1
|
Tsuchiya T, Shinya Y, Shiokawa Y, Tanishima T, Tamura A, Ono H. Bypass-Assisted Microsurgical Clipping for an Endovascular Treatment-Resistant Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm, Recurring Two Decades Postinitial Clipping: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01133. [PMID: 38651892 DOI: 10.1227/ons.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/28/2024] [Indexed: 04/25/2024] Open
Abstract
Salvage treatment of postclipping recurrent aneurysms remains challenging.1,2 The salvage microsurgical clipping is a possible intervention but sometimes difficult because of tissue adhesions around the aneurysm and previously installed clips; therefore, salvage coil embolization may have certain advantages.1-5 However, when coil embolization is not applicable,6 microsurgical clipping is a stand-alone curative treatment, requiring proficient and reliable microsurgical techniques. This article describes a unique case of a 70-year-old female patient complaining of a severe headache with subarachnoid hemorrhage due to a recurrent ruptured left internal carotid-posterior communicating artery aneurysm after microsurgical clipping 23 years ago. An initial attempt at coil embolization proved unsuccessful because of the aneurysm shape. Consequently, the salvage microsurgical clipping was planned. Given the additional time for trapping the internal carotid artery for the old clip removal, a superficial temporal artery-middle cerebral artery bypass was also planned. The operation entailed a superficial temporal artery-middle cerebral artery bypass, a Sylvian fissure dissection, the old clip removal, and aneurysm clipping. Intraoperatively, the complete aneurysm neck clipping was successfully performed without any complication, and patient postoperative course was uneventful. A wide surgical field should be obtained to be able to manipulate the aneurysm and old clip safely under a microscope. It is also important to temporarily trap the main artery to ensure removal of old clips and to prepare for intraprocedural ischemia using bypass after a precise assessment of hemodynamics before surgery. The patient provided informed consent for the procedure and the publication of the case along with its pertinent imaging, and this report was approved by the institutional review board at our hospital.
Collapse
Affiliation(s)
- Takahiro Tsuchiya
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
| | - Yuki Shinya
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
| | - Takeo Tanishima
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
| | - Akira Tamura
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Japan
| |
Collapse
|
2
|
Hibiya T, Nagahama K, Matsumoto Y, Saito K, Sasaki N, Kobayashi K, Otsu A, Shimasaki T, Takeuchi K, Shiokawa Y, Nagane M, Shibahara J. Epstein-Barr virus-positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report. Neuropathology 2024; 44:104-108. [PMID: 37424259 DOI: 10.1111/neup.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete bacterium Treponema pallidum. Neurosyphilis results from the infection of the nervous system with Treponema pallidum, which can occur at any stage of syphilis. Neurosyphilis is often overlooked because of its rarity. Early-stage neurosyphilis with brain mass formation is rare. We present a case of early-stage neurosyphilis with prominent Epstein-Barr virus (EBV)-positive monoclonal lymphoplasmacytic proliferation in an immunocompetent patient. A 36-year-old man presented with a chief complaint of a progressively worsening headache, a newly developed skin rash, and a fever. Magnetic resonance imaging showed a mass lesion, which measured 18 mm in diameter, in the left frontal lobe of the cerebrum. The patient underwent an emergency operation to remove the abscess. A pathological investigation revealed complex findings. There was an abscess in the cerebrum. Lymphoplasmacytic meningitis was also noted. In addition, a vaguely nodular lesion, which was composed of plasmacytoid and lymphoid cells, was observed around the abscess. Immunohistochemically, an anti-Treponema pallidum antibody revealed numerous Treponemas around the abscess. In situ hybridization revealed that the plasmacytoid and lymphoid cells were Epstein-Barr encoding region (EBER)-positive; κ-positive cells were significantly more prevalent than λ-positive cells, suggesting light-chain restriction. Postoperatively, parenteral antibiotics were administered for four weeks. The patient has been free of recurrence for two years since the surgery. No association between neurosyphilis and EBV-positive lymphoplasmacytic proliferation has ever been reported. Mass formation in early-stage neurosyphilis is an exceptionally rare event. The present case indicates that in syphilis patients, lymphoproliferative disorders that lead to mass formation may be caused by concomitant EBV reactivation. Furthermore, when treating patients with mass lesions of the central nervous system, it is important to check their medical history and perform laboratory screening for infectious diseases to avoid overlooking syphilis infections.
Collapse
Affiliation(s)
- Takashi Hibiya
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Akiyasu Otsu
- Department of Infectious Disease, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Teppei Shimasaki
- Department of Infectious Disease, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Seiya Y, Maruyama K, Imai H, Shiokawa Y, Nakatomi H. Outcome of Visual Function after Removal of Tuberculum Sellae Meningioma Presenting with Scotoma at the Lower Visual Field Center. NMC Case Rep J 2024; 11:55-59. [PMID: 38454913 PMCID: PMC10917652 DOI: 10.2176/jns-nmc.2023-0234] [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: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 03/09/2024] Open
Abstract
Tuberculum sellae meningiomas commonly present as bitemporal hemianopia and loss of visual acuity due to optic nerve compression. Two female patients (48 and 58 years old) presented with a small scotoma at the lower visual field center due to tuberculum sellae meningioma (25 and 10 mm, respectively). Despite the fact that their visual field defect was not very large, daily activities, including walking or reading were hindered. By the total removal of the tumors in both patients, the scotoma was cured and daily activities recovered. When patients exhibit visual deficits, especially in the lower center fields, surgical removal should be considered even if the tumors are small and visual deficits are limited because improvement of both vision and daily activities can be achieved.
Collapse
Affiliation(s)
- Yosuke Seiya
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroya Imai
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Murata H, Tashiro S, Sakamoto H, Ishida R, Kuwabara M, Matsuda K, Shiokawa Y, Hirano T, Momozaki R, Maeda K, Wakabayashi H, Yamada S. Impact of rehabilitation dose on body mass index change in older acute patients with stroke: a retrospective observational study. Front Nutr 2023; 10:1270276. [PMID: 38115884 PMCID: PMC10728649 DOI: 10.3389/fnut.2023.1270276] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Background It is established that a low body mass index (BMI) correlates with a diminished home discharge rate and a decline in activities of daily living (ADL) capacity among elderly stroke patients. Nevertheless, there exists a paucity of knowledge regarding strategies to mitigate BMI reduction during the acute phase. This investigation seeks to elucidate the impact of rehabilitation dose, as determined by both physical and occupational therapy, on BMI alterations, positing that a heightened rehabilitation dose could thwart BMI decline. Methods This retrospective, observational study was conducted in the stroke unit of a university hospital. Enrollees comprised individuals aged ≥65 years, hospitalized for stroke, and subsequently relocated to rehabilitation facilities between January 2019 and November 2020. The percentage change in BMI (%ΔBMI) was calculated based on BMI values at admission and discharge. Multivariate multiple regression analysis was employed to ascertain the influence of rehabilitation dose on %ΔBMI. Results A total of 187 patients were included in the analysis, of whom 94% experienced a reduction in BMI during acute hospitalization. Following adjustment for sociodemographic and clinical factors, multivariable analyzes revealed a positive association between rehabilitation dose and %ΔBMI (β = 0.338, p < 0.001). Conclusion The findings of this study suggest that, in the context of acute stroke treatment, an augmented rehabilitation dose is associated with a diminished decrease in BMI.
Collapse
Affiliation(s)
- Hiroyasu Murata
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Sakamoto
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Rika Ishida
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Mayuko Kuwabara
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Kyohei Matsuda
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Ryo Momozaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Shinjuku, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
| |
Collapse
|
5
|
Ishikawa T, Ikawa F, Ichihara N, Yamaguchi K, Funatsu T, Nakatomi H, Shiokawa Y, Sorimachi T, Murayama Y, Suzuki K, Kurita H, Fukuda H, Ueba T, Shimamura N, Ohkuma H, Morioka J, Nakahara I, Uezato M, Chin M, Kawamata T. Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan. Neurosurgery 2023:00006123-990000000-00980. [PMID: 38038438 DOI: 10.1227/neu.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The differences in clinical outcomes between endovascular coiling (EC) and surgical clipping (SC) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) are controversial. Therefore, this study aimed to evaluate whether EC is superior to SC and identify risk factors in patients with poor-grade aSAH. METHODS We used data from the "Predict for Outcome Study of aneurysmal SubArachnoid Hemorrhage." World Federation of Neurological Societies (WFNS) grade III-V aSAH was defined as poor-grade aSAH, and unfavorable clinical outcomes (modified Rankin Scale scores 3-6) were compared between SC and EC after propensity score matching (PSM). In-hospital mortality was similarly evaluated. Predictors of unfavorable clinical outcomes were identified using multivariable analysis. RESULTS Ultimately, 1326 (SC: 847, EC: 479) and 632 (SC: 316, EC: 316) patients with poor-grade aSAH were included before and after PSM, respectively. Unfavorable clinical outcomes at discharge were significantly different between SC and EC before (72.0% vs 66.2%, P = .026) and after PSM (70.6% vs 63.3%, P = .025). In-hospital mortality was significantly different between groups before PSM (10.5% vs 16.1%, P = .003) but not after PSM (10.4% vs 12.7%, P = .384). Predictors of unfavorable clinical outcomes in both SC and EC were WFNS grade V, older than 70 years, and Fisher computed tomography (CT) grade 4. Predictors of unfavorable clinical outcomes only in SC were WFNS grade IV (odds ratio: 2.46, 95% CI: 1.22-4.97, P = .012) and Fisher CT grade 3 (4.90, 1.42-16.9, P = .012). Predictors of unfavorable clinical outcome only in EC were ages of 50s (3.35, 1.37-8.20, P = .008) and 60s (3.28, 1.43-7.52, P = .005). CONCLUSION EC resulted in significantly more favorable clinical outcomes than SC in patients with poor-grade aSAH, without clear differences in in-hospital mortality. The benefit of EC over SC might be particularly remarkable in patients with WFNS grade IV and Fisher CT grade 3.
Collapse
Affiliation(s)
- Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
- Department of Cardiovascular Surgery, Jikei University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | | | | | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Norihito Shimamura
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| |
Collapse
|
6
|
Yoshimura S, Koga M, Okada T, Inoue M, Miwa K, Fukuda-Doi M, Kondo R, Inoue T, Ichijo M, Ohtaki M, Nagakane Y, Itabashi R, Sakai N, Kimura K, Kamiyama K, Shiokawa Y, Yagita Y, Iwama T, Yakushiji Y, Kusumi M, Yamaki T, Uemura J, Yasuura A, Noshiro S, Fukunaga D, Yazawa Y, Aoki J, Yoshikawa M, Ihara M, Toyoda K. Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes with Alteplase at 0.6 mg/kg in Clinical Practice: THAWS2 Study. Cerebrovasc Dis 2023; 53:46-53. [PMID: 37263235 DOI: 10.1159/000530995] [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: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the safety and efficacy of intravenous (IV) alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice. METHODS This multicenter observational study enrolled acute ischemic stroke patients with last-known-well time >4.5 h who had mismatch between DWI and FLAIR and were treated with IV alteplase. The safety outcomes were symptomatic intracranial hemorrhage (sICH) after thrombolysis, all-cause deaths, and all adverse events. The efficacy outcomes were favorable outcome defined as an mRS score of 0-1 or recovery to the same mRS score as the premorbid score, complete independence defined as an mRS score of 0-1 at 90 days, and change in NIHSS at 24 h from baseline. RESULTS Sixty-six patients (35 females; mean age, 74 ± 11 years; premorbid complete independence, 54 [82%]; median NIHSS on admission, 11) were enrolled at 15 hospitals. Two patients (3%) had sICH. Median NIHSS changed from 11 (IQR, 6.75-16.25) at baseline to 5 (3-12.25) at 24 h after alteplase initiation (change, -4.8 ± 8.1). At discharge, 31 patients (47%) had favorable outcome and 29 (44%) had complete independence. None died within 90 days. Twenty-three (35%) also underwent mechanical thrombectomy (no sICH, NIHSS change of -8.5 ± 7.3), of whom 11 (48%) were completely independent at discharge. CONCLUSIONS In real-world clinical practice, IV alteplase for unclear-onset stroke patients with DWI-FLAIR mismatch provided safe and efficacious outcomes comparable to those in previous trials. Additional mechanical thrombectomy was performed safely in them.
Collapse
Affiliation(s)
- Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan,
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Okada
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mayumi Fukuda-Doi
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Rei Kondo
- Department of Neurosurgery, Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Takeshi Inoue
- Department of Stroke Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Japanese Red Cross Hospital, Musashino, Japan
| | - Masafumi Ohtaki
- Department of Neurosurgery, Obihiro Kosei Hospital, Obihiro, Japan
| | | | - Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Mitaka, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | | | - Tetsu Yamaki
- Department of Neurosurgery, Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Jyunichi Uemura
- Department of Stroke Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Asuka Yasuura
- Department of Neurology, Musashino Japanese Red Cross Hospital, Musashino, Japan
| | - Shouhei Noshiro
- Department of Neurosurgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Daiki Fukunaga
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masaaki Yoshikawa
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
7
|
Kurogi R, Kada A, Ogasawara K, Nishimura K, Kitazono T, Iwama T, Matsumaru Y, Sakai N, Shiokawa Y, Miyachi S, Kuroda S, Shimizu H, Yoshimura S, Osato T, Horie N, Nagata I, Nozaki K, Date I, Hashimoto Y, Hoshino H, Nakase H, Kataoka H, Ohta T, Fukuda H, Tamiya N, Kurogi AI, Ren N, Nishimura A, Arimura K, Shimogawa T, Yoshimoto K, Onozuka D, Ogata S, Hagihara A, Saito N, Arai H, Miyamoto S, Tominaga T, Iihara K. National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study. BMJ Open 2023; 13:e068642. [PMID: 37037619 PMCID: PMC10111904 DOI: 10.1136/bmjopen-2022-068642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. DESIGN Retrospective study. SETTING Six hundred and thirty-one primary care institutions in Japan. PARTICIPANTS Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. PRIMARY AND SECONDARY OUTCOME MEASURES Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). RESULTS In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. CONCLUSIONS The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.
Collapse
Affiliation(s)
- Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Kada
- Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Yanagido, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City General Hospital, Kobe, Japan
| | | | - Shigeru Miyachi
- Department of Neurosurgery, Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Toyama University, Toyama, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Kita-kyushu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Nankoku, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - A I Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nice Ren
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Onozuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Iihara
- Director General, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
| |
Collapse
|
8
|
Shimamura N, Katagai T, Ohkuma H, Fujiwara N, Nakahara I, Morioka J, Kawamata T, Ishikawa T, Kurita H, Suzuki K, Chin M, Uezato M, Sorimachi T, Shiokawa Y, Murayama Y, Ueba T, Ikawa F. Analysis of Factors Influencing Delayed Presentation in Japanese Patients with Subarachnoid Hemorrhage. World Neurosurg 2023; 171:e590-e595. [PMID: 36529428 DOI: 10.1016/j.wneu.2022.12.058] [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: 10/16/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Some aneurysmal subarachnoid hemorrhage (SAH) patients are delayed in their presentation. This can cause a washout of the subarachnoid hematoma and a potential misdiagnosis. As a result, they may suffer rerupture of the aneurysm and preventable deterioration. We investigated the factors that influence delayed SAH presentation. METHODS Aneurysmal SAH patients treated at 9 stroke centers from 2002 to 2020 were included. Age, gender, pre-SAH modified Rankin scale, World Federation of Neurological Surgeons grade, Fisher group, day of presentation, aneurysm treatment method, past history of cerebral stroke, comorbidity of hypertension and/or diabetes mellitus, and modified Rankin scaleat discharge were assessed retrospectively. We formed 2 groups based on the day of presentation after the onset of SAH: day 0-3 (early) and other (delayed). Logistic regression analyses detected the factors that influenced the day of presentation and outcome for SAH. A P- value <0.05 was considered significant. RESULTS Delayed presentation comprised 282 cases (6.3%) of 4507 included cases. Logistic regression analyses showed that patients in an urban area, of male gender, low WFNS grade and low Fisher group correlated significantly with a delayed presentation. But delayed presentation did not influence outcome at discharge. CONCLUSIONS Area of residency and gender correlated with delayed presentation after SAH in Japan. Urbanization, male gender, and mild SAH lead patients to delay presentation. The factors underlying these tendencies will be analyzed in a future prospective study.
Collapse
Affiliation(s)
- Norihito Shimamura
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan; Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Takeshi Katagai
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan; Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan
| | - Nozomi Fujiwara
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Aichi, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kaima Suzuki
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | | | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| |
Collapse
|
9
|
Kawano H, Adachi T, Saito M, Amano T, Gomyo M, Yokoyama K, Shiokawa Y, Hirano T. Correlation between pretreatment and follow-up infarct volume using CT perfusion imaging: the Bayesian versus singular value decomposition method. Neurol Sci 2023; 44:2041-2047. [PMID: 36689012 DOI: 10.1007/s10072-023-06627-w] [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: 10/03/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Pretreatment ischemic core volume is conceptually equal to follow-up infarct volume (FIV) in patients with successful recanalization. However, there is sometimes an absolute volume difference (AD) between pretreatment core volume and FIV. The aim was to compare the AD values between the Bayesian and the singular value decomposition (SVD) methods with time from onset-to-imaging in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy. METHODS Consecutive AIS patients were included if they had the following: (1) anterior large vessel occlusion (internal carotid or middle cerebral artery); (2) within 24 h of onset; (3) pretreatment CT perfusion (CTP); (4) successful recanalization (mTICI ≥ 2b); and (5) 24-h diffusion-weighted imaging (DWI). FIV was measured on 24-h DWI. The AD value between FIV and the pretreatment core volume was calculated for Bayesian and SVD methods. Spearman's rank correlation coefficient (rho) was calculated as appropriate. RESULTS In the 47 patients enrolled (25 men; median age 78 years; median baseline National Institutes of Health Stroke Scale, 22), the median time from onset-to-imaging and onset-to-recanalization was 136 and 220 min, respectively. Shorter onset-to-imaging time was correlated with a larger AD value, and more trend was seen in the SVD method (rho = - 0.28, p = 0.05) compared with the Bayesian method (rho = - 0.08). A larger pretreatment core volume was correlated with a larger AD value, and this tendency was slightly stronger for the SVD (rho = 0.63, p < 0.01) than for the Bayesian (rho = 0.32, p = 0.03) method. CONCLUSIONS The Bayesian method might be more correlated with FIV than the SVD method in patients with a large ischemic lesion immediately after stroke onset, but not perfect.
Collapse
Affiliation(s)
- Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan.
| | - Takuya Adachi
- Department of Radiology, Kyorin University Hospital, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Mikito Saito
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Tatsuo Amano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Miho Gomyo
- Department of Radiology, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Kenichi Yokoyama
- Department of Radiology, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka, 181-8611, Japan
| |
Collapse
|
10
|
Sasaki N, Kume S, Tateishi K, Nakamura T, Ibayashi K, Yamagishi Y, Saito K, Kobayashi K, Matsushita Y, Hibiya Y, Kitahara M, Suzuki S, Nagano R, Yamashita S, Nakatomi H, Shiokawa Y, Ichimura K, Nagane M. GEN-13 PAIRED MUTATIONAL ANALYSIS IN SECONDARY NERVOUS SYSTEM LYMPHOMA AND PCNSL SYSTEMIC RELAPSE REVEALS DRIVER MUTATION CANDIDATES IN THE CENTRAL NERVOUS SYSTEM. Neurooncol Adv 2022. [DOI: 10.1093/noajnl/vdac167.014] [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: 12/05/2022] Open
Abstract
Abstract
Primary central nervous system lymphoma (PCNSL) is an aggressive extranodal non-Hodgkin lymphoma confined to the brain, eyes, and the spinal cord. The mechanism of central nervous system (CNS) tropism in PCNSL has not been fully elucidated. Diffuse large B cell lymphomas (DLBCLs) occasionally present with distant recurrence, which can involve inside and outside the CNS. Secondary central nervous system lymphomas (SCNSLs) are CNS relapse of systemic lymphoma. PCNSLs also rarely present with systemic relapse. We have previously reported in our study of whole exome sequencing that PCNSLs harbor frequent mutations in genes of B cell receptor pathway members and aberrant somatic hypermutation (aSHM) target genes. Although several genetic alterations were identified as more frequent in PCNSLs compared with systemic lymphomas, specific genetic alterations which serve as the driver for CNS tropism in PCNSLs has not been identified. In order to search for mutations which might serve as driver mutations in the CNS, we have performed targeted sequencing in paired samples from patients with recurrent lymphomas, either SCNSLs or PCNSL systemic relapses, using Ion Torrent multiplex PCR. Mutational profiles were compared between the primary and recurrent tumor. Six cases (four SCNSL cases and two PCNSL systemic relapse cases) were analyzed. Of note, in the SCNSL cases, several de novo mutations were enriched only among the recurrent CNS tumors. Among these mutations, BTG2 mutations were observed in 3/4 (75%), and B2M and KLHL14 mutations were observed in 2/4 (50%) cases. In the two PCNSL systemic relapse cases, KMT2D mutations were enriched only in the recurrent systemic tumors. It is suggested that these de novo mutations in the recurrent CNS tumors might serve as driver mutations in the CNS. Further analysis in larger cohorts, and functional studies are required in order to validate these findings.
Collapse
Affiliation(s)
- Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Satoshi Kume
- Department of Neurosurgery, Akiru Municipal Medical Center
| | | | | | | | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Yuko Matsushita
- Department of Brain Disease Translational Research, Juntendo University Facility of Medicine
| | - Yuko Hibiya
- Department of Brain Disease Translational Research, Juntendo University Facility of Medicine
| | - Mai Kitahara
- Department of Brain Tumor Translational Research, National Cancer Center Research Institute
| | - Saki Suzuki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Reiko Nagano
- Department of Epigenomics, National Cancer Center Research Institute
| | - Satoshi Yamashita
- Department of Informatics and Biotechnology Engineering, Maebashi Institute of Technology
| | | | | | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Facility of Medicine
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| |
Collapse
|
11
|
Yamagishi Y, Hanayama N, Sasaki N, Saito K, Kobayashi K, Nakatomi H, Shiokawa Y, Nagane M. NQPC-21 QOL EVALUATION IN THE TREATMENT COURSE OF CNS LYMPHOMA. Neurooncol Adv 2022. [DOI: 10.1093/noajnl/vdac167.077] [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: 12/05/2022] Open
Abstract
Abstract
Background
Primary central nervous system lymphoma (PCNSL) is the second common primary malignant brain tumor. Compared to glioma, the treatment period is often longer, but there have been few research reports on QOL evaluation during the treatment yet. In this study, we retrospectively examined the QOL scores obtained during and following treatment of PCNSL to determine the association between changes in the QOL score and response to treatment, with particular interest in the issue in the evaluation over time.
Methods
Patients with newly-diagnosed PCNSL who were treated and evaluated for QOL by EORTC QLQ-C30/BN-20 at our facility since April 2016 were included.
Results
A total of 69 patients were included, with a median age of 69, and a male to female ratio of 41:32. The median KPS was 70, and the median MMSE score was 29 points, indicating that a majority of the patients who could undergo the testing retained adequate cognitive function. There were 38 patients (55.1%) who maintained CR during the QOL evaluation period, and their QOL function scores tended to be maintained above the baseline. In contrast, 31 patients (44.9%) who relapsed during the QOL evaluation period showed a tendency to decline in global health at the time of recurrence or evaluation immediately before recurrence, with the worsened symptom score reflecting the localization of recurrence. Any associations of changes in QOL score with therapeutic methods were identified. Changes in QOL scores were rather frequently observed with exacerbation of comorbidities, perhaps due to a high incidence of PCNSL in the elderly patients.
Conclusions
EORTC QLQ-C30/BN-20 enabled QOL evaluation that might reflect treatment effect in PCNSL. The reporting rate to the questionnaire was low in patients with substantial brain dysfunction, and QOL evaluation may also be affected by comorbidities. Further investigation of influencing factors on QOL evaluation is warranted.
Collapse
Affiliation(s)
- Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Naomi Hanayama
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine , Tokyo , Japan
| |
Collapse
|
12
|
Saito K, Sasaki N, Sasaki Y, Yamagishi Y, Kobayashi K, Shiokawa Y, Nakatomi H, Nagane M. ACT-15 EFFICACY AND SAFETY OF SUBTOTAL RESECTION, 'FLAIRECTOMY' FOR RECURRENT GLIOBLASTOMA. Neurooncol Adv 2022. [DOI: 10.1093/noajnl/vdac167.031] [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: 12/05/2022] Open
Abstract
Abstract
Background
Aggressive resection of recurrent glioblastoma has been reported to prolong survival and should be considered for resectable recurrences. In recent years, expanded resection for primary glioblastoma, especially removal of the FLAIR hyperintensity region beyond the contrast-enhancing lesion (FLAIRectomy; FR), has been reported, but there are no reports of FR for recurrent glioblastomas. In this study, we examined the efficacy and safety of FR for recurrent glioblastoma.
Methods
Recurrent glioblastoma operated on at our institution from January 2014 to July 2022 were included. The extent of resection (EOR) of contrast-enhancing lesions and FLAIR hyperintensity lesion was measured. Progression-free survival (PFS), overall survival (OS), surgical morbidity, KPS, and MMSE were analyzed retrospectively. Removal of at least 20% of the FLAIR hyperintensity lesion was defined as FR.
Results
Thirty-five surgeries in 28 patients (age at surgery 15-81 years; median 54 years, male 20/female 15) were included. The EOR of the contrast-enhancing lesion was 96.6± 7.4%, with GTR in 28 cases and non-GTR in 7. The EOR of the lesion with FLAIR hyperintensity was 33.2±36.5% and FR was achieved in 15 cases (42.9%). The median preoperative KPS was 90 (50-100; mean 83.3 ) in the FR group and 80 (60-100; mean 81) in the non-FR group. Both PFS and OS from surgery at recurrence were significantly prolonged in the FR group (median PFS; 8.1 months vs. 4.6 months, p=0.032, median OS; 36.1 months vs. 15.9 months, p=0.009); there was no difference in PFS or OS between the GTR and non-GTR groups (p=0.33, 0.79). There were significantly fewer patients in the FR group having a decrease in KPS of 20 or more at 30/90 days postoperatively (p=0.037, 0.020).
Conclusion
In our retrospective analysis, FR prolongs PFS and OS without decreasing KPS for resectable recurrent glioblastoma. Further validation in prospective studies is warranted.
Collapse
Affiliation(s)
- Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuta Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | | | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| |
Collapse
|
13
|
Saito K, Sasaki Y, Shimizu S, Nagai J, Yamagishi Y, Sasaki N, Kobayashi K, Shiokawa Y, Nakatomi H, Nagane M. BIOM-27. PROGNOSTIC SIGNIFICANCE OF EXTENT OF RESECTION IN GLIOMA ACCORDING TO THE 2021 WHO CLASSIFICATION. Neuro Oncol 2022. [PMCID: PMC9660310 DOI: 10.1093/neuonc/noac209.037] [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] Open
Abstract
Abstract
BACKGROUND
In the updated 2021 WHO classification, diffuse gliomas were strictly reclassified by molecular statuses. In glioblastoma (GBM), the prognostic significance of the resection has been shown, but the excision rate to be achieved in the new classification has not been defined. Moreover, the correlation between the extent of resection (EOR) and the prognosis is still controversial for other gliomas.
METHODS
IDH 1/2 mutations and TERT promoter mutations were analyzed by Sanger sequencing, 1p/19q co-deletion by microsatellite or MLPA, and EGFR amplification and CDKN2A deletions by MLPA. The correlation between the resection rate and prognosis of each tumor type in the 2021/2016 WHO classification was analyzed retrospectively.
RESULTS
According to the 2021 classification, 293 patients with GBM, IDH-wild type, 68 with astrocytoma, IDH-mutant (2/3/4 22/26/20), and 58 with oligodendroglioma, IDH-mutant and 1p/19q co-deleted were identified. Based on the 2016 classification, they were diagnosed as 314 GBM, 106 astrocytoma (Gd II/III 37/69), and 59 oligodendroglioma. For GBM, IDH-wild type (2021 classification), a prolonged OS benefit was observed with >25% removal (p=0.042), whereas, more than 20% of tumor removal for patients with GBM (2016 classification) resulted in OS prolongation. EOR was a significant favorable prognostic factor for grade II/III astrocytoma by the 2016 classification, but not for astrocytoma, IDH-mutant (grade 2/3) in the 2021 classification. When analyzed only in patients with astrocytoma, IDH-mutant by the 2021 classification, EOR was not significantly prognostic, suggesting that poorer prognosis of patients with unresectable IDH-wild type astrocytomas (2016 classification) might have a negative impact on the outcome.
CONCLUSION
There was a strong correlation between EOR and prognosis in patients with GBM, and >25% removal was considered significant according to the 2021 classification. For astrocytoma in the 2021 classification, EOR did not show a prognostic significance, but further validation including grading effect is warranted.
Collapse
Affiliation(s)
- Kuniaki Saito
- Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Yuta Sasaki
- Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Saki Shimizu
- Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Jun Nagai
- Kyorin University Faculty of Medicine , Tokyo , Japan
| | | | | | | | | | | | - Motoo Nagane
- Kyorin University Faculty of Medicine , Tokyo , Japan
| |
Collapse
|
14
|
Inoue M, Ota T, Hara T, Shigeta K, Kamiya Y, Arakawa H, Aoki R, Tsuruta W, Ichijo M, Kaneko J, Shiokawa Y, Hirano T. An Initial High National Institutes of Health Stroke Scale Score and Any Intracranial Hemorrhage Are Independent Factors for a Poor Outcome in Nonagenarians Treated with Thrombectomy for Acute Large Vessel Occlusion: The Tokyo/Tama-REgistry of Acute Endovascular Thrombectomy (TREAT) Study. World Neurosurg 2022; 165:e325-e330. [PMID: 35717017 DOI: 10.1016/j.wneu.2022.06.038] [Citation(s) in RCA: 2] [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: 04/01/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is effective in acute ischemic stroke patients ≥80 years old with large vessel occlusion (LVO). However, data for patients ≥90 years old remain very limited, and factors influencing functional outcomes are unclear. This study aimed to investigate factors influencing functional outcomes in patients ≥90 years old treated with MT for acute LVO. METHODS This retrospective observational study used prospectively collected data from the Tokyo/tama-REgistry of Acute endovascular Thrombectomy (TREAT) study. Inclusion criteria were as follows: 1) patients ≥90 years old treated with MT for LVO and 2) prestroke modified Rankin Scale (mRS) score, 0-3. The functional outcome was defined based on the mRS score at 90 days after the procedure: good functional outcome, mRS score 0-3 and poor functional outcome, mRS score 4-6. RESULTS Data were analyzed for 104 patients ≥90 years old. The good functional outcome was observed in 25 patients (24.0%), and the poor functional outcome was observed in the remaining 79 patients. Significant differences were identified in initial National Institutes of Health Stroke Scale (NIHSS) score, modified Thrombolysis in Cerebral Infarction grade 2b-3, modified Thrombolysis in Cerebral Infarction grade 3, and any intracranial hemorrhage and hemorrhagic infarction in univariate analyses. Multivariable analysis confirmed the initial NIHSS score (odds ratio, 1.08; 95% confidence interval, 1.01-1.17; P = 0.045) and any intracranial hemorrhage (odds ratio, 11.6; 95% confidence interval, 1.43-95.0; P = 0.022) as independent factors for the functional outcome. CONCLUSIONS An initial high NIHSS score and any intracranial hemorrhage are independent factors for the poor functional outcome in acute ischemic stroke patients ≥90 years old treated with MT.
Collapse
Affiliation(s)
- Masato Inoue
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hideki Arakawa
- Department of Neurosurgery, Omori Red Cross Hospital, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| |
Collapse
|
15
|
Yoshimoto T, Yamagami H, Sakai N, Toyoda K, Hashimoto Y, Hirano T, Iwama T, Goto R, Kimura K, Kuroda S, Matsumaru Y, Miyamoto S, Ogasawara K, Okada Y, Shiokawa Y, Takagi Y, Tominaga T, Uno M, Yoshimura S, Ohara N, Imamura H, Sakai C. Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan. Neurol Med Chir (Tokyo) 2022; 62:369-376. [PMID: 35753763 PMCID: PMC9464481 DOI: 10.2176/jns-nmc.2022-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | - Rei Goto
- Graduate School of Business Administration, Keio University
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | | | | | | | - Yasushi Okada
- Departments of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center
| | | | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Medicine
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
| | | | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Chiaki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| |
Collapse
|
16
|
Miyamoto S, Ogasawara K, Kuroda S, Itabashi R, Toyoda K, Itoh Y, Iguchi Y, Shiokawa Y, Takagi Y, Ohtsuki T, Kinouchi H, Okada Y, Takahashi JC, Nakase H, Kakuda W. Japan Stroke Society Guideline 2021 for the Treatment of Stroke. Int J Stroke 2022; 17:1039-1049. [PMID: 35443847 PMCID: PMC9615334 DOI: 10.1177/17474930221090347] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The revised Japan Stroke Society Guidelines for the Treatment of Stroke were published in Japanese in July 2021. In this article, the extracted recommendation statements are published. The revision keeps pace with the great progress in stroke control based on the recently enacted Basic Act on Stroke and Cardiovascular Disease in Japan. The guideline covers the following areas: primary prevention, general acute management of stroke, ischemic stroke and transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, asymptomatic cerebrovascular disease, other cerebrovascular disease, and rehabilitation.
Collapse
Affiliation(s)
- Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiaki Itoh
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Toshiho Ohtsuki
- Stroke Center, Kindai University Hospital, Osakasayama, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | | |
Collapse
|
17
|
Sasaki N, Kobayashi K, Saito K, Onoda R, Seiya Y, Suzuki S, Yamagishi Y, Nakatomi H, Shiokawa Y, Nagane M. ML-12 Clinical impact and management of skin-related disorders during treatment of relapsed PCNSL by tirabrutinib. Neurooncol Adv 2021. [PMCID: PMC8648233 DOI: 10.1093/noajnl/vdab159.091] [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: 11/15/2022] Open
Abstract
Abstract
BACKGROUNDS: Tirabrutinib is a second-generation Bruton’s tyrosine kinase (BTK) inhibitor, approved by the Japanese Pharmaceutical and Medical Devices Agency (PMDA) for relapsed and refractory PCNSL in March 2020. Skin-related disorder (SRD)s are the most prevalent adverse events in tirabrutinib, which accounted for 54.5% in a phase I/II trial. While the use of tirabrutinib is increasingly considered in clinical practice, the prevalence and clinical impact of tirabrutinib-related SRDs in real-world practice remains unclear. METHODS: Relapsed PCNSL patients treated with tirabrutinib at the author’s institution were identified, and divided into those with SRDs (SRD group), and without SRDs (non-SRD group). Response rate and progression-free survival (PFS) were retrospectively analyzed and compared between the two groups. RESULTS: Eleven patients were identified (median age: 73 [range: 50–83], median KPS: 70 [range: 40–90]), which included six (54.5%) from the SRD group and five (45.5%) from the non-SRD group. Response rate was 100% in the SRD group and 60% in the non-SRD group. Median PFS was 2.8 months in the SRD group and 36.3 months in the non-SRD group, which yielded no significant difference (p=0.446). While antihistamine prophylaxis using fexofenadine was performed in seven patients, among them SRDs were observed in three (27.3%). SRDs lead to tirabrutinib interruption (for seven days or more) in two (18.2%), dose reduction in three (27.3%), and discontinuation in two (18.2%) patients. Four patients in whom tirabrutinib was interrupted or discontinued due to SRDs had shorter PFS, compared with the two patients from the SRD group in whom tirabrutinib was continued (median PFS: 2.3 and 29.6 months, respectively) (p=0.049). CONCLUSIONS: SRDs substantially lead to tirabrutinib interruption or discontinuation, which could result in early PD. Since fexofenadine prophylaxis seems ineffective for preventing SRDs, other antihistamines should be considered. Establishment of the optimal management of tirabrutinib-related SRDs is warranted.
Collapse
Affiliation(s)
- Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Ryo Onoda
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Yosuke Seiya
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Saki Suzuki
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Yuki Yamagishi
- Division of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Neurosurgery, Kyorin University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin university faculty of medicine, Tokyo, Japan
| |
Collapse
|
18
|
Nagane M, Sasaki N, Saito K, Kobayashi K, Onoda R, Seiya Y, Yamagishi Y, Nakatomi H, Ohnishi H, Takayama N, Shiokawa Y. ML-18 High-dose chemotherapy supported by autologous stem cell transplant in relapsed and refractory primary CNS lymphoma. Neurooncol Adv 2021. [PMCID: PMC8648182 DOI: 10.1093/noajnl/vdab159.095] [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: 11/14/2022] Open
Abstract
While whole brain radiation therapy (WBRT) has been performed as consolidation therapy in primary central nervous system lymphoma (PCNSL), high-dose chemotherapy supported by autologous stem cell transplant (HDC/ASCT) is widely investigated today as an alternative treatment strategy, given the high risk for radiation-induced neurotoxicity in WBRT. Various conditioning regimens have been investigated in phase II trials, which report non-inferiority of HDC/ASCT in efficacy and preservation of neurocognitive function in comparison with WBRT. Besides its promising efficacy, treatment-related deaths are reported in 11% in patients treated by a conditioning regimen using thiotepa, busulfan and cyclophosphamide (TBC), which raises a concern for safety. Among several conditioning regimens, analysis using registry data of Japan Society for Hematopoietic Cell Transplantation has revealed that the use of conditioning regimens containing thiotepa was a positive factor for longer PFS. According to the result of a phase I trial in Japan which investigated HDC/ASCT using thiotepa and busulfan (BuTT), thiotepa was approved by the pharmaceuticals and medical devices agency (PMDA) on March 2020. In comparison with the TBC regimen, cyclophosphamide is omitted, and the dose of thiotepa is lower (250 mg/m2, 3 days in TBC; 5 mg/kg, 2 days in BuTT) in BuTT, therefore BuTT could be less toxic in comparison with TBC, and no treatment-related deaths were observed in the phase I study in Japan. Further investigation on the efficacy and safety of BuTT in actual clinical practice is warranted. We have constituted a multi-disciplinary team in our institution in order to perform HDC/ASCT using BuTT in relapsed/refractory PCNSL. Treatment indications are as follows; 65 years old or younger, previously treated by rituximab, methotrexate, procarbazine and vincristine (R-MPV), good organ function and neurological status. Future directions along with preliminary treatment results will be discussed at the meeting.
Collapse
Affiliation(s)
- Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Ryo Onoda
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yosuke Seiya
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine
- Department of Neurosurgery, Kyorin University Graduate School of Medicine
- Division of Brain Disease Translational Research, Juntendo University Facility of Medicine
| | | | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Kyorin University Faculty of Medicine
| | | | | |
Collapse
|
19
|
Kobayashi K, Sasaki N, Saito K, Yamagishi Y, Hanayama N, Nakatomi H, Shiokawa Y, Nagane M. NQPC-5 Does high-dose methotrexate-based chemotherapy for relapsed primary CNS lymphoma increase a risk of leukoencephalopathy with prior whole brain radiotherapy? Neurooncol Adv 2021. [PMCID: PMC8648221 DOI: 10.1093/noajnl/vdab159.083] [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: 11/14/2022] Open
Abstract
Abstract
Backgrounds: Standard care for primary central nervous system lymphoma (PCNSL) comprises high-dose (HD) methotrexate (MTX) -based chemotherapy with or without consolidation whole brain radiotherapy (WBRT). HD-MTX administration following WBRT has been suggested to increase a risk of leukoencephalopathy. However, given that there are no other agents with efficacy similar to or better than MTX, patients with relapsed PCNSL may often be treated with regimens containing HD-MTX if the initial MTX treatment achieved a long-term complete remission. Here, we retrospectively analyzed prevalence and an extent of white mater damages in association with prior WBRT in patients with relapsed PCNSL treated with HD-MTX based therapy. Patients & methods: Among 79 patients with relapsed/refractory PCNSL in a total of 162 patients with newly-diagnosed PCNSL treated in our institution from April, 2000 to February, 2021, 35 patients were identified with evaluable KPS, MMSE, and Fazekas scale data at both baseline and follow-up periods. Of the 35 patients, 22 were treated with chemotherapy at a relapse (10 with prior WBRT, while 12 without WBRT), and were included in this preliminary study. Results: In the WBRT group (male/female: 5/5), median age was 65 years (range, 45–73), initial median KPS was 70 (40–90), and median WBRT dose was 27 Gy (23.4–40). Median progression-free survival (mPFS) was 11.8 months, and median overall survival (mOS) was not reached. In the non-WBRT group (M/F 8/4), median age 75 (62–84), initial mKPS 80 (50–90), mPFS 16.2 m, and mOS not reached. Initial KPS and MMSE score tended to be worse in WBRT group, presumably due to enrichment of patients with poorer performance status and more comorbidities. A decline in the Fazekas score was not associated with MMSE deterioration.Conclusions: The preliminary analysis was not informative enough, and further extensive imaging analysis will be exploited.
Collapse
Affiliation(s)
- Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
- Division of Brain Disease Translational Research, Juntendo University Facility of Medicine, Tokyo, Japan
- Department of Neurosurgery, Kyorin University Graduate School of Medicine, Tokyo, Japan
| | - Naomi Hanayama
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Yuki Y, Sasaki N, Matsushita Y, Shimizu S, Matsumoto Y, Saito K, Kobayashi K, Nakatomi H, Shiokawa Y, Ichimura K, Nagane M. ML-7 Liquid biopsy for MYD88 mutation in cerebrospinal fluid in patients with suspected primary CNS lymphoma. Neurooncol Adv 2021. [PMCID: PMC8664634 DOI: 10.1093/noajnl/vdab159.088] [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: 12/01/2022] Open
Abstract
Background: Treatment intervention for central nervous system lymphoma (CNSL) requires pathological diagnosis by surgical biopsy. However, there are some cases in which the risk of surgery is high due to age, comorbidities, localization of lesions, etc. We are developing a CNSL diagnostic method based on the detection of MYD88 L265P mutation by digital PCR (dPCR) using CSF-DNA, and a high accuracy with a sensitivity of 92.9% and a specificity of 100% has been reported. Here, we report two cases with suspected brain stem CNSL, whose treatment strategy was determined by integrated clinico-laboratory information including neurological presentations, imaging, and the result of liquid biopsy. Result: Case 1. A 63-year-old woman visited our hospital with a complaint of right hemiplegia, which deteriorated in two months. MR images revealed a contrast-enhancing lesion in the left midbrain-ventral pons, suggesting CNSL. Biopsy was not considered because of its location, while dPCR using CSF-DNA showed a cluster of MYD88 mutation signals. Based on these work-ups, she was treated with high-dose methotrexate-based chemotherapy, resulting in a complete response with marked improvement of symptoms. Case 2. An 83-year-old man was referred for a history of diplopia and ataxic gait lasting for a month. MR images revealed an invasive lesion on his right midbrain-dorsal pons. Biopsy was declined due to the location, and liquid biopsy using CSF-DNA was performed to assist the diagnosis. In the first test, the CSF-DNA yield was too insufficient to determine the mutation signal by dPCR. The second dPCR using sufficient amount of CSF-DNA resulted in the Target/Total value of 0.049% which was lower than the threshold, suggesting the absence of MYD88 mutation. The patient underwent radiation therapy accordingly.Conclusions: CSF MYD88 mutation analysis by dPCR may have clinical utility and requires sufficient amount of CSF-DNA for exclusion of noise signals.
Collapse
Affiliation(s)
- Yamagishi Yuki
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
- Division of Brain Disease Translational Research, Juntendo University Facility of Medicine, Tokyo, Japan
- Department of Neurosurgery, Kyorin University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Yuko Matsushita
- Division of Brain Disease Translational Research, Juntendo University Facility of Medicine, Tokyo, Japan
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Disease Translational Research, Juntendo University Facility of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculity of Medicine, Tokyo, Japan
| |
Collapse
|
21
|
Saito K, Sasaki N, Kobayashi K, Nakatomi H, Shiokawa Y, Nagane M. FLGS-05. Maximal safe glioma resection using high resolution exoscope with 5-ALA-induced fluorescence. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
5-aminolevulinic acid (5-ALA) guided surgery has been reported to prolong progression-free survival of patients with high grade glioma. Although blue-light capable microscope enables us to detect fluorescence intraoperatively, visualization of anatomy is difficult under blue-light microscope. On the other hand, exoscope permits to visualize both fluorescence and anatomy under blue-light conditions. We introduce our glioma surgery using an exoscope equipped with a 5-ALA fluorescence visual system.
METHODS
We attempted maximal safe resection for the patients with high grade glioma using 3D/4K exoscope with 5-ALA-induced fluorescence, neuronavigation, and electrophysiological monitoring or awake mapping. Visualization of fluorescence and anatomy under blue light, extent of resection, morbidity, and postoperative infarction were retrospectively reviewed.
RESULTS
Twenty patients (age 26–79, male 10/female 10, glioblastoma 11/lower grade glioma 9) underwent exoscopic tumor removal. Intraoperative fluorescence was observed in 100% of the tumor with gadolinium enhancement. Surrounding structures such as white matter, vessels and nerves were clearly visualized under blue light. Even perforators were visible and could be preserved. Supra-total resection and gross total resection of gadolinium-enhancing tumor was achieved in 6 (30%) and 10 (50%) patients, respectively. Surgical morbidity included hemianopsia in 1 patient and transient hemiparesis in 1 patient. Postoperative infarction was observed in 2 (10%) patients, which tended to be lower compared to 23 of 77 (29.9%) patients with glioblastoma who underwent tumor resection with fluorescence-equipped microscope(p=0.05).
CONCLUSION
Clear visualization of 5-ALA-indced tumor fluorescence and anatomical structures with use of high resolution exoscope help maximal safe tumor resection. Longer progression-free survival is expected as a result of greater extent of tumor resection.
Collapse
Affiliation(s)
| | | | | | | | | | - Motoo Nagane
- Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
22
|
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.
Collapse
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
| | | |
Collapse
|
23
|
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.
Collapse
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
| | | |
Collapse
|
24
|
Yamagishi Y, Sasaki N, Nakano Y, Matushita Y, Omura T, Shimizu S, Saito K, Kobayashi K, Narita Y, Kondo A, Shiokawa Y, Nagane M, Ichimura K. Liquid biopsy of cerebrospinal fluid for MYD88 L265P mutation is useful for diagnosis of central nervous system lymphoma. Cancer Sci 2021; 112:4702-4710. [PMID: 34523186 PMCID: PMC8586690 DOI: 10.1111/cas.15133] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
The current standard of diagnosing central nervous system (CNS) lymphoma is stereotactic biopsy, however the procedure has a risk of surgical complication. Liquid biopsy of the CSF is a less invasive, non-surgical method that can be used for diagnosing CNS lymphoma. In this study, we established a clinically applicable protocol for determining mutations in MYD88 in the CSF of patients with CNS lymphoma. CSF was collected prior to the start of chemotherapy from 42 patients with CNS lymphoma and matched tumor specimens. Mutations in MYD88 in 33 tumor samples were identified using pyrosequencing. Using 10 ng each of cellular DNA and cell-free DNA (cfDNA) extracted from the CSF, the MYD88 L265P mutation was detected using digital PCR. The conditions to judge mutation were rigorously determined. The median Target/Total value of cases with MYD88 mutations in the tumors was 5.1% in cellular DNA and 22.0% in cfDNA. The criteria to judge mutation were then determined, with a Target/Total value of 0.25% as the cutoff. When MYD88 mutations were determined based on these criteria, the sensitivity and specificity were 92.2% and 100%, respectively, with cellular DNA; and the sensitivity and specificity were 100% with cfDNA. Therefore, the DNA yield, mutated allele fraction, and accuracy were significantly higher in cfDNA compared with that in cellular DNA. Taken together, this study highlights the importance of detecting the MYD88 L265P mutation in cfDNA of the CSF for diagnosing CNS lymphoma using digital PCR, a highly accurate and clinically applicable method.
Collapse
Affiliation(s)
- Yuki Yamagishi
- Division of Brain Tumor Translational ResearchNational Cancer Center Research InstituteChuo‐kuTokyoJapan
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
- Department of Brain Disease Translational ResearchJuntendo University Facility of MedicineBunkyo‐kuTokyoJapan
| | - Nobuyoshi Sasaki
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Yoshiko Nakano
- Division of Brain Tumor Translational ResearchNational Cancer Center Research InstituteChuo‐kuTokyoJapan
| | - Yuko Matushita
- Division of Brain Tumor Translational ResearchNational Cancer Center Research InstituteChuo‐kuTokyoJapan
- Department of Brain Disease Translational ResearchJuntendo University Facility of MedicineBunkyo‐kuTokyoJapan
| | - Takaki Omura
- Division of Brain Tumor Translational ResearchNational Cancer Center Research InstituteChuo‐kuTokyoJapan
- Department of Neurosurgery and Neuro‐OncologyNational Cancer Center HospitalChuo‐kuTokyoJapan
| | - Saki Shimizu
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Kuniaki Saito
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Keiichi Kobayashi
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro‐OncologyNational Cancer Center HospitalChuo‐kuTokyoJapan
| | - Akihide Kondo
- Department of Brain Disease Translational ResearchJuntendo University Facility of MedicineBunkyo‐kuTokyoJapan
| | - Yoshiaki Shiokawa
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Motoo Nagane
- Department of NeurosurgeryKyorin University Facility of MedicineMitaka‐shiTokyoJapan
| | - Koichi Ichimura
- Division of Brain Tumor Translational ResearchNational Cancer Center Research InstituteChuo‐kuTokyoJapan
- Department of Brain Disease Translational ResearchJuntendo University Facility of MedicineBunkyo‐kuTokyoJapan
| |
Collapse
|
25
|
van der Kamp LT, Rinkel GJE, Verbaan D, van den Berg R, Vandertop WP, Murayama Y, Ishibashi T, Lindgren A, Koivisto T, Teo M, St George J, Agid R, Radovanovic I, Moroi J, Igase K, van den Wijngaard IR, Rahi M, Rinne J, Kuhmonen J, Boogaarts HD, Wong GKC, Abrigo JM, Morita A, Shiokawa Y, Hackenberg KAM, Etminan N, van der Schaaf IC, Zuithoff NPA, Vergouwen MDI. Risk of Rupture After Intracranial Aneurysm Growth. JAMA Neurol 2021; 78:1228-1235. [PMID: 34459846 DOI: 10.1001/jamaneurol.2021.2915] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Unruptured intracranial aneurysms not undergoing preventive endovascular or neurosurgical treatment are often monitored radiologically to detect aneurysm growth, which is associated with an increase in risk of rupture. However, the absolute risk of aneurysm rupture after detection of growth remains unclear. Objective To determine the absolute risk of rupture of an aneurysm after detection of growth during follow-up and to develop a prediction model for rupture. Design, Setting, and Participants Individual patient data were obtained from 15 international cohorts. Patients 18 years and older who had follow-up imaging for at least 1 untreated unruptured intracranial aneurysm with growth detected at follow-up imaging and with 1 day or longer of follow-up after growth were included. Fusiform or arteriovenous malformation-related aneurysms were excluded. Of the 5166 eligible patients who had follow-up imaging for intracranial aneurysms, 4827 were excluded because no aneurysm growth was detected, and 27 were excluded because they had less than 1 day follow-up after detection of growth. Exposures All included aneurysms had growth, defined as 1 mm or greater increase in 1 direction at follow-up imaging. Main Outcomes and Measures The primary outcome was aneurysm rupture. The absolute risk of rupture was measured with the Kaplan-Meier estimate at 3 time points (6 months, 1 year, and 2 years) after initial growth. Cox proportional hazards regression was used to identify predictors of rupture after growth detection. Results A total of 312 patients were included (223 [71%] were women; mean [SD] age, 61 [12] years) with 329 aneurysms with growth. During 864 aneurysm-years of follow-up, 25 (7.6%) of these aneurysms ruptured. The absolute risk of rupture after growth was 2.9% (95% CI, 0.9-4.9) at 6 months, 4.3% (95% CI, 1.9-6.7) at 1 year, and 6.0% (95% CI, 2.9-9.1) at 2 years. In multivariable analyses, predictors of rupture were size (7 mm or larger hazard ratio, 3.1; 95% CI, 1.4-7.2), shape (irregular hazard ratio, 2.9; 95% CI, 1.3-6.5), and site (middle cerebral artery hazard ratio, 3.6; 95% CI, 0.8-16.3; anterior cerebral artery, posterior communicating artery, or posterior circulation hazard ratio, 2.8; 95% CI, 0.6-13.0). In the triple-S (size, site, shape) prediction model, the 1-year risk of rupture ranged from 2.1% to 10.6%. Conclusion and Relevance Within 1 year after growth detection, rupture occurred in approximately 1 of 25 aneurysms. The triple-S risk prediction model can be used to estimate absolute risk of rupture for the initial period after detection of growth.
Collapse
Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yuichi Murayama
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Antti Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Junta Moroi
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Keiji Igase
- Department of Advanced Neurosurgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
| | | | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Johanna Kuhmonen
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong, China
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Basement, Yue Kong Pao Centre for Cancer and the Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Hong Kong, China
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
26
|
Katsumata M, Ota T, Kaneko J, Jimbo H, Aoki R, Fujitani S, Ichijo M, Inoue M, Shigeta K, Miyauchi Y, Sakai Y, Arakawa H, Otsuka Y, Ariyada K, Kuroshima Y, Fuse T, Shiokawa Y, Hirano T. Impact of Coronavirus Disease 2019 on Time Delay and Functional Outcome of Mechanical Thrombectomy in Tokyo, Japan. J Stroke Cerebrovasc Dis 2021; 30:106051. [PMID: 34419835 PMCID: PMC8361142 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106051] [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: 06/07/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives An association has been reported between delays in the onset-to-door (O2D) time for mechanical thrombectomy (MT) and outbreaks of coronavirus disease 2019 (COVID-19). However, the association between other MT time courses or functional outcomes and COVID-19 outbreaks remains unclear. We compared the time courses of stroke pathways or functional outcomes in 2020 (the COVID-19 era) with those in 2019 (the pre-COVID-19 era) in Tokyo, Japan. Materials and methods This retrospective observational study used data from the Tokyo-tama-REgistry of Acute endovascular Thrombectomy (TREAT), a multicenter registry of MT for acute large vessel occlusion in the Tokyo Metropolitan Area. Patients who had undergone acute MT from January 2019 to December 2020 were included. Patients were classified by the year they had undergone MT (2019 or 2020). Results In total, 477 patients were analyzed. O2D time was significantly longer in 2020 (146.0 min) than in 2019 (105.0 min; p = 0.034). No significant difference in door-to-puncture time (D2P) time or modified Rankin Scale (mRS) score 0–2 at 90 days was seen between 2019 and 2020. In the subgroup analysis, O2D time was significantly longer in the first half of 2020 compared with 2019. Multivariable logistic regression analysis revealed that the year 2020 was a independent predictor of longer O2D time, but not for mRS score 0–2 at 90 days. Conclusions Although O2D time was significantly longer in the COVID-19 compared with the pre-COVID-19 era, D2P may not be significantly delayed and functional outcomes may not be different, despite the COVID-19 pandemic.
Collapse
Affiliation(s)
- Masahiro Katsumata
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shigeta Fujitani
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Yoshifumi Miyauchi
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yu Sakai
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan
| | - Hideki Arakawa
- Department of Neurosurgery, Omori Red Cross Hospital, Tokyo, Japan
| | - Yoshinobu Otsuka
- Department of Neurology, Machida Municipal Hospital, Tokyo, Japan
| | - Kenichi Ariyada
- Department of Neurosurgery, Tokyo Metropolitan Bokuto Hospital, Tokyo, Japan
| | | | - Takahisa Fuse
- Department of Neurosurgery, Public Fussa Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| |
Collapse
|
27
|
Nakanishi K, Kawano H, Yamagishi Y, Kamma H, Shiokawa Y, Hirano T. Tumor Cells Detected in Retrieved Thrombus: Cancer-associated Stroke. Intern Med 2021; 60:2491-2494. [PMID: 33678737 PMCID: PMC8381188 DOI: 10.2169/internalmedicine.6201-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 51-year-old man with a history of renal cell carcinoma presented with sudden aphasia, right hemiparesis, and dysesthesia. MRA showed left middle cerebral artery occlusion, and he was diagnosed with acute ischemic stroke and treated with intravenous recombinant tissue plasminogen activator and endovascular thrombectomy. The pathological diagnosis of the retrieved thrombus was consistent with the already-known pathological findings of the primary renal cell carcinoma. Therefore, a diagnosis of cerebral embolism caused by tumor cells was made. The pathological findings of the retrieved thrombi were important in determining the cause of ischemic stroke.
Collapse
Affiliation(s)
- Kaoru Nakanishi
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Japan
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Japan
| | | | | | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Japan
| |
Collapse
|
28
|
Nakatomi H, Kiyofuji S, Ono H, Tanaka M, Kamiyama H, Takizawa K, Imai H, Saito N, Shiokawa Y, Morita A, Flemming KD, Link MJ. Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction-Clinicopathological and Surgical Outcome. Neurosurgery 2021; 88:82-95. [PMID: 32745190 PMCID: PMC7891276 DOI: 10.1093/neuros/nyaa317] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/15/2019] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Giant fusiform and dolichoectatic aneurysms of the basilar trunk and
vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat. OBJECTIVE To evaluate factors influencing survival and outcome of BTVBJ-GFDA by
performing a retrospective multicenter cohort study. METHODS A total of 32 patients with BTVBJ-GFDA were included in this study.
Clinicopathological characteristics, treatment measures, and outcomes were
collected from medical records and imaging studies. Autopsy and histological
findings of the aneurysm and adjacent brain tissue were also obtained in 9
cases. RESULTS A total of 11 patients did not undergo surgery, of whom 10 died; 3 from
progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from
brainstem infarction, and 1 from associated atherosclerotic disease. The
remaining 21 patients underwent a surgical treatment, consisting of
immediately proximal parent artery occlusion, remotely proximal parent
artery occlusion, clip reconstruction, and distal bypass and achieved
significantly longer overall survival compared with those who received
conservative therapy (adjusted hazard ratio 1.508, 95% CI
1.058-2.148, P = .02). Histological
examination of the aneurysms demonstrated staged clots, open lumen, and
intrathrombotic channels with endothelial lining. The patients younger than
45 yr of age showed statistically longer survival than those equal and older
than 45 yr (P = .03). CONCLUSION Surgical intervention achieved greater survival than conservative management
in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the
aneurysm to maintain sufficient but not excess supply should be targeted
based on the hemodynamics of both the posterior communicating arteries and
perforating vessel collaterals.
Collapse
Affiliation(s)
- Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.,Division of Collaborative Laboratory for Medical Science of Neural Dynamics, RIKEN Center for Brain Science, Saitama, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideaki Ono
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery and Stroke, Teishinkai Hospital, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Hideaki Imai
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Akio Morita
- Department of Neurosurgery, Nippon Medical University, Tokyo, Japan
| | | | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
29
|
Kurogi R, Kada A, Ogasawara K, Kitazono T, Sakai N, Hashimoto Y, Shiokawa Y, Miyachi S, Matsumaru Y, Iwama T, Tominaga T, Onozuka D, Nishimura A, Arimura K, Kurogi A, Ren N, Hagihara A, Nakaoku Y, Arai H, Miyamoto S, Nishimura K, Iihara K. Effects of case volume and comprehensive stroke center capabilities on patient outcomes of clipping and coiling for subarachnoid hemorrhage. J Neurosurg 2021; 134:929-939. [DOI: 10.3171/2019.12.jns192584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEImproved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH.METHODSThe authors conducted a nationwide retrospective cohort study in 27,490 SAH patients who underwent clipping or coiling in 621 institutions between 2010 and 2015 and whose data were collected from the Japanese nationwide J-ASPECT Diagnosis Procedure Combination database. The CSC capabilities of each hospital were assessed by use of a validated scoring system based on answers to a previously reported 25-item questionnaire (CSC score 1–25 points). Hospitals were classified into quartiles based on CSC scores and case volumes of clipping or coiling for SAH.RESULTSOverall, the absolute risk reductions associated with high versus low case volumes and high versus low CSC scores were relatively small. Nevertheless, in patients who underwent clipping, a high case volume (> 14 cases/yr) was significantly associated with reduced in-hospital mortality (Q1 as control, Q4 OR 0.71, 95% CI 0.55–0.90) but not with short-term poor outcome. In patients who underwent coiling, a high case volume (> 9 cases/yr) was associated with reduced in-hospital mortality (Q4 OR 0.69, 95% CI 0.53–0.90) and short-term poor outcomes (Q3 [> 5 cases/yr] OR 0.75, 95% CI 0.59–0.96 vs Q4 OR 0.65, 95% CI 0.51–0.82). A high CSC score (> 19 points) was significantly associated with reduced in-hospital mortality for clipping (OR 0.68, 95% CI 0.54–0.86) but not coiling treatment. There was no association between CSC capabilities and short-term poor outcomes.CONCLUSIONSThe effects of case volume and CSC capabilities on in-hospital mortality and short-term functional outcomes in SAH patients differed between patients undergoing clipping and those undergoing coiling. In the modern endovascular era, better outcomes of clipping may be achieved in facilities with high CSC capabilities.
Collapse
Affiliation(s)
- Ryota Kurogi
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Akiko Kada
- 2Department of Clinical Trials and Research, National Hospital Organization, Nagoya Medical Center, Nagoya
| | | | - Takanari Kitazono
- 4Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Nobuyuki Sakai
- 5Department of Neurosurgery, Kobe City Medical Centre General Hospital, Kobe
| | | | - Yoshiaki Shiokawa
- 7Department of Neurosurgery, Kyorin University School of Medicine, Mitaka
| | - Shigeru Miyachi
- 8Department of Neurosurgery, Aichi Medical University, Nagakute
| | - Yuji Matsumaru
- 9Department of Neurosurgery, University of Tsukuba, Tsukuba
| | - Toru Iwama
- 10Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu
| | - Teiji Tominaga
- 11Department of Neurosurgery, Tohoku University School of Medicine, Sendai
| | - Daisuke Onozuka
- 12Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita
| | - Ataru Nishimura
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Koichi Arimura
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ai Kurogi
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Nice Ren
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Akihito Hagihara
- 12Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita
| | - Yuriko Nakaoku
- 12Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita
| | - Hajime Arai
- 13Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Susumu Miyamoto
- 14Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kunihiro Nishimura
- 12Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita
| | - Koji Iihara
- 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| |
Collapse
|
30
|
Yoshimura S, Koga M, Okada T, Inoue M, Miwa K, Fukuda-doi M, Kondo R, Inoue T, Ichijo M, Ohtaki M, Nagakane Y, Itabashi R, Sakai N, Aoki J, Shiokawa Y, Yagita Y, Iwama T, Yakushiji Y, Kusumi M, Kamiyama K, Doijiri R, Igarashi S, Kanzawa T, Matsumoto S, Ito Y, Yoshimura S, Ohsaki M, Ihara M, Toyoda K. Abstract MP6: Thrombolysis for Acute Wake-Up And Unclear Onset Strokes With Alteplase at 0.6mg /kg in Clinical Practice: THAWS2 Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.mp6] [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:
IV alteplase at 0.6 mg/kg for acute wake-up and unclear onset strokes was recommended in Japanese stroke guidelines in March 2019. We determined the safety and effectiveness of this newly recommended thrombolysis in clinical practice.
Methods:
This is a multicenter observational study, enrolling acute ischemic stroke patients with a time last-known-well >4.5 h who have a mismatch between DWI and FLAIR treated with intravenous alteplase. The safety outcomes are intracranial hemorrhage (ICH) with neurological deterioration within 36 h after thrombolysis, all cause deaths within 90 days, and adverse events. The efficacy outcomes are functionally independence defined as a mRS score of 0-1 at 90 days, and NIHSS change at 24h from baseline.
Results:
Between 2019 March and 2020 March, 63 patients (33 females; age, 74±11y; premorbid functionally independence, 50 (82%); median NIHSS on admission, 11) were enrolled at 14 hospitals. Of them, 40 patients (63%) recognized stroke symptoms at wake-up time, and median time between last-known-well and admission was 6.5 h. Baseline MRA showed any vessel occlusion in 52 patients (88%). IV alteplase was disrupted in one patient. Two patients (3%) had symptomatic ICH (≥4 increase in NIHSS) within 36 h. NIHSS change was -5.1±8.1. Twenty-one patients (36%) had functionally independence at discharge and there was no death during acute hospitalization. Of the overall 63 patients, 22 also underwent mechanical thrombectomy (36%, 72±9y, median NIHSS 16), showing no symptomatic ICH, mean NIHSS change of -8.9±7.5, and 8 patients (42%) had functionally independence at discharge.
Conclusions:
In clinical practice, IV alteplase for wake-up and unclear onset stroke patients with DWI-FLAIR mismatch seemed to be safe and effective compared with previous randomized control trials. Mechanical thrombectomy could be combined with alteplase safely and effectively.
Collapse
Affiliation(s)
- Sohei Yoshimura
- Dept of Cerebrovascular Medicine,, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masatoshi Koga
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Takashi Okada
- Dept of Cerebrovascular Medicine,, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Manabu Inoue
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kaori Miwa
- Dept of Cerebrovascular Medicine,, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Mayumi Fukuda-doi
- Dept of Data Science, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Rei Kondo
- Dept of Neurosurgery, Stroke Cntr, Yamagata City Hosp Saiseikan, Yamagata, Japan
| | - Takeshi Inoue
- Dept of Stroke Medicine, Kawasaki Med Sch General Med Cntr, Okayama, Japan
| | - Masahiko Ichijo
- Dept of Neurology, Japanese Red Cross Musashino Hosp, Musashino, Japan
| | | | | | - Ryo Itabashi
- Dept of Stroke Neurology, Kohnan Hosp, Sendai, Japan
| | - Nobuyuki Sakai
- Dept of Neurosurgery, Kobe City Med Cntr General Hosp, Kobe, Japan
| | - Junya Aoki
- Dept of Neurology, Graduate Sch of Medicine, Nippon Med Sch, Tokyo, Japan
| | | | - Yoshiki Yagita
- Dept of Stroke Medicine, Kawasaki Med Sch, Kurashiki, Japan
| | - Toru Iwama
- Dept of Neurosurgery, Gifu Univ Sch of Medicine, Gifu, Japan
| | - Yusuke Yakushiji
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | | | - Kenji Kamiyama
- Dept of Neurosurgery, Nakamura Memorial Hosp, Sapporo, Japan
| | - Ryosuke Doijiri
- Dept of Neurology, Iwate Prefectural Central Hosp, Morioka, Japan
| | | | - Takao Kanzawa
- Dept of Stroke Medicine, Institute of Brain and Blood Vessels, Mihara Memorial Hosp, Isesaki, Japan
| | - Shoji Matsumoto
- Dept of Comprehensive Strokology, Fujita Health Univ Hosp, Toyoake, Japan
| | - Yasuhiro Ito
- Dept of Neurology, TOYOTA Memorial Hosp,, Toyota, Japan
| | | | - Masato Ohsaki
- Dept of Cerebrovascular Medicine, Stroke Cntr,, Steel Memorial Yawata Hosp, Kitakyushu, Japan
| | - Masafumi Ihara
- Dept of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| |
Collapse
|
31
|
Yamagami H, Hayakawa M, Inoue M, Iihara K, Ogasawara K, Toyoda K, Hasegawa Y, Ohata K, Shiokawa Y, Nozaki K, Ezura M, Iwama T. Guidelines for Mechanical Thrombectomy in Japan, the Fourth Edition, March 2020: A Guideline from the Japan Stroke Society, the Japan Neurosurgical Society, and the Japanese Society for Neuroendovascular Therapy. Neurol Med Chir (Tokyo) 2021; 61:163-192. [PMID: 33583863 DOI: 10.2176/nmc.nmc.st.2020-0357] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Manabu Inoue
- Division of Stroke Care Unit/Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.,Stroke Center and Department of Neurology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | | | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | | |
Collapse
|
32
|
Kaneko J, Ota T, Unemoto K, Shigeta K, Inoue M, Aoki R, Jimbo H, Ichijo M, Arakawa H, Shiokawa Y, Hirano T. Endovascular treatment of acute basilar artery occlusion: Outcomes, influencing factors and imaging characteristics from the Tama-REgistry of acute thrombectomy (TREAT) study. J Clin Neurosci 2021; 86:184-189. [PMID: 33775325 DOI: 10.1016/j.jocn.2020.12.034] [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: 08/03/2020] [Revised: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO. METHODS We retrospectively investigated patients with ABAO who underwent MT using modern stent retrievers and an aspiration device between January 2015 and March 2019 at 12 comprehensive stroke centers. Functional outcomes and 90-day mortality rates were analyzed as primary outcomes. Factors influencing outcomes were analyzed as secondary outcomes. Relationships between outcome and affected area of infarction on arrival were also analyzed. RESULTS Seventy-three patients were included. Good outcome (modified Rankin Scale (mRS) score 0-2) was achieved in 25/73 patients (34.2%) and the all-cause 90-day mortality rate was 23.3% (17/73). Successful recanalization (modified Thrombolysis In Cerebral Infarction grade 2b and 3) was achieved in 70/73 patients (95.9%). In univariate analyses, age, National Institutes of Health Stroke Scale score, and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) differed significantly between good and poor functional outcome groups. Age and pc-ASPECTS were significantly associated with functional outcomes in the logistic regression model. Positive findings for the midbrain on diffusion-weighted imaging on pc-ASPECTS and brainstem score were significantly associated with poor outcomes. CONCLUSION MT with modern devices for ABAO resulted in highly successful recanalization and good outcomes. A positive finding for the midbrain on initial imaging might predict poor outcomes. Further studies are required to confirm our results.
Collapse
Affiliation(s)
- Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hideki Arakawa
- Department of Neurosurgery, Omori Red Cross Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | | |
Collapse
|
33
|
Shigeta K, Ota T, Kaneko J, Sato K, Aoki R, Jimbo H, Sato Y, Kuroshima Y, Shiokawa Y, Hirano T. Negative impact of Interhospital Transfer on Clinical Outcomes of Mechanical Thrombectomy for Fast Progressive Stroke. J Stroke Cerebrovasc Dis 2021; 30:105633. [PMID: 33517031 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105633] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The time-dependence of the clinical outcome of mechanical thrombectomy is higher in the "fast progressor" in whom cerebral ischemia progresses rapidly. The impact of time-consuming interhospital transfer (IT) on the clinical outcome of such patients is unknown. The effect on clinical outcomes of IT of fast progressors was investigated. METHODS Among the patients enrolled in the Tokyo/Tama REgistry of Acute endovascular Thrombectomy, fast progressor cerebral ischemia cases were retrospectively investigated. In this study, a fast progressor was defined as a case with an Alberta Stroke Program Early CT Score less than 6 and last known well (LKW) to arterial puncture within 6 h. Patients' background characteristics, treatment progress, and the modified Rankin Scale (mRS) score at 3 months were examined. RESULTS Of a total of 1182 patients, 92 (7.8%) were included, with 76 patients in the direct transfer (DT) group, and 16 patients in the IT group. Median LKW to reperfusion was 190 min and 272 min, respectively (P<.001). The number of patients with mRS scores 0-2 at three months was 22 (28.9%) in the DT group and 1 (6.2%) in the IT group. Interhospital transfer was an independent factor associated with worse outcomes (odds ratio 0.08, 95% confidence interval 0.01-0.87, P=.038). CONCLUSION This study showed that, among fast progressor patients, the IT group had a worse prognosis than the DT group. To provide good clinical outcomes for fast progressor patients, those who are likely to undergo mechanical thrombectomy should be sent directly to a thrombectomy-capable center.
Collapse
Affiliation(s)
- Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256, Midorhicho, Tachikawa, Tokyo 190-0014, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
| | - Katsuya Sato
- Department of Neurosurgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Tokyo 192-0032, Japan.
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan.
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashino, Tokyo 180-8610, Japan.
| | - Yoshiaki Kuroshima
- Department of Neurosurgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo 191-0062, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.
| |
Collapse
|
34
|
Katsumata M, Ota T, Tsuruta W, Akiyama T, Sakai Y, Shigeta K, Kaneko J, Nogawa S, Ichijo M, Shiokawa Y, Hirano T. Comparisons of Characteristics and Outcomes after Mechanical Thrombectomy for Vertebrobasilar Occlusion with Cardioembolism or Atherosclerotic Brain Infarction: Data from the Tokyo-Tama-Registry of Acute Endovascular Thrombectomy (TREAT). World Neurosurg 2021; 148:e680-e688. [PMID: 33508493 DOI: 10.1016/j.wneu.2021.01.071] [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: 12/06/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some reports suggest the efficacy of mechanical thrombectomy (MT) for acute vertebrobasilar artery (VBA) occlusion. The major causes of VBA occlusion include cardioembolism (CE) and large-artery atherosclerosis (LAA). However, the clinical characteristics of each cause remain unclear, and they might be important for decision making related to the indications and strategy of MT. OBJECTIVE This study aimed to compare functional outcomes and factors affecting outcomes between patients with CE and LAA with acute VBA occlusion. METHODS This was a retrospective and prospective observational study using data from TREAT (Tokyo-Tama-Registry of Acute Endovascular Thrombectomy), a multicenter registry of MT for acute large-vessel occlusion in the Tokyo metropolitan area. Patients with VBA occlusion classified into CE and LAA groups were analyzed. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. RESULTS Seventy-nine patients (57 with CE and 22 with LAA) were eligible from January 2015 to March 2020. Despite significantly shorter puncture-to-recanalization and onset-or-last-well-known-to-recanalization times in the CE group, the primary outcome was not significantly different between the 2 groups (CE, 31.6% vs. LAA, 45.5%; P = 0.248). In the subgroup analysis, patients with CE had worse clinical outcomes in the onset-or-last-well-known-to-door time ≥180 minutes, onset-or-last-well-known-to-door time ≥300 minutes, and low posterior circulation Alberta Stroke Program Early CT Score (≤7) subgroups. CONCLUSIONS Functional outcomes of VBA occlusion were not significantly different between CE and LAA. Based on the subgroup analysis, patients with CE might have poorer collateral status than do patients with LAA, and earlier recanalization might therefore be desired.
Collapse
Affiliation(s)
- Masahiro Katsumata
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yu Sakai
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Shigeru Nogawa
- Department of Neurology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurosurgery, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| |
Collapse
|
35
|
Tabei Y, Kobayashi K, Saito K, Shimizu S, Suzuki K, Sasaki N, Shiokawa Y, Nagane M. Survival in patients with glioblastoma at a first progression does not correlate with isocitrate dehydrogenase (IDH)1 gene mutation status. Jpn J Clin Oncol 2021; 51:45-53. [PMID: 32888020 PMCID: PMC7767982 DOI: 10.1093/jjco/hyaa162] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/19/2020] [Accepted: 08/19/2020] [Indexed: 01/06/2023] Open
Abstract
Backgrounds Mutations in the isocitrate dehydrogenase (IDH)1 gene are favourable prognostic factors in newly diagnosed diffuse gliomas, whereas it remains controversial in the recurrent glioblastoma setting. Methods A total of 171 patients with newly diagnosed glioblastoma, either ‘primary’ glioblastoma or ‘secondary’ glioblastoma, treated at Kyorin University Hospital or Japanese Red Cross Medical Center from 2000 to 2015 were included. Patients with confirmed IDH1 status and O6-methylguanine-DNA methyltransferase promoter methylation status were retrospectively analysed for overall survival from the initial diagnosis (n = 147) and after the first progression (n = 122). Results IDH1 mutation but not IDH2 was noted in 19 of 147 patients with glioblastoma (12.9%). In patients with ‘primary’ glioblastoma (n = 136), median overall survival after the first progression was 13.5 and 10.5 months for mutant IDH1 and wild-type IDH1 glioblastoma, respectively (P = 0.747). Multivariate analysis revealed O6-methylguanine-DNA methyltransferase promoter methylation, and Karnofsky Performance status 60 or higher, were independent prognostic factors for better overall survival after the first progression. When ‘primary’ glioblastoma and ‘secondary’ glioblastoma were combined, median overall survival from the first progression was not significantly different between the mutant IDH1 group (10.1 months) and wild-type IDH1 group (10.5 months) (P = 0.559), whereas median overall survival from the initial diagnosis was significantly different (47.5 months vs.18.3 months, respectively; P = 0.035). Conclusions These results suggest that IDH1 mutation may not be a prognostic factor for survival at the first progression of patients with ‘primary’ glioblastoma and pretreated ‘secondary’ glioblastoma, and further warrant investigation in prospective studies.
Collapse
Affiliation(s)
- Yusuke Tabei
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo.,Department of Neurosurgery, The Japanese Red Cross Medical Center, 4-1-20 Hiroo, Shibuya, Tokyo
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| | - Kaori Suzuki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo.,Department of Neurosurgery, Kyorin University Graduate School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo.,Department of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo
| |
Collapse
|
36
|
Ota T, Shiokawa Y, Hirano T. Impact of COVID-19 on Stroke Admissions and the Medical Care System in the Tokyo Metropolitan Area. Front Neurol 2021; 11:601652. [PMID: 33424751 PMCID: PMC7793774 DOI: 10.3389/fneur.2020.601652] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
Aims: This study aimed to assess the number of patients with acute stroke seeking medical emergency care since the declaration of the state of emergency in the COVID-19 pandemic in the Tokyo metropolitan area of Japan. Methods: In this combined retrospective and prospective multicenter survey, data on the numbers of hospital admissions due to acute ischemic stroke, of large vessel occlusion (LVO) cases, and of reperfusion therapies performed from February to July 2020, restrictions of the medical care system, and comprehensive stroke center (CSC) scale scores were collected in 19 stroke centers in Tokyo. Results: In the survey period, 3,456 patients were admitted with acute stroke. There was a decrease in the number of admissions (-22%), LVO (-22%), thrombolysis (-6%), and thrombectomy (-23%) during the state of emergency, but the ratio of thrombectomy to LVO cases was not different. The acceptance of acute stroke cases by emergency transport and emergent operations in the central eastern area of Tokyo, was also significantly decreased to <50% and remains <60%. According to CSC scores, each hospital restricted their infrastructure or educational activities according to their medical resources. There was only one stroke case with COVID-19 (thrombectomy case) in all 3,456 patients in this study. Conclusion: The COVID-19 pandemic had a major impact on stroke care in Tokyo, including stroke admissions and medical care systems, resulting in a significant reduction in thrombolysis and thrombectomy. The extent of the drop may be the result of the number of COVID-19 patients.
Collapse
Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| |
Collapse
|
37
|
Hong S, Maruyama K, Noguchi A, Hirano T, Nagane M, Shiokawa Y. Is using intracerebral hemorrhage scoring systems valid for mortality prediction in surgically treated patients? Neurosurg Rev 2021; 44:2747-2753. [PMID: 33411094 DOI: 10.1007/s10143-020-01451-8] [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: 10/12/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
While intracerebral hemorrhage (ICH) scoring systems provide mortality and morbidity prediction, the actual mortality rates seem to be lower than those predicted by scoring systems in our clinical impression. To assess the validity of the ICH score and the Surgical Swedish ICH (SwICH) score, we retrospectively reviewed surgically treated ICH patients between 2012 and 2019. Uni- and multivariate analyses were performed to identify variables in predicting 30-day mortality. We identified 203 patients (mean ICH score 2.7; mean SwICH score 2.0). The actual 30-day mortality was 7%, which was significantly lower than those predicted by the ICH and the SwICH scores (55% and 16%, respectively; p < 0.001). Both scores were strongly correlated with the modified Rankin scale (mRS) at discharge (correlation coefficient 0.97 and 0.98; critical value 0.81). The only significant prognostic factors for the 30-day mortality by multivariate analysis were anisocoria (p = 0.03) and preoperative Glasgow Coma Scale (p = 0.03). These two factors also predicted mRS at discharge (p < 0.001). After discharge, 15% of patients improved regarding mRS and 29% of wheelchair-bound patients gained the ability to ambulate. No significant relationship existed between the degree of recovery after discharge and preoperative ICH score (p = 0.25). The ICH and SwICH scores were more valid in predicting morbidity, rather than mortality after surgical intervention for ICH. Anisocoria and Glasgow Coma Scale < 7 were the only two factors that predicted 30-day mortality and morbidity at discharge.
Collapse
Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan.
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan
| | - Akio Noguchi
- Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan
| | - Teruyuki Hirano
- Department of Stroke, Kyorin University Hospital, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Hospital, Tokyo, Japan
| |
Collapse
|
38
|
Kawano H, Ebisawa S, Ayano M, Kono Y, Saito M, Johno T, Maruoka H, Ryoji N, Yamashita H, Nakanishi K, Honda Y, Amano T, Unno Y, Komatsu Y, Ogawa Y, Shiokawa Y, Hirano T. Improving Acute In-Hospital Stroke Care by Reorganization of an In-Hospital Stroke Code Protocol. J Stroke Cerebrovasc Dis 2021; 30:105433. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/17/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022] Open
|
39
|
Hong S, Maruyama K, Hatanaka R, Noguchi A, Shimoyamada H, Nagane M, Shiokawa Y. Frontotemporal dermoid cyst with incomplete dermal sinus tract in an adult: A case report. Surg Neurol Int 2020; 11:429. [PMID: 33365191 PMCID: PMC7749934 DOI: 10.25259/sni_504_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background Non-midline supratentorial dermoid cyst with dermal sinus tract has been rarely reported especially in adults. We recently experienced a noteworthy patient with frontotemporal dermoid cyst with incomplete dermal sinus tract. Case Description A 43-year-old female presented with recurrent subcutaneous mass in the left superolateral orbital region. She had a history of active bronchial asthma, which precluded her from contrast-enhanced imaging studies. Plain imaging studies showed a subcutaneous mass which was continuous with an intrasylvian fissure mass by a tract in the sphenoid ridge and the lesser wing of the sphenoid bone. Frontotemporal craniotomy was performed to reset the mass and the tract. Intraoperative finding showed no intradural tumor components. Extradural component was carefully removed focusing attention on the frontal branch of the facial nerve. The pathology was consistent with dermoid cyst and dermal sinus tract. Postoperatively, she had mild facial palsy of the corrugator supercilii (House and Brackmann Grade II). She was discharged home with modified Rankin scale 1. Conclusion Dermoid cyst needs to be included in the differential diagnosis of adult-onset subcutaneous mass in the frontotemporal regions. After thorough imaging studies for the presence and extent of the sinus tract, the symptomatic lesion should be excised completely once and for all.
Collapse
Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Ryo Hatanaka
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Akio Noguchi
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| |
Collapse
|
40
|
Sasaki N, Chiba T, Saito K, Kobayashi K, Shiokawa Y, Shibahara J, Nagane M. PATH-05. A CASE OF PILOCYTIC ASTROCYTOMA HARBORING THE FGFR1 GENE MUTATION WITH A PREDOMINANT OLIGODENDROGLIOMA-LIKE COMPONENT. Neuro Oncol 2020. [PMCID: PMC7715897 DOI: 10.1093/neuonc/noaa222.641] [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
Pilocytic astrocytomas rarely present with oligodendroglioma-like morphological features, which gives rise to a diagnostic challenge. In this report we present a case of pilocytic astrocytoma harboring the FGFR1 mutation, accompanied with a predominant oligodendroglioma-like component, thus initially diagnosed as oligodendroglioma. A 14-year-old female presented with syncope and simple partial seizure involving her right upper limb. Contrast-enhanced MRI revealed an enhancing lesion with substantial cystic portion and perifocal edema in the left parietal lobe. Open surgery was performed and a gross total resection of the tumor was achieved. On initial histopathological diagnosis, tumor cells with monotonous round nuclei and perinuclear halo predominated with branching capillaries, which were strongly suggestive for oligodendroglioma. Immunohistochemically, IDH1 R132H was negative, and Ki-67 index was around 5%. The patient was thus initially diagnosed as oligodendroglioma, WHO grade II, based on the 2007 WHO classification criteria. However, histopathological re-review revealed a minor astrocytic component with Rosenthal fibers and rare eosinophilic granular bodies, thus the diagnosis was changed as pilocytic astrocytoma. FGFR1 K654E mutation was confirmed by Sanger sequencing. Although she postoperatively developed mild sensory disturbance in her right hands, finger agnosia, and left-right disorientation, her symptoms had gradually improved, and she was discharged on day 17 with a Karnofsky performance status (KPS) of 90 and no cognitive decline. Without any adjuvant therapies, she has remained recurrence-free for 85 months. While the diagnosis of pilocytic astrocytoma with predominant oligodendroglioma-like component can be challenging, analysis of IDH1 and FGFR1 mutations can be beneficial in certain cases.
Collapse
Affiliation(s)
- Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
- Department of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tomohiro Chiba
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
41
|
Nagane M, Sasaki N, Kobayashi K, Saito K, Shimada D, Matsumoto Y, Iijima S, Yamagishi Y, Shimizu S, Sasaki Y, Shiokawa Y. ML-02 Chemotherapy for patients with relapsed or refractory primary CNS lymphoma. Neurooncol Adv 2020. [PMCID: PMC7699036 DOI: 10.1093/noajnl/vdaa143.066] [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: 11/29/2022] Open
Abstract
BACKGROUNDS: Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy, particularly with R-MPV-A with or without whole-brain radiotherapy (WBRT), however, the optimal treatment for relapsed/refractory (r/r)PCNSL has not been established yet. Approval of a second-generation BTK inhibitor, tirabrutinib, for r/rPCNSL in Japan in March 2020, prompted us to evaluate retrospectively efficacy of R-MPV-A for r/rPCNSL to compare their activities. PATIENTS: Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens. RESULTS: Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA, 14 with HD-MTX monotherapy, and 11 with DeVIC (DEX, etoposide, ifosfamide, CDBCA). Median age/KPS were 69 yo (20–87)/ 80 (40–100), 27 patients had received prior WBRT. RMPVA was given at the first relapse in 11 patients, median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Median PFS and OS for HD-MTX monotherapy were 5.1m and 36.6 m, while those for DeVIC were 4.4 m and 9.1 m, respectively. Treatment was generally well-tolerated but there was one treatment-related death. CONCLUSIONS: Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.
Collapse
Affiliation(s)
- Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Daisuke Shimada
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Shohei Iijima
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuta Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | |
Collapse
|
42
|
Kobayashi K, Sasaki N, Saito K, Yamagishi Y, Matsumoto Y, Sasaki Y, Shimizu S, Shiokawa Y, Nagane M. ML-21 Tirabrutinib monotherapy for relapsed/refractory primary central nervous system lymphoma. Neurooncol Adv 2020. [PMCID: PMC7699110 DOI: 10.1093/noajnl/vdaa143.078] [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: 11/24/2022] Open
Abstract
Backgrounds & purpose: Prognosis of patients with primary central nervous system lymphoma (PCNSL) remains poor despite multiagent immunochemotherapy, and standard of care for relapsed or refractory (r/r) PCNSL has not been established. Recent progresses on molecular genetics and biology of PCNSL have led to development of novel molecular targeted therapies, especially targeting Bruton’s tyrosine kinase (BTK), located in the B-cell receptor and Toll-like receptor signaling pathways. Tirabrutinb, a second generation BTK inhibitor, was approved for r/rPCNSL in March 2020 in Japan. Methods: Patients with r/rPCNSL treated with tirabrutinib since December 2017 were eligible for this retrospective study. Tirabrutinib was given orally at doses 320–480 mg/day daily until progression or unacceptable toxicity. Results: A total of 7 patients were enrolled (6 relapses, 1 refractory), 4 males, median age was 73 (range, 54–80 years), and median KPS was 70 (70–90). Three patients had received prior whole brain radiotherapy. Median number of prior therapies was 1 (1–2). Best overall response rate was 57.1%; 42.9% with a complete response (CR/CRu), 14.3% with a partial response (PR), while there were 3 PDs (42.9%). Four patients experienced PD and estimated median progression-free survival (mPFS) was 29.6 months. All patients were alive at the data cutoff with median follow up of 21.4 months (2–30.4). Common adverse events (AEs) include grade 4 neutropenia (n=1), grade 3 lymphopenia (n=3), and hepatic dysfunction (n=1). Toxic rash was observed in four patients (grade 3 in one, grade 2 in three) leading to discontinuation of tirabrutinib in two patients, while others continued on TIR with dose reduction and steroid use. The median time to rash presentation was 28 days (12–28). Conclusions: Tirabrutinib was well tolerated with frequent minor to moderate skin rash emerging within one month and active for r/rPCNSL. Long-term efficacy and safety profile need to be determined with a larger cohort.
Collapse
Affiliation(s)
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuta Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| |
Collapse
|
43
|
Sasaki N, Kobayashi K, Saito K, Sasaki Y, Okamura Y, Yamagishi Y, Shimizu S, Shiokawa Y, Nagane M. ML-08 Safety and efficacy of consolidation cytarabine for newly-diagnosed primary central nervous system lymphoma. Neurooncol Adv 2020. [PMCID: PMC7699114 DOI: 10.1093/noajnl/vdaa143.071] [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: 11/22/2022] Open
Abstract
Backgrounds: While consolidation therapies which incorporate whole brain radiotherapy (WBRT) and/ or chemotherapies such as high dose (HD)- cytarabine are commonly applied following induction chemotherapies in primary central nervous system lymphoma (PCNSL), the optimal treatment for consolidation therapy has not been established. We aimed to investigate the safety and efficacy of consolidation cytarabine with a dose modification policy in PCNSL. Patients and methods: PCNSL patients initially treated by R-MPV (rituximab, methotrexate, procarbazine and vincristine) and subsequently treated either by WBRT of 24Gy followed by cytarabine (WBRT-AraC group), or cytarabine alone (AraC group) were identified. WBRT was deferred in patients 71 years old or younger who had obtained a complete response (CR) after R-MPV. Cytarabine was dose-modified according to age groups (3 g/m2 in patients 70 years old or younger, 2 g/m2 in patients aged 71–75 years, 1 g/m2 in patients aged 76–80 years). Toxicity profiles, progression-free survival (PFS), overall survival (OS) were analyzed. Results: Twenty-five patients were identified (median age: 69 [range: 34–80], median KPS:70 [range: 40–90]), including 11 patients from the WBRT-AraC group, and 14 patients from the AraC group. Median PFS was unreached in the WBRT-AraC group, and 41.8 months in the AraC group. Median OS was unreached in both groups. The overall rate of grade 3/4 hematologic toxicities was high (92%), but mostly manageable without major complications. Fourteen patients received 3 g/m2, 4 patients received 2 g/m2, 7 patients received 1 g/m2 of cytarabine, and the rate of grade 4 leukopenia/ thrombocytopenia was 64%/57%, 25%/50%, and 29%/29%, respectively. Discussion: HD-cytarabine consolidation therapy with dose modification according to age groups for PCNSL was feasible and well-tolerated in patients 80 years of age or younger. The efficacy of HD-cytarabine was undetermined and further investigation is warranted.
Collapse
Affiliation(s)
- Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin university faculty of medicine
| | | | - Kuniaki Saito
- Department of Neurosurgery, Kyorin university faculty of medicine
| | - Yuta Sasaki
- Department of Neurosurgery, Kyorin university faculty of medicine
| | - Yuma Okamura
- Department of Neurosurgery, Kyorin university faculty of medicine
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin university faculty of medicine
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin university faculty of medicine
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin university faculty of medicine
| |
Collapse
|
44
|
Saito K, Kobayashi K, Shimada D, Iijima S, Sasaki N, Sasaki Y, Shiokawa Y, Nagane M. STMO-09 Recovery from speech deficit after injury to frontal aslant tract in glioma surgery. Neurooncol Adv 2020. [PMCID: PMC7699094 DOI: 10.1093/noajnl/vdaa143.044] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The frontal aslant tract (FAT) is a white matter fiber connecting the superior frontal gyrus to the lateral inferior frontal gyrus. Damage to FAT in dominant hemisphere can lead to speech deficits which, in most cases, resolve within weeks to months. However, little is known about mechanisms of recovery and factors for predicting permanent language deficits. METHODS: Eighteen patients with glioma (age ranged 24 to 78, 10 glioblastomas and 8 lower grade gliomas) located in the medial frontal lobe in the dominant hemisphere involving the supplementary motor area (SMA) and FAT were included. FAT was visualized using diffusion tensor imaging tractography in pre- and postoperative MRI. Postoperative language deficit, resected area of FAT and surrounding brain regions including the cingulate gyrus and corpus callosum (CC) were retrospectively reviewed. RESULTS: In 17 of 18 cases, postoperative language deficits were observed. Speech deficits resolved within a month in 12 cases, while recovery was incomplete in five cases. In two patients without complete recovery, CC located beneath SMA was removed because of tumor infiltration. Other two patients had substantial injury of middle third portion of FAT. The last case had preceding infarction in the contralateral frontal white matter including FAT. In cases with complete language recovery, transcallosal fibers connecting the contralateral SMA to the ipsilateral inferior frontal gyrus were detected by postoperative DTI-tractography. These fibers were damaged anywhere along its length in patients without complete language recovery, indicating that they may play an important role in recovery after FAT injury. CONCLUSION: Injury to CC or middle third portion of FAT can cause permanent language disorder. Transcallosal fibers from contralateral SMA seems to be involved in the recovery from language deficit after injury to FAT. In glioma surgery involving dominant SMA or FAT, these fibers should be preserved to avoid permanent speech deficit.
Collapse
Affiliation(s)
- Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Daisuke Shimada
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Shohei Iijima
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yuta Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| |
Collapse
|
45
|
Yamagishi Y, Sasaki N, Matsushita Y, Shimizu S, Saito K, Kobayashi K, Shiokawa Y, Nagane M, Ichimura K. ML-06 Diagnostic value of liquid biopsy for CNS lymphoma by detection of specific gene mutations in the cerebrospinal fluid. Neurooncol Adv 2020. [PMCID: PMC7699077 DOI: 10.1093/noajnl/vdaa143.069] [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: 11/13/2022] Open
Abstract
Backgrounds & Purpose: Central nervous system lymphoma (CNSL) is the second most common primary malignant brain tumor. Brain biopsy is indispensable to confirm the diagnosis of CNSL, but has a potential risk of inducing hemorrhagic complications in the brain. Therefore, liquid biopsy using the cerebrospinal fluid (CSF) has attracted an attention as a less invasive diagnostic method. In this study, we established a digital PCR-based method to detect MYD88 mutations in CSF and evaluated its efficacy. Methods: Matched CSF and biopsy samples from CNSL patients collected before the start of chemotherapy were used. Cellular DNA and cell free DNA (cfDNA) of CSF were separately extracted from the pellet and the supernatant fraction of CSF, respectively. Presence of the MYD88 L265P mutation was examined in each fraction by the digital PCR. The mutational status obtained by liquid biopsy was compared with that of the matched biopsy specimen examined by pyrosequencing. Result: A total of 36 paired samples were used. When the cutoff value of Target/Total ratio was 0.25%, sensitivity, specificity, and area under the curve (AUC) of the digital PCR detection using cellular DNA were 92.9%, 100%, and 0.95, respectively, while they were 100%, 100%, and 1.00 using cfDNA. Conclusion: We showed that the digital PCR method was highly sensitive and specific in detecting MYD88 mutations in the CSF. We propose that CSF liquid biopsy may serve a clinically applicable surrogate to make a diagnosis of CNSL.
Collapse
Affiliation(s)
- Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuko Matsushita
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
46
|
Toyoda K, Palesch YY, Koga M, Foster L, Yamamoto H, Yoshimura S, Ihara M, Fukuda-Doi M, Okazaki S, Tanaka K, Miwa K, Hasegawa Y, Shiokawa Y, Iwama T, Kamiyama K, Hoshino H, Steiner T, Yoon BW, Wang Y, Hsu CY, Qureshi AI. Regional Differences in the Response to Acute Blood Pressure Lowering After Cerebral Hemorrhage. Neurology 2020; 96:e740-e751. [PMID: 33219136 PMCID: PMC7884997 DOI: 10.1212/wnl.0000000000011229] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To compare the impact of intensive blood pressure (BP) lowering right after intracerebral hemorrhage (ICH) on clinical and hematoma outcomes among patients from different geographic locations, we performed a prespecified subanalysis of a randomized, multinational, 2-group, open-label trial to determine the efficacy of rapidly lowering BP in hyperacute ICH (Antihypertensive Treatment of Acute Cerebral Hemorrhage [ATACH]-2), involving 537 patients from East Asia and 463 recruited outside of Asia. Methods Eligible patients were randomly assigned to a systolic BP target of 110 to 139 mm Hg (intensive treatment) or 140 to 179 mm Hg (standard treatment). Predefined outcomes were poor functional outcome (modified Rankin Scale score 4–6 at 90 days), death within 90 days, hematoma expansion at 24 hours, and cardiorenal adverse events within 7 days. Results Poor functional outcomes (32.0% vs 45.9%), death (1.9% vs 13.3%), and cardiorenal adverse events (3.9% vs 11.2%) occurred significantly less frequently in patients from Asia than those outside of Asia. The treatment-by-cohort interaction was not significant for any outcomes. Only patients from Asia showed a lower incidence of hematoma expansion with intensive treatment (adjusted relative risk [RR] 0.56, 95% confidence interval [CI] 0.38–0.83). Both Asian (RR 3.53, 95% CI 1.28–9.64) and non-Asian (RR 1.71, 95% CI 1.00–2.93) cohorts showed a higher incidence of cardiorenal adverse events with intensive treatment. Conclusions Poor functional outcomes and death 90 days after ICH were less common in patients from East Asia than those outside of Asia. Hematoma expansion, a potential predictor for poor clinical outcome, was attenuated by intensive BP lowering only in the Asian cohort. ClinicalTrials.gov Identifier NCT01176565. Classification of Evidence This study provides Class II evidence that, for patients from East Asia with ICH, intensive blood pressure lowering significantly reduces the risk of hematoma expansion.
Collapse
Affiliation(s)
- Kazunori Toyoda
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis.
| | - Yuko Y Palesch
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Masatoshi Koga
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Lydia Foster
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Haruko Yamamoto
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Sohei Yoshimura
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Masafumi Ihara
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Mayumi Fukuda-Doi
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Shuhei Okazaki
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Kanta Tanaka
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Kaori Miwa
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Yasuhiro Hasegawa
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Yoshiaki Shiokawa
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Toru Iwama
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Kenji Kamiyama
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Haruhiko Hoshino
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Thorsten Steiner
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Byung-Woo Yoon
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Yongjun Wang
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Chung Y Hsu
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | - Adnan I Qureshi
- From the Department of Cerebrovascular Medicine (K. Toyoda, M.K., S.Y., K. Tanaka, K.M.), Center for Advancing Clinical and Translational Sciences (H.Y., M.F.-D., S.O.), and Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Public Health Sciences (Y.Y.P., L.F.), Medical University of South Carolina, Charleston; Department of Neurology (Y.H.), St. Marianna University School of Medicine, Kawasaki; Department of Neurosurgery and Stroke Center (Y.S.), Kyorin University School of Medicine, Mitaka; Department of Neurosurgery (T.I.), Gifu University Graduate School of Medicine; Department of Neurosurgery (K.K.), Nakamura Memorial Hospital, Sapporo; Department of Neurology (H.H.), Tokyo Saiseikai Central Hospital, Japan; Department of Neurology (T.S.), Klinikum Frankfurt Höchst, Germany; Department of Neurology (B.-W.Y.), Seoul National University Hospital, South Korea; Beijing Tiantan Hospital (Y.W.), China; China Medical University (C.Y.H.), Taichung, Taiwan; and Zeenat Qureshi Stroke Research Center (A.I.Q.), University of Minnesota, Minneapolis
| | | |
Collapse
|
47
|
Ren N, Nishimura A, Kurogi A, Nishimura K, Matsuo R, Ogasawara K, Hashimoto Y, Higashi T, Sakai N, Toyoda K, Shiokawa Y, Tominaga T, Miyachi S, Kada A, Abe K, Ono K, Matsumizu K, Arimura K, Kitazono T, Miyamoto S, Minematsu K, Iihara K. Measuring Quality of Care for Ischemic Stroke Treated With Acute Reperfusion Therapy in Japan - The Close The Gap-Stroke. Circ J 2020; 85:201-209. [PMID: 33229795 DOI: 10.1253/circj.cj-20-0639] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND In Japan there is no consensus on how to efficiently measure quality indicators (QIs), defined as a standard of care, for acute ischemic stroke (AIS). Using information from a health insurance claims database and electronic medical records, we evaluated the feasibility and validity of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) or endovascular therapy (EVT).Methods and Results:AIS patients receiving rt-PA or EVT between 2013 and 2015 were identified. We selected 17 AIS QI measures for primary stroke centers (PSCs) and 8 for comprehensive stroke centers (CSCs). Defined QIs were calculated for each hospital and then averaged. In total, the data of 8,206 patients (rt-PA 83.7%, EVT 34.9%) from 172 hospitals were obtained. Median National Institute of Health Stroke Scale score at admission was 14, and 37.7% of the patients were functionally independent at discharge. All target QIs were successfully measured with fewer missing values, and the accuracy of preset data was about 90%. Adherence rates were low (<50%) in 5 QI measures among PSCs, including door-to-needle time ≤1 h, and in 1 QI measure among CSCs (door-to-brain and vascular imaging time ≤30 min). CONCLUSIONS Measuring QIs for AIS by this novel approach was feasible and reliable in the provision of a national benchmark.
Collapse
Affiliation(s)
- Nice Ren
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Ai Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Takahiro Higashi
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center Hospital
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | | | - Akiko Kada
- Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center
| | - Keisuke Abe
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Kotaro Ono
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Kazunori Matsumizu
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center Hospital
| | - Koji Iihara
- Director General, National Cerebral and Cardiovascular Center Hospital
| |
Collapse
|
48
|
Tokunaga K, Koga M, Yoshimura S, Okada Y, Yamagami H, Todo K, Itabashi R, Kimura K, Sato S, Terasaki T, Inoue M, Shiokawa Y, Takagi M, Kamiyama K, Tanaka K, Takizawa S, Shiozawa M, Okuda S, Kameda T, Nagakane Y, Hasegawa Y, Shibuya S, Ito Y, Matsuoka H, Takamatsu K, Nishiyama K, Kario K, Yagita Y, Mizoguchi T, Fujita K, Ando D, Kumamoto M, Miwa K, Arihiro S, Toyoda K. Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation. Cerebrovasc Dis 2020; 49:619-624. [DOI: 10.1159/000511393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). <b><i>Methods:</i></b> Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. <b><i>Results:</i></b> A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). <b><i>Conclusion:</i></b> Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.
Collapse
|
49
|
Nagane M, Sasaki N, Kobayashi K, Saito K, Shimada D, Matsumoto Y, Iijima S, Yamagishi Y, Shimizu S, Takayama N, Shiokawa Y. CTNI-65. COMBINED RITUXIMAB, METHOTREXATE, PROCARBAZINE, VINCRISTINE, AND CYTARABINE (R-MPV-A) TREATMENT FOR PATIENTS WITH RELAPSED PRIMARY CNS LYMPHOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.231] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUNDS
Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy including an induction R-MPV with consolidation whole-brain radiotherapy (WBRT) and HD-cytarabine to achieve complete remission, however, the optimal treatment for relapsed/refractory (r/r) PCNSL has not been established yet, besides the recent approval of a BTK inhibitor, tirabrutinib, in Japan. We evaluated retrospectively efficacy of R-MPV-A for r/rPCNSL.
PATIENTS
Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens.
RESULTS
Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA either at the first relapse (11) or at the second or later relapse (12). Median age/KPS of this salvage RMPVA group were 71 (42–87)/80 (40–100). Nine patients were pretreated with the first-line RMPVA. HD-cytarabine was given to 13 patients. Median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Among patients with salvage RMPVA, HD-cytarabine was associated with better PFS (P=0.066), and complete responses were significantly correlated with longer OS. Treatment was generally well-tolerated but there was one treatment-related death.
CONCLUSIONS
Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.
Collapse
Affiliation(s)
- Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Daisuke Shimada
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shohei Iijima
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyuki Takayama
- Department of Hematology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
50
|
Sasaki N, Kobayashi K, Saito K, Shimizu S, Suzuki K, Lee J, Yamagishi Y, Shibahara J, Takayama N, Shiokawa Y, Nagane M. Consecutive single-institution case series of primary central nervous system lymphoma treated by R-MPV or high-dose methotrexate monotherapy. Jpn J Clin Oncol 2020; 50:999-1008. [PMID: 32469065 DOI: 10.1093/jjco/hyaa073] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/04/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The optimal regimen for use of high dose-methotrexate-based chemotherapy in primary central nervous system lymphoma is still under debate. We conducted a retrospective study to evaluate the treatment outcome of a combination immunochemotherapy consisting of rituximab, methotrexate, procarbazine and vincristine followed by with or without whole brain radiotherapy and consolidation cytarabine, in comparison with high dose-methotrexate monotherapy followed by full dose whole brain radiotherapy. METHODS Newly diagnosed primary central nervous system lymphoma patients treated with either rituximab, methotrexate, procarbazine and vincristine or high dose-methotrexate in Kyorin University Hospital were identified, and the response rates and survival were compared. Toxicities, post-treatment transition of Mini-Mental State Examination, Karnofsky performance status score, Fazekas scale and prognostic factors were analysed in the rituximab, methotrexate, procarbazine and vincristine group. RESULTS Ninety-five patients treated with rituximab, methotrexate, procarbazine and vincristine (n = 39) or high dose-methotrexate (n = 56) were analysed. The complete response/complete response unconfirmed rate was significantly higher in the rituximab, methotrexate, procarbazine and vincristine group (74.4 vs. 15.4%, P < 0.001). Accordingly, both median progression-free survival and overall survival were significantly longer in the rituximab, methotrexate, procarbazine and vincristine group (median progression-free survival: unreached vs. 14.75 months, P < 0.001) (median overall survival: unreached vs. 63.15 months, P = 0.005). Although the rate of grade 3/4 hematologic toxicities was high both during rituximab, methotrexate, procarbazine and vincristine and consolidation cytarabine, the rate of grade 3/4 infections was low, and no treatment related deaths were observed. Deterioration in Karnofsky performance status or Mini-Mental State Examination was rare, except on disease recurrence. Although whole brain radiotherapy was associated with Fazekas scale deterioration, its association with Karnofsky performance status or Mini-Mental State Examination deterioration was not significant. CONCLUSIONS Rituximab, methotrexate, procarbazine and vincristine was apparently promising in comparison with high dose-methotrexate monotherapy with manageable toxicity in this retrospective study, and further investigation is warranted.
Collapse
Affiliation(s)
- Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Graduate School of Medicine, Tokyo, Japan.,Department of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery, Koyama Memorial Hospital, Kashima, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Saki Shimizu
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kaori Suzuki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Jeunghun Lee
- Department of Neurosurgery, Kanto Central Hospital, Tokyo, Japan
| | - Yuki Yamagishi
- Department of Neurosurgery, Kyorin University Graduate School of Medicine, Tokyo, Japan.,Department of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyuki Takayama
- Department of Hematology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|