Publications by authors named "Yuichi Murayama"

194 Publications

Multimodal treatment including lumbar facet joint denervation for severe low back pain in patients with neuromuscular disorders.

Neurol Sci 2021 May 10. Epub 2021 May 10.

Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.

Background: Severe low back pain (LBP) is an occasional complaint in patients with neuromuscular disorders (NMDs). Accurate diagnosis and treatment are required to manage LBP; however, the precise pathophysiology differs for each patient. This study aimed to evaluate the efficacy of lumbar facet joint denervation (FJD) and adjunctive modalities in the treatment of LBP in patients with NMD-associated kyphoscoliosis.

Methods: A total of 16 patients (22 sites) with NMD (bilateral, n = 6; unilateral, n = 10) and LBP treated with lumbar FJD were evaluated. The patients were divided into two groups: those treated with FJD alone (group 1) and those treated with multimodal treatment, including FJD along with radiofrequency ablation for sacroiliac joint pain, piriform muscle block, botulinum toxin injection into the paraspinal muscles, spinal cord stimulation, or any of their combinations (group 2). All patients were followed up for 48 weeks postoperatively. The two groups were compared with respect to the duration required for improvements in LBP by more than 50% (numerical rating scale ≤ 5).

Results: There was no significant difference between the groups regarding the age, duration since the onset of Parkinson's syndrome, and radiographic analysis. The effective period of improved pain was greater in group 2 than in group 1 (30.7 vs. 8.4 weeks, P < 0.01).

Conclusions: Multimodal treatment including FJD is safe and relatively effective in patients with NMD-associated kyphoscoliosis. Hence, it is a potential substitute for conventional spinal fixation surgery, which has a higher risk of complications.
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http://dx.doi.org/10.1007/s10072-021-05298-9DOI Listing
May 2021

Modified Computed Tomography Classification for Chronic Subdural Hematoma Features Good Interrater Agreement: A Single-Center Retrospective Cohort Study.

World Neurosurg 2021 Jul 20;151:e407-e417. Epub 2021 Apr 20.

Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.

Objective: The present study aimed to establish whether our modified Nakaguchi computed tomography (CT) classification improves the interrater agreement of chronic subdural hematoma (CSDH) classification and prediction of CSDH recurrence relative to 2 other CT classifications.

Methods: This retrospective study considered 277 consecutive patients with CSDH and 307 hematomas treated with burr-hole surgery between January 2009 and December 2018. Two neurosurgeons blinded to patients' clinical data classified the CT scans of patients with CSDH into 4 or 5 types according to the Nomura classification (high, iso, low, mixed, and layering), Nakaguchi classification (homogenous, laminar, separated, and trabecular), and our modified Nakaguchi classification (homogenous, gradation, laminar, separated, and trabecular). The κ statistic was used to evaluate the interrater agreement of the 3 CT classifications. Univariable and multivariable logistic regression analyses were used to calculate odds ratios for CSDH recurrence.

Results: κ values of the modified, Nakaguchi, and Nomura classification were 0.78, 0.63, and 0.70, respectively. During the 3 months follow-up, the recurrence rate for CSDH was 11.4% (35/307 hematomas). Of the types defined by the modified classification, the gradation type was associated with the highest recurrence (mean recurrence rate, 15.9% ± 0.3%). Multivariable logistic regression analyses showed that a gradation-type hematoma, as defined with the modified classification, was an independent risk factor associated with recurrence (odds ratio, 2.36; 95% confidence interval, 1.11-4.98; P = 0.025).

Conclusions: The modified classification was useful for preoperative CT classification of CSDH and the prediction of recurrence, with high agreement between raters.
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http://dx.doi.org/10.1016/j.wneu.2021.04.052DOI Listing
July 2021

MRI characteristics of syringomyelia associated with foramen magnum arachnoiditis: differentiation from Chiari malformation.

Acta Neurochir (Wien) 2021 06 21;163(6):1593-1601. Epub 2021 Apr 21.

Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.

Background: It is important to distinguish foramen magnum arachnoiditis (FMA) from Chiari malformation (CM) before surgery because the operative strategies for these diseases differ. In the current study, we compared pretreatment magnetic resonance imaging (MRI) of FMA with CM and investigated the MRI findings useful to differentiate between these diseases.

Methods: We retrospectively reviewed patients with FMA or CM aged ≥ 18 years who underwent surgeries at our institution between 2007 and 2019. The morphologies of the syrinx, neural elements, and posterior cranial fossa were preoperatively evaluated with MRI. We used the receiver operating characteristic (ROC) curve for the fourth ventricle-to-syrinx distance (FVSD).

Results: Ten patients with FMAs and 179 with CMs were included. FVSD in the FMA group was significantly shorter than that in the CM group (7.5 mm [IQR, 2.8-10 mm] in FMA vs. 29.9 mm [IQR, 16.3-52.9 mm] in CM, p < 0.0001). The other MRI findings that showed the height, size, and length of the syrinx; size of the foramen magnum; degree of cerebellar tonsillar descent; shape of the cerebellar tonsil; and dorsal subarachnoid space at the foramen magnum differed significantly between the two groups. The ROC curve analysis showed that patients whose FVSD was less than 11 mm could be diagnosed with FMA with a specificity of 90% and sensitivity of 96%.

Conclusions: A more cranial syrinx development (FVSD < 11 mm) appears to be the characteristic MRI finding in FMA.
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http://dx.doi.org/10.1007/s00701-021-04845-9DOI Listing
June 2021

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic.

Stroke Vasc Neurol 2021 Mar 26. Epub 2021 Mar 26.

Department of Radiology, Beaumont Hospital, Dublin, Ireland.

Background: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.

Methods: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.

Findings: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.

Interpretation: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
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http://dx.doi.org/10.1136/svn-2020-000695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006491PMC
March 2021

Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone.

Surg Neurol Int 2021 2;12:85. Epub 2021 Mar 2.

Department of Neurosurgery, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.

Background: Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy.

Case Description: A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery.

Conclusion: This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.
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http://dx.doi.org/10.25259/SNI_858_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982113PMC
March 2021

A Smartphone Application as a Telemedicine Tool for Stroke Care Management.

Neurol Med Chir (Tokyo) 2021 Apr 12;61(4):260-267. Epub 2021 Mar 12.

Department of Neurosurgery, The Jikei University School of Medicine.

Since smartphone applications are revolutionizing telemedicine, a new application specifically for stroke care (JOIN) was designed. Addition of the JOIN smartphone application to the stroke treatment workflow in our hospital was assessed. JOIN has key functions that may improve the care of stroke patients, including the ability to (1) exchange information such as patient data and medical images in real-time throughout the entire process of patient management; (2) track each step of the protocol from door to discharge; and (3) facilitate real-time interaction of all team members via text, audio, and a video chat system. Two periods, 2.7 years before the implementation of JOIN (Pre-JOIN) with 37 patients and 2.2 years after (Post-JOIN) with 54 patients, were compared, and the workflow for all 91 patients who had a cerebral infarction and were treated with tissue plasminogen activator (tPA) and/or thrombectomy between October 2012 and July 2017 was reviewed. There were noticeable reductions in overall patient management time, including times for door-to-imaging, starting tPA treatment, and endovascular intervention with JOIN. Staff members were unanimously satisfied with JOIN, due to the increased efficiency of information exchange and the ability for real-time discussions with different professionals when needed. No significant changes in patient outcomes (as assessed by modified Rankin Scale [mRS] scores) at 3 months and in the total cost for the treatment were observed. A smartphone-based application with the capability of sharing information instantaneously among healthcare professionals facilitated time-sensitive, acute care of ischemic stroke patients.
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http://dx.doi.org/10.2176/nmc.oa.2020-0302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048116PMC
April 2021

Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy.

Neurol Sci 2021 Feb 26. Epub 2021 Feb 26.

Department of Neurosurgery, The JIKEI University School of Medicine, Tokyo, Japan.

Background And Objectives: Communication-type medical smartphone applications enable text, neuroimaging, photos, and videos to be shared securely among the stroke team. Our aim was to investigate whether use of a smartphone application would shorten the duration from admission to reperfusion therapy in patients with hyper-acute ischemic stroke.

Methods: Enrolled were acute ischemic stroke patients who underwent reperfusion therapy (intravenous tissue plasminogen activator (IV t-PA) and mechanical thrombectomy (MT)) at our hospital between October 2012 and September 2018. We divided the patients into two groups based on the date of availability on smartphones of communication-type medical application: (1) Control group, conventional communication prior to September 2015, and (2) App group, communication via the smartphone app from October 2015 onwards. We compared door-to-image time (DIT), image-to-needle time (INT), door-to-needle time (DNT) for thrombolysis, and DIT, image-to-puncture time (IPT), and door-to-puncture time (DTP) for thrombectomy between the groups.

Results: We retrospectively enrolled 139 patients (68% male; median age, 69 years; median NIHSS score, 7) who were assigned into the App group (n = 86) and Control group (n = 53). Of the overall patients, 109 underwent IV t-PA (IV t-PA alone, 79 patients), and 63 underwent MT (MT alone, 30 patients), and 33 patients underwent combined IV t-PA and MT. There was no significant difference in DIT between the App and Control groups (23 min vs. 22 min, p = 0.493). DNT, DPT, INT, and IPT were significantly shorter in the App group than in the Control group (DNT, 62 min for the App group vs. 72 min for Control group, p = 0.038; INT, 42 vs. 48 min, p = 0.009; DPT, 106 vs. 129 min, p = 0.046; IPT, 89 vs. 117 min, p = 0.004).

Conclusion: The present findings indicate that communication-type medical smartphone apps have potential for shortening the time elapsed between admission and reperfusion therapy, especially INT and IPT.
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http://dx.doi.org/10.1007/s10072-021-05132-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908941PMC
February 2021

Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment.

Interv Neuroradiol 2021 Feb 21:1591019921996886. Epub 2021 Feb 21.

Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.

Background: Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck.

Methods: From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA.

Results: Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% ( = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy.

Conclusions: The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.
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http://dx.doi.org/10.1177/1591019921996886DOI Listing
February 2021

Thoracic and lumbar spine pedicle morphology in Japanese patients.

Surg Radiol Anat 2021 Jun 16;43(6):833-842. Epub 2021 Feb 16.

Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan.

Purpose: Pedicle morphology is important for intraoperative surgical anatomy and to define pedicle screw design and parameters. However, differences of pedicle size according to ethnicity and gender are not well studied. The purpose of this study is to investigate morphological characteristics of the pedicle in Japanese patients for determining adequate screw size and optimal surgical planning.

Methods: We investigated thoracic and lumbar pedicle morphology in Japanese patients using computed tomography (CT) measurements and analyzed the standard size of pedicles on upper thoracic to lumbar spine CT images in 227 Japanese patients.

Results: Gender had a larger impact on the shape and size of pedicles than racial differences. In the distribution of pedicle width, we calculated the ratio of values less than 4.5 mm, that in females resulted to be over 30% for the Th3-Th9 segment, and particularly high, above 60% at Th4 and Th5.

Conclusion: Our measurement analysis showed that pedicle morphological parameters in Japanese patients showed tendency to be smaller to those found in other studies, and particularly in female patients, they were statistically significantly smaller. Adequate transpedicular instrumentation for Japanese patients will require smaller size pedicle-related devices that will match our anatomical findings to achieve safe device placement. In addition, serving ethnically non-homogenous patient population can require further to spinal morphometric for precise device selection.
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http://dx.doi.org/10.1007/s00276-021-02707-8DOI Listing
June 2021

Significantly high concentrations of vascular endothelial growth factor in chronic subdural hematoma with trabecular formation.

Clin Neurol Neurosurg 2021 Mar 6;202:106458. Epub 2021 Jan 6.

Department of Neurosurgery, Jikei University School of Medicine, Japan.

The underlying mechanism of chronic subdural hematoma (CSDH) after minor head injury is complex, probably due to mechanical injury of the arachnoid membrane, hematological coagulopathy, and pathological angiogenesis in the dura caused by inflammatory cytokines including vascular endothelial growth factor (VEGF). To confirm whether VEGF might be a reliable predictive biomarker for the natural history of CSDH, including progression and recurrence, we analyzed the correlation of VEGF concentration in the subdural fluid with CT findings and clinical features, including interval from minor head injury. Based on CT classification by hematoma density, the mean concentration of VEGF in hematoma fluid was found to be highest in the trabecular group, whereas the recurrence of CSDH was most frequent in the separated group in which VEGF concentration was low. There was a significant correlation between VEGF concentration and the CT classification. Furthermore, only in the trabecular group, a significant negative correlation between the VEGF concentration and interval from minor head injury to surgery was observed. These results suggest that VEGF concentration in the hematoma alone could not be a reliable predictive biomarker for the natural history of CSDH including its recurrence. Amongst the classified groups of CSDH, the trabecular group is likely to follow a different time course of VEGF concentration in the hematoma fluid compared to the other three groups.
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http://dx.doi.org/10.1016/j.clineuro.2020.106458DOI Listing
March 2021

Global impact of COVID-19 on stroke care.

Int J Stroke 2021 07 29;16(5):573-584. Epub 2021 Mar 29.

Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.

Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior).

Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers.

Results: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions.

Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
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http://dx.doi.org/10.1177/1747493021991652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010375PMC
July 2021

Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients.

Interv Neuroradiol 2021 Jan 7:1591019920987345. Epub 2021 Jan 7.

Department of Neurosurgery, The 12839Jikei University School of Medicine Tokyo, Tokyo, Japan.

Background And Purpose: The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients.

Methods: From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received dual antiplatelet drugs before the procedure. Eleven patients (21.2%) (12 procedures) were treated with the DCEA. The rest were treated with TFBA. The main indication of the DCEA was an unfavorable aortic arch or vessel tortuosity. Complications and the duration of the procedure were compared between the two groups.

Results: There were no significant differences between the two groups in age, aneurysm location, preoperative antiplatelet use, heparin use, or maximum activated clotting time (ACT) values. All endovascular treatments were successfully performed by DCEA. Among all parameters, the DCEA group had only bigger average aneurysm diameter (14 mm) and higher number of pipeline embolic device (PED) placement (58%). Time to the guiding-catheter placement was not significantly different between the groups (DCEA vs TFBA = 31.0 min vs 24.7 min, p = 0.178). No significant complications of DCEA, such as subcutaneous hematomas, were observed. .

Conclusion: Even with the use of antiplatelet and anticoagulation therapy, the DCEA can be performed safely for unruptured aneurysms in elderly patients.
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http://dx.doi.org/10.1177/1591019920987345DOI Listing
January 2021

Flow Diverter Apposition in Patients with Large or Giant Intracranial Aneurysms Evaluated on Three-Dimensional Fusion Images Acquired by High-Resolution Cone-Beam Computed Tomography and Digital Subtraction Angiography.

World Neurosurg 2021 03 7;147:e388-e395. Epub 2021 Jan 7.

Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Minato-ku, Tokyo, Japan.

Objective: To investigate flow diverter (FD) apposition on fused images acquired by high-resolution cone-beam computed tomography (CBCT) and 3-dimensional (3D) digital subtraction angiography.

Methods: Patients with large or giant internal carotid artery aneurysms treated with Pipeline FDs who underwent CBCT imaging at our institution between October 2016 and May 2019 were included. Two neurosurgeons measured the maximum malapposition between FDs and vessel walls on 3D fusion images of high-resolution CBCT images displaying the FD and 3D digital subtraction angiography images displaying the vessels. Associations between the relative malapposition, FD diameter, vessel diameter, proximal and distal vessel diameter discrepancy, and siphon angle were evaluated by linear regression analysis. Inter-rater and intermethod (3D and 2D image) agreements of the malapposition measurements were assessed by Bland-Altman analysis and by interclass correlation coefficients.

Results: Images of 2 patients were excluded because of image artifacts or fusion errors, and 3D fusion images were acquired in the remaining 26 patients. Our results did not suggest that relative malapposition was associated with vessel diameter (P = 0.12), vessel diameter discrepancy (P = 0.60), or syphon angle (P = 0.34), but relative malapposition increased by an estimated 13% (95% confidence interval: 4%-23%, P = 0.006) for each 1 mm increase in FD diameter. Inter-rater and intermethod agreements for apposition measurements were excellent and good, respectively.

Conclusions: Three-dimensional fusion images provided clear visualization of structures of both the stent and parent artery with excellent diagnostic reliability. Careful deployment may be needed for FDs with larger diameters, as they tended to have larger relative malapposition.
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http://dx.doi.org/10.1016/j.wneu.2020.12.068DOI Listing
March 2021

Comparison of Clinical Outcomes After Stent-Assisted Coiling with 3 Types of Self-Expanding Laser-Cut Stents in Patients with Wide-Necked Intracranial Aneurysms.

World Neurosurg 2021 02 9;146:e701-e707. Epub 2020 Nov 9.

Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Minato-ku, Tokyo, Japan.

Objective: We report the clinical outcomes of stent-assisted coiling for wide-necked intracranial aneurysms using 3 low-profile laser-cut stents and compare the results according to stent type.

Methods: All patients treated with stent-assisted coiling for their intracranial aneurysms at our hospital between July 2010 and September 2019 were reviewed. We selected patients with Enterprise, Neuroform EZ, or Neuroform Atlas stents who underwent imaging follow-up and investigated aneurysm and stent features, stent-related complications, recanalization, and retreatment rates. We compared the retreatment risk among the patients treated with the 3 stent types using Kaplan-Meier survival analysis and Cox regression analysis.

Results: We evaluated 364 consecutive cases (103 Enterprise, 105 Neuroform EZ, and 156 Neuroform Atlas stents). Neuroform Atlas was more frequently used in distal vessels: 8 (7.8%) Enterprise, 2 (1.9%) Neuroform EZ, and 41 (26.3%) Neuroform Atlas cases, respectively. The median follow-up durations were 6.49, 4.91, and 1.24 years for the Enterprise, Neuroform EZ, and Neuroform Atlas cases, respectively, and retreatment was performed in 11 (10.1%), 9 (8.6%), and 6 (3.8%) cases. In the first 2 years of follow-up, the estimated retreatment risk ratios for Neuroform EZ and Neuroform Atlas with Enterprise as reference were 0.63 (95% confidence interval, 0.24-1.65; P = 0.35) and 0.54 (95% confidence interval, 0.18-1.59; P = 0.26), respectively.

Conclusions: Neuroform Atlas stents were more frequently deployed in small-caliber vessels compared with the other 2 types of stents. The complication rate and retreatment risk until at least 1 year after the aneurysm treatment appeared to be similar for the 3 stent types.
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http://dx.doi.org/10.1016/j.wneu.2020.10.166DOI Listing
February 2021

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study.

BMC Musculoskelet Disord 2020 Nov 7;21(1):725. Epub 2020 Nov 7.

Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan.

Background: Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients.

Methods: In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland's classification of grade 5 or 6, and assessed for the changes in Bland's classification grade before and after surgery. Those who showed improvement from preoperative grades 5-6 to postoperative grades 1-4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups.

Results: Among the 60 hands of 46 patients who had a preoperative Bland's classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland's classification grade was correlated with the degree of clinical symptom improvement.

Conclusions: Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.
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http://dx.doi.org/10.1186/s12891-020-03750-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648948PMC
November 2020

[Technical "Tips" for Epidural Tenting Using DuraGen® for Surgical Management of Large Dural Defects:A Technical Note].

No Shinkei Geka 2020 Oct;48(10):903-907

Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital.

DuraGen®, an absorbable, engineered collagen-based artificial graft was introduced in Japan in September 2019 for cranial, transsphenoidal, and spinal surgeries. In addition to its efficacy and safety profile, owing to sutureless dural repair, DuraGen® is widely accepted by neurosurgeons. Direct tenting with DuraGen® is occasionally required in patients with large dural defects, particularly in cases of tumors adherent to the dura. To overcome this limitation, we introduced a surgical technique for epidural tenting using DuraGen®. A 78-year-old man with a history of alexia underwent craniotomy for resection of a left temporal lobe metastatic tumor. We completely removed the recurrent tumor, which was strongly adherent to the dura in the middle cranial fossa. A layer of DuraGen® was used as a subdural underlay beneath the autologous dura to close the wide dural defect. To avoid postoperative epidural fluid collection, we retracted the DuraGen® from the epidural aspect and interposed several pieces of muscle, which were sutured on the subdural aspect to ensure that the muscle pieces securely plugged the dural defect. We placed an additional overlay of DuraGen® along the autologous dura. The patient's postoperative course was uneventful without cerebrospinal fluid leakage, tension pneumocephalus, or wound infection. Reoperations for tumor resection, particularly surgical procedures for refractory meningiomas and malignant tumors cause increasing fragility and wide defects of the dura. DuraGen® placement enables sutureless closure and is less time-consuming. Our technique of epidural direct tenting with DuraGen® using muscle pieces sutured on the subdural aspect could be useful in patients with significantly large dural defects and can prevent postoperative epidural fluid collection to ensure complete dural sealing.
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http://dx.doi.org/10.11477/mf.1436204294DOI Listing
October 2020

4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations.

J Stroke Cerebrovasc Dis 2020 Dec 28;29(12):105327. Epub 2020 Sep 28.

Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan. Electronic address:

Purpose: To assess the benefit and radiation dose of four-dimensional (4D) digital subtraction angiography (DSA) - a time resolved three-dimensional (3D) DSA application - to evaluate the flow and architecture of aneurysms and vascular malformations.

Methods: All patients with cerebrovascular disease were considered who underwent 4D-DSA at our institution between January 2015 and February 2016. For the aneurysm patients, we evaluated the image quality in terms of the visualization of contrast flow in the aneurysm on a 3-point scale (excellent, fair and poor). Interrater agreement between two raters was estimated using Cohen's Kappa statistics. For the shunt disease patients, the additional information obtained from the 4D-DSA was described for each disease. The median radiation dose and volume of contrast medium required for the acquisitions were estimated.

Results: A total of 173 patients underwent 4D-DSA; 126 intracranial aneurysms, 10 arteriovenous malformations (AVM), 15 dural arteriovenous fistula (dAVF) and 22 other diseases. For aneurysm patients, excellent and fair visualization of the intra-aneurysmal flow was observed in 27.7%, 72.3%, and excellent (κ = 0.9) agreement between the raters was found. For AVM and dAVF patients, 4D-DSA clarified the complex vasculature by viewing the discrete time phase of contrast filling. Median radiation dose for intracranial lesions was 79.6 mGy for 6s 4D-DSA, and 175 mGy for 12s 4D-DSA. The median amount of contrast medium used was 18.0 ml for 6s 4D-DSA and 21.0 ml for 12s 4D-DSA.

Conclusions: 4D-DSA provided additional information regarding intra-aneurysmal flow and contributed to detect different component of nidus or shunt points.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105327DOI Listing
December 2020

Sex and Genetic Background Effects on the Outcome of Experimental Intracranial Aneurysms.

Stroke 2020 10 11;51(10):3083-3094. Epub 2020 Sep 11.

Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (T.Y., T.S., T.T., D.Y.C., T.Q., A.M., C.A.).

Background And Purpose: Intracranial aneurysm formation and rupture risk are, in part, determined by genetic factors and sex. To examine their role, we compared 3 mouse strains commonly used in cerebrovascular studies in a model of intracranial aneurysm formation and rupture.

Methods: Intracranial aneurysms were induced in male CD1 (Crl:CD1[ICR]), male and female C57 (C57BL/6NCrl), and male 129Sv (129S2/SvPasCrl or 129S1/SvImJ) mice by stereotaxic injection of elastase at the skull base, combined with systemic deoxycorticosterone acetate-salt hypertension. Neurological deficits and mortality were recorded. Aneurysms and subarachnoid hemorrhage grades were quantified postmortem, either after spontaneous mortality or at 7 to 21 days if the animals survived. In separate cohorts, we examined proinflammatory mediators by quantitative reverse transcriptase-polymerase chain reaction, arterial blood pressure via the femoral artery, and the circle of Willis by intravascular latex casting.

Results: We found striking differences in aneurysm formation, rupture, and postrupture survival rates among the groups. 129Sv mice showed the highest rates of aneurysm rupture (80%), followed by C57 female (36%), C57 male (27%), and CD1 (21%). The risk of aneurysm rupture and the presence of unruptured aneurysms significantly differed among all 3 strains, as well as between male and female C57. The same hierarchy was observed upon Kaplan-Meier analysis of both overall survival and deficit-free survival. Subarachnoid hemorrhage grades were also more severe in 129Sv. CD1 mice showed the highest resistance to aneurysm rupture and the mildest outcomes. Higher mean blood pressures and the major phenotypic difference in the circle of Willis anatomy in 129Sv provided an explanation for the higher incidence of and more severe aneurysm ruptures. TNFα (tumor necrosis factor-alpha), IL-1β (interleukin-1-beta), and CCL2 (chemokine C-C motif ligand 2) expressions did not differ among the groups.

Conclusions: The outcome of elastase-induced intracranial aneurysm formation and rupture in mice depends on genetic background and shows sexual dimorphism.
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http://dx.doi.org/10.1161/STROKEAHA.120.029651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530050PMC
October 2020

Spontaneous cerebrospinal fluid otorrhea and pneumocephalus on the contralateral side of the previous cranial surgery.

Surg Neurol Int 2020 15;11:245. Epub 2020 Aug 15.

Department of Neurosurgery, Jikei University School of Medicine, Nishi-Shimbashi, Tokyo, Japan.

Background: Cerebrospinal fluid (CSF) leaks and pneumocephalus commonly occur due to head trauma or surgical procedures. Spontaneous CSF (sCSF) leaks, however, occur without any clear etiology and are relatively uncommon.

Case Description: An 84-year-old woman presented with the right-sided otorrhea. The patient had a history of a ventriculoperitoneal shunt placement following a subarachnoid hemorrhage treated by clip ligation of a left-sided ruptured cerebral aneurysm 7 years before presentation, with shunt catheter ligation after evidence of intraventricular pneumocephalus 6 years before presentation. At admission, computed tomography (CT) imaging of the head showed enlargement of the lateral ventricles, a right mastoid fluid collection, and a defect of the superior wall of the right petrous bone. We performed a right temporal craniotomy for the repair of the CSF leak. Intraoperatively, it was noted that temporal lobe parenchyma herniated into the mastoid air cells through lacerated dura and a partially defective tegmen mastoideum. The leak point was successfully obliterated with a pericranial graft and reinforced by a collagen sheet and fibrin glue. There was no recurrence of otorrhea postoperatively.

Conclusion: This report presents a very unique case of a patient with a CSF leak and pneumocephalus occurring on the contralateral side of a previous cranial surgery. We accurately identified the defect site with CT imaging and repaired the CSF leak by temporal craniotomy. Awareness of the mechanisms by which sCSF leaks can be caused by aberrant arachnoid granulations is imperative for neurosurgeons.
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http://dx.doi.org/10.25259/SNI_268_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468192PMC
August 2020

Complete Obliteration of a Foramen Magnum Dural Arteriovenous Fistula by Microsurgery After Failed Endovascular Treatment Using Onyx: Case Report and Literature Review.

World Neurosurg 2020 12 15;144:43-49. Epub 2020 Aug 15.

Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan.

Background: Foramen magnum dural arteriovenous fistula (DAVF) is a rare disease, with some reported cases of successful treatment. We achieved complete obliteration of the foramen magnum DAVF through microsurgery after complications of endovascular embolization. We reviewed the treatment modalities and outcomes, focusing on pathologic and anatomic features from the literature.

Case Description: A 65-year-old man was admitted to our hospital with sudden diplopia. Magnetic resonance imaging revealed a subarachnoid hemorrhage around the right side of the prepontine cistern, and a foramen magnum DAVF was diagnosed by angiography. Subsequent angiography revealed that the fistula was supplied by the right neuromeningeal trunk of the ascending pharyngeal artery and the right posterior meningeal artery of the vertebral artery (VA), and the veins of the pouch via the fistula were retrogradely draining into the intracranial veins. We aimed to treat complete occlusion endovascularly with balloon-augmented transarterial Onyx injection via the posterior meningeal artery, but Onyx was refluxed to the VA through the anastomosis between the VA and posterior meningeal artery. Onyx subsequently migrated to the top of the basilar artery, causing occlusion, so we urgently removed the Onyx with a stent retriever (Trevo). Several weeks later, we performed complete obliteration of the foramen magnum DAVF via a lateral suboccipital approach with a C1 laminectomy.

Conclusions: Most foramen magnum DAVFs were obliterated completely with only endovascular treatment. Microsurgery is an effective and reliable treatment for incomplete occlusion and complications.
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http://dx.doi.org/10.1016/j.wneu.2020.08.077DOI Listing
December 2020

IgG4-Related Disease in the Frontal Convexity Concomitant with Smoldering Multiple Myeloma: A Case Report and Review of the Literature Regarding Therapeutic Implications.

World Neurosurg 2020 11 5;143:247-260. Epub 2020 Aug 5.

Department of Pathology, Gumma University Graduate School of Medicine, Maebashi, Japan.

Background: We have reported an extremely rare case of a frontal convexity tumor diagnosed as IgG4-related disease (IgG4-RD) with unique neuroradiological images.

Case Description: A 64-year-old man with a history of monoclonal gammopathy of undetermined significance and conservative treatment had presented with a left facial spasm. Computed tomography showed a high-density round tumor with perifocal edema in the right frontal convexity. Magnetic resonance imaging demonstrated unique findings, including low signal intensity on T1- and T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images, with slight gadolinium enhancement. The tumor was totally removed via right frontal craniotomy. It had been located in the subdural space, was not adherent to the dura, and was less vascular than meningiomas. Histological investigation demonstrated plasma cells that were strongly positive for IgG4 and contained κ and λ light chains at a ratio of 1.5:1. The serum IgG4 level was elevated. The tumor met the diagnostic criteria for IgG4-RD. The patient was followed up for 3 years during postoperative adjuvant steroid therapy. The steroid therapy was discontinued, and during the next 4 years, neither tumor recurrence nor symptoms were observed.

Conclusion: Intracranial IgG4-RD with smoldering monoclonal gammopathy of undetermined significance is extremely rare. We reviewed the differential diagnosis of plasma cell granuloma and plasmacytoma, therapeutic implications, and clinical outcomes. Complete resection of a conspicuous and solitary IgG4-RD lesion in the frontal convexity is simple and could provide a cure with less-aggressive adjuvant therapy.
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http://dx.doi.org/10.1016/j.wneu.2020.07.212DOI Listing
November 2020

An Automated Workflow for Hemodynamic Computations in Cerebral Aneurysms.

Comput Math Methods Med 2020 17;2020:5954617. Epub 2020 Jun 17.

Siemens Medical Solutions USA, Inc., Princeton, USA.

In recent years, computational fluid dynamics (CFD) has become a valuable tool for investigating hemodynamics in cerebral aneurysms. CFD provides flow-related quantities, which have been shown to have a potential impact on aneurysm growth and risk of rupture. However, the adoption of CFD tools in clinical settings is currently limited by the high computational cost and the engineering expertise required for employing these tools, e.g., for mesh generation, appropriate choice of spatial and temporal resolution, and of boundary conditions. Herein, we address these challenges by introducing a practical and robust methodology, focusing on computational performance and minimizing user interaction through automated parameter selection. We propose a fully automated pipeline that covers the steps from a patient-specific anatomical model to results, based on a fast, graphics processing unit- (GPU-) accelerated CFD solver and a parameter selection methodology. We use a reduced order model to compute the initial estimates of the spatial and temporal resolutions and an iterative approach that further adjusts the resolution during the simulation without user interaction. The pipeline and the solver are validated based on previously published results, and by comparing the results obtained for 20 cerebral aneurysm cases with those generated by a state-of-the-art commercial solver (Ansys CFX, Canonsburg PA). The automatically selected spatial and temporal resolutions lead to results which closely agree with the state-of-the-art, with an average relative difference of only 2%. Due to the GPU-based parallelization, simulations are computationally efficient, with a median computation time of 40 minutes per simulation.
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http://dx.doi.org/10.1155/2020/5954617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317611PMC
May 2021

Rapid Recurrence and Anaplastic Transformation of a Pilocytic Astrocytoma in an Elderly Patient: Case Report and Review of the Literature.

World Neurosurg 2020 10 4;142:441-449. Epub 2020 Jul 4.

Department of Pathology, Gumma University Graduate School of Medicine, Maebashi, Gummna, Japan.

Background: Rapid recurrence of a pilocytic astrocytoma with anaplastic transformation is extremely rare. The case of an elderly patient with a cerebellar pilocytic astrocytoma with anaplastic transformation during short-term follow-up is reported.

Case Description: An 83-year-old woman presented initially with dizziness and a gait deviation to the right. Magnetic resonance imaging demonstrated a homogeneously enhanced mass in the right cerebellar hemisphere, and the tumor was subtotally removed by right suboccipital craniotomy. Histologic examination showed that the tumor cells contained eosinophilic cytoplasm and spindle-shaped processes with Rosenthal fibers and eosinophilic granular bodies, diagnosed as a typical pilocytic astrocytoma (PA). The MIB-1 index was <1%. The patient did not receive postoperative adjuvant radiation and chemotherapy. Two months after surgery, magnetic resonance imaging showed growth of the residual tumor adjacent to the fourth ventricle, causing obstructive hydrocephalus. She underwent surgery again, and the tumor was totally removed. Histologic findings showed mitotic cells and increased cellularity compared with the primary tumor, which was compatible with anaplastic transformation of PA with a MIB-1 index of 50%. Postoperatively, she was observed with best supportive care without postoperative adjuvant therapy. Nine months after the second operation, she died due to tonsillar herniation and obstructive hydrocephalus caused by a recurrent tumor. An autopsy was performed.

Conclusions: It is extremely rare, as in the present case, that a cerebellar PA in an elderly patient recurs rapidly with anaplastic transformation, despite deferred postoperative adjuvant therapy including radiation and chemotherapy. A novel molecular-targeted therapy is needed for anaplastic PA showing aggressive biological behavior.
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http://dx.doi.org/10.1016/j.wneu.2020.06.173DOI Listing
October 2020

Reliability of Smartphone for Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study.

J Med Internet Res 2020 06 9;22(6):e15893. Epub 2020 Jun 9.

Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.

Background: High-quality neuroimages can be viewed using a medical app installed on a smartphone. Although interdevice agreement between smartphone and desktop PC monitor was found to be favorable for evaluating computed tomography images, there are no interdevice agreement data for diffusion-weighted imaging (DWI).

Objective: The aim of our study was to compare DWI interpretation using the Join smartphone app with that using a desktop PC monitor, in terms of interdevice and interrater agreement and elapsed interpretation time.

Methods: The ischemic change in the DWI of consecutive patients with acute stroke in the middle cerebral artery territory was graded by 2 vascular neurologists using the Join smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) ≥7 or DWI-ASPECTS <7 according to the Japanese Society for Neuroendovascular Therapy. We analyzed interdevice agreement and interrater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by the Join smartphone app and a desktop PC monitor.

Results: We analyzed the images of 111 patients (66% male; median age=69 years; median National Institutes of Health Stroke Scale score on admission=4). Interdevice agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable (vascular neurologist 1: κ=0.777, P<.001, vascular neurologist 2: κ=0.787, P<.001). Interrater agreement was also satisfactory for the smartphone (κ=0.710, P<.001) and the desktop PC monitor (κ=0.663, P<.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1: 1.7 min vs 1.6 min; P=.64); vascular neurologist 2: 2.4 min vs 2.0 min; P=.14).

Conclusions: The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The Join medical smartphone app shows great promise in the management of acute stroke.
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http://dx.doi.org/10.2196/15893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312257PMC
June 2020

Risk Factor for Poor Outcome in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage Based on Post Hoc Analysis of the Modified WFNS Scale Study.

World Neurosurg 2020 09 29;141:e466-e473. Epub 2020 May 29.

Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Objective: There is currently no precise guide for the treatment and management of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). Thus, the aim of this study was to clarify the factors of poor outcome and mortality in elderly patients with aSAH.

Methods: In the modified World Federation of Neurosurgical Societies (mWFNS) scale study, 1124 patients were divided into 2 groups, elderly (age ≥65 years) and non-elderly (age <65 years), with aSAH investigated between October 2010 and March 2013 in Japan. The odds ratio (OR) and 95% confidence interval (CI) of each risk factor was calculated through multivariate logistic regression analysis for poor outcomes, as indicated by the modified Rankin Scale (mRS) score ≥3 and mortality at 3 months after onset in each group.

Results: Both groups demonstrated that the mWFNS scale was significant as a grade order risk factor for poor outcomes and mortality associated with disease. In the elderly group, risk factors for poor outcomes at 3 months after onset were older age (OR 1.10, 95% CI 1.06-1.14), male sex (OR 2.03, 95% CI 1.10-3.73), and severe cerebral vasospasm category (OR 10.13, 95% CI 4.30-23.87). Risk factors for mortality at 3 months after onset were older age (OR 1.06, 95% CI 1.01-1.11) and severe vasospasm category (OR 2.17, 95% CI 1.00-4.72).

Conclusions: The mWFNS scale is a useful prognostic predictor for both non-elderly and elderly patients with aSAH. Elderly male patients with aSAH presenting with severe vasospasm should be managed more carefully.
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http://dx.doi.org/10.1016/j.wneu.2020.05.196DOI Listing
September 2020

Identification of Metal-Binding Peptides and Their Conjugation onto Nanoparticles of Superparamagnetic Iron Oxides and Liposomes.

ACS Appl Mater Interfaces 2020 Jun 19;12(22):24623-24634. Epub 2020 May 19.

Department of Bioengineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.

Metallic materials are used for clinical medical devices such as vascular stents and coils to treat both ischemic and hemorrhagic vascular diseases. An antiplatelet drug is required to avoid thromboembolic complication until metallic surface is covered with a neo-endothelial cell layer. It is important to identify endothelial cell coverage on the metallic surface. However, it is difficult since there are no selective ligands. Here, we used the phage display method to identify peptide ligands that had high affinity for the metallic surface of Ni-Ti stents, Pt-W coils, and Co-Cr stents. The binding assay using fluorescence labeling revealed that several synthetic peptides could bind onto those surfaces. We also chose some oligopeptides for the conjugation onto superparamagnetic iron oxide (SPIO) nanoparticles and liposome-encapsulating SPIO nanoparticles and studied their ability to bind to the stent and coils. By SEM and fluorophotometry, we found that those modified SPIOs and liposomes were selectively bound onto those surfaces. In addition, both treated stents and coils could be detected by magnetic resonance imaging due to the magnetic artifact through the SPIOs and liposomes that were immobilized onto the surface. Thus, we identified metal-binding peptides which may enable to stop antiplatelet therapy after vascular stenting or coiling.
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http://dx.doi.org/10.1021/acsami.0c06138DOI Listing
June 2020

Alterations of the tumor microenvironment in glioblastoma following radiation and temozolomide with or without bevacizumab.

Ann Transl Med 2020 Mar;8(6):297

Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

Background: The immunosuppressive tumor microenvironment (TME) contributes to the tumor progression and treatment failure. Our previous study demonstrated alterations in the TME during bevacizumab (Bev) therapy in human glioblastoma (GB) specimens obtained from patients who underwent surgical resection. Continuous Bev administration downregulates the expression of programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1), suppresses the infiltration of tumor associated macrophages (TAMs) and regulatory T cells (Tregs), and increases cytotoxic T lymphocytes (CTLs) infiltration. However, one may argue that these immunosupportive effects might also be induced by radiation therapy (RT) or temozolomide (TMZ), and they cannot necessarily be attributed to Bev alone.

Methods: In the present study, changes in the molecules relevant to the TME were analyzed by immunohistochemistry using paired pre- and post-treatment samples of malignant glioma specimens from 15 patients who received RT and TMZ therapy without Bev.

Results: The expression levels of CD34, vascular endothelial growth factor (VEGF)-A, VEGF receptor 2 (VEGFR2), HIF-1α, CA9, nestin, CD4, CD8, CD163, PD-1, and PD-L1 were not significantly changed after the treatment with RT and TMZ. However, VEGFR1 expression and the number of Foxp3-positive cells tended to be upregulated and increased after the treatment (P=0.058, P=0.082, respectively).

Conclusions: This was the first study to show the alterations of TME following RT and TMZ therapy using paired pre- and post-treatment malignant glioma samples. Long-term treatment of RT and TMZ might worsen immunosuppressive TME in malignant gliomas.
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http://dx.doi.org/10.21037/atm.2020.03.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186631PMC
March 2020

Total Spinal Epidural "Blood Patch" Application Through a Racz Catheter in Spontaneous Intracranial Hypotension.

World Neurosurg 2020 Mar 6;135:131-134. Epub 2019 Dec 6.

Department of Neurosurgery, Jikei University School of Medicine, Nishi-Shinbashi, Minato-Ku, Tokyo, Japan.

Background: Epidural "blood patch" (EBP) is a standard treatment of spontaneous intracranial hypotension (SIH). In recent years, there are some reports of Racz catheter use for EBP performance at upper cervical spine levels. However, the practical use of Racz catheter for single-entry multisite EBP has never been reported until now.

Case Description: We treated a 60-year-old man diagnosed with SIH presenting with cerebrospinal fluid leaks from the cervical to the sacral segments. We discuss the advantages of the single-entry multisite EBP and the convenience of Racz catheter use in such cases.

Conclusions: The Racz catheter can be a convenient means to deliver large-volume EBPs from a single entry point in the treatment of SIH.
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http://dx.doi.org/10.1016/j.wneu.2019.11.169DOI Listing
March 2020

Rupture Risk of Small Unruptured Intracranial Aneurysms in Japanese Adults.

Stroke 2020 02 9;51(2):641-643. Epub 2019 Dec 9.

Department of Neurosurgery, The Jikei University School of Medicine (H.T., K.O., T.I., Y.M.).

Background and Purpose- Therapeutic decision making for small unruptured intracranial aneurysms (<10 mm) is difficult. We aimed to develop a rupture risk model for small intracranial aneurysms in Japanese adults, including clinical, morphological, and hemodynamic parameters. Methods- We analyzed 338 small unruptured aneurysms; 35 ruptured during the observation period, and 303 remained stable. Clinical, morphological, and hemodynamic parameters were considered. Computational fluid dynamics was used to calculate hemodynamic parameters based on computed tomography images of all aneurysms in their unruptured state. Differences between the ruptured and unruptured groups were tested by the Mann-Whitney or Fisher exact tests. Multivariate logistic regression was applied to obtain a rupture risk model. Its predictive ability was investigated by receiver operating characteristic analysis. Results- The risk model revealed that rupture may be more likely to in younger patients (odds ratio [OR], 0.92 for each age increase of 1 year [95% CI, 0.88-0.96] <0.001) with multiple aneurysms (OR, 2.58 [95% CI, 1.07-6.19] =0.03), located at a bifurcation (OR, 5.45 [95% CI, 1.87-15.85] =0.002), with a bleb (OR, 4.09 [95% CI, 1.42-11.79] =0.009), larger length (OR, 1.91 for each increase of 1 mm [95% CI, 1.42-2.57] <0.001), and lower pressure loss coefficient (OR, 0.33 for each decrease of 1 unit [95% CI, 0.14-0.77] =0.01). The sensitivity, specificity, and area under the curve were 0.800, 0.752, and 0.826 (95% CI, 0.739-0.914) respectively. Conclusions- Younger age, presence of multiple aneurysms, location at a bifurcation, presence of a bleb, larger length, and lower pressure loss coefficient were identified as risk factors for rupture of small intracranial aneurysms. The risk model should be validated in further studies.
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http://dx.doi.org/10.1161/STROKEAHA.119.027664DOI Listing
February 2020

Eliminating transmissibility of bovine spongiform encephalopathy by dry-heat treatment.

J Gen Virol 2020 01;101(1):136-142

National Institute of Animal Health, National Agriculture and Food Research Organization, Tsukuba, Ibaraki 305-0856, Japan.

Bovine spongiform encephalopathy (BSE) prion is more resistant to heat inactivation compared to other prions, but the effect of heat inactivation has been reported to differ depending on the BSE-contaminated tissue state or heating type. We aimed to evaluate the secure level of inactivation of original BSE transmissibility by dry-heating. Cattle tissues affected with BSE were subjected to dry-heat treatment for 20 min at various temperatures ranging from 150 to 1000 °C. To assess the inactivation effect, we conducted protein misfolding cyclic amplification (PMCA) and follicular dendritic cell (FDC) assays in transgenic mice expressing bovine prion protein genes. Under dry-heating at 600 °C or higher, BSE cattle tissues lost their transmissibility in transgenic mice. In contrast, transmissibility was detected in the cattle tissues treated at temperatures of 400 °C or lower through the FDC assay combined with PMCA. In this study, we confirmed that transmissibility was eliminated in BSE-affected cattle tissues by dry-heating at 600 °C or higher.
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http://dx.doi.org/10.1099/jgv.0.001335DOI Listing
January 2020
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