamada Memorial Hospital
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Ikawa F, Michihata N, Oya S, Hidaka T, Ohata K, Saito K, Yoshida K, Fushimi K, Yasunaga H, Tominaga T, Kurisu K, Horie N. A nationwide registry study: The 5-factor modified frailty index of meningioma surgery in non-elderly and elderly patients. Clin Neurol Neurosurg 2022; 222:107445. [PMID: 36174406 DOI: 10.1016/j.clineuro.2022.107445] [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: 05/31/2022] [Revised: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The simplified 5-factor modified frailty index (mFI-5) is a useful indicator of outcome for patients undergoing surgeries as frailty is considered an important risk factor in elderly patients. However, its usefulness has not been validated based on age groups. Therefore, we aimed to investigate risk factors, including the mFI-5, across age groups for complications and worse outcomes in meningioma surgery using data obtained from the nationwide database in Japan. METHODS We extracted data from the nationwide registry database in Japan between 2010 and 2015. Age (< 65, 65-74, and ≥ 75 years), sex, Barthel Index (BI), mFI-5 scores, and complications were evaluated. Multivariate logistic regression analyses identified risk factors for worsening BI scores and complications after surgery across all age groups. RESULTS Among 8138 included patients, an mFI-5 score ≥ 2 items was a significant risk factor for worsening BI scores in patients aged < 65 years (odds ratio: 2.3; 95 % confidence interval: 1.5-3.4), but not in patients aged 65-74 years and those aged ≥ 75 years, contrary to chronological age. Similar results were noted for any complications in patients aged < 65 years (2.5; 1.8-3.6) and aged 65-74 years (1.5; 1.1-2.1), but not in patients aged ≥ 75 years. CONCLUSION Although the mFI-5 scores could predict the risk of in-hospital worsening outcomes, mortality, and complications, it was more useful in non-elderly patients aged < 65 years rather than in elderly patients aged ≥ 75 years, contrary to chronological age. Further prospective studies should be performed in the future to clarify the utility of the mFI-5.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 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
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ozono I, Ikawa F, Hidaka T, Yoshiyama M, Kuwabara M, Matsuda S, Yamamori Y, Nagata T, Tomimoto H, Suzuki M, Yamaguchi S, Kurisu K, Horie N. Hypertension and advanced age increase the risk of cognitive impairment after mild traumatic brain injury: A registry-based study. World Neurosurg 2022; 162:e273-e280. [PMID: 35276396 DOI: 10.1016/j.wneu.2022.03.010] [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: 01/18/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE As the global population ages, the incidence of traumatic brain injury (TBI) increases. While mild TBI can impair the cognitive function of older adults, the cause and background of mild TBI-induced cognitive impairment remains unclear, and the evaluation of risk factors for cognitive impairment after mild TBI remain open for consideration especially in the current aging society. This study aimed to evaluate the risks associated with cognitive impairment following mild TBI. METHODS Between January 2006 and December 2018, 2,209 patients with TBI required hospitalization in Shimane Prefectural Central Hospital. Mild TBI was defined as a Japan coma scale ≤ 10 at admission. The cognitive function of the patients was measured with the Hasegawa Dementia Rating Scale-revised or Mini-mental state examination at least twice during the patients' hospital stays. The odds ratio (OR) and 95% confidence interval (CI) of each considered risk factor was calculated with multivariable logistic regression analysis after univariate analysis. RESULTS Among 1,674 patients with mild TBI, 172 patients underwent cognitive function examinations, and 145 patients (84.3%) were found to have cognitive impairment at discharge. Significant risk factors for cognitive impairment included age (P = 0.008) and hypertension (P = 0.013) in univariate analysis; and age (OR 1.04: 95% CI 1.01-1.07) and hypertension (OR 5.81: 95% CI 1.22-27.68) by multivariable analysis. CONCLUSIONS Older patients with hypertension displayed significantly higher cognitive impairment risk after even mild TBI. For these patients, we should take carefully management even after mild TBI.
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Affiliation(s)
- Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Yuji Yamamori
- Department of Critical care, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Tomoko Nagata
- Department of Rehabilitation, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | | | | | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Furuta T, Kubo T, Sakuda T, Saito T, Kurisu K, Muragaki Y, Adachi N. Utility of intraoperative magnetic resonance imaging for giant cell tumor of bone after denosumab treatment: a pilot study. Acta Radiol 2022; 63:176-181. [PMID: 33517664 DOI: 10.1177/0284185121989515] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is an intermediate but locally aggressive neoplasm. Current treatment of high-risk GCTB involves administration of denosumab, which inhibits bone destruction and promotes osteosclerosis. However, denosumab monotherapy is not a curative treatment for GCTB and surgical treatment remains required. Denosumab treatment complicates surgery, and the recurrence rate of GCTB is high (20%-30%). PURPOSE To examine the utility of intraoperative magnetic resonance imaging (iMRI) for detection and reduction of residual tumor after denosumab treatment and to investigate the utility of iMRI, which is not yet widely used. MATERIAL AND METHODS We enrolled five patients who received denosumab for a median period of eight months (range 6-12 months). Surgery was performed when the degree of osteosclerosis around the articular surface was deemed appropriate. We performed iMRI using a modified operation table to identify residual tumor after initial curettage and evaluated the rate of detection of residual tumor by iMRI, intraoperative and postoperative complications, exposure time of iMRI, and operation time. RESULTS Suspected residual tumor tissue was identified in all five cases and was confirmed by histopathology after additional curettage. The rate of detection of residual tumor by iMRI was 100%. Residual tumor was located in sites which were difficult to remove due to osteosclerosis. The iMRI was performed safely and without trouble. During the median follow-up period of 10 months (range 6-24 months), no adverse events or recurrences occurred. CONCLUSION Intraoperative MRI could contribute to the reduction of residual tumor tissue and it may prevent recurrence of GCTB after denosumab therapy.
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Affiliation(s)
- Taisuke Furuta
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tadahiko Kubo
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tomohiko Sakuda
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Taiichi Saito
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgey, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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Shimizu K, Mitsuhara T, Takeda M, Kurisu K, Yamaguchi S. Spinal Osseous Epidural Arteriovenous Fistula with Intradural Reflux: A Case Report. NMC Case Rep J 2022; 8:229-233. [PMID: 35079468 PMCID: PMC8769409 DOI: 10.2176/nmccrj.cr.2020-0124] [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: 04/25/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
The authors report a rare case of spinal osseous epidural arteriovenous fistula (AVF) with intradural reflux. A 71-year-old lady with a past history of a T12 compression fracture and neurofibromatosis type 1 presented with progressive paraparesis. Magnetic resonance (MR) images of the thoracolumbar spine showed edema of the spinal cord and flow voids. Catheter angiography revealed segmental arteries from T11 to L1 feeding an AVF in the epidural space. The AVF drained not only into the epidural venous plexus but also into the perimedullary veins. Of note, there was an intraosseous drainage route that involved the basivertebral vein of T12. Under the diagnosis of spinal osseous epidural AVF with intradural reflux, surgical interruption of the intradural arterialized draining vein was performed. Spinal osseous epidural AVF with intradural reflux is rare with only four cases reported in the past. We believe that spinal osseous epidural AVF should be recognized as a variant of spinal epidural AVF.
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Affiliation(s)
- Kiyoharu Shimizu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masaaki Takeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Hiroshima, Japan
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Iihara K, Saito N, Suzuki M, Date I, Fujii Y, Houkin K, Inoue T, Iwama T, Kawamata T, Kim P, Kinouchi H, Kishima H, Kohmura E, Kurisu K, Maruyama K, Matsumaru Y, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Takahashi JC, Ueki K, Wakabayashi T, Yoshimoto K, Arai H, Tominaga T. The Japan Neurosurgical Database: Statistics Update 2018 and 2019. Neurol Med Chir (Tokyo) 2021; 61:675-710. [PMID: 34732592 PMCID: PMC8666296 DOI: 10.2176/nmc.st.2021-0254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/20/2022] Open
Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of Medicine
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | - Phyo Kim
- Department of Neurologic Surgery, Utsunomiya Neurospine Center
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Eiji Kohmura
- Kinki Central Hospital of the Mutual Aid Association of Public School Teachers
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University, School of Medicine
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | | | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Keisuke Ueki
- Department of Neurologic Surgery, Dokkyo Medical University
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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11
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Ikawa F, Ichihara N, Uno M, Shiokawa Y, Toyoda K, Minematsu K, Kobayashi S, Yamaguchi S, Kurisu K. Visualisation of the non-linear correlation between age and poor outcome in patients with aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2021; 92:1173-1180. [PMID: 34170840 DOI: 10.1136/jnnp-2020-325306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To visualise the non-linear correlation between age and poor outcome at discharge in patients with aneurysmal subarachnoid haemorrhage (SAH) while adjusting for covariates, and to address the heterogeneity of this correlation depending on disease severity by a registry-based design. METHODS We extracted data from the Japanese Stroke Databank registry for patients with SAH treated via surgical clipping or endovascular coiling within 3 days of SAH onset between 2000 and 2017. Poor outcome was defined as a modified Rankin Scale Score ≥3 at discharge. Variable importance was calculated using machine learning (random forest) model. Correlations between age and poor outcome while adjusting for covariates were determined using generalised additive models in which spline-transformed age was fit to each neurological grade of World Federation of Neurological Societies (WFNS) and treatment. RESULTS In total, 4149 patients were included in the analysis. WFNS grade and age had the largest and second largest variable importance in predicting the outcome. The non-linear correlation between age and poor outcome was visualised after adjusting for other covariates. For grades I-III, the risk slope for unit age was relatively smaller at younger ages and larger at older ages; for grade IV, the slope was steep even in younger ages; while for grade V, it was relatively smooth, but with high risk even at younger ages. CONCLUSIONS The clear visualisation of the non-linear correlation between age and poor outcome in this study can aid clinical decision making and help inform patients with aneurysmal SAH and their families better.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan .,Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical school, Kurashiki, Okayama, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Neurology, Iseikai Medical Corporation, Osaka, Japan
| | - Shotai Kobayashi
- Department of Neurology, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Shimane University School of Medicine, Izumo, Shimane, Japan.,Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Neurosurgery, Chugoku Rosai Hospital, Kure, Hiroshima, Japan
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Imada Y, Mihara C, Kawamoto H, Kurisu K. Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein. Neurol Med Chir (Tokyo) 2021; 61:731-740. [PMID: 34645716 PMCID: PMC8666298 DOI: 10.2176/nmc.oa.2021-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/21/2022] Open
Abstract
The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.
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Affiliation(s)
| | - Chie Mihara
- Department of Neurosurgery, Yamada Memorial Hospital
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku Rosai Hospital
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13
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Araki H, Uchida K, Yoshimura S, Kurisu K, Shime N, Sakamoto S, Aoki S, Ichinose N, Kajihara Y, Tominaga A, Naka H, Mizoue T, Sumida M, Hirotsune N, Nomura E, Matsushige T, Kanazawa J, Kato Y, Kawamoto Y, Kuroki K, Morimoto T. Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke. J Neurointerv Surg 2021; 14:677-682. [PMID: 34413244 PMCID: PMC9209665 DOI: 10.1136/neurintsurg-2021-017863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/02/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals. OBJECTIVE To explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI). METHODS We implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO. RESULTS The cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO. CONCLUSIONS Use of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke.
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Affiliation(s)
- Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.,Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Yosuke Kajihara
- Department of Neurosurgery, Itsukaichi Memorial Hospital, Hiroshima, Japan
| | - Atsushi Tominaga
- Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiromitsu Naka
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masayuki Sumida
- Department of Neurosurgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Nobuyuki Hirotsune
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Yukio Kato
- Department of Neurosurgery, Saiseikai Hiroshima Hospital, Aki-gun, Japan
| | | | - Kazuhiko Kuroki
- Department of Neurosurgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
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14
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Hosomi K, Yamamoto T, Agari T, Takeshita S, Tanei T, Imoto H, Mori N, Oshino S, Kurisu K, Kishima H, Saitoh Y. Benefit of spinal cord stimulation for patients with central poststroke pain: a retrospective multicenter study. J Neurosurg 2021; 136:601-612. [PMID: 34214987 DOI: 10.3171/2020.11.jns202999] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) has been considered an ineffective procedure for patients with central poststroke pain (CPSP). However, recent case series that included small numbers of patients reported the possible efficacy of SCS as a treatment of CPSP. This multicenter retrospective study aimed to examine the outcomes of using SCS to treat patients with CPSP and to explore factors related to outcomes. METHODS The authors reviewed the medical records of patients with CPSP who underwent SCS to collect data regarding their background, surgical information, and outcomes of SCS at trial stimulation and last follow-up after long-term implantation in six study centers. Outcomes were evaluated with a pain score for intensity (range 0-10) and the Patient Global Impression of Changes (PGIC) scale. Factors associated with outcomes were explored with univariable and multivariable analyses. RESULTS The authors collected data from a total of 166 patients (mean age 63.4 years; mean pain score at baseline 8.2). Of these patients, 163 underwent trial stimulation. The mean pain score decreased by 42.0%, 104 (64%) patients had ≥ 30% decrease in pain score, and 96 (59%) reported much or very much improved condition on the PGIC scale at trial stimulation. Moreover, 106 (64%) patients underwent long-term implantation of SCS devices. The mean decrease in pain score was 41.4%, 63 (59%) patients continued to show ≥ 30% decrease in pain score at last follow-up, and 60 (56%) reported much or very much improved condition on the PGIC scale at last follow-up (median [range] follow-up period 24 [24-63] months). Eleven device-related complications and 10 permanent explantations were observed. Univariable and multivariable analyses suggested that young age, less sensory disturbance, implantation of cervical leads, treatment of upper-limb pain, and extensive treated regions were associated with satisfactory outcomes at last follow-up after long-term implantation. CONCLUSIONS These findings indicate that SCS may modestly benefit patients with CPSP. SCS has therapeutic potential for patients with intractable CPSP owing to the lower invasiveness of the SCS procedure and refractory nature of CPSP. Nevertheless, trial stimulation is necessary because of the high initial failure rate.
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Affiliation(s)
- Koichi Hosomi
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Takamitsu Yamamoto
- 3Department of Neurological Surgery, Nihon University School of Medicine, Tokyo
| | - Takashi Agari
- 4Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo.,5Department of Neurological Surgery, Kurashiki-Heisei Hospital, Okayama
| | - Shinichiro Takeshita
- 6Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima
| | - Takafumi Tanei
- 7Department of Neurosurgery, Komaki City Hospital, Aichi
| | - Hirochika Imoto
- 8Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi; and
| | - Nobuhiko Mori
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Satoru Oshino
- 2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Kaoru Kurisu
- 9Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Haruhiko Kishima
- 2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
| | - Youichi Saitoh
- Departments of1Neuromodulation and Neurosurgery and.,2Neurosurgery, Osaka University Graduate School of Medicine, Osaka
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Katagiri M, Otsubo H, Kagawa K, Seyama G, Hashizume A, Okamura A, Ishikawa N, Hanaya R, Arita K, Kurisu K, Iida K. Interpersonal communication skills related to seizure outcomes in pediatric patients with vagus nerve stimulation. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.101080] [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: 10/22/2022] Open
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16
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Imada Y, Takumi T, Aoyama H, Sadatomo T, Kurisu K. Morphological Classification of the Medial Frontal Cortex Based on Cadaver Dissections: A Guide for Interhemispheric Approach. Neurol Med Chir (Tokyo) 2021; 61:302-311. [PMID: 33854001 PMCID: PMC8120095 DOI: 10.2176/nmc.oa.2020-0192] [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] [Indexed: 11/20/2022] Open
Abstract
The medial frontal cortex (MFC) is a part of the medial surface of the frontal lobe situated in the rostral portion of the corpus callosum (CC). In a surgical interhemispheric approach (IHA), the MFC covers the anterior communicating artery (Aco) complex until the final stage of dissection. To clarify the anatomical relationship between the MFC and the Aco complex, and to facilitate orientation in IHA, we analyzed the morphological features of the MFC in number, size, and pattern of gyri from the medial surface of the hemisphere in the subcallosal portion using 53 adult cadaveric hemispheres. The mean width of the MFC excluding cingulate gyrus (MFCexcg) was 20.6 ± as mm in the subcallosal portion. MFCexcg consisting of 2, 3, 4, or 5 gyri were observed in 7.5%, 56.6%, 32.1%, or 3.8% of the hemispheres, respectively. Bilateral MFCexcg consisting of >2 gyri were observed in approximately 85% of the hemispheres. Therefore, in many cases, the dissection performed at 2 cm upward from the base of the straight gyrus (SG) or 3–4 gyri of the MFC is sufficient to safely reach the upper portion of the cistern of lamina terminalis located distal to the Aco complex in IHA. The MFC is a good landmark for intraoperative orientation in IHA.
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Affiliation(s)
| | - Toru Takumi
- Department of Integrative Bioscience, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Physiology and Cell Biology, Kobe University School of Medicine
| | - Hirohiko Aoyama
- Department of Anatomy and Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Faculty of Health Science, Hiroshima International University
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku-Rosai Hospital
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Thohar Arifin M, Hanaya R, Bakhtiar Y, Bintoro AC, Iida K, Kurisu K, Arita K, Bunyamin J, Askoro R, Brilliantika SP, Khairunnisa NI, Muttaqin Z. Initiating an epilepsy surgery program with limited resources in Indonesia. Sci Rep 2021; 11:5066. [PMID: 33658553 PMCID: PMC7930083 DOI: 10.1038/s41598-021-84404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/23/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the first period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the first period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170–9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia.
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima Prefecture, Japan
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima City, Hiroshima Prefecture, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima City, Hiroshima Prefecture, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima Prefecture, Japan
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Surya Pratama Brilliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Novita Ikbar Khairunnisa
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang City, Central Java Province, Indonesia
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Ikawa F, Isobe N, Michihata N, Oya S, Ohata K, Saito K, Yoshida K, Fushimi K, Yasunaga H, Tominaga T, Kurisu K. In-Hospital Complications After Surgery in Elderly Patients with Asymptomatic or Minor Symptom Meningioma: A Nationwide Registry Study. World Neurosurg 2021; 148:e459-e470. [PMID: 33444840 DOI: 10.1016/j.wneu.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/20/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asymptomatic or minor symptom meningiomas (AMSMs) in the elderly are incidental findings, with no consensus reached on the optimal management strategy. In the present study, we aimed to determine the surgical risk factors for elderly patients with AMSMs using a nationwide registry database in Japan. METHODS We identified patients with surgically treated AMSMs using the Diagnosis Procedure Combination database from 2010 to 2015 and reviewed the medical records for age (<65 years; pre-elderly, 65-74 years; and elderly, ≥75 years), sex, Barthel index (BI) score, medical history, tumor location, and complications. An AMSM was defined by a BI score of 100 points at admission. The risk factors for all stroke complications, BI deterioration at discharge, and in-hospital mortality were determined using multivariate logistic regression analyses. RESULTS From a total of 10,535 patients with meningioma, 6628 were included. Advanced age was a significant risk factor (odds ratio, 3.54; 95% confidence interval, 2.80-4.46) for BI deterioration but not for all-stroke complications or in-hospital mortality. Midline and posterior fossa tumors, diabetes mellitus, and chronic heart disease were significant risk factors for in-hospital mortality. CONCLUSIONS For elderly patients with surgically treated AMSMs, advanced age was a prominent risk factor for functional decline at discharge. Our study identified several factors that should be evaluated before proceeding with surgery for AMSMs in elderly and pre-elderly patients. These findings could, not only improve decision-making among clinicians treating patients with AMSMs, but also help in predicting the results of surgery for elderly patients with AMSMs.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | - Naoyuki Isobe
- Department of Neurosurgery, JA Onomichi General Hospital, Onomichi, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Takano M, Kinoshita Y, Sugiyama K, Kolakshyapati M, Takayasu T, Yonezawa U, Taguchi A, Akiyama Y, Amatya VJ, Takeshima Y, Kurisu K, Yamasaki F. Detecting non-germinomatous germ cell tumor component by arterial spin labeling perfusion-weighted MR imaging in central nervous system germ cell tumor. Eur J Radiol 2021; 136:109523. [PMID: 33460957 DOI: 10.1016/j.ejrad.2021.109523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/15/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Differentiating between germinoma and non-germinomatous germ cell tumor (NGGCT) is important because sensitivity to chemotherapy and/or radiotherapy is quite different between these two subgroups. In this study, we evaluated whether the arterial spin labeling (ASL) based perfusion-weighted imaging (PWI) could provide additional information for the differential diagnosis between germinoma and NGGCT. METHOD Between 2011 and 2018, 20 patients with central nervous system (CNS) germ cell tumor (GCT) who underwent preoperative MR imaging including ASL-PWI were enrolled in this study. Relative tumor blood flow (rTBF) was evaluated on ASL-PWI by manually placing regions of interest at gadolinium enhanced part of the tumors and normal subcortical white matter. Presence of intratumoral T1 hyperintense foci and apparent diffusion coefficient (ADC) were also evaluated. The final diagnosis was made by the combination of tumor markers and the histological diagnosis. RESULTS Among 20 patients of CNS-GCT, 11 were diagnosed as germinoma and 9 were diagnosed as NGGCT. In the germinoma subgroup, the rTBF ranged from 0.90 to 1.71 (mean 1.21, median 1.09), while it ranged from 1.14 to 5.75 (mean 3.91, median 3.31) in NGGCT subgroup. The receiver operating characteristic (ROC) curve showed that calculating rTBF is useful for differentiating between germinoma and NGGCT (area under the curve (AUC) 0.929, P = 0.0012) compared to intratumoral T1 hyperintense foci (AUC 0.788, P = 0.0304) and ADC (AUC 0.919, P = 0.0016). CONCLUSIONS High rTBF obtained by ASL-PWI implied the presence of NGGCT component. This information might help in deciding the chemotherapy/radiotherapy intensity.
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Affiliation(s)
- Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yasuyuki Kinoshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Neurosurgery, B & B Hospital, Gwarko, Lalitpur, Nepal
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Akiyama
- Department of Clinical Radiology, Hiroshima University, Hiroshima 734-8551, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Kaoru Kurisu
- Director, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima 737-0193, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Yoshiyama M, Ikawa F, Hidaka T, Matsuda S, Ozono I, Toyoda K, Kobayashi S, Yamaguchi S, Kurisu K. Development and Validation of Scoring Indication of Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage from the Post Hoc Analysis of Japan Stroke Data Bank. Neurol Med Chir (Tokyo) 2020; 61:107-116. [PMID: 33390556 PMCID: PMC7905300 DOI: 10.2176/nmc.oa.2020-0262] [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] [Indexed: 12/03/2022] Open
Abstract
There are no scoring methods for optimal treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH). We developed a scoring model to predict clinical outcomes according to aSAH risk factors using data from the Japan Stroke Data Bank (JSDB). Of 5344 patients initially registered in the JSDB, 3547 met the inclusion criteria. Patients had been diagnosed with aSAH and treated with surgical clipping or endovascular coiling between 1998 and 2013. We performed multivariate logistic regression for poor outcomes at discharge, indicated by a modified Rankin Scale (mRS) score >2, and in-hospital mortality for both treatment methods. Based on each risk factor, we developed a scoring model assessing its validity using another dataset of our institution. In the surgical clipping group, scoring criteria for aSAH were age >72 years, history of more than once stroke, World Federation of Neurological Societies (WFNS) grades II–V, aneurysmal size >15 mm, and vertebrobasilar artery (VBA) aneurysm location. In the endovascular coiling group, scoring criteria were age >80 years, history of stroke, WFNS grades III–V, computed tomography (CT) Fisher group 4, and aneurysmal location in the middle cerebral artery (MCA) and anterior cerebral artery (ACA). The rates of poor outcome of mRS score >2 in an isolated dataset using these scoring criteria were significantly correlated with our model’s scores, so this scoring model was validated. This scoring model can help in the more objective treatment selection in patients with aSAH.
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Affiliation(s)
- Michitsura Yoshiyama
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Shimizu K, Mitsuhara T, Takeda M, Kurisu K, Yamaguchi S. Effects of Preservation of the Semispinalis Cervicis Inserted into C2 on Craniocervical Alignment After Laminoplasty. World Neurosurg 2020; 146:e1367-e1376. [PMID: 33309896 DOI: 10.1016/j.wneu.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/23/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The preservation of nuchal musculature is essential for preventing axial pain and cervical malalignment after laminoplasty. A few studies have examined the effect of preservation of nuchal musculature on the degenerative progression after laminoplasty. We aimed to clarify the influence of preservation of the semispinalis cervicis inserted into C2 on cervical degenerative change and alignment after laminoplasty. METHODS We retrospectively reviewed 106 consecutive patients who underwent C3-7 laminoplasty for cervical spondylotic myelopathy during 2006-2017. Patients were classified into 2 groups according to the preservation (P-group; n = 33) or detachment (D-group; n = 73) of the Semispinalis cervicis muscles inserted into the C2 spinous process. Parameters of cervical sagittal alignment, range of motion, and progressive degenerative changes next to or within the range of laminoplasty were evaluated in cervical spine radiographs, and magnetic resonance images obtained during follow-up period. RESULTS In the D-group, the postoperative C2-7 Cobb angle significantly decreased (-0.06°/month), while the O-C2 Cobb angle significantly increased (0.07°/month). In addition, the C2-7 range of motion significantly decreased in the D-group (-0.12°/month). Degenerative changes in the laminoplasty range were found in 5 patients per group. Three patients from the D-group developed retroodontoid pseudotumors (P < 0.001). CONCLUSIONS To maintain horizontal gaze, the craniocervical segment can compensate for the loss of lordosis by increasing the Cobb angle. Excessive compensation may exert mechanical stress on the atlantoaxial junction, contributing to the development of a retroodontoid pseudotumor. Preservation of the semispinalis cervicis inserted into C2 is critical for the prevention of malalignment after laminoplasty.
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Affiliation(s)
- Kiyoharu Shimizu
- Departments of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takafumi Mitsuhara
- Departments of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaaki Takeda
- Departments of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Departments of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Satoshi Yamaguchi
- Departments of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Kuwabara M, Sakamoto S, Okazaki T, Oshita J, Taguchi A, Kurisu K. Pediatric pial arteriovenous fistula located at the bottom of the callosal sulcus presenting with intraventricular hemorrhage: a case report and literature review. Childs Nerv Syst 2020; 36:3129-3133. [PMID: 32346787 DOI: 10.1007/s00381-020-04635-1] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A pial arteriovenous fistula (pAVF) is a rare condition characterized by a direct connection between a cerebral artery and cerebral vein without an intervening nidus. The prognosis is poor in untreated cases with hemorrhagic manifestations, indicating that surgical treatment is desirable. We describe a successful endovascular treatment for a pediatric case of ruptured pAVF located at the bottom of the sulcus. CLINICAL DESCRIPTION An 11-year-old girl presented with severe headache and mild disturbance of consciousness. Head computed tomography showed hemorrhage in the callosal sulcus and ventricle. Cerebral angiography showed an arteriovenous shunt without a nidus. The branching artery from the pericallosal artery was connected directly to the thalamostriate vein without varix, and the shunt point was located at the bottom of the callosal sulcus. The patient was diagnosed with pAVF involving a single feeder and single drainer. Emergency endovascular transarterial embolization was performed using 20% N-butyl cyanoacrylate, and the shunt disappeared completely without complications. The patient was discharged with no neurological deficits. CONCLUSION Endovascular treatment is feasible, safe, and effective for pediatric cases of deeply located pAVF.
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Affiliation(s)
- Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan.
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
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23
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Ohba H, Ikawa F, Hidaka T, Yoshiyama M, Matsuda S, Akiyama Y, Ohkuma H, Yamaguchi S, Inagawa T, Kurisu K. Aging Changes of Aneurysmal Subarachnoid Hemorrhage: A 35-year, Hospital-Based Study. J Stroke Cerebrovasc Dis 2020; 29:105247. [PMID: 33066898 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105247] [Citation(s) in RCA: 2] [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: 06/22/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The etiology and background factors which cause decreases in the size of ruptured intracranial aneurysms remain unclear. OBJECTIVE To clarify the age- and sex-related differences in aneurysmal subarachnoid hemorrhage (SAH) based on a 35-year-old hospital database and demographic data. METHODS A database of patients admitted to our hospital with aneurysmal SAH from 1983 to 2017 was split into 5-year intervals and analyzed. Demographic data of the general population were also analyzed for reference. RESULTS Altogether, 1,523 aneurysmal SAH events were enrolled in the analysis. Age (p<0.001), proportion of elderly patients ≥ 65 years old (p<0.001), female sex (p=0.005), very small aneurysms less than 5 mm (p<0.001), and the yearly-averaged number of fatal events showed increasing trends. The proportion of aneurysm size of 10 mm or more (p = 0.011) and the yearly-averaged population of Shimane prefecture (p < 0.001) showed declining trends. In the subgroup analyses, the proportion of very small aneurysms was found to increase significantly in the non-elderly male and elderly female subgroups. The proportion of large aneurysms (10 mm or more) decreased in the non-elderly subgroup (p<0.05). As for the elderly subgroups, the yearly-averaged number of events did not show a significant tendency, although the yearly-averaged population of Shimane prefecture showed an increasing trend. CONCLUSION We found an increasing trend in the prevalence of very small aneurysms in elderly females. Recent aging may contribute to this trend. The number of aneurysmal SAH events was confirmed to not increase, despite the increased aging population of Shimane prefecture.
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Affiliation(s)
- Hideo Ohba
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | | | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Japan.
| | - Shuhei Yamaguchi
- Hospital Bureau of Shimane Prefecture, Izumo, Japan; Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
| | - Tetsuji Inagawa
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.
| | - Kaoru Kurisu
- Hiroshima University Graduate School of Biomedical Sciences, Department of Neurosurgery, Hiroshima, Japan.
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Takayasu T, Kurisu K, Esquenazi Y, Ballester LY. Ion Channels and Their Role in the Pathophysiology of Gliomas. Mol Cancer Ther 2020; 19:1959-1969. [PMID: 33008831 PMCID: PMC7577395 DOI: 10.1158/1535-7163.mct-19-0929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/24/2020] [Accepted: 08/06/2020] [Indexed: 01/10/2023]
Abstract
Malignant gliomas are the most common primary central nervous system tumors and their prognosis is very poor. In recent years, ion channels have been demonstrated to play important roles in tumor pathophysiology such as regulation of gene expression, cell migration, and cell proliferation. In this review, we summarize the current knowledge on the role of ion channels on the development and progression of gliomas. Cell volume changes through the regulation of ion flux, accompanied by water flux, are essential for migration and invasion. Signaling pathways affected by ion channel activity play roles in cell survival and cell proliferation. Moreover, ion channels are involved in glioma-related seizures, sensitivity to chemotherapy, and tumor metabolism. Ion channels are potential targets for the treatment of these lethal tumors. Despite our increased understanding of the contributions of ion channels to glioma biology, this field remains poorly studied. This review summarizes the current literature on this important topic.
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Affiliation(s)
- Takeshi Takayasu
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Hiroshima, Japan
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Medical School, Houston, Texas.
- Memorial Hermann Hospital-TMC, Houston, Texas
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Medical School, Houston, Texas
- Memorial Hermann Hospital-TMC, Houston, Texas
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25
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Arifin MT, Hanaya R, Bakhtiar Y, Bintoro AC, Iida K, Kurisu K, Arita K, Bunyamin J, Askoro R, Brillantika SP, Muttaqin Z. Preoperative sensory aura predicts risk for seizure in temporal lobe epilepsy surgery. Epilepsy Behav 2020; 111:107255. [PMID: 32759061 DOI: 10.1016/j.yebeh.2020.107255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/17/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with temporal lobe epilepsy (TLE) often report viscerosensory and experiential auras, with substantial epilepsy localization. However, few previous studies have investigated the epileptic preoperative aura, particularly with regard to its effect on surgical outcomes in patients with drug-resistant epilepsy. OBJECTIVE This study investigated the potential role of preoperative aura in predicting outcomes after surgery for TLE. MATERIAL AND METHODS This study included consecutive patients diagnosed with TLE who underwent anterior temporal lobectomy (ATL) for drug-resistant TLE during the period from January 1999 to December 2017. Data pertaining to patient age at the time of surgery, sex, age at initial seizure onset, duration of epilepsy, presence of preoperative aura, comprehensive clinical semiology, side of surgery, and type of pathology were analyzed. Preoperative auras were classified as autonomic, sensory, mental and affective, or multiple manifestations. Patients were followed at 3 and 12 months after surgery and at regular intervals thereafter. RESULTS AND CONCLUSIONS A total of 498 patients were included in the study. Positive preoperative aura was observed in 386 patients (77.51%). The correlation of each variable with seizure outcomes was analyzed, and the only variable found to correlate with seizure outcome was the presence of preoperative aura. Compared with those with negative preoperative aura, those with positive preoperative aura were 1.74-fold more likely to be seizure-free after surgery for TLE. The analysis of patient data suggested a later onset of initial seizure in those with positive preoperative aura, compared with those without (p = 0.04, 95% confidence interval (CI): 0.55-3.24). Patients with a shorter duration of disease prior to TLE surgery were more likely to achieve seizure-free status postoperatively. Preoperative sensory aura was a good predictor that a patient would be seizure-free during follow-up (p = 0.022).
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Affiliation(s)
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Surya P Brillantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Indonesia
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Okamura A, Otsubo H, Hashizume A, Kagawa K, Katagiri M, Seyama G, Kurisu K, Iida K. Secondary epileptogenesis on gradient magnetic-field topography correlates with seizure outcomes after vagus nerve stimulation. Epilepsy Res 2020; 167:106463. [PMID: 32987243 DOI: 10.1016/j.eplepsyres.2020.106463] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the correlation between secondary unilateral or bilateral spreading on gradient magnetic-field topography (GMFT) before and after vagus nerve stimulation (VNS), and postoperative seizure outcomes. METHODS We analyzed pre- and post-VNS magnetoencephalography (MEG) in 15 patients with VNS implants. We applied McHugh classification to evaluate seizure outcomes. GMFT visualized the spatiotemporal spread of the gradient magnetic field from MEG (>300 fT/cm) before and after the spike peak. We compared the proportion of bilaterally spreading (PBS) MEG spikes and seizure outcomes. We also compared the interhemispheric time difference (ITD) between patients with and without corpus callosotomy. RESULTS We allocated patients with favorable seizure outcomes of class I and II to group A (9 patients) and poor outcomes of class III-V to group B (6 patients). The number of post-VNS MEG spikes was significantly reduced compared to pre-VNS MEG spikes in group A, but not in group B. Group A showed significantly higher preoperative PBS than group B. Postoperative ITD significantly decreased in 5 patients who underwent corpus callosotomy compared to 10 patients without. CONCLUSION GMFT can detect the inter- and intrahemispheric spreading of spikes with high spatiotemporal resolution on the brain surface. Frequent interictal MEG spikes propagating bilaterally on GMFT may reflect a favorable seizure outcome after VNS. GMFT can identify dependent secondary epileptogenic spikes responding to VNS, which may be used to control generalized seizures in a subset of patients with pharmaco-resistant epilepsy.
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Affiliation(s)
- Akitake Okamura
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Otsubo
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Akira Hashizume
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Kota Kagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Masaya Katagiri
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Go Seyama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Epilepsy Center, Hiroshima University Hospital, Hiroshima, Japan.
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Takayasu T, Shah M, Dono A, Yan Y, Borkar R, Putluri N, Zhu JJ, Hama S, Yamasaki F, Tahara H, Sugiyama K, Kurisu K, Esquenazi Y, Ballester LY. Cerebrospinal fluid ctDNA and metabolites are informative biomarkers for the evaluation of CNS germ cell tumors. Sci Rep 2020; 10:14326. [PMID: 32868820 PMCID: PMC7459305 DOI: 10.1038/s41598-020-71161-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/24/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Serum and cerebrospinal fluid (CSF) levels of α-fetoprotein and β-subunit of human chorionic gonadotropin are used as biomarkers for the management of central nervous system (CNS) germ cell tumors (GCTs). However, additional discriminating biomarkers are required. Especially, biomarkers to differentiate non-germinomatous germ cell tumors (NGGCTs) from germinomas are critical, as these have a distinct prognosis. We investigated CSF samples from 12 patients with CNS-GCT patients (8 germinomas and 4 NGGCTs). We analyzed circulating tumor DNA (ctDNA) in CSF to detect mutated genes. We also used liquid chromatography-mass spectrometry to characterize metabolites in CSF. We detected KIT and/or NRAS mutation, known as frequently mutated genes in GCTs, in 3/12 (25%) patients. We also found significant differences in the abundance of 15 metabolites between control and GCT, with unsupervised hierarchical clustering analysis. Metabolites related to the TCA cycle were increased in GCTs. Urea, ornithine, and short-chain acylcarnitines were decreased in GCTs. Moreover, we also detected several metabolites (e.g., betaine, guanidine acetic acid, and 2-aminoheptanoic acid) that displayed significant differences in abundance in patients with germinomas and NGGCTs. Our results suggest that ctDNA and metabolites in CSF can serve as novel biomarkers for CNS-GCTs and can be useful to differentiate germinomas from NGGCTs.
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Affiliation(s)
- Takeshi Takayasu
- Department of Pathology and Laboratory Medicine, Molecular Genetic Pathology and Neuropathology, The University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ward, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Mauli Shah
- Department of Pathology and Laboratory Medicine, Molecular Genetic Pathology and Neuropathology, The University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, UTHealth McGovern Medical School, the University of Texas Health Science Center, Houston, TX, USA
| | - Yuanqing Yan
- Vivian L. Smith Department of Neurosurgery, UTHealth McGovern Medical School, the University of Texas Health Science Center, Houston, TX, USA
| | - Roshan Borkar
- Metabolomics Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Nagireddy Putluri
- Metabolomics Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Jay-Jiguang Zhu
- Vivian L. Smith Department of Neurosurgery, UTHealth McGovern Medical School, the University of Texas Health Science Center, Houston, TX, USA.,Memorial Hermann Hospital-TMC, Houston, TX, USA
| | - Seiji Hama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ward, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ward, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Hidetoshi Tahara
- Department of Cellular and Molecular Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ward, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, UTHealth McGovern Medical School, the University of Texas Health Science Center, Houston, TX, USA.,Memorial Hermann Hospital-TMC, Houston, TX, USA.,Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center, Houston, USA
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, Molecular Genetic Pathology and Neuropathology, The University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA. .,Vivian L. Smith Department of Neurosurgery, UTHealth McGovern Medical School, the University of Texas Health Science Center, Houston, TX, USA. .,Memorial Hermann Hospital-TMC, Houston, TX, USA.
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Oshita J, Sakamoto S, Okazaki T, Kuwabara M, Kurisu K. Access-route Visualization Using Ultrasonography and CT Angiography to Predict the Feasibility of Transvenous Embolization via the Facial Vein for Cavernous Sinus Dural Arteriovenous Fistulas. J Neuroendovasc Ther 2020; 14:373-380. [PMID: 37501667 PMCID: PMC10370907 DOI: 10.5797/jnet.oa.2020-0038] [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] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/07/2020] [Indexed: 07/29/2023]
Abstract
Objective Transvenous embolization (TVE) is an effective treatment for cavernous sinus dural arteriovenous fistulas (CS-DAVFs). The facial vein (FV) can be used as an access route for TVE when a trans-inferior petrosal sinus (IPS) approach is difficult. We evaluated the usefulness of combining ultrasonography (US) with computed tomography angiography (CTA) for confirming that the FV is a suitable access route for treating CS-DAVFs. Methods Trans-FV TVE was planned for five CS-DAVF patients in whom the shunt point was located in the posterior compartment of the CS and anterior venous drainage predominantly occurred via the superior ophthalmic vein (SOV). The anterior drainage route was examined with CTA and US. We reviewed the relationships between preoperative CTA/US findings and the accessibility of CS-DAVFs via the FV. Results The periorbital and perimandibular drainage pathways were clearly more visible on US than on CTA, and the cervical and thoracic drainage pathways were more visible on CTA than on digital subtraction angiography (DSA). CS-DAVFs were accessible via the FV when (1) the entire drainage pathway could be confirmed on CTA and US, (2) the periorbital and perimandibular pathways were unclear on CTA, but could be confirmed on US, or (3) the FV pathway drained into the internal jugular vein (IJV) or external jugular vein (EJV). On the other hand, TVE was challenging to perform via the FV when (1) the periorbital pathway was unclear on CTA and US, (2) the FV pathway drained into the brachiocephalic vein, or (3) the SOV thrombosed intraoperatively. In all five patients, TVE for CS-DAVFs performed via the FV or IPS was successful. Conclusion CTA and US are useful for confirming the anterior access route for trans-FV TVE for CS-DAVFs and predicting the feasibility of such treatment. Our findings suggest that CS-DAVFs can be accessed via the FV if the periorbital drainage pathway can be confirmed on US, even if the pathway is unclear on CTA.
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Affiliation(s)
- Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Hashimoto Y, Matsushige T, Shimonaga K, Takahashi H, Mizoue T, Kaneko M, Ono C, Yamashita H, Yoshioka H, Sakamoto S, Kurisu K. Magnetic resonance vessel wall imaging predicts morphological deterioration in unruptured intracranial artery dissection. J Stroke Cerebrovasc Dis 2020; 29:105006. [PMID: 32807422 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105006] [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: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The mechanism involved in progression of unruptured intracranial artery dissection (IAD) is poorly understood. We investigated the relationship between contrast enhancement of dissecting lesions on magnetic resonance vessel wall imaging (MR-VWI) and unruptured IAD progression on the hypothesis that this finding might predict its instability. METHODS A total of 49 unruptured IADs were investigated retrospectively. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and the dissecting lesion/pituitary stalk contrast enhancement ratio (CRstalk) was calculated. Unruptured IAD progression was defined as morphological deterioration; progressive dilatation or stenosis. The relations between unruptured IAD progression and potential risk factors were statistically investigated. RESULTS Morphological deterioration was demonstrated in eleven of 49 unruptured IADs (22 %). The CRstalk value and male predominance was significantly higher in progressed IADs than stable ones (1.0 vs. 0.65; p = 0.0035, 82% vs 37%; p= 0.015, respectively). On stepwise multivariable logistic regression analysis, the CRstalk value was independently associated with unruptured IAD progression with odds ratio of 102.5 (95% CI, 2.59-4059, P=0.0013). The optimal cutoff value of CRstalk to estimate IADs with progression was 0.87 (sensitivity, 0.82; specificity, 0.74). Multimodalic images showed contrast enhancement on VWI corresponded to residual stagnant flow in dissecting lesions. CONCLUSIONS Quantitative analysis of contrast enhancement on VWI could predict instability of unruptured IADs. Contrast enhancement in dissecting lesions would be a clue to understand the mechanism of unruptured IAD progression.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Yamashita
- Department of Neurology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ozono I, Ikawa F, Hidaka T, Yoshiyama M, Matsuda S, Michihata N, Kobata H, Murayama Y, Sato A, Kato Y, Sano H, Yamaguchi S, Kurisu K. Risk Factor for Poor Outcome in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage Based on Post Hoc Analysis of the Modified WFNS Scale Study. World Neurosurg 2020; 141:e466-e473. [PMID: 32474089 DOI: 10.1016/j.wneu.2020.05.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/11/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE There is currently no precise guide for the treatment and management of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). Thus, the aim of this study was to clarify the factors of poor outcome and mortality in elderly patients with aSAH. METHODS In the modified World Federation of Neurosurgical Societies (mWFNS) scale study, 1124 patients were divided into 2 groups, elderly (age ≥65 years) and non-elderly (age <65 years), with aSAH investigated between October 2010 and March 2013 in Japan. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor was calculated through multivariate logistic regression analysis for poor outcomes, as indicated by the modified Rankin Scale (mRS) score ≥3 and mortality at 3 months after onset in each group. RESULTS Both groups demonstrated that the mWFNS scale was significant as a grade order risk factor for poor outcomes and mortality associated with disease. In the elderly group, risk factors for poor outcomes at 3 months after onset were older age (OR 1.10, 95% CI 1.06-1.14), male sex (OR 2.03, 95% CI 1.10-3.73), and severe cerebral vasospasm category (OR 10.13, 95% CI 4.30-23.87). Risk factors for mortality at 3 months after onset were older age (OR 1.06, 95% CI 1.01-1.11) and severe vasospasm category (OR 2.17, 95% CI 1.00-4.72). CONCLUSIONS The mWFNS scale is a useful prognostic predictor for both non-elderly and elderly patients with aSAH. Elderly male patients with aSAH presenting with severe vasospasm should be managed more carefully.
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Affiliation(s)
- Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | | | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Kobata
- Department of Neurosurgery, Osaka Mishima Emergency Critical Care Center, Osaka, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Sato
- Department of Emergency, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Hirotoshi Sano
- Department of Neurosurgery, Shinkawabashi Hospital, Kawasaki, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Arifin MT, Bakhtiar Y, Andar EBPS, Kurnia B H, Priambada D, Risdianto A, Kusnarto G, Tsaniadi K, Bunyamin J, Hanaya R, Arita K, Bintoro AC, Iida K, Kurisu K, Askoro R, Briliantika SP, Muttaqin Z. Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources. Sci Rep 2020; 10:8144. [PMID: 32424296 PMCID: PMC7235248 DOI: 10.1038/s41598-020-64968-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 11/08/2022] Open
Abstract
Approximately 26-30% of temporal lobe epilepsy (TLE) cases display a normal-appearing magnetic resonance image (MRI) leading to difficulty in determining the epileptogenic focus. This causes challenges in surgical management, especially in countries with limited resources. The medical records of 154 patients with normal-appearing MRI TLE who underwent epilepsy surgery between July 1999 and July 2019 in our epilepsy centre in Indonesia were examined. The primary outcome was the Engel classification of seizures. Anterior temporal lobectomy was performed in 85.1% of the 154 patients, followed by selective amygdalo-hippocampectomy and resection surgery. Of 82 patients (53.2%), Engel Class I result was reported in 69.5% and Class II in 25.6%. The median seizure-free period was 13 (95% CI,12.550-13.450) years, while the seizure-free rate at 5 and 12 years follow-up was 96.3% and 69.0%, respectively. Patients with a sensory aura had better seizure-free outcome 15 (11.575-18.425) years. Anterior temporal lobectomy and selective amygdala-hippocampectomy gave the same favourable outcome. Despite the challenges of surgical procedures for normal MRI TLE, our outcome has been favourable. This study suggests that epilepsy surgery in normal MRI TLE can be performed in centres with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia.
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Erie B P S Andar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Happy Kurnia B
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Dody Priambada
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ajid Risdianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Gunadi Kusnarto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Krisna Tsaniadi
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Surya P Briliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
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Yonezawa U, Karlowee V, Amatya VJ, Takayasu T, Takano M, Takeshima Y, Sugiyama K, Kurisu K, Yamasaki F. Radiology Profile as a Potential Instrument to Differentiate Between Posterior Fossa Ependymoma (PF-EPN) Group A and B. World Neurosurg 2020; 140:e320-e327. [PMID: 32428725 DOI: 10.1016/j.wneu.2020.05.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/24/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Posterior fossa ependymoma (PF-EPN) was categorized into PF-EPN-A and PF-EPN-B subgroups based on the DNA methylation profiling. PF-EPN-A was reported to have poorer prognosis compared with PF-EPN-B. In this study, we particularly evaluated preoperative imaging to distinguish PF-EPN-A from PF-EPN-B. METHODS Sixteen cases of PF-EPN were treated in our institution from 1999 to 2018. The patients were divided into PF-EPN-A and PF-EPN-B groups based on H3K27me3 immunostaining positivity. We evaluated progression-free survival, overall survival, as well as preoperative magnetic resonance imaging and computed tomography scan images in both groups. Based on T1WI and Gd-T1WI magnetic resonance images, the tumor contrast rate was determined from dividing the volume of gadolinium enhanced tumor by the overall tumor volume. RESULTS Nine cases (4 male, 5 female) were grouped as PF-EPN-A, and 7 (4 male, 3 female) as PF-EPN-B. The median age of PF-EPN-A and PF-EPN-B were 4 and 43 years old, respectively. In the PF-EPN-A group, the progression-free survival median value was 32.6 months, and the overall survival median was 96.9 months. In contrast, PFS in PF-EPN-B did not reach a median value (P < 0.05) and all the patients were alive (P < 0.05) at the end of the study. With imaging, tumor contrast rate in PF-EPN-B was more than 50% and significantly different from PF-EPN-A (P = 0.0294). Calcification was mainly observed in PF-EPN-A, whereas cystic formation was only seen in PF-EPN-B. CONCLUSIONS Contrast rate less than 50%, based on the magnetic resonance images, was characteristic in the PF-EPN-A group. Comparatively, cystic component and absence of calcification were more characteristic in the PF-EPN-B group.
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Affiliation(s)
- Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Vega Karlowee
- Department of Pathological Anatomy, Diponegoro University, Semarang, Indonesia
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Takeishi Y, Takayasu T, Kolakshyapati M, Yonezawa U, Amatya VJ, Takano M, Taguchi A, Takeshima Y, Sugiyama K, Kurisu K, Yamasaki F. Advantage of high b value diffusion-weighted imaging for differentiation of common pediatric brain tumors in posterior fossa. Eur J Radiol 2020; 128:108983. [PMID: 32438259 DOI: 10.1016/j.ejrad.2020.108983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/07/2019] [Revised: 03/15/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The pediatric posterior fossa (PF) brain tumors with higher frequencies are embryonal tumors (ET), ependymal tumors (EPN) and pilocytic astrocytomas (PA), however, it is often difficult to make a differential diagnosis among them with conventional MRI. The ADC calculated from DWI could be beneficial for diagnostic work up. METHOD We acquired DWI at b = 1000 and 4000(s/mm2). The relationship between ADC and the three types of brain tumors was evaluated with Mann-Whitney U test. We also performed simple linear regression analysis to evaluate the relationship between ADC and cellularity, and implemented receiver operating characteristic curve (ROC curve) to test the diagnostic performance among tumors. RESULTS The highest ADC (b1000/b4000 × 10-3 mm2/s) was observed in PA (1.02-1.91/0.73-1.28), followed by PF-EPN (0.83-1.28/0.60-0.79) and the lowest was ET (0.41-0.75/0.29-0.47). There was significant difference among the groups in both ADC value (b-1000/b-4000: ET vs. PF-EPN p < 0.0001/0.0001, ET vs. PA p < 0.0001/0.0001, PF-EPN vs. PA p < 0.0001/0.0001). ROC analysis revealed that ADC in both b-values showed complete separation between ET and PF-EPN. And it also revealed that ADC at b-4000 could differentiate PF-EPN and PA (96.0%) better than ADC at b-1000 (90.1%). The stronger negative correlation was observed between the ADC and cellularity at b-4000 than at b-1000 (R2 = 0.7415 vs.0.7070) CONCLUSIONS: ADC of ET was significantly lower than the other two groups, and ADC of PA was significantly higher than the other two groups in both b-1000 and b-4000. Our results showed that ADC at b-4000 was more useful than ADC at b-1000 especially for differentiation between PF-EPN and PA.
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Affiliation(s)
- Yusuke Takeishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | | | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Minami-ku, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
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Nakagawa K, Tomoi M, Higashi K, Utsumi S, Kawano R, Tanaka E, Kurisu K, Yuge L. Short-term effect of a close-fitting type of walking assistive device on spinal cord reciprocal inhibition. J Clin Neurosci 2020; 77:142-147. [PMID: 32386864 DOI: 10.1016/j.jocn.2020.04.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/27/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
One of the major problems with walking encountered by patients with spastic hemiplegia is diminished toe clearance due to spasticity of their leg muscles. To improve their walking, a specialized robot assist for ankle movements (RE-Gait) has been utilized. The present study examined the neurophysiological effects whether spinal cord reciprocal Ia inhibition (RI) in the leg was altered by using RE-Gait. Sixteen patients with a clinical diagnosis of stroke were divided into the two groups, RE-Gait walking group (Group R) and normal (controlled) walking group (Group C). In each group, they walked on a flat floor for 15 min with or without RE-Gait. The depression of soleus (Sol) H-reflexes conditioned by common peroneal nerve stimuli with the conditioning-test (C-T) intervals of 1, 2, 3, and 4 ms were assessed before and immediately after each walking session. After the intervention, the LSM (SE) of Sol H-reflex amplitude with 1, 2 and 3 ms C-T interval conditions were significantly decreased in group R (1 ms: 88.15 (4.60), 2 ms: 86.37 (4.60), 3 ms: 89.68 (4.62)) compared to group C (1 ms: 105.57 (4.56), 2 ms: 100.89 (4.58), 3 ms: 107.72 (4.58)) [1 ms: p = 0.012, 2 ms: p = 0.035, 3 ms: p = 0.011]. Walking assistive robot that targets ankle movements might be a new rehabilitation tool for regulating spinal cord excitability.
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Affiliation(s)
- Kei Nakagawa
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Tomoi
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Higashi
- Department of Rehabilitation, Innoshima Medical Association Hospital, Onomichi, Japan
| | - Sho Utsumi
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Reo Kawano
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Eiichiro Tanaka
- Graduate School of Information, Production and Systems, Faculty of Science and Engineering, Waseda University, Kita-Kyushu, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Louis Yuge
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Natsume A, Aoki K, Ohka F, Maeda S, Hirano M, Adilijiang A, Motomura K, Sumi M, Nishikawa R, Narita Y, Muragaki Y, Maruyama T, Ito T, Beppu T, Nakamura H, Kayama T, Sato S, Nagane M, Mishima K, Nakasu Y, Kurisu K, Yamasaki F, Sugiyama K, Onishi T, Iwadate Y, Terasaki M, Kobayashi H, Matsumura A, Ishikawa E, Sasaki H, Mukasa A, Matsuo T, Hirano H, Kumabe T, Shinoura N, Hashimoto N, Aoki T, Asai A, Abe T, Yoshino A, Arakawa Y, Asano K, Yoshimoto K, Shibui S, Okuno Y, Wakabayashi T. Genetic analysis in patients with newly diagnosed glioblastomas treated with interferon-beta plus temozolomide in comparison with temozolomide alone. J Neurooncol 2020; 148:17-27. [PMID: 32367437 DOI: 10.1007/s11060-020-03505-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to explore the genetic alterations and to identify good responders in the experimental arm in the tumor samples from newly diagnosed glioblastoma (GBM) patients enrolled in JCOG0911; a randomized phase II trial was conducted to compare the efficacy of interferonβ (IFNβ) plus temozolomide (TMZ) with that of TMZ alone. EXPERIMENTAL DESIGN: Of 122 tumors, we performed deep targeted sequencing to determine the somatic mutations, copy number variations, and tumor mutation burden; pyrosequencing for O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation; Sanger sequencing for the telomerase reverse transcriptase (TERT) promoter; and microsatellite instability (MSI) testing in 95, 91, 91 and 72 tumors, respectively. We performed a multivariable Cox regression analysis using backward stepwise selection of variables including clinical factors (sex, age, performance status, residual tumor after resection, tumor location) and genetic alterations. RESULTS Deep sequencing detected an IDH1 mutation in 13 tumors (14%). The MGMT promoter methylation by quantitative pyrosequencing was observed in 41% of the tumors. A mutation in the TERT promoter was observed in 69% of the tumors. While high tumor mutation burden (> 10 mutations per megabase) was seen in four tumors, none of the tumors displayed MSI-high. The clinical and genetic factors considered as independent favorable prognostic factors were gross total resection (hazard ratio [HR]: 0.49, 95% confidence interval, 0.30-0.81, P = 0.0049) and MGMT promoter methylation (HR: 0.43, 0.21-0.88, P = 0.023). However, tumor location at the temporal lobe (HR: 1.90, 1.22-2.95, P = 0.0046) was an independent unfavorable prognostic factor. No predictive factors specific to the TMZ + IFNβ + Radiotherapy (RT) group were found. CONCLUSION This additional sub-analytical study of JCOG0911 among patients with newly diagnosed GBM showed that tumor location at the temporal lobe, gross total resection, and MGMT promoter methylation were significant prognostic factors, although no factors specific to IFNβ addition were identified.
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Affiliation(s)
- Atsushi Natsume
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachi Maeda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Hirano
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Alimu Adilijiang
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Minako Sumi
- Radiation Oncology Department, Cancer Institute Hospital, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamio Ito
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Takaaki Beppu
- Department of Neurosurgery, Iwate Medical University, Iwate, Japan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Takamasa Kayama
- Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Shinya Sato
- Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoko Nakasu
- Department of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Takanori Onishi
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mizuhiko Terasaki
- Department of Neurosurgery, Kurume University Graduate School of Medicine, Kurume, Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobusada Shinoura
- Department of Neurosurgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomokazu Aoki
- Department of Neurosurgery, Kitano Hospital, Osaka, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan
| | - Soichiro Shibui
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Okuno
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ozono I, Sakamoto S, Okazaki T, Oshita J, Ishii D, Kurisu K. Management of post-puncture bleeding after neurointerventional procedures performed with a large-bore sheath introducer. J Clin Neurosci 2020; 74:61-64. [DOI: 10.1016/j.jocn.2020.01.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/12/2020] [Indexed: 12/16/2022]
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Iihara K, Tominaga T, Saito N, Suzuki M, Date I, Fujii Y, Hongo K, Houkin K, Kato A, Kato Y, Kawamata T, Kim P, Kinouchi H, Kohmura E, Kurisu K, Maruyama K, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Sonoda Y, Takahashi JC, Ueki K, Wakabayashi T, Yamamoto T, Yoshida K, Kayama T, Arai H. The Japan Neurosurgical Database: Overview and Results of the First-year Survey. Neurol Med Chir (Tokyo) 2020; 60:165-190. [PMID: 32238620 PMCID: PMC7174247 DOI: 10.2176/nmc.st.2019-0211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] Open
Abstract
The Japan Neurosurgical Database (JND) is a prospective observational study registry established in 2017 by the Japan Neurosurgical Society (JNS) to visualize real-world clinical practice, promote science, and improve the quality of care and neurosurgery board certification in Japan. We summarize JND’s aims and methods, and describes the 2018 survey results. The JND registered in-hospital patients’ clinical data mainly from JNS training institutions in 2018. Caseload, patient demographics, and in-hospital outcomes of the overall cohort and a neurosurgical subgroup were examined according to major classifications of main diagnosis. Neurosurgical caseload per neurosurgeon in training in core hospitals in 2018 was calculated as an indicator of neurosurgical training. Of 523,283 cases (male 55.3%) registered from 1360 participating institutions, the neurosurgical subgroup comprised of 33.9%. Among the major classifications, cerebrovascular diseases comprised the largest proportion overall and in the neurosurgical subgroup (53.1%, 41.0%, respectively), followed by neurotrauma (19.1%, 25.5%), and brain tumor (10.4%, 12.8%). Functional neurosurgery (6.4%, 3.7%), spinal and peripheral nerve disorders (5.1%, 10.1%), hydrocephalus/developmental anomalies (2.9%, 5.3%), and encephalitis/infection/inflammatory and miscellaneous diseases (2.9%, 1.6%) comprised smaller proportions. Most patients were aged 70–79 years in the overall cohort and neurosurgical subgroup (27.8%, 29.4%). Neurotrauma and cerebrovascular diseases in the neurosurgical subgroup comprised a higher and lower proportion, respectively, than in the overall cohort in elderly patients (e.g. 80 years, 46.9% vs. 33.5%, 26.8% vs. 54.4%). The 2018 median neurosurgical caseload per neurosurgeon in training was 80.7 (25–75th percentile 51.5–117.5). These initial results from 2018 reveal unique aspects of neurosurgical practice in Japan.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, Kyushu University Graduate School of Medical Sciences
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | | | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine.,Department of Neurosurgery, Ina Central Hospital
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Amami Kato
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital
| | | | - Phyo Kim
- Neurologic Surgery, Dokkyo Medical University
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | - Kenji Ohata
- Department of Neurosurgery, Osaka City University
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University Faculty of Medicine
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | | | | | | | - Takamasa Kayama
- Department of Advanced Medicine, Yamagata University School of Medicine
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine
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Ikawa F, Morita A, Nakayama T, Goto Y, Sakai N, Iihara K, Shiokawa Y, Date I, Nozaki K, Kinouchi H, Houkin K, Saito N, Tominaga T, Suzuki M, Miyamoto S, Kurisu K, Arai H. A register-based SAH study in Japan: high incidence rate and recent decline trend based on lifestyle. J Neurosurg 2020; 134:983-991. [PMID: 32217794 DOI: 10.3171/2020.1.jns192848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/29/2019] [Accepted: 01/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Japan has been reported to have the highest (and increasing) incidence of subarachnoid hemorrhage (SAH) in the world. However, there has never been a report on the nationwide incidence rate and recent trends for SAH in Japan. In this register-based study, the authors aimed to clarify the estimated nationwide SAH incidence rate and the recent trend in SAH incidence in Japan and the reasons for any changes in this trend. METHODS The authors compiled data from the Japanese Ministry of Health, Labour and Welfare and from the records of the Japan Neurosurgical Society. They reviewed the age-standardized nationwide SAH mortality rate, the estimated age-standardized SAH incidence rate according to the age-standardized SAH mortality rate, and the estimated crude SAH incidence rate, including the 95% confidence intervals, from 2003 to 2015. The trends in the number of treatments for unruptured and ruptured cerebral aneurysms, as well as the prevalence of hypertension, current smoking status, and use of cholesterol-lowering drugs, were assessed. The estimated treatment rate for unruptured cerebral aneurysms (UCAs) was also calculated along with the 95% confidence interval. RESULTS The estimated age-standardized nationwide SAH incidence rate significantly declined from 31.34 cases (95% CI 31.32-31.34) to 27.63 (95% CI 27.59-27.63; decrease by 11.8%) per 100,000 person-years. This decline was based on the 2010 population as the reference from 2003 through 2015 and a case-fatality rate of SAH that was assumed to decrease by 1% annually from 44% in 2003 to 32% in 2015. According to sensitivity analysis, the change rate of the estimated age-standardized SAH incidence rate ranged from -56.69% to 23.27%, with a mean of -30.91% (SD 20.52%), and there were decline trends in 92% of all trends. The estimated nationwide crude SAH incidence rate also showed a significant decline from 23.79 (95% CI 23.78-23.79) to 20.25 (95% CI 20.24-20.25; decrease by 14.9%) per 100,000 person-years. The trend in treatment numbers for UCAs increased significantly (p < 0.0001) from 2003 through 2015; however, the estimated treatment rate for UCAs was only 0.19 (95% CI 0.19-0.20) to 0.51 (95% CI 0.50-0.51) among all UCA patients. The prevalence of hypertension (males, p = 0.0003; females, p < 0.0001) and current smoking status (males, p < 0.0001; females, p = 0.0002) declined significantly from 2003 through 2015, while the use of cholesterol-lowering drugs increased significantly (males, p < 0.0001; females, p = 0.0005) during the same period. CONCLUSIONS The estimated nationwide SAH incidence rate in Japan was higher than rates in other countries, although it has declined recently. An improving lifestyle may have contributed to the declining rate of SAH incidence in Japan.
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Affiliation(s)
- Fusao Ikawa
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Akio Morita
- 2Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo
| | | | - Yoshihito Goto
- 4Clinical Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto
| | - Nobuyuki Sakai
- 5Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Koji Iihara
- 6Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Yoshiaki Shiokawa
- 7Department of Neurosurgery, Kyorin University School of Medicine, Tokyo
| | - Isao Date
- 8Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama
| | - Kazuhiko Nozaki
- 9Department of Neurosurgery, Shiga University of Medical Science, Shiga
| | | | - Kiyohiro Houkin
- 11Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo
| | | | - Teiji Tominaga
- 13Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai
| | - Michiyasu Suzuki
- 14Department of Neurosurgery, Yamaguchi University School of Medicine, Ube
| | - Susumu Miyamoto
- 15Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and
| | - Kaoru Kurisu
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Hajime Arai
- 16Department of Neurosurgery, Juntendo University, Tokyo, Japan
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39
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Shimonaga K, Hama S, Tsuji T, Yoshimura K, Nishino S, Yanagawa A, Soh Z, Matsushige T, Mizoue T, Onoda K, Yamashita H, Yamawaki S, Kurisu K. The right hemisphere is important for driving-related cognitive function after stroke. Neurosurg Rev 2020; 44:977-985. [PMID: 32162124 DOI: 10.1007/s10143-020-01272-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/27/2019] [Revised: 02/01/2020] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
Considering quality of life (QOL) after stroke, car driving is one of the most important abilities for returning to the community. In this study, directed attention and sustained attention, which are thought to be crucial for driving, were examined. Identification of specific brain structure abnormalities associated with post-stroke cognitive dysfunction related to driving ability would help in determining fitness for car driving after stroke. Magnetic resonance imaging was performed in 57 post-stroke patients (51 men; mean age, 63 ± 11 years) who were assessed for attention deficit using a standardized test (the Clinical Assessment for Attention, CAT), which includes a Continuous Performance Test (CPT)-simple version (CPT-SRT), the Behavioral Inattention Test (BIT), and a driving simulator (handle task for dividing attention, and simple and selective reaction times for sustained attention). A statistical non-parametric map (SnPM) that displayed the association between lesion location and cognitive function for car driving was created. From the SnPM analysis, the overlay plots were localized to the right hemisphere during handling the hit task for bilateral sides (left hemisphere damage related to right-side neglect and right hemisphere damage related to left-side neglect) and during simple and selective reaction times (false recognition was related to damage of both hemispheres). A stepwise multiple linear regression analysis confirmed the importance of both hemispheres, especially the right hemisphere, for cognitive function and car driving ability. The present study demonstrated that the right hemisphere has a crucial role for maintaining directed attention and sustained attention, which maintain car driving ability, improving QOL for stroke survivors.
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Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Seiji Hama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. .,Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan.
| | - Toshio Tsuji
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | | | - Shinya Nishino
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Akiko Yanagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Zu Soh
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University, Matsue, Shimane, Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neuroscience, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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40
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Yamasaki F, Takano M, Yonezawa U, Taguchi A, Kolakshyapati M, Okumichi H, Kiuchi Y, Kurisu K. Bevacizumab for optic pathway glioma with worsening visual field in absence of imaging progression: 2 case reports and literature review. Childs Nerv Syst 2020; 36:635-639. [PMID: 31701281 DOI: 10.1007/s00381-019-04407-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/23/2019] [Accepted: 10/03/2019] [Indexed: 11/27/2022]
Abstract
Children with optic pathway gliomas (OPGs) frequently suffer from problems of visual function resulting from tumors. Previous reports showed that bevacizumab improved visual function in patients with OPG via tumor response to treatment. In these two case reports, we show that bevacizumab improved visual field without tumor response as seen in imaging. Both, a 10-year-old girl and a 6-year-old boy, had previous history of treatment with platinum-based chemotherapy. They had visual deterioration without tumor progression on MR imaging. Bevacizumab effectively and immediately improved visual field in both patients without imaging response of OPG. We emphasize that bevacizumab should be considered for patients with OPGs having visual deterioration without tumor progression.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Department of Neuroscience, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Hideaki Okumichi
- Department of Ophthalmology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Ikawa F, Morita A, Nakayama T, Kurisu K. Abstract WMP92: High Nationwide Incidence and Decline Trend of Subarachnoid Hemorrhage From Register-based Study in Japan. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp92] [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: 11/16/2022]
Abstract
Background and Purpose:
There has never been a report of the nationwide incidence rate and the recent trend of subarachnoid hemorrhage (SAH) in Japan. This study aimed to clarify the age-standardized nationwide incidence rate and recent trend of SAH in Japan and reasons for recent changes in this trend.
Methods:
We compiled data from the Japan Neurosurgical Society and records from the Ministry of Health, Labor, and Welfare in Japan. We reviewed the age-standardized mortality rate and estimated crude incidence rate of SAH including the 95% confidence interval (CI) from 2002 to 2017. The trend in treatment numbers of unruptured cerebral aneurysms (UCAs), ruptured cerebral aneurysms, the estimated treatment rate of UCAs with 95% CI, and the prevalence of hypertension, current smoking and use of cholesterol-lowering drugs were assessed.
Results:
Based on the 2010 population as a reference, the age-standardized nationwide SAH mortality rate significantly declined from 13.91 (95%CI:13.90-13.91) to 8.12 (8.12-8.13) by 41.7% per 100,000 person-years from 2002 through 2017. The estimated crude incidence rate of SAH excluding conservative survivors per 100,000 also showed a significant decline from 25.41 (25.40-25.42) to 21.35 (21.34-21.36) by 16.0 % and from 23.89 (23.88-23.89) to 20.05 (20.04-20.05) by 16.1% , if the in-hospital mortality was 10% and 20%, respectively. The prevalence of hypertension and current smoking declined significantly (p<0.05) and use of cholesterol-lowering drugs increased significantly (p<0.05) during the same period.
Conclusions:
The nationwide incidence rate of SAH in Japan was higher than in other countries. However, the declining trend of SAH was shown in this study. Improving lifestyle might contribute to reducing the incidence of SAH in Japan.
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Affiliation(s)
| | - Akio Morita
- Dept of Neurological Surgery, Nippon Med Sch Hosp, Tokyo, Japan
| | - Takeo Nakayama
- Graduate Sch of Medicine and Faculty of Medicine Kyoto Univ, Kyoto, Japan
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Matsuda S, Ikawa F, Ohzono I, Yoshiyama M, Hidaka T, Kurisu K. Abstract TP178: The Decline of the Age-Adjusted Mortality Rate of Subarachnoid Hemorrhage in Shimane Prefecture, Japan. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp178] [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: 11/16/2022]
Abstract
Object:
This study aimed to assess the relationships between trend of mortality rate from subarachnoid hemorrhage (SAH) and blood pressure and smoking prevalence among about 700,000 residents of Shimane prefecture, Japan.
Methods:
A retrospective review was performed to identify the age-adjusted mortality rate from SAH calculated using the standard population of Japan in 2010 and changes in population of Shimane prefecture used the date based on government statistics during 1999 through 2017. Blood pressure dates were extracted from Ministry of Health, Labour and Welfare during 2008 through 2015, and smoking prevalence from Cancer Registry and Statistics. Cancer Information Service, National Cancer Center, Japan every 3 years since 2001.
Result:
Age-adjusted mortality rate from SAH in Shimane prefecture tended to decline by 3.6% between 1999 through 2017 regardless of gender, as 14.86 (95%CI:14.65-15.07) per 100,000 person-year in 1999 to 7.96 (95%CI:7.81-8.11) in 2017. The Population of Shimane prefecture, where one of the most aging region in Japan, was decreased by 10.4% since 764,291 in 1999 to 684,668 in 2017. Blood pressure was invariable during 2008 through 2015, while smoking prevalence decreased since 2001 to 2016, as 25.0% to 18.0%.
Conclusion:
Age-adjusted mortality rate from SAH in Shimane prefecture have declined since 1999 to 2017, regardless of decrease of population and advancement of aging region. The factor of decline might be not only development of treatment and management, but decrease of incidence of SAH in Japan accompanied by improvement of smoking prevalence or lifestyle habitation.
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Affiliation(s)
| | - Fusao Ikawa
- Neurosurgery, Shimane Prefectural Hosp, Izumo, Japan
| | - Iori Ohzono
- Neurosurgery, Shimane Prefectural Hosp, Izumo, Japan
| | | | | | - Kaoru Kurisu
- Neurosurgery, HIroshima Univ Hosp, Hiroshima, Japan
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Ikawa F, Michihata N, Iihara K, Akiyama Y, Morita A, Fushimi K, Yasunaga H, Kurisu K. Risk Management of Aneurysmal Subarachnoid Hemorrhage by Age and Treatment Method from a Nationwide Database in Japan. World Neurosurg 2020; 134:e55-e67. [DOI: 10.1016/j.wneu.2019.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022]
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Takeishi Y, Yamasaki F, Sakamoto S, Okazaki T, Oshita J, Ishii D, Hosomi N, Ueno H, Aoki S, Nezu T, Maruyama H, Kurisu K. Abstract TP88: Usefulness of High and Standard B-value DWI for Analysis of Pathophysiology in Acute Stage Cerebral Infarction. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp88] [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: 11/16/2022]
Abstract
Introduction:
Standard b-value DWI (sDWI) and high b-value DWI (hDWI) and ADC calculation from each DWI have been widely used for diagnosis of (acute ischemic stroke) AIS. However, diagnosis of AIS subtypes by using hDWI and ADC have not been well investigated.
Hypothesis:
AIS has several pathophysiological subtypes such as lacunar infarction, cardio-embolism(CE), and atherothrombotic brain infarction (ATBI), and so on, and condtion of collateral circulations differ among those subtypes. Several studies have shown that hDWI is relatively dominant in intracellular diffusion, conversely, sDWI is comparatively dominant in extracellular diffusion. Therefore, our hypothesis is that calculation of ADC from sDWI and hDWI could give valuable information for differentiation among AIS subtypes.
Methods:
We evaluated 130 AIS patients from medical records. Pathophysiological diagnoses were made by experienced neurologists. We acquired sDWI and hDWI at 3T MRI in all patients. 321 ADC values were obtained by calculating 200 ischemic lesions sequentially. We used relative ADC (rADC) value to adjust the difference caused by location and age. The rADC values were measured by manually placing regions of interest on the ADC maps at the ischemic lesion defined by DWI high and divided by the ADC values on the contralateral normal brain. For assessment of the AIS (within 30hrs from the onset) relationship between ATBI and CE, we subtract high b-value rADC (hrADC) from standard b-value rADC (srADC) to focus on the extracellular diffusion. To analyze the subacute phase stroke relationship between ATBI and CE, we evaluated the each rADC. And at both phase we conducted Mann-Whitney U test.
Results:
In superacute phase, hDWI more clearly showed hyper-intense signal than sDWI. From the onset, rADC of CE was lower than that of ATBI (median srADC-hrADC: ATBI/CE =0.0699/0.0244) (P=0.0445), this might imply the poor collateral status in CE. Contrary, for subacute phase, CE rapidly underwent necrosis in the ischemic core, rADC was higher than ATBI rADC (median ATBI/CE:0.5939/0.6480) (P=0.0011).
Conclusions:
We found that quantitative assessment of hrADC and srADC could give valuable information for differential diagnoses of AIS subtypes.
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Affiliation(s)
- Yusuke Takeishi
- Dept of Neurosurgery and neuroendovascular therapy, Hiroshima Prefectural Hosp, Hiroshima, Japan
| | | | | | | | - Jumpei Oshita
- Dept of Neurosurgery, Hiroshima Univ, Hiroshima, Japan
| | - Daizo Ishii
- Dept of Neurosurgery, Univ of Iowa, Iowa City, IA
| | | | - Hiroki Ueno
- Dept of Neurology, Hiroshima Univ, Hiroshima, Japan
| | - Shiro Aoki
- Dept of Neurology, Hiroshima Univ, Hiroshima, Japan
| | | | | | - Kaoru Kurisu
- Dept of Neurosurgery, Hiroshima Univ, Hiroshima, Japan
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Taguchi A, Sakamoto S, Okazaki T, Oshita J, Kuwabara M, Kurisu K. Safety of carotid artery stenting for elderly patients with cervical carotid artery stenosis. Interv Neuroradiol 2020; 26:439-445. [PMID: 31969075 DOI: 10.1177/1591019919900831] [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: 11/16/2022] Open
Abstract
BACKGROUND Several recent randomized controlled trials have reported that perioperative complications of carotid artery stenting increase with age, and Japan has the highest proportion of elderly in the world. We retrospectively compared clinical factors, treatment outcomes, and adverse events between younger and elderly carotid artery stenting patients at a single institution in Japan to assess carotid artery stenting safety for the aged population. METHODS A total of 150 consecutive patients treated with carotid artery stenting using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method were enrolled. Patients were classified into an elderly (O) group ≥75 years (54/150, 36.0%) and a younger (Y) group <75 years (96/150, 64%) for comparison of demographics, clinical background, incidence of captured debris during the procedure, outcome, minor stroke, major adverse events (major stroke, myocardial infarction, or death) within 30 days, hyperintense spots on diffusion-weighted images after carotid artery stenting, and postoperative hospitalization days. RESULTS The carotid artery stenting procedure was successful in all cases. No major adverse events occurred within 30 days in the Y group, and only one occurred in the O group (P = 0.348). Visible debris was captured in a significantly greater proportion of O group patients than in Y group patients (33/54 (63.5%) vs. 40/96 (42.1%), P = 0.016), but there was no significant difference in the frequency of hyperintense spots on diffusion-weighted images between Y and O groups (23/96 (24.0%) vs. 16/52 (30.8%), P = 0.435). CONCLUSIONS Carotid artery stenting using dual protection and blood aspiration is equally safe for younger and elderly patients.
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Affiliation(s)
- Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Oshita J, Okazaki T, Mitsuhara T, Imura T, Nakagawa K, Otsuka T, Kurose T, Tamura T, Abiko M, Takeda M, Kawahara Y, Yuge L, Kurisu K. Early Transplantation of Human Cranial Bone-derived Mesenchymal Stem Cells Enhances Functional Recovery in Ischemic Stroke Model Rats. Neurol Med Chir (Tokyo) 2020; 60:83-93. [PMID: 31956170 PMCID: PMC7040434 DOI: 10.2176/nmc.oa.2019-0186] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We analyzed the cell characteristics, neuroprotective, and transplantation effects of human cranial bone-derived mesenchymal stem cells (hcMSCs) in ischemic stroke model rats compared with human iliac bone-derived mesenchymal stem cells (hiMSCs). The expressions of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) as neurotrophic factors were analyzed in both MSCs. hiMSCs or hcMSCs were intravenously administered into ischemic stroke model rats at 3 or 24 h after middle cerebral artery occlusion (MCAO) and neurological function was evaluated. The survival rate of neuroblastoma × glioma hybrid cells (NG108-15) after 3 or 24 h oxidative or inflammatory stress and the neuroprotective effects of hiMSCs or hcMSCs-conditioned medium (CM) on 3 or 24 h oxidative or inflammatory stress-exposed NG108-15 cells were analyzed. The expressions of BDNF and VEGF were higher in hcMSCs than in hiMSCs. hcMSCs transplantation at 3 h after MCAO resulted in significant functional recovery compared with that in the hiMSCs or control group. The survival rate of stress-exposed NG108-15 was lower after 24 h stress than after 3 h stress. The survival rates of NG108-15 cells cultured with hcMSCs-CM after 3 h oxidative or inflammatory stress were significantly higher than in the control group. Our results suggest that hcMSCs transplantation in the early stage of ischemic stroke suppresses the damage of residual nerve cells and leads to functional recovery through the strong expressions of neurotrophic factors. This is the first report demonstrating a functional recovery effect after ischemic stroke following hcMSCs transplantation.
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Affiliation(s)
- Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Takeshi Imura
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kei Nakagawa
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Takashi Otsuka
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Tomoyuki Kurose
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Masaru Abiko
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Masaaki Takeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Louis Yuge
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Space Bio-Laboratories Co., Ltd
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Ikawa F, Michihata N, Akiyama Y, Iihara K, Morita A, Kato Y, Yamaguchi S, Kurisu K, Fushimi K, Yasunaga H. Propensity Score Matching Analysis for the Patients of Unruptured Cerebral Aneurysm from a Post Hoc Analysis of a Nationwide Database in Japan. World Neurosurg 2020; 136:e371-e379. [PMID: 31931237 DOI: 10.1016/j.wneu.2020.01.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to compare the functional outcome at discharge for unruptured cerebral aneurysms (UCAs) between surgical clipping and endovascular coiling in total, nonelderly (<65 years), and elderly (≥65 years) patients by nonbiased analysis based on a national database in Japan. METHODS A total of 15,671 patients with UCA were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. The outcome of the Barthel Index (BI) at discharge was investigated, and propensity score-matched analysis was conducted in total, nonelderly, and elderly patient groups. RESULTS Propensity score-matched analysis found no significant difference for in-hospital mortality between the 2 treatment methods in the total and both age-groups. The rate of morbidity of BI <90 at discharge was higher after surgical clipping than after endovascular coiling in the total (4.9% vs. 3.9%; P = 0.040; risk difference, -1.0%; 95% confidence interval, -3.6 to 2.3%) and the elderly age-group (8.1% vs. 5.0%; P < 0.001; risk difference, -3.1%; -4.8% to 1.5%), however, no significant association between the 2 treatment methods (2.4% vs. 2.6%; P = 0.67; risk difference, 0.22%; -0.79 to 1.22%) was found in the nonelderly group. CONCLUSIONS In elderly patients with UCA, a better outcome at discharge after endovascular coiling was found. However, no significantly different functional outcome at discharge between surgical clipping and endovascular coiling for UCA in nonelderly patients was confirmed by propensity score-matched analysis from a nationwide database in Japan.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Yasuhiko Akiyama
- Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 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, University of Tokyo, Tokyo, Japan
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Onishi S, Amatya VJ, Karlowee V, Takeshima Y, Sugiyama K, Kurisu K, Yamasaki F. Radiological and Immunostaining Characteristics of H3.3 G34R-Mutant Glioma: A Report of 3 Cases and Review of the Literature. Pediatr Neurosurg 2020; 55:319-325. [PMID: 33227796 DOI: 10.1159/000511672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/07/2019] [Accepted: 09/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION H3.3 G34R/V mutation is predominantly identified in the supratentorial nonmidline tumors. However, this tumor is not yet categorized as an entity in 2016 WHO CNS classification. More information is necessary to further determine the characteristics of this tumor. CASE PRESENTATION Three cases of adolescent hemispheric glioma were treated in our institution. All tumors showed the characteristics of huge tumor size with mild peritumoral edema on T2WI/FLAIR, hyperintense on DWI, and slight partial enhancement by gadolinium. The single-voxel proton MR spectroscopy revealed characteristics of high choline peak, marked decrease in N-acetyl aspartate peak, and small lactate peak. The histopathological diagnosis, based on 2007 WHO CNS classification, was high-grade glioma in 2 cases and a PNET. Immuno-staining revealed that the tumor cells were positive against H3.3 G34R, H3K27me3, and p53 antibodies and negative against H3K27M, IDH1-R132H, ATRX, and Olig2 antibodies. Pyrosequencing analysis confirmed H3.3 G34R mutation, IDH-wildtype, and BRAF-wildtype. CONCLUSION Radiological and immunostaining findings are characteristic in our 3 cases of H3.3 G34-mutant glioma. It is essential to consider H3.3 G34-mutant glioma as a differential diagnosis particularly in pediatric and adolescents and young adult hemispheric tumors.
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Affiliation(s)
- Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Vega Karlowee
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan,
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Yoshihiro M, Okamoto J, Saito T, Usui S, Yonezawa U, Kurisu K, Goto T, Fujii Y, Hongo K, Horisawa S, Taira T, Nitta M, Maruyama T, Fukui A, Tsuzuki S, Masamune K, Kawamata T, Iseki H. STMO-06 SMART CYBER OPERATING THEATER REALIZED BY INTERNET OF THINGS - RESULTS OF CLINICAL STUDY FOR 56 CASES. Neurooncol Adv 2019. [PMCID: PMC7213086 DOI: 10.1093/noajnl/vdz039.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Unlike conventional operating rooms that provide a sterilized space, we have developed a Smart Cyber Operating Theater (SCOT) in which the room itself performs treatment as a single medical device. We report the clinical results of 3 types of SCOT. METHODS Basic SCOT packaged with intraoperative MRI (0.4Tesla) was introduced in Hiroshima University in 2016. Standard SCOT networked with middleware OPeLiNK was introduced to Shinshu University in 2018, and Hyper SCOT introduced to Tokyo Women’s Medical University in 2019. RESULTS The average of all 56 patients was 44 years old. There were 38 brain tumors (68%), 11 functional diseases (19%), and 7 orthopedic diseases (13%). Basic SCOT is used for 41 cases (/56; 73%) with 22 gliomas, 10 epilepsies, 7 bone tumors, and 2 benign brain tumors. Standard SCOT with 20 networked devices is used for 14 cases (/56; 25%) with 6 gliomas including brain stem and thalamus, 6 pituitary tumors and 2 benign brain tumors. The strategy desk can display a variety of digital data synchronized in time, and the review and comment functions also operate. It is useful for remote advice through mutual communication via strategy desk. Hyper SCOT was used in February 2019 for the first case (1/56 cases; 2%). MRI images were taken with an average of 1.3 shots with good image quality. For 46/56 neoplastic lesions (82%), additional removal of residual tumor was performed in 31/46 cases (67%), and 26/46 cases (57%) were totally removed, with an average removal rate of 89.2%. There was no reoperation (0%) within 1 month in all cases. CONCLUSIONS Three types of SCOT contributed to planned surgical outcome including maximal tumor resection without serious related complications. We will proceed with verification of clinical effects, and develop robotized devices, and utilize AI for strategy desk at Hyper SCOT.
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Affiliation(s)
- Muragaki Yoshihiro
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Jun Okamoto
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Taiichi Saito
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Satoshi Usui
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Ushio Yonezawa
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Kaoru Kurisu
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Tetsuya Goto
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Yu Fujii
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Kazuhiro Hongo
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Shiro Horisawa
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Takaomi Taira
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Masayuki Nitta
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Takashi Maruyama
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Atsushi Fukui
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Shunsuke Tsuzuki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Ken Masamune
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Takakazu Kawamata
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
| | - Hiroshi Iseki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University
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Yamasaki F, Takano M, Yonezawa U, Taguchi A, Onishi S, Kurisu K, Sugiyama K. COT-17 EFFECT OF BEVACIZUMAB AGAINST CYSTIC COMPONENT OF PRIMARY/METASTATIC BRAIN TUMORS. Neurooncol Adv 2019. [PMCID: PMC7213219 DOI: 10.1093/noajnl/vdz039.197] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Bevacizumab (BEV) improves the symptom via reducing the peritumoral edema and sometimes via reducing the size of brain tumor. However,the effect of BEV against cystic part of brain tumor has not been documented yet. In this report,we investigated the effect of BEV on cystic component of brain tumors.
MATERIALS AND METHODS
Our institutional review board approved this retrospective study. Between 2008 and 2018,139 patients with primary or metastatic brain tumor were treated with BEV in our Hospital. We defined cystic lesions as high intense lesion of size 1 cm or bigger on T2WI,and excluded necrotizing cysts and cystic changes in surgical resection cavity. The symptoms and images before and after administration of bevacizumab were evaluated. Changes in cyst size of brain tumor was evaluated as follows: CR (complete response=disappearance),PR (reduction by 50% or more),MR (reduction by 25–50%),SD (size change less than 25%),PD (increase by 25% or more). The effect of bevacizumab on tumor itself was determined according to RANO criteria.
RESULTS
Of the 139 patients,21 (15.1%) brain tumors had cystic component. The best response of cyst to BEV were as follows: CR 6,PR 7,MR 4,SD 4. The group of patients with progressively increasing cysts prior to BEV administration had significant cyst size reduction compared to stable cyst size groups at best response timing (mean 76.3% vs. 32.8%,P<0.01). Patients with cyst showed significant improvement of symptoms after the treatment with BEV compared to patients without cyst (P<0.01). However,response rate against tumor itself was not different between patients with or without cyst. Overall survival of glioblastoma patients after starting BEV was not different between tumor with cyst and without cyst.
CONCLUSION
BEV may be effective for patients who are symptomatic due to cystic enlargement.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Motoki Takano
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Ushio Yonezawa
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Akira Taguchi
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Shumpei Onishi
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Kaoru Kurisu
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
| | - Kazuhiko Sugiyama
- Department of Neurosurgery,Hiroshima University Hospital,Hiroshima,Japan
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