論文 - 堀口　崇

Anterior transpetrosal approach and the tumor removal rate, postoperative neurological changes, and complications: experience in 274 cases over 33 years

Tomio R., Horiguchi T., Shibao S., Tamura R., Yoshida K., Kawase T.

Journal of Neurosurgery 141 （ 1 ） 108 - 116 2024年07月

ISSN  00223085

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OBJECTIVE The authors report on the anterior transpetrosal approach (ATPA) and the results of surgeries performed over a 33-year period for petroclival tumors, including meningioma, trigeminal schwannoma, chordoma, and epidermoid tumor. They analyze early postoperative neurological changes, surgical complications, and trends over the decades. METHODS A retrospective analysis of 274 surgical cases that had undergone the ATPA from January 1984 to March 2017 was conducted. Data were collected from charts, clinical summaries, operative records, and operative videos. The analyzed parameters included patient diagnosis, tumor size, disease location, operation date, tumor removal rate, pre- and postoperative neurological symptoms (consciousness level, motor and sensory deficits of the limbs, sensory aphasia, and cranial nerve III–VIII injuries), surgical deaths, and radiologically recognized brain injuries after the operation (contusion, infarction, hemorrhage). RESULTS Gross-total resection (GTR) was achieved in 53.5% of the 243 tumors with available data. The GTR rate for meningiomas (148 cases) was 54.1%. Trigeminal schwannomas had a high GTR rate of 87.1%, whereas chordomas had a low GTR rate of 14.3%. The rate of early neurological deterioration immediately after the ATPA, referred to as “early neurological change,” was as follows: consciousness disturbance in 1.9% of cases (5 cases), improvement of hemiparesis in 45.0% of cases but deterioration in 8.1% of cases, sensory aphasia in 2.3% of cases due to temporal lobe injury, improvement of cerebellar symptoms in 39.3% of cases with rare deterioration (1.9% of cases), worsening of preoperative diplopia in 49.4% of patients and rarely improving, improvement of trigeminal symptoms in 19.1% of cases (mostly trigeminal neuralgia) among the 43.7% of patients who had them preoperatively, and deterioration of facial hypesthesia and/or paresthesia in 27.4% of cases. Early neurological deterioration was monitored in 183 patients for 6 months to determine the surgical complications of ATPA. Consciousness disturbance recovered in half of the cases but persisted in 3 (1.5%). Hemiparesis fully recovered in 63.2% of cases, resulting in a complication rate of 3.0%. The most frequent complication was diplopia (36.4%), with a complete remission rate of 26.4%. The second most frequent complication was facial hypesthesia (24.0%), with a recovery rate of 16.1%. Facial nerve palsy improved in 63.0% of cases and had a complication rate of 4.9%. Cerebellar symptoms showed complete recovery in all cases. CONCLUSIONS The ATPA allows the removal of petroclival tumors extending into Meckel’s cave and the middle fossa, making it preferred for dumbbell trigeminal schwannomas and meningiomas. However, the ATPA’s aggressive tumor removal can risk a lower recovery of cranial nerve IV–VI deficits. For benign meningiomas, initial observation with regular follow-up is recommended. Surgery is appropriate for high-growth cases aiming for total removal, accompanied by a thorough explanation of the risks. If the risks are not accepted, subtotal removal can be considered, and radiosurgery is suggested for residual tumor.

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Interprofessional competency in clinical students: validating the Clinical student version of the Japanese Self-assessment Scale of Interprofessional Competency (C-JASSIC)

Haruta J., Tomizaki E., Horiguchi T., Nakamura T., Ishikawa S., Monkawa T.

Journal of Interprofessional Care 38 （ 5 ） 875 - 882 2024年

ISSN  13561820

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In this study, we developed and validated the Clinical Student Version of the Japanese Interprofessional Competency Self-Assessment Scale (C-JASSIC) for healthcare students in their clinical practice phase. Data obtained from 331 students (medical, 98; nursing, 99; pharmacy, 134) during orientation for interprofessional education (pre-IPE) and from 319 students (medical, 94; nursing, 93; pharmacy, 132) within a week following IPE (post-IPE) were analyzed. Exploratory pre-IPE and Confirmatory post-IPE factor analyses revealed a consistent 6-factor structure aligning with the Japanese Interprofessional Competency domains. The scale exhibited strong internal consistency, with Cronbach’s α values exceeding 0.8 for all factors both pre- and post-IPE. Scores for overall competency and individual domains increased post-IPE in 234 matched cases. A notable significant pre vs post difference concerned “Understanding of Others,” indicating enhanced interprofessional comprehension after clinical practice. There was a weak but significant positive correlation between IPE satisfaction and difference in pre- and post-IPE scores. However, no significant differences were observed among medical, nursing, and pharmacy students. Despite its strengths, such as its competency-based design and cultural relevance to Japan, a limitation of the study may be potential self-reporting bias. Nonetheless, C-JASSIC represents a valuable tool for seamless competency evaluations from student to professional stages, with implications for broader Asian contexts.

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Executive summary: Japanese guidelines for adult asthma (JGL) 2021.

Niimi A, Fukunaga K, Taniguchi M, Nakamura Y, Tagaya E, Horiguchi T, Yokoyama A, Yamaguchi M, Nagata M

Allergology international : official journal of the Japanese Society of Allergology 72 （ 2 ） 207 - 226 2023年04月

ISSN  1323-8930

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A simple combined approach using anterior transpetrosal and retrosigmoid approach: A case report

Tamura R., Ueda R., Karatsu K., Sayanagi T., Takahara K., Hino U., Iwama T., Nogawa H., Nakaya M., Horiguchi T., Toda M.

Frontiers in Surgery 10   1094387 2023年

ISSN  2296-875X

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Background: A combined transpetrosal approach (CTP) is often used for large lesions in the posterior cranial fossa (PCF). Although CTP provides a wide surgical corridor, it has complex and time-consuming bony work of mastoidectomy and cosmetic issues. Here, we describe a simple combined surgical technique to approach the supratentorial region, anterolateral surface of the brainstem, petroclival region, and foramen magnum by drilling only the petrous apex with a combination of retrosigmoid approach (RA). Clinical presentation: A 27-year-old female was referred with extra-axial left cerebellopontine angle space-occupying epidermoid cyst extending to the prepontine cistern, anterior to the basilar artery, superior to the chiasma, and caudally to the foramen magnum. A one-stage surgical procedure using the anterior transpetrosal approach (ATP) and RA was performed after one-piece temporal-suboccipital craniotomy. These two approaches complemented each other well. Near-total removal was achieved. Conclusion: A one-stage surgical procedure using ATP and RA provides the wider viewing and better visualization of the PCF with minimal technical difficulty.

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Odontogenic Pericarotid Abscess after Carotid Endarterectomy.

Takahara K, Takahashi S, Hino U, Horiguchi T, Toda M

NMC Case Report Journal （一般社団法人 日本脳神経外科学会）  9 （ 0 ） 377 - 382 2022年12月

ISSN  2188-4226

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<p>Carotid endarterectomy (CEA) and carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis have specific risks. Therefore, the accurate evaluation and management of each risk factor are important, especially for patients who are at high risk for both CEA and CAS.</p><p>We report the case of a 77-year-old man with right ICA stenosis that progressed despite optimal medical treatment. In addition, he had several risk factors for both CEA and CAS, including previous cervical radiation therapy, contralateral ICA occlusion, chronic kidney insufficiency, and severe aortic valve stenosis. CEA was performed with priority given to aortic valve stenosis without complications, and the patient was discharged 10 days postoperatively, without neurological sequelae. However, a pericarotid cervical abscess was detected by carotid echo, computed tomography (CT), and magnetic resonance imaging (MRI) 1 month after CEA that required surgical drainage. The infection was thought to be odontogenic because the pathogen was identified as normal oral bacterial flora, and a wound infection was not apparent. Teeth extraction and abscess drainage, in combination with antibiotic therapy, successfully cured the infection without additional complications.</p><p>Odontogenic cervical abscesses after CEA can occur, especially if the patient is at risk of infection. Therefore, both preoperative and postoperative dental evaluation and management are recommended. As in this case, a cervical abscess can occur without wound infection, and the abscess diagnosis is sometimes difficult from wound inspection alone. Cervical echocardiogram and CT were useful for detecting fluid collection, whereas MRI was useful for qualitatively evaluating the lesion.</p>

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Imaging of the venous plexus of Rektorzik using CT-digital subtraction venography: a retrospective study

Imai R., Mizutani K., Akiyama T., Horiguchi T., Takatsume Y., Toda M.

Neuroradiology 64 （ 10 ） 1961 - 1968 2022年10月

ISSN  00283940

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Purpose: The venous plexus of Rektorzik (VPR), first described by Rektorzik in 1858, is a venous plexus around the internal carotid artery in the carotid canal. However, the VPR has never been investigated using the recently developed imaging modalities. In this study, we analyzed the VPR using computed tomography-digital subtraction venography (CT-DSV). Methods: This study included 253 patients who had undergone head CT-DSV. The presence or absence of the right and left VPRs and their connecting veins were visually examined by two researchers. Results: The VPR was observed in 60 patients (24%), 39 of which showed VPR only on the right side, 10 only on the left side, and 11 on both sides. VPR was significantly more common on the right side (p = 0.0002) and was observed more frequently around the horizontal segment of the internal carotid artery than around the vertical segment. The most common veins identified as distal and proximal VPR connections were the cavernous sinus (63/71, 89%) and the anterior condylar confluence (27/71, 38%), respectively. The mean age was significantly lower in patients with the VPR than in those without (53 vs. 57 years, p = 0.02). Conclusion: The VPR was significantly more frequent on the right side and in younger patients but was not a radiographically constant structure. In most cases, the VPR connected the cavernous sinus and anterior condylar confluence. Preoperative evaluation of VPR may lead to refined surgical procedures.

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Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications

Tomio R., Horiguchi T., Borghei-Razavi H., Tamura R., Yoshida K., Kawase T.

Journal of Neurosurgery 136 （ 2 ） 413 - 421 2022年02月

ISSN  00223085

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OBJECTIVE The anterior transpetrosal approach (ATPA) was initially reported in 1985. The authors' institution has 274 case records of surgery performed with the ATPA during the period from 1984 to 2017. Although many technical advances and modifications in the ATPA have occurred over those 33 years, to the authors' knowledge no articles to date have reported a detailed analysis of variations and complications of the ATPA. In this study, the authors analyzed their patient series to elucidate improvements over time in ATPA methodology while highlighting unresolved problems and evaluating how to avoid surgical complications. METHODS All surgical cases (274 patients) using the ATPA at the authors' institution during the period from 1984 to 2017 were analyzed retrospectively using charts, clinical summaries, operative records, and operative videos. Obtained parameters were patient age and sex, diagnosis, size of tumors, location of disease, operative date, neurological symptoms before and after surgery, radiographically identified brain injury, and other surgical complications. The most common diagnosis was petroclival meningioma (n = 158), followed by trigeminal schwannoma (n = 32), chordoma (n = 25), epidermoid tumor (n = 21), other tumor (n = 27), aneurysm (n = 6), and other (n = 5). RESULTS The original ATPA was performed in 239 cases. In an additional 35 cases, a modified ATPA was performed. Zygomatic osteotomy with ATPA was a common modification that was used in 19 of the 35 cases to decrease retraction damage to the temporal lobe for high-positioned tumors. Brain injury by temporal lobe retraction without venous hemorrhage still occurred in 8 of the 19 cases (3.1%) with surgical death in 1 of these cases (0.4%) of reoperation with sacrifice of the petrosal vein. Symptomatic CSF leak was the most frequent complication noted and was observed in 35 cases (13.5%). In most of these cases the patients were cured by observation or lumbar drain, but in 6 cases (17.1%) reoperation was needed. Facial nerve damage related to surgical approach decreased from 6.2% to 3.5% after 2010; however, the incidence of CSF leaks (13.5%) has not improved. CONCLUSIONS There have been several modifications and advancements made in the ATPA to increase tumor removal and decrease surgical complications. However, complications related to surgical approach occurred, such as venous occlusion-related brain injury and facial nerve damage at pyramid resection. CSF leak remained an unsolved problem related to the ATPA procedures. Preoperative assessment of venous variation of the middle fossa, pneumatization of the temporal bone, and intraoperative monitoring of cranial nerves are important procedures to decrease these complications.

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Suboccipital trans-horizontal fissure approach for cerebellar hemorrhage with rupture into the upper fourth and third ventricles: the first clinical experience. Illustrative cases

Tamura R., Katayama M., Kuranari Y., Horiguchi T.

Journal of Neurosurgery: Case Lessons 3 （ 7 ）  2022年

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BACKGROUND The authors’ previous cadaveric study reported a new surgical approach that can expose the deep cerebellar hemisphere, cerebellopontine angle, and upper fourth ventricle through dissection of the horizontal fissure of the suboccipital cerebellar hemisphere. Here, the authors present their experience with the first clinical use of the suboccipital trans-horizontal fissure (SOTHF) approach requiring access to the third and upper fourth ventricle lesions, a challenging compartment to access by traditional approaches. OBSERVATIONS In cases 1 and 2, computed tomography demonstrated large hematomas in the left cerebellar hemisphere with extension into the third ventricle and/or the upper fourth ventricle, resulting in obstructive hydrocephalus. Large hematomas in both the cerebellar hemisphere and the upper fourth ventricle were successfully removed via an SOTHF approach alone without external ventricular drainage. Furthermore, the hematoma in the third ventricle was removed through the aqueduct in case 2. Access to the upper fourth ventricle and the third ventricle were intraoperatively verified using a neuronavigation system. The patients immediately regained consciousness, and the result of cerebellar function testing was almost normal after the operation. LESSONS An SOTHF approach can achieve the removal of cerebellar and intraventricular hematomas simultaneously, is a faster and potentially safer method than others, and subsequently allows rapid clinical improvement.

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Suboccipital Transhorizontal Fissure Approach for Posterior Cranial Fossa Lesions: A Cadaveric Study and First Clinical Experience

Tamura R., Katayama M., Yamamoto K., Horiguchi T.

Operative Neurosurgery 21 （ 6 ） E479 - E487 2021年12月

ISSN  23324252

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BACKGROUND: Surgical treatment of pathological lesions in the deep cerebellar hemisphere, cerebellopontine angle (CPA), and fourth ventricle of the posterior cranial fossa (PCF) is challenging. Conventional neurosurgical approaches to these lesions are associated with risk of various complications. Mastery of efficient fissure dissection is imperative when approaching deep-seated lesions. The horizontal fissure (HF) is the largest and deepest fissure of the cerebellum. OBJECTIVE: To conduct an anatomical study and introduce a novel suboccipital trans-HF (SOTHF) approach to access lesions of the deep cerebellar hemispheres, CPA, and upper fourth ventricle of the PCF. METHODS: We performed a cadaveric dissection study focusing on anatomical landmarks and surgical feasibility of the SOTHF approach then implemented it in 2 patients with a deep cerebellar hemispheric tumor. RESULTS: Anatomical feasibility of the SOTHF approach was demonstrated and compared with conventional approaches in the cadaveric study. Opening the suboccipital surface of the HF to create medial, intermediate, and lateral surgical corridors provided optimal viewing angles and wide access to the deep cerebellar hemispheres, CPA, and upper fourth ventricle without heavy cerebellar retraction. Sacrificing cerebellar neural structures and complex skull base techniques were not required to obtain adequate exposure. The SOTHF approach was successfully applied without complication in 2 patients with a deep cerebellar hemispheric tumor. CONCLUSION: The HF is an important cerebellar fissure that provides a gateway to deep areas of the PCF. Further studies are needed to define and expand applications of the SOTHF approach.

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Cone-Beam Computed Tomography Fusion Technique for Vascular Assessment of Skull Base Meningiomas

Yoshida K., Akiyama T., Takahashi S., Miwa T., Horiguchi T., Sasaki H., Toda M.

World Neurosurgery 151   61 - 69 2021年07月

ISSN  18788750

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Objective: Cone-beam computed tomography (CBCT) images for skull base tumors provide detailed vascular information and localization in regard to surrounding bony structures. We report use of the CBCT fusion technique for skull base meningiomas. Methods: Six patients with petroclival or petrotentorial meningiomas supplied by multiple arterial systems were preoperatively evaluated using CBCT fusion imaging. Fusion images were reconstructed from three-dimensional rotational angiography with contrast agent injections from the internal carotid artery (ICA) and external carotid artery in 4 cases, vertebral artery and external carotid artery in 1 case, and ICA and vertebral artery in 1 case. Results: The feeding pedicles and tumor stains from 2 arterial systems were differentiated by separate colors. The courses and territories of the ICA dural feeders or ICA/vertebral artery pial feeders were easily distinguished from the external carotid artery dural feeders. Anastomoses between thin feeders from different arterial systems could be detected. Mixed stain (stain with both colors) was observed in some tumor compartments, suggesting dual supply from 2 arterial systems and the presence of peritumoral anastomoses. All patients underwent preoperative embolization without complications. Conclusions: CBCT fusion images clearly visualized the feeders from each arterial system, the vascular compartments within the tumor, and possible peritumoral anastomoses. This technique provides a substantial contribution to both preoperative embolization and surgical resection of skull base meningiomas.

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当院における頸部頸動脈瘤に対する治療戦略

堀口 崇, 淺田 英穂, 寺尾 聡, 秋山 武紀, 大石 裕美子, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  49 （ 4 ） 259 - 264 2021年07月

ISSN  0914-5508

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当院で頸部頸動脈瘤に対し直達術を行った6例(男性1例、女性5例、平均年齢56.7歳)について検討した。その結果、全例が症候性内頸動脈瘤であり、瘤径は平均35.8mm、動脈瘤内血栓化を2例に認められた。手術法は3例で動脈瘤の切除と内頸動脈の端々吻合による血行再建が行われ、残る3例で母血管閉塞が行われていた。動脈瘤を切除した3例の病理所見はいずれも動脈硬化性動脈瘤であった。5例が転帰良好であったが、1例は内頸動脈閉塞から中大脳動脈塞栓を生じ、広範な脳梗塞により死亡していた。

特集 脳卒中:内科医が知っておくべき最新診療 脳卒中急性期治療　高血圧性脳出血

堀口 崇

診断と治療 （(株)診断と治療社）  109 （ 5 ） 651 - 654 2021年05月

ISSN  0370999X

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Adult Langerhans Cell Histiocytosis Diagnosed by Biopsy of the Skull Tumor Generated after Craniotomy.

Kono M, Inomoto C, Horiguchi T, Sugiyama I, Nakamura N, Saito R

NMC Case Report Journal （一般社団法人 日本脳神経外科学会）  8 （ 1 ） 101 - 105 2021年

ISSN  2188-4226

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<p>Langerhans cell histiocytosis (LCH) is a disease characterized by the proliferation of Langerhans cells. Most cases of LCH occur in children, although it can be seen in adults as well. We encountered an adult case of LCH. A 44-year-old woman who was diagnosed as diabetes insipidus underwent a magnetic resonance imaging (MRI) of the head which revealed sellar and suprasellar gadolinium-enhanced mass. Prolactin level was high and cabergoline was prescribed. The size of this mass had reduced, so we supposed the tumor was prolactinoma. However, after 4 years of observation, it had increased once again. The biopsy of pituitary stalk lesion was performed via transcranial approach. The histological diagnosis was initially gangliocytoma. The patient complained of back pain after surgery. Three months after the biopsy, a computed tomography (CT) scan revealed multiple osteolytic lesions throughout the entire body. One of the osteolytic lesions of the skull was removed to determine the diagnosis. The pathological examination of the skull led to a diagnosis of LCH. We concluded retrospectively that the lesion of the pituitary stalk was LCH mimicking gangliocytoma though classical pathological findings were not obtained. In conclusion, LCH should be considered as a differential diagnosis in adult cases of diabetes insipidus with hypothalamic–pituitary lesion.</p>

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当院における頚部頚動脈瘤に対する治療戦略

堀口 崇, 淺田 英穂, 寺尾 聡, 秋山 武紀, 大石 裕美子, 吉田 一成

脳卒中の外科 （一般社団法人 日本脳卒中の外科学会）  49 （ 4 ） 259 - 264 2021年

ISSN  09145508

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<p>We report the clinical features of six patients who underwent direct surgery at our hospital for large or giant cervical internal carotid artery aneurysms (CICAAs). Three patients underwent aneurysm resection with end-to-end anastomosis of the internal carotid artery (ICA), and three patients underwent proximal occlusion of the ICA. Five patients had good outcomes, including one case with transient dysphagia. In one case, a middle cerebral artery embolization occurred due to ICA occlusion, and the patient died due to extensive cerebral infarction. To avoid ischemic complications in direct surgery for CICAA, preoperative cerebral blood flow assessment and perioperative antithrombotic therapy are indispensable. In addition, to avoid lower cranial nerve palsy during dissection of the aneurysm from surrounding structures, a bloodless surgical field; safe, reliable internal shunt insertion and vascular suture techniques; and an accurate understanding of the anatomy of the neck are also necessary.</p>

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Surgical education using cadaver dissection for modern practical skull base surgical techniques

Horiguchi T.

Japanese Journal of Neurosurgery （日本脳神経外科コングレス）  30 （ 9 ） 665 - 672 2021年

ISSN  0917950X

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We have outlined the modern cadaver surgical training to facilitate safe complex and advanced skull base surgeries. The normal formalin‒fixed cadaver head was useful for learning detailed skull base anatomy and histological research by removing the brain. Our fixation method, with the addition of phenol, ethanol, and methanol, was suitable for surgical simulation. To utilize the dissection performed by doctors for the development of surgical skills, it is essential to create an organization within the university.

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硬膜動静脈瘻治療における外科治療の役割

秋山 武紀, 堀口 崇, 高橋 里史, 大平 貴之, 秋山 武和, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  48 （ 6 ） 420 - 426 2020年11月

ISSN  0914-5508

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2009年以降の硬膜動静脈瘻(dAVF)のうち外科的治療をメインとした20例20手技(男性17例、女性3例、平均年齢57.9歳)について検討した。検討内容は病変の特徴、部位、治療方法、全治療における外科治療の頻度、位置付け、合併症とした。また、直達術を行う際に注意が必要であった4例を呈示した。

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INVESTIGATION OF SERUM MICRORNAS AND THEIR TARGET GENES IN CEREBRAL VASCULAR ENDOTHELIAL CELLS THAT CAN REFLECT THE EXTENT OF EARLY BRAIN INJURY AFTER SUBARACHNOID HEMORRHAGE

Takahashi, S; Arai, N; Nakagawa, S; Koike, K; Yanagisawa, K; Mihara, K; Akiyama, T; Horiguchi, T; Yoshida, K

INTERNATIONAL JOURNAL OF STROKE 15 （ 1_SUPPL ） 581 - 581 2020年11月

ISSN  1747-4930

Hemodynamic stress distribution identified by SPECT reflects ischemic symptoms of Moyamoya disease patients

Arai N., Horiguchi T., Takahashi S., Nakahara T., Akiyama T., Jinzaki M., Yoshida K.

Neurosurgical Review 43 （ 5 ） 1323 - 1329 2020年10月

ISSN  03445607

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This study aimed to validate the hypothesis that the ratio of cerebral blood flow (CBF) at rest in the lenticular nucleus (LN) territory to that in the middle cerebral artery (MCA) territory is higher in symptomatic Moyamoya disease (MMD) patients than in asymptomatic MMD patients. This was a retrospective observational study of adult patients with documented MMD who underwent single-photon emission computed tomography (SPECT) and had been examined at the Department of Neurosurgery of Keio University Hospital during a 10-year period (2006–2016). The diagnosis was made on the basis of typical imaging findings. We classified unoperated MMD patients into three groups: class I, no evidence of stenosis or occlusion hemispheres and without symptoms in unilateral MMD patients; class II, hemispheres with stenosis or occlusion but without ischemic symptoms; and class III, hemispheres with evidence of stenosis or occlusion associated with ischemic symptoms. Hemodynamic stress distribution (hdSD) was defined as the ratio of CBF in one LN to the CBF in the peripheral MCA; this was obtained by SPECT at rest. We compared the values of CBF and hdSD among the groups. A total of 173 adult patients were diagnosed with MMD from January 1, 2006, to January 1, 2016. Among them, 85 MMD patients underwent SPECT studies. After excluding inappropriate cases, 144 hemispheres were included in our analysis. hdSD was significantly higher (p < 0.001) in hemispheres with ischemic symptoms (class III, mean hdSD = 1.1; 36 sides) than in those without symptoms (class II, mean hdSD = 1.03; 82 sides). However, CBF at rest in the MCA or LN was not significantly associated with ischemic symptoms. The optimal threshold for hdSD to have ischemic symptoms was 1.040 (area under the curve; 74% sensitivity 91.7% and specificity 54.9%). We used SPECT to investigate cerebral blood from MMD patients and found that high hdSD values were predictive of ischemic symptom development in these patients.

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Relationship between ischaemic symptoms during the early postoperative period in patients with moyamoya disease and changes in the cerebellar asymmetry index

Takahashi S., Horiguchi T.

Clinical Neurology and Neurosurgery 197   106090 2020年10月

ISSN  03038467

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Objective: The aim of this study was to clarify the relationship between ischaemic symptoms during the early postoperative period in patients with moyamoya disease and changes in the cerebellar asymmetry index (AI), a parameter used to quantitatively identify crossed cerebellar diaschisis (CCD). Patients and methods: We analysed the data of 18 patients with moyamoya disease who underwent quantitative IMP-cerebral blood flow SPECT at least once during the follow-up period. Cerebellar AI scores were calculated using the CBF of the cerebellum calculated automatically from multiple slices of SPECT images with automated ROI setup software and categorized and statistically examined according to the presence or absence of ischaemic symptoms. Results: The cerebellar AI calculated from SPECT performed in the patients who presented with ischaemic symptoms was 0.094 ± 0.023 (mean ± SD), which was significantly elevated compared to the value of 0.013 ± 0.025 (mean ± SD) calculated from SPECT performed when the patients did not present with ischaemic symptoms (p < 0.0001). Limiting the time of SPECT to calculate the cerebellar AI to be compared to the acute phase within 2 weeks after surgery did not change this trend, and again, the cerebellar AI was statistically significantly elevated in the presence of ischaemic symptoms (0.094 ± 0.023 (mean ± SD)) compared to the AI in the absence of ischaemic symptoms (0.000081 ± 0.026 (mean ± SD)) (p = 0.0003). In patients who underwent quantitative SPECT in the acute phase during the first postoperative week, the cerebellar AI values calculated from the results of SPECT performed during the preoperative period as well as multiple times during postoperative period were followed over time in each case. The cerebellar AI increased in patients who presented with symptoms of ischaemia postoperatively but then tended to decrease reversibly and approach zero with the disappearance of symptoms of ischaemia. Conclusions: Since the cerebellar AI reflects the symptom of ischaemia in patients with moyamoya disease, especially in the early stage after revascularization surgery, and is a parameter that improves with symptom improvement, it seems to be useful for understanding the state of cerebral blood flow after bypass surgery in patients with moyamoya disease.

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Novel method to evaluate the risk of tumor adhesions and post-operative hemorrhage of meningiomas using 320 row CT-DSA: A clinical research study

Arai N., Mizutani K., Horiguchi T., Akiyama T., Takahashi S., Yanagisawa K., Koike K., Yoshida K.

Acta Neurochirurgica 162 （ 9 ） 2145 - 2153 2020年09月

ISSN  00016268

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Objective: Meningioma is an extra-axial tumor that forms adhesions toward the brain surface in the course of its growth. Predicting adhesions between the tumor and the brain surface leads to better predictions of surgical results. There are few studies on brain–tumor adhesions or postoperative hemorrhage. This study aimed to assess tumor vascularity of the dura and cerebral surface, and predict surgical outcomes using four-dimensional computed tomography angiography (4D CTA). Patients and methods: Using a dynamic contrast CT, we conducted a retrospective study of 27 patients with convexity (n = 15), falx (n = 6), and parasagittal (n = 6) meningiomas treated in our hospital from January 2016 to September 2018. We set the region of interest on the dural layer and cerebral surface side of meningiomas and calculated the mean CT value in each region. Distribution of blood flow in the tumor was classified into two groups: A, which has a higher CT value of the dural side than that of the brain surface side at every timing, and B, which meets the criteria other than those in group A. Demographic data, preoperative characteristic images, and postoperative complications were compared between the groups. Results: Twelve and 15 patients were classified into groups A and B, respectively. The extent of adhesions against the cerebral cortex in group A was significantly less severe compared with that in group B (p = 0.038). The rate of postoperative hemorrhage occurrence in group B (53%) was significantly higher than that in group A (8%) (p = 0.04). There were no significant differences in the other preoperative characteristic images or perioperative parameters between groups A and B. Conclusion: A 320-row dynamic contrast CT scanner can detect meningiomas with a high probability of severe adhesion toward the brain surface and postoperative intraparenchymal hematoma.

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Silent MRA: arterial spin labeling magnetic resonant angiography with ultra-short time echo assessing cerebral arteriovenous malformation

Arai N., Akiyama T., Fujiwara K., Koike K., Takahashi S., Horiguchi T., Jinzaki M., Yoshida K.

Neuroradiology 62 （ 4 ） 455 - 461 2020年04月

ISSN  00283940

　概要を見る

Purpose: MR angiography using the silent MR angiography algorithm (silent MRA), which combines arterial spin labeling and an ultrashort time echo, has not been used for the evaluation of cerebral arteriovenous malformations (CAVMs). We aimed to determine the usefulness of silent MRA for the evaluation of CAVMs. Methods: Twenty-nine CAVMs of 28 consecutive patients diagnosed by 4D CT angiography or digital subtraction angiography, who underwent both time-of-flight (TOF) MRA and silent MRA, were enrolled. Two observers independently assessed the TOF-MRA and silent MRA images of CAVMs. Micro AVM was defined as AVM with a nidus diameter less than 10 mm. The detection rate, visualization of the components, and accuracy of Spetzler–Martin grade were evaluated with statistical software R. Results: For all 29 CAVMs, 23 (79%) lesions were detected for TOF-MRA and all for silent MRA. Of 10 micro AVMs, only 4 (40%) lesions were detectable on TOF-MRA and all (100%) on silent MRA. The visibility of the nidus and drainer was significantly better for silent MRA than TOF-MRA (p < 0.001), while there was no significant difference in the feeder between the two sequences. The accuracy rates of the Spetzler–Martin grade for the TOF and silent MRA were 38% (11/29) and 79.3% (23/29), respectively (p < 0.001). Conclusions: Silent MRA is useful for evaluating CAVM components and detecting micro AVM.

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Clipping versus coiling in unruptured anterior cerebral circulation aneurysms

Mohammad F., Horiguchi T., Mizutani K., Yoshida K.

Surgical Neurology International 11 （ 50 ） 50 2020年03月

ISSN  2229-5097

　概要を見る

Background: Unruptured intracranial aneurysms (UIAs) are not uncommon, especially in Japan. Treatment strategy for UIAs has evolved in the past decades in Western countries with the increased use of endovascular treatment as the primary option, but in Japan, clipping still has the upper hand. Methods: This study retrospectively included 200 patients treated by clipping or coiling for UIAs located in the anterior cerebral circulation. Postoperative angiographic and clinical outcomes were evaluated. Results: Of 200 UIAs, 147 and 53 were treated by surgery and coiling, respectively. The average follow-up duration was 30.2 ± 18.8 months for clipping and 29.3 ± 17.6 months for coiling. Complete occlusion was greater in the surgery group (78.9%) than the endovascular group (18.8%). Regrowth occurred in 1.4% of the clipping group and 13.2% of the coiling group. Ischemic events were encountered in both groups; asymptomatic ones were higher in the coiling group (24.5%) than in the clipping group (2%), while symptomatic ischemic complications were equal (7.5%) in both groups. The deterioration of modified Rankin scale was detected totally in 13 UIAs (6.5%) with no statistical difference between groups. Postoperative hospital period was longer in clipping (P = 0.01). Conclusion: Clipping and coiling were both safe and feasible in the treatment of unruptured aneurysms. The clipping was advantageous in durability, while the rate of morbidity was lower, and hospitalization period was shorter in the coiling group. The clipping and coiling should coexist while complementing each other by understanding the advantages and disadvantages of both.

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Loss of consciousness at ictus and/or poor World Federation of Neurosurgical Societies grade on admission reflects the impact of EBI and predicts poor outcome in patients with SAH

Takahashi S., Akiyama T., Horiguchi T., Miwa T., Takemura R., Yoshida K.

Surgical Neurology International 11 （ 40 ） 40 2020年03月

ISSN  2229-5097

　概要を見る

Background: There are many scores and markers that predict poor outcome in patients with subarachnoid hemorrhage (SAH). However, parameters that can predict outcomes in patients with SAH with high specificity and sensitivity, which can be identified in the early postictal state and utilized as a clinical marker of early brain injury (EBI) have not been identified so far. Methods: Thirty-nine patients with SAH due to a saccular intracranial aneurysm rupture were reviewed. We retrospectively analyzed the relationships between patients' baseline characteristics and patients' outcomes to identify parameters that could predict patient outcomes in the early postictal state. Results: In the univariate analysis, older age (>65), loss of consciousness (LOC) at ictus, poor initial World Federation of Neurosurgical Societies (WFNS) grade (3-5), and delayed cerebral ischemia (DCI) were associated with poor outcome (GOS 1-3). Statistical analyses revealed that combined LOC at ictus and/or poor initial WFNS grade (3-5) was a more powerful surrogate marker of outcome (OR 15.2 [95% CI 3.1-75.5]) than either LOC at ictus or the poor initial WFNS grade (3-5) alone. Multivariate logistic regression analyses revealed that older age, combined LOC at ictus and/or poor initial WFNS grade, and DCI were independently associated with poor outcome. Conclusion: Combined LOC at ictus and/or poor initial WFNS grade (3-5) reflects the impact of EBI and was a useful surrogate marker of poor prognosis in SAH patients, independent of patients' age and state of DCI.

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Altered expression of microRNAs in body fluids in after aneurysmal subarachnoid hemorrhage

Mihara, K; Takahasi, S; Yanagisawa, K; Mizutani, K; Akiyama, T; Katayama, M; Akaji, K; Horiguchi, T; Suga, S; Yoshida, K

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 39   179 - 179 2019年07月

ISSN  0271-678X

Factors that predicts poor outcome in patients with subarachnoid hemorrhage

Takahashi, S; Akiyama, T; Horiguchi, T; Yoshida, K

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 39   180 - 180 2019年07月

ISSN  0271-678X

Short-Term Spontaneous Resolution of Ruptured Peripheral Aneurysm in Moyamoya Disease

Yamada H., Saga I., Kojima A., Horiguchi T.

World Neurosurgery （World Neurosurgery）  126   247 - 251 2019年06月

ISSN  18788750

　概要を見る

© 2019 Elsevier Inc. Background: Peripheral aneurysms are known to be a source of intracranial hemorrhage in patients with moyamoya disease. However, the natural history of ruptured peripheral aneurysms remains unclear. Some regress spontaneously, whereas others may rebleed. Direct treatments, such as surgical or intravascular treatment of the peripheral aneurysm, can have a risk of severe neurologic complications owing to the depth of the operative field and the fragility of the parent artery. A careful treatment policy is required. Case Description: In a 29-year-old man with moyamoya disease with intraventricular hemorrhage, rupture of a right anterior choroidal artery aneurysm was diagnosed by cerebral angiography. The aneurysm was approximately 4 mm in size and existed in the plexal segment of the right anterior choroidal artery. Endovascular embolization of the aneurysm was planned. However, repeat angiography 3 weeks after aneurysm diagnosis demonstrated complete resolution of the aneurysm. Such short-term disappearance of an aneurysm is remarkably rare. We believe that the aneurysm was thrombosed for a brief period considering the slow blood flow detected inside the aneurysm during the initial angiography. The patient was discharged with no neurologic deficit and has remained recurrence-free for >1 year. Conclusions: Given that spontaneous resolution of an aneurysm may occur in a short period of time, we suggest that conservative treatment be considered as an option for ruptured peripheral aneurysms associated with moyamoya disease when direct treatment is risky.

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Pros and cons of using ORBEYE™ for microneurosurgery

Takahashi S., Toda M., Nishimoto M., Ishihara E., Miwa T., Akiyama T., Horiguchi T., Sasaki H., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery）  174   57 - 62 2018年11月

ISSN  03038467

　概要を見る

© 2018 Elsevier B.V. Objective: To evaluate the pros and cons of using a newly developed microscope, ORBEYE™, during microneurosurgery. Patients and methods: ORBEYE™ use in 14 microneurosurgical procedures was retrospectively assessed by nine neurosurgeons after the procedure. A questionnaire comprising 20 questions was designed and used for evaluation. Results: Compared with the current gold standard, the binocular microscope, ease of setting up the equipment was scored the highest, whereas ease of conducting surgery in a position of an assistant was scored the lowest. Among characteristics of ORBEYE™ itself, the space-saving feature was scored the highest and was followed by the ability to perform procedures in a comfortable position. The only characteristic that was rated below average was ease of operation in a position of an assistant. Neurosurgeons with greater experience (more than five procedures using ORBEYE™) provided significantly higher scores (p = 0.0196) for characteristics of ORBEYE™ itself compared with neurosurgeon with fewer ORBEYE™ experience. Conclusions: The main benefits of the ORBEYETM are its compact size and freedom from focusing through the eye lens of a conventional binocular microscope. However, it appears to be disadvantageous for operating in a position of an assistant because the surgical field has a rotated view on the monitor from a position of an assistant. Nonetheless, because of certain advantages, we believe the ORBEYE™ could be of additional help to use of conventional binocular microscope at the moment and will facilitate microneurosurgery in the future.

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An analysis of the anatomic route of the hypoglossal nerve within the hypoglossal canal using dynamic computed tomography angiography in patients with anterior condylar arteriovenous fistulas

Oishi Y., Akiyama T., Mizutani K., Horiguchi T., Imanishi N., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery）  174   207 - 213 2018年11月

ISSN  03038467

　概要を見る

© 2018 Elsevier B.V. Objective: The venous outlet of anterior condylar arteriovenous fistulas (AC-AVFs) often empties into the anterior condylar vein (ACV). Hypoglossal nerve palsy is one of the major complications after transvenous embolization (TVE) for the AC-AVF within the hypoglossal canal. However, no studies have investigated the route of the hypoglossal nerve within the hypoglossal canal in AC-AVF. The aim of the current study is to retrospectively verify the anatomical route of the hypoglossal nerve within its canal using dynamic computed tomography angiography (CTA) in order to facilitate the safe TVE for AC-AVF. Patients and methods: We included five patients with AC-AVF from 2011 to 2017. Dynamic CTA was performed on all patients. When the ACV was well-visualized by dynamic CTA, the hypoglossal nerve could be recognized as a less-intense structure within the surrounding enhanced vasculatures and the nerve route within the canal was analyzed. We also analyzed the location of the fistulas by digital subtraction angiography and cone-beam computed tomography. Results: In all five patients, the filling defect of the hypoglossal nerve ran through the most caudal portion of the hypoglossal canal. The fistulous pouches were located in the hypoglossal canal in three cases, and in the jugular tubercle venous complex in two cases. In all three cases with AC-AVF in the hypoglossal canal, the fistulous pouches were located in the superior wall of the hypoglossal canal, which means superior to the ACV. We performed TVE in four patients and none developed post-therapeutic hypoglossal nerve palsy. Conclusion: In the current study, dynamic CTA is useful for detecting the hypoglossal nerve within the hypoglossal canal. The hypoglossal nerve usually ran the bottom of its canal and the fistulous pouches were usually located at the superior aspect of the canal opposite side to the hypoglossal nerve. Accordingly, the selective embolization within the fistulous pouch located in the superior aspect of the ACV including jugular tubercle venous complex can reduce the risk of hypoglossal nerve palsy.

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Hybrid operating room(HOR)における複雑な脳血管障害に対する開頭および血管内複合治療の有用性　Hybrid operating room導入前後の検討

堀口 崇, 秋山 武紀, 高橋 里史, 大平 貴之, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  46 （ 6 ） 453 - 461 2018年11月

ISSN  0914-5508

　概要を見る

開頭手術と血管内複合治療(術中血管撮影を含む)を行った脳血管障害の症例を、手術台と血管撮影装置を兼ね備えたhybrid operating room(HOR)導入前後で比較し、HORの有用性について検討した。血管内治療医と共同で複合治療を行った脳血管障害の患者17例(男性10例、女性7例、平均49歳)を対象に、HOR導入前の前期11例、導入以後の後期6例に分類した。前期の11例中、部屋を移動して血管内治療を行ったのは4例であった。後期の6例はいずれも問題なく治療が終了した。転帰は原疾患の重症度が理由でsevere disabilityとなった症例を除き、全例でgood recoveryであったが、術後のminor strokeによる軽度顔面神経麻痺を1例に認めた。複雑な脳血管病変に対する開頭手術と血管内治療の複合治療は、HORを使用することで、より安全かつ円滑に完遂させることが可能であった。

Preoperative Assessment of Pathologic Subtypes of Meningioma and Solitary Fibrous Tumor/Hemangiopericytoma Using Dynamic Computed Tomography: A Clinical Research Study

Arai N., Mizutani K., Takahashi S., Morimoto Y., Akiyama T., Horiguchi T., Mami H., Yoshida K.

World Neurosurgery （World Neurosurgery）  115   e676 - e680 2018年07月

ISSN  18788750

　概要を見る

© 2018 Elsevier Inc. Background: Solitary fibrous tumors (SFTs)/hemangiopericytomas (HPCs) are highly vascularized tumors well known for malignant, invasive, and highly vascular features. To date, several studies have reported the preoperative imaging findings of SFTs/HPCs. In this study, computed tomography (CT) tumor values acquired from dynamic CT scan were selected to determine the tumor pathology of highly vascular tumors, such as SFTs/HPCs. Methods: We conducted a retrospective study on patients with pathologically diagnosed meningiomas and SFTs/HPCs who had undergone a dynamic contrast CT scan. We assessed and compared the CT values of these tumors according to the pathology. Results: From a total of 34 patients, 30 patients with meningiomas and 4 patients with HPCs were included. The mean CT values of SFTs/HPCs and angiomatous meningioma were statistically significantly higher than those of the other meningioma subtypes (P = 0.003). We also performed receiver operating characteristic curve analyses to detect an appropriate cutoff point for the CT value to differentiate tumor pathology, and the calculated threshold was 161 Hounsfield units (HU) (sensitivity, 100%; specificity, 75%; area under the curve, 0.87; 95%, CI 0.75–0.99). Conclusions: This study showed that obtaining a CT value is useful in determining highly vascular tumor pathology preoperatively. When considering neurosurgical extra-axial tumor removal, and when the CT value of tumors is >161 HU, then highly vascular tumors such as SFTs/HPCs or angiomatous meningiomas are likely, and this should be considered prior to surgical intervention and for risk assessment.

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Hyperperfusion after Clipping of Aneurysm: A Rare Entity

堀口 崇

Journal of Stroke and Cerebrovascular Diseases （Journal of Stroke and Cerebrovascular Diseases）  27 （ 5 ） 1425 - 1430 2018年01月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  10523057

　概要を見る

© 2018 National Stroke Association Background: Cerebral vasospasm is an uncontrollable and sometimes fatal complication occurring after subarachnoid hemorrhage. However, cerebral hyperperfusion syndrome is a rare complication after subarachnoid hemorrhage. Although plain computed tomography of cerebral hyperperfusion syndrome looks similar to cerebral infarction induced by cerebral vasospasm, they should be distinguished from each other because they require completely different treatments. Case Description: A 65-year-old man complained of severe headache and vomiting. A computed tomography scan of his head showed subarachnoid hemorrhage with acute hydrocephalus caused by intraventricular hematoma and aneurysm of the left middle cerebral artery. After endoscopic irrigation of the ventricular hematoma to decrease the intracranial pressure, we performed neck clipping for the ruptured aneurysm. We used a temporary clip to the proximal M1 segment twice for a total of 15 minutes. Five days after the clipping, a computed tomography scan of the patient's head showed a large low-density area in the left cerebral hemisphere. Although cerebral infarction caused by cerebral vasospasm was suspected, his perfusion computed tomography demonstrated a state of hyperperfusion corresponding to the low-density area. We started treatment to prevent vasodilation and excessive cerebral blood flow instead of treatment for cerebral vasospasm. After changing the treatment, the patient's symptoms gradually improved, and his perfusion computed tomography (8 days after surgery) showed no excessive increased blood flow. Conclusions: We present a case of cerebral hyperperfusion syndrome and its successful treatment, distinct from that of cerebral vasospasm, after ruptured aneurysm clipping. In addition, we discuss the mechanism of this rare syndrome based on previous reports.

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Hybrid operating room (HOR)における複雑な脳血管障害に対する開頭および 血管内複合治療の有用性ーHybrid operating room 導入前後の検討ー

堀口崇、秋山武紀、高橋里史、大平貴之、吉田一成

脳卒中の外科 46   453 - 461 2018年

研究論文（学術雑誌）, 共著, 査読有り

Hybrid operating room（HOR）における複雑な脳血管障害に対する開頭および血管内複合治療の有用性 ─Hybrid operating room導入前後の検討─

堀口 崇, 秋山 武紀, 高橋 里史, 大平 貴之, 吉田 一成

脳卒中の外科 （一般社団法人 日本脳卒中の外科学会）  46 （ 6 ） 453 - 461 2018年

ISSN  09145508

　概要を見る

Here we investigated the changes in utility and limits of combined microsurgical and endovascular treatment for complex cerebrovascular disease before and after the introduction of the hybrid operating room (HOR) in our department. Since 2006, a total of 17 patients (cerebral aneurysm in 12, cerebral arteriovenous malformation in 5) underwent integrated microsurgery with endovascular treatment. In 3 of 11 patients treated before the introduction of HOR, certain problems such as time consumption during patient transfer, disconnected workflow, and complicated operation due to poor quality of support equipment occurred. In contrast, all 6 operations in the HOR were uncomplicated. All therapeutic steps including anesthesia management were planned in a single session. In conclusion, HOR provides a safe and smooth workflow in combined microsurgical and endovascular treatment for complex cerebrovascular diseases.

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microRNA expression profiling in serum of patients with subarachnoid hemorrhage

Takahashi, S; Akiyama, T; Horiguchi, T; Mizutani, K; Mihara, K; Yanagisawa, K; Akaji, K; Mihara, B; Yoshida, K

CEREBROVASCULAR DISEASES 45   247 - 247 2018年

ISSN  1015-9770

　概要を見る

くも膜下出血患者の血清中でコントロールと比較して発現が1/4以下に低下している49種の（hsa-miR-223等）、2倍以上に上昇している27種のマイクロRNA（hsa-miR-451a等）を同定した。モデルマウスでは、頭蓋内圧上昇を5秒とすると、海馬でモデル作成後1日で微小血管基底膜が脱落し、アストロサイトの足突起が基底膜から剥がれた。3日後には基底膜周辺のアストロサイトのGFAP染色性が低下し、神経細胞自体の形態学的、数的変化は認めずに神経機能が障害された。くも膜下出血後のNVU統合性の崩壊は微小血管周囲に始まり、周辺アストロサイトの機能障害を介して、神経機能障害に至る可能性が考えられた。

再狭窄、最大内膜中膜複合体圧(max-IMT)、全身他臓器疾患合併から検討したCEAの長期成績

堀口　崇、秋山　武紀、高橋　里史、吉田　一成

脳卒中の外科 45 （ 5 ） 370 - 377 2017年10月

共著, 査読有り

再狭窄、最大内膜中膜複合体厚(max-IMT)、全身他臓器疾患合併から検討したCEAの長期成績

堀口 崇, 秋山 武紀, 高橋 里史, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  45 （ 5 ） 370 - 377 2017年09月

ISSN  0914-5508

　概要を見る

頸動脈内膜剥離術(CEA)施行後2年以上の経過観察が可能であった頸動脈狭窄症40例(男性36例、女性4例、平均72歳)、41病変(症候性35例、無症候性6例)を対象とした。定期的通院を中断した2例を除いた38例39病変において、31例が術前のmodified Rankin Scale(mRS)を維持できていたが、1例が転倒による急性硬膜下血腫を生じmRS 4となった。無症候性の6例全例の術後経過は良好であったが、1例が膵臓がんに罹患半年後に死亡した。最大内膜中膜複合体厚(max-IMT)の経時変化は、完全閉塞の1例を除き38病変で測定し、観察期間内における最大値は、平均2.0±1.1mm、1mm未満が6病変、1mm以上2mm未満が17病変、2mm以上3mm未満が8病変、3mm以上4mm未満3病変、4mm以上が4病変であった。術1ヵ月後よりも肥厚したのは15例で、全て術6ヵ月後に生じた。max-IMTが2mm以上になった群と2mm未満で留まった群において危険因子の有無と術後管理の成否を単項目で比較し、術後の糖尿病管理の成否のみに有意差を認めた。

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経過観察となった5 mm未満の未破裂脳動脈瘤に対する治療方針ー治療介入を決定する因子と時期についてー

堀口　崇、秋山　武紀、高橋　里史、吉田　一成

脳卒中の外科 44 （ 4 ） 276 - 282 2016年08月

共著, 査読有り

Marfan症候群に生じたくも膜下出血に対し開頭クリッピングを施行した1例ー症例報告と文献的考察ー

高橋里史、堀越知、金澤徳典、秋山武紀、堀口　崇、吉田一成

脳卒中の外科 44 （ 4 ） 307 - 310 2016年08月

共著, 査読有り

Marfan症候群の患者に生じたくも膜下出血に対し開頭クリッピングを施行した1例　症例報告と文献的考察

高橋 里史, 堀越 知, 金澤 徳典, 秋山 武紀, 堀口 崇, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  44 （ 4 ） 307 - 310 2016年07月

ISSN  0914-5508

　概要を見る

60歳代女性。Marfan症候群の既往に有する。今回、突然の激しい頭痛を主訴に近医を受診、CT所見でくも膜下出血を指摘され、治療目的で著者らの施設へ救急搬送となった。3D-CTA所見より右内頸動脈-後交通動脈分岐部の動脈瘤破裂と診断され、緊急で開頭クリッピング術を施行されることとなった。だが、全身麻酔、手術に先立ち、腰椎ドレナージの留置を検討したところ、Marfan症候群による脊椎の側彎が強く、正中確認が困難であった。そこで、術前3D-CTAから想定された動脈瘤は小さく、形状から解離も考えられたため、脆弱である可能性を念頭に、エダラボン点滴の上、右頭蓋内内頸動脈近位部を注意深くtemporary clipにて遮断し、瘤内の圧力を減じてから後交通動脈および近位側ネックを確認後、クリッピングした。その結果、術後経過は良好で、患者は後遺症なく第18病日目に独歩退院となった。尚、術後3ヵ月経過でのmRSは0で、動脈瘤の再発はみられていない。

経過観察となった5mm未満の未破裂脳動脈瘤に対する治療方針　治療介入を決定する因子と時期について

堀口 崇, 秋山 武紀, 高橋 里史, 吉田 一成

脳卒中の外科 （(一社)日本脳卒中の外科学会）  44 （ 4 ） 276 - 282 2016年07月

ISSN  0914-5508

　概要を見る

発見時の最大径が5mm未満で、経過観察となった未破裂脳動脈瘤316瘤を対象に、治療介入を決定する因子と的確な介入時期について検討した。その結果、1)本検討では局在(a-com、IC-PC)に加え、速い年間増大速度と形状変化(blebあるいは細長い変形)を伴う増大は破裂の危険が高く、迅速に治療介入を行う必要があると考えられた。2)治療介入時期を逃さないためには、2回目の検査は3ヵ月以内に実施し、その後も半年ごとの定期検査を2年間は継続する必要があると考えられた。

Marfan症候群の患者に生じたくも膜下出血に対し開頭クリッピングを施行した1例─症例報告と文献的考察─

高橋 里史, 堀越 知, 金澤 徳典, 秋山 武紀, 堀口 崇, 吉田 一成

脳卒中の外科 （一般社団法人 日本脳卒中の外科学会）  44 （ 4 ） 307 - 310 2016年

ISSN  09145508

　概要を見る

We report a case of subarachnoid hemorrhage due to a rupture of an aneurysm at the right internal carotid artery-posterior communicating artery in a patient with Marfan syndrome. Since the patient had a history of aortic dissection that was treated conservatively, we selected clipping rather than coil embolization as the surgical strategy for the patient. She was surgically treated successfully, and discharged from our hospital without neurological sequelae 18 days postoperatively. From the findings of the present case in combination with a review of the literature, cerebral aneurysms in patients with Marfan syndrome may be developed due to the fragility of elastic membranes of major cerebral arteries, and we emphasize the importance of developing surgical strategy based on the fragility of elastic membranes.

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経過観察となった5mm未満の未破裂脳動脈瘤に対する治療方針─治療介入を決定する因子と時期について─

堀口 崇, 秋山 武紀, 高橋 里史, 吉田 一成

脳卒中の外科 （一般社団法人 日本脳卒中の外科学会）  44 （ 4 ） 276 - 282 2016年

ISSN  09145508

　概要を見る

To clarify the optimal timing of surgical or endovascular treatment for patients with small-sized (<5 mm) unruptured intracranial aneurysms (UIA) with conventional follow-up, we retrospectively evaluated the characteristics of UIA that ruptured or enlarged during observation. From 1999 to 2014, 316 UIA (271 cases) were initially treated without surgical or endovascular intervention. Four ruptured and 17 grown UIAs were treated with clipping or coil embolization. In these cases, the ratio of the internal carotid to the posterior communicating artery and that of the anterior cerebral artery to the anterior communicating artery was 71%. Intraoperative findings revealed that the bleb formed during follow-up was observed as a very thin wall. Ruptured UIAs are prone to rapid growth. We conclude that location, growth rate, and bleb formation are useful to estimate the risk of rupture of smallsized UIAs during follow-up.

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The early histomorphological changes of neurovascular unit after subarachnoid hemorrhage in mice model

Mizutani, K; Takahashi, S; Akiyama, T; Horiguchi, T; Yoshida, K

CEREBROVASCULAR DISEASES 41   204 - 204 2016年

ISSN  1015-9770

The process of change in hemodynamics after revascularization in the ischemic brain

Shidoh, Satoka, Akiyama, Takenori, Horiguchi, Takashi, Ohira, Takayuki, Yoshida, Kazunari

NEUROREPORT 26 （ 11 ） 629 - 633 2015年08月

研究論文（学術雑誌）,  ISSN  0959-4965

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Gruber's ligament as a useful landmark for the abducens nerve in the transnasal approach

堀口 崇

JOURNAL OF NEUROSURGERY 122 （ 3 ） 499 - 503 2015年03月

研究論文（学術雑誌）,  ISSN  0022-3085

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CEAとCASの選択

堀口 崇

診断と治療 103   65 - 69 2015年

A case of basilar artery aneurysm rupture from 1836

Demetriades Andreas K., Horiguchi Takashi, Goodrich James T., Kawase Takeshi

World Neurosurgery 82 （ 5 ） 902 - 905 2014年11月

ISSN  1878-8750

　概要を見る

<p>Although credit is given to Sir William Gull for highlighting the clinical picture of subarachnoid hemorrhage in 1859, we discuss a case presented by Mr. Egerton A. Jennings, Fellow of the Linnaean Society, published 23 years earlier in the 1836 edition of the Transactions of the Provincial Medical and Surgical Association. This case, probably the first reported in the English language of a basilar aneurysm rupture, is of medico-historical interest. Jennings provided a remarkably accurate and detailed description of the patient, who experienced coma as a result of the severity of subarachnoid hemorrhage. The detailed clinical observations on initial assessment and the description of the patient's deterioration to the time of death are a succinct representation of the natural history of this disease. The author's discussion provides evidence of a philosophy committed to medical education and progress at the time based on principles of rational observation, meticulous clinical acumen, insight into experimental physiology, and the awareness of ethical boundaries. In provincial 1836 England, similar to most of Europe, cerebral localization was elementary. Nonetheless, this case report highlights the attempt at linking structure to function by means of observation on the effects of lesioning. It provides evidence of an established thought process already in progress in England in the 19th century. It is characteristic that this thought process came from a surgical practitioner. The cultivation of practical observation in British surgical culture would allow the late 19th century surgeon scientists to match the contributions of British neurologists with landmark steps in the development and establishment of neurosurgery.</p>

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Systematic review of complications for proper informed consent (6) surgery for sphenoid ridge/parasellar meningiomas

Horiguchi Takashi, Yoshida Kazunari

Neurological Surgery 41 （ 2 ） 163 - 184 2013年02月

ISSN  0301-2603

合併症のシステマティック・レビュー　適切なInformed Consentのために　髄膜腫手術　sphenoid ridge, parasellarの髄膜腫

堀口 崇, 吉田 一成

Neurological Surgery （(株)医学書院）  41 （ 2 ） 163 - 184 2013年02月

ISSN  0301-2603

　概要を見る

蝶形骨縁及び傍鞍部髄膜腫に関連する論文総数は68編(英文66編、和文2編)であり、髄膜腫発生部位ごとではclinoid:12編、sphenoorbital:8編、sphenoid wing:9編、parasellar:6編、tuberculum:24編、olfactory groove:9編であった。手術総数は2829例、全摘率は平均73.5%、再発率は平均9.02%、合併症発生率は平均37.2%、永続する合併症発生率は平均10.1%、手術関連死亡率は平均1.74%、傍鞍部髄膜腫の術後の視機能悪化率は平均10.4%であった。合併症としては、1)傍鞍部に存在する脳神経、動静脈、間脳下垂体に関わる合併症、2)脳損傷による合併症、3)脳脊髄液に関わる合併症、4)手術部位感染症、5)手術による後遺症状、6)周術期の全身性合併症に分類された。手術関連死では頭蓋内合併症より周術期の全身性合併症が多く、特に肺塞栓症が最多であり、死亡に至らない肺塞栓を含めて平均4.2%の発生率であった。

髄膜種

堀口　崇、坂本　茜、吉田一成

BRAIN NURSING 29   74 - 77 2013年

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Recanalisation of spontaneously occluded vertebral artery dissection after subarachnoid haemorrhage

堀口 崇

NEUROSURGICAL REVIEW 35 （ 4 ） 615 - 619 2012年10月

研究論文（学術雑誌）,  ISSN  0344-5607

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Nontraumatic acute subdural hematoma associated with the myelodysplastic/myeloproliferative neoplasms

Ichimura Shinya, Horiguchi Takashi, Inoue Satoshi, Yoshida Kazunari

Journal of Neurosciences in Rural Practice 3 （ 1 ） 98 - 99 2012年01月

ISSN  0976-3147

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Importance of Preserved Periosteum Around Jugular Foramen Neurinomas for Functional Outcome of Lower Cranial Nerves: Anatomic and Clinical Studies

堀口 崇

NEUROSURGERY 69   230 - 240 2011年12月

研究論文（学術雑誌）,  ISSN  0148-396X

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Untitled Reply

Ohba Shigeo, Onozuka Satoshi, Horiguchi Takashi, Kawase Takeshi, Yoshida Kazunari

NEUROLOGIA MEDICO-CHIRURGICA 51 （ 7 ） 547 - 547 2011年07月

ISSN  0470-8105

Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas

堀口 崇

JOURNAL OF NEUROSURGERY 114 （ 5 ） 1278 - 1287 2011年05月

研究論文（学術雑誌）,  ISSN  0022-3085

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Perimedullary Arteriovenous Fistula at the Craniocervical Junction-Case Report

堀口 崇

NEUROLOGIA MEDICO-CHIRURGICA 51 （ 4 ） 299 - 301 2011年04月

研究論文（学術雑誌）,  ISSN  0470-8105

Perimedullary arteriovenous fistula at the craniocervical junction

Ohba S., Onozuka S., Horiguchi T., Kawase T., Yoshida K.

Neurologia Medico-Chirurgica 51 （ 4 ） 299 - 301 2011年04月

ISSN  04708105

　概要を見る

Perimedullary arteriovenous fistulas (AVFs) at the craniocervical junction are uncommon, and are often fed by the anterior spinal artery, with only a few cases fed by the intradural vertebral artery (VA). A 55-year-old man presented with a case of perimedullary AVF fed by the VA at the craniocervical junction manifesting as subarachnoid hemorrhage. Left vertebral angiography demonstrated an AVF supplied by branches from the VA. Three-dimensional computed tomography angiography (3D-CTA) revealed that the feeding arteries originated from the VA at the intradural position. Two feeding arteries were coagulated and dissected, followed by coagulation of a small feeder. The draining veins became discolored and shrank. 3D-CTA performed 2 months after the operation revealed disappearance of the AVF. Open surgery was successfully performed for the almost perimedullary AVF at the craniocervical junction, and is considered to be preferable for the treatment of this disease.

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Reconstruction of the scalp with a calvarial defect

堀口 崇

SURGERY TODAY 41 （ 2 ） 189 - 196 2011年02月

研究論文（学術雑誌）,  ISSN  0941-1291

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Capsule Formation Can Make Secondary Reconstruction of the Dura Mater Unnecessary After Cranial Infection

堀口 崇

JOURNAL OF CRANIOFACIAL SURGERY 22 （ 1 ） 84 - 88 2011年01月

研究論文（学術雑誌）,  ISSN  1049-2275

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Greater petrosal nerve schwannomas-analysis of four cases and review of the literature

堀口 崇

NEUROSURGICAL REVIEW 33 （ 4 ） 477 - 482 2010年10月

研究論文（学術雑誌）,  ISSN  0344-5607

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Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence

堀口 崇

ACTA NEUROCHIRURGICA 152 （ 1 ） 79 - 86 2010年01月

研究論文（学術雑誌）,  ISSN  0001-6268

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Brain metastasis of a papillary renal cell carcinoma, identified as type 2

堀口 崇

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 14 （ 3 ） 270 - 272 2009年06月

研究論文（学術雑誌）,  ISSN  1341-9625

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連載 脳神経外科疾患治療のスタンダード 6.無症候性脳腫瘍

堀口 崇, 河瀬 斌

Neurological Surgery 脳神経外科 （株式会社医学書院）  37 （ 5 ） 503 - 510 2009年05月

ISSN  03012603

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Asymptomatic Brain Tumor

堀口 崇

NEUROLOGICAL SURGERY 37 （ 5 ） 503 - 510 2009年05月

研究論文（学術雑誌）,  ISSN  0301-2603

[Clinical standard of neurosurgical disorder (6). Asymptomatic brain tumor].

Horiguchi T, Kawase T

No shinkei geka. Neurological surgery 37 （ 5 ） 503 - 10 2009年05月

ISSN  0301-2603

Subcortical Intracerebral Hemorrhage Caused by Mucormycosis in a Patient with a History of Bone-marrow Transplantation

堀口 崇

JOURNAL OF STROKE &amp; CEREBROVASCULAR DISEASES 18 （ 5 ） 405 - 406 2009年01月

研究論文（学術雑誌）,  ISSN  1052-3057

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Mechanisms involved in the cerebrovascular dilator effects of cortical spreading depression

堀口 崇

PROGRESS IN NEUROBIOLOGY 86 （ 4 ） 379 - 395 2008年12月

研究論文（学術雑誌）,  ISSN  0301-0082

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Periventricular hyperintensity deteriorates word fluency in normal subjects

Fukunaga, A; Kato, M; Horiguchi, T; Sasaki, H; Toda, M; Yazaki, T; Asada, H; Inoue, H; Yoshida, K; Otani, M; Hattori, M; Kawase, T; Mizukami, M

EUROPEAN JOURNAL OF NEUROLOGY 15   290 - 290 2008年08月

ISSN  1351-5101

脳腫瘍手術の安全対策

堀口 崇

厚生労働科学研究費補助金医療技術評価総合研究事業　脳神経外科手術におけるヒヤリ•ハット事例、事故事例、訴訟事例の分析による手術治療安全対策ガイドライン作成に関する研究    16 - 33 2007年

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Therapeutic hypothermia for severely head-injured patients with acute subdural haematoma

堀口 崇

JOURNAL OF CLINICAL NEUROSCIENCE 13 （ 7 ） 733 - 737 2006年08月

研究論文（学術雑誌）,  ISSN  0967-5868

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Cyclooxygenase-2 mediates the development of cortical spreading depression-induced tolerance to transient focal cerebral ischemia in rats

Horiguchi T., Snipes J. A., Kis B., Shimizu K., Busija D. W.

Neuroscience 140 （ 2 ） 723 - 730 2006年

ISSN  0306-4522

　概要を見る

<p>We examined the role of cyclooxygenase-2 in the development of ischemic tolerance induced by cortical spreading depression against transient, focal brain ischemia. Cortical spreading depression was continuously induced for 2 h with topical KCl (13±1 depolarizations/2 h) in male Wistar rats. At 1, 2, 3, 4, and 5 days following recovery, the middle cerebral artery was transiently occluded for 120 min. Four days later, the animals were killed and infarct volume was determined. Additionally, cyclooxygenase-2 levels in the cerebral cortex and 15 deoxy-Δ(12, 14) PGJ ₂ levels in cerebrospinal fluid were determined at these times with Western blotting and immunoassay, respectively. Infarct volume was reduced compared with non-cortical spreading depression control animals (274.3±15.3 mm ³) when cortical spreading depression was performed 3 and 4 days before middle cerebral artery occlusion (163.9±14.2 mm ³, 154.9±14.2 mm ³) but not at 1, 2 and 5 days (280.4±17.3 mm ³, 276.3±16.9 mm ³ and 268.5±17.3 mm ³). Cyclooxygenase-2 levels increased most dramatically starting at 2 days, peaked at 3 days, and started to return toward baseline at 4 days after cortical spreading depression. 15 Deoxy-Δ(12, 14) PGJ ₂ levels increased from 134.7±83 pg/ml at baseline to 718±98 pg/ml at 3 days. Administration of N-[2-cyclohexyloxy-4-nitrophenyl] methanesulphonamide (10 mg/kg, i.v.), a selective cyclooxygenase-2 inhibitor, at 1 h prior to middle cerebral artery occlusion in cortical spreading depression preconditioned animals did not affect infarct volume (162.6±62.1 mm ³). However, administration of N-[2-cyclohexyloxy-4-nitrophenyl] methanesulphonamide given three times prior to middle cerebral artery occlusion prevented the reduced infarct volume induced by cortical spreading depression preconditioning (272.9±63.2 mm ³). Administration of l-nitro-arginine methyl ester (4 mg/kg, i.v.) prior to cortical spreading depression blocked increases in cyclooxygenase-2 normally seen at 3 and 4 days. We conclude that NO-mediated cyclooxygenase-2 upregulation by cortical spreading depression protects the brain against ischemic damage. © 2006 IBRO.</p>

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Cortical spreading depression (CSD)-induced tolerance to transient focal cerebral ischemia in halothane anesthetized rats is affected by anesthetic level but not ATP-sensitive potassium channels

Horiguchi Takashi, Kis Bela, Rajapakse Nishadi, Shimizu Katsuyoshi, Busija David W.

Brain Research 1062 （ 1-2 ） 127 - 133 2005年11月

ISSN  0006-8993

　概要を見る

<p>We investigated the participation of ATP-sensitive potassium (K _ATP) channels, adenosine A1 receptors, and the effects of different levels of halothane anesthesia in the development of CSD-induced ischemic tolerance. To elicit CSD, 0.5 M KCl was applied for 2 h to the right hemisphere of halothane anesthetized male Wistar rats. The inhalation concentration of halothane during CSD was maintained at 0.5% (n = 8), 1.0% (n = 8), or 2.0% (n = 8). For control animals, saline was applied instead of KCl (n = 8). To inhibit K_ATP channels or adenosine A1 receptors, glibenclamide (0.1 mg/kg icv; n = 8), 5-hydroxydeconaoate (5-HD; 100 mg/kg ip; n = 12), or 8-Cyclopentyl-1, 3-dipropylxanthine (DPCPX) (1.0 mg/kg ip; n = 8) was applied before preconditioning during 1.0% halothane anesthesia. Temporary occlusion (120 min) of the right middle cerebral artery was induced 4 days after preconditioning and the infarct volume was measured. Preconditioning elicited under 1.0% halothane reduced cortical infarct volume from 277 ± 15 mm³ in the control group to 159 ± 14 mm³ in the CSD group (mean ± SEM, P &lt; 0.05). In contrast, CSD induced during inhalation of 0.5% or 2.0% halothane did not confer ischemic tolerance. The reduction in infarct area with CSD during inhalation of 1% halothane was not changed in animals treated with glibenclamide or 5-HD or DPCPX. These results uncover a crucial role of halothane level but not of K_ATP channels or adenosine A1 receptors in the preconditioning effects of CSD. © 2005 Elsevier B.V. All rights reserved.</p>

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The role of nitric oxide in the development of cortical spreading depression-induced tolerance to transient focal cerebral ischemia in rats

Horiguchi Takashi, Snipes James A., Kis Bela, Shimizu Katsuyoshi, Busija David W.

Brain Research 1039 （ 1-2 ） 84 - 89 2005年03月

ISSN  0006-8993

　概要を見る

<p>Cortical spreading depression (CSD) has been documented to confer ischemic tolerance on brain. Although nitric oxide (NO) is a crucial mediator in preconditioning under certain circumstances, the role of NO in CSD-induced neuroprotection is unclear. We examined the effect of L-NAME, an inhibitor of NO synthase, on CSD-induced tolerance against transient focal cerebral ischemia. A solution of 0.5 M KCl was applied for 2 h on the right hemisphere to induce CSD. Animals received either vehicle or L-NAME (4 mg/kg, iv) 30 min before CSD. Temporary occlusion (120 min) of the right middle cerebral artery was induced 4 days after preconditioning and the infarct volume was measured. Additionally, ERK 1/2 activation and cyclooxygenase-2 (COX-2) expression in the cerebral cortex were examined by Western blotting analysis immediately after cessation of CSD, or at 1, 2, 4, 8, and 24 h after CSD. CSD reduced infarct volume from 275 ± 15 mm³ (mean ± SEM) in the non-CSD group to 155 ± 14 mm³ in the CSD group (P &lt; 0.05). L-NAME abolished this protection (281 ± 14 mm³; P &lt; 0.05 vs. CSD group). Elevated ERK activation and COX-2 expression were observed immediately after or 8 h after preconditioning, respectively. Those responses are significantly augmented by L-NAME (3-fold for ERK and 4-fold for COX-2). These results suggest a crucial role of NO in the establishment of preconditioning with CSD. © 2005 Elsevier B.V. All rights reserved.</p>

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重症頭部外傷における脳圧亢進時の脳温と膀胱温の解離

斉藤良一、中村芳樹、三島　牧、黒島義明、堀口　崇、市来嵜　潔

脳死・脳蘇生 17   35 - 38 2005年

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くも膜下出血における脳低温療法

斉藤良一、中村芳樹、堀口　崇、三島　牧、黒島義明、市来嵜　潔

救急・集中治療 17   425 - 429 2005年

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脳圧制御困難な重症頭部外傷における低体温療法の適応　特に年齢と治療成績の観点から

斎藤 良一, 堀口 崇, 稲桝 丈司, 三島 牧, 真柳 圭太, 黒島 義明, 中村 芳樹, 市来嵜 潔

神経外傷 （(一社)日本脳神経外傷学会）  27 （ 1 ） 90 - 94 2004年12月

ISSN  0389-5610

　概要を見る

重症頭部外傷で循環動態が安定していて重篤な合併症のなかった36例(2〜75歳,平均41±19歳)に低体温療法を施行し,入院時Glasgowコーマスケール(GCS),年齢,脳圧値,治療成績を解析し,低体温療法の適応を検討した.導入時の脳圧と膀胱温の平均値は44±14mmHgと36.2±1.4℃で,導入後は35±18mmHgと33.5±0.9℃で,導入後いずれも有意に低下した.導入後12例は脳圧のコントロールが良好となったが,24例は不能であった.入院時GCS4,5点の23例の死亡率は83%と高かったが,良好な結果を得たのは2歳と15歳の2例であった.GCS6,7点は13例で死亡率は54%で,良好な結果となった6例中5例が21〜27歳であった.脳圧亢進に対する低体温療法の転帰には年齢が大きく影響し,脳圧のコントロールが困難な小児例,若年例(特に入院時GCS6,7点)は低体温療法の良い適応となり得ることが分かった

Targeting mitochondrial ATP-sensitive potassium channels - A novel approach to neuroprotection

Busija David W., Lacza Zsombor, Rajapakse Nishadi, Shimizu Katsuyoshi, Kis Béla, Bari Ferenc, Domoki Ferenc, Horiguchi Takashi

Brain Research Reviews 46 （ 3 ） 282 - 294 2004年11月

ISSN  0165-0173

　概要を見る

<p>Mitochondrial responses to ischemic stress play an important role in necrosis and apoptosis of brain cells. Recent studies using several different experimental preparations have shown that activation of ATP-sensitive potassium channels in mitochondria (mitoK _ATP channels) is able to protect neurons and astroglia against injury and death. Thus, targeting of mitoK _ATP channels appears to be a novel approach to neuroprotection. However, little is known about the mechanisms involved. The purpose of this review is to detail the current state of knowledge about this important, emerging area of investigation, and to provide suggestions for future studies. © 2004 Elsevier B.V. All rights reserved.</p>

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The mitochondrial K_ATP channel opener BMS-191095 induces neuronal preconditioning

Kis Bela, Nagy Krisztina, Snipes James A., Rajapakse Nishadi C., Horiguchi Takashi, Grover Gary J., Busija David W.

NeuroReport 15 （ 2 ） 345 - 349 2004年02月

ISSN  0959-4965

　概要を見る

<p>BMS-191095, reportedly a selective mitoK_ATp channel opener which is free from the known side effects of the prototype mitoK_ATP channel opener diazoxide, induced acute and delayed preconditioning against glutamate excitotoxicity and delayed preconditioning against oxygen-glucose deprivation in primary cultures of rat cortical neurons. BMS-191095 dose dependency depolarized the mitochondria, increased the phosphorylation of PKC isoforms, but had no detectable effects on the activation of MAP kinases and did not influence the expressions of HSP70 and Mn-SOD. In BMS-191095- preconditioned neurons the glutamate-induced free-radical production was abolished. Our data give the first evidence that selective opening of mitoK _ATP channels with BMS-191095 leads to remarkable neuroprotection via mechanisms that involve mitochondrial depolarization, PKC activation and attenuated free radical production during neuronal stress. © 2004 Lippincott Williams &amp; Wilkins.</p>

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The mitochondrial K-ATP channel opener BMS-191095 induces neuronal preconditioning

B Kis, K Nagy, JA Snipes, NC Rajapakse, T Horiguchi, GJ Grover, DW Busija

NEUROREPORT （LIPPINCOTT WILLIAMS & WILKINS）  15 （ 2 ） 345 - 349 2004年02月

研究論文（学術雑誌）, 共著,  ISSN  0959-4965

　概要を見る

BMS-191095, reportedly a selective mitoK(ATP) channel opener which is free from the known side effects of the prototype mitoK(ATP) channel opener diazoxide, induced acute and delayed preconditioning against glutamate excitotoxicity and delayed preconditioning against oxygen-glucose deprivation in primary cultures of rat cortical neurons. BMS-191095 dose dependently depolarized the mitochondria, increased the phosphorylation of PKC isoforms, but had no detectable effects on the activation of MAP kinases and did not influence the expressions of HSP70 and Mn-SOD. In BMS-191095-preconditioned neurons the glutamate-induced free-radical production was abolished. Our data give the first evidence that selective opening of mitoK(ATP) channels with BMS-191095 leads to remarkable neuroprotection via mechanisms that involve mitochondrial depolarization, PKC activation and attenuated free radical production during neuronal stress.

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Malignant Peripheral Nerve Sheath Tumor in the Anterior Skull Base Associated with Neurofibromatosis Type 1

Ueda Ryo, Saito Ryoichi, Horiguchi Takashi, Nakamura Yoshiki, Ichikizaki Kiyoshi

Neurologia Medico-Chirurgica 44 （ 1 ） 38 - 42 2004年01月

ISSN  0470-8105

　概要を見る

<p>A 36-year-old man presented with a tumor in the anterior skull base manifesting as headache and visual disturbance. Neurofibromatosis type 1 (NF-1) was identified in early childhood in the patient, and also in his father. Subtotal excision of the tumor was performed, leaving the portion extending outside of the cranium. The histological diagnosis was malignant peripheral nerve sheath tumor. Local radiotherapy was instituted postoperatively. Facial paralysis and dysphagia appeared 7 months after the first operation. Magnetic resonance imaging revealed new lesions in the lateral ventricle and around the brainstem. These tumors were also subtotally excised, but the patient died 10 months after the first operation. The tumor very likely originated from the meningeal branch of the trigeminal nerve. Treatment of such tumors developing inside the cranium should include the widest resection possible, followed by irradiation of the entire neuraxis including the spinal cord to inhibit dissemination through the cerebrospinal fluid. Treatment should be started as quickly as possible if the tumor is associated with NF-1, because of the poor prognosis associated with this condition.</p>

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虚血後から開始した低脳温はラット一過性前脳虚血後に生じるヒドロキシラジカルの産生を抑制する

堀口　崇

脳卒中 26   498 - 502 2004年

研究論文（学術雑誌）, 単著

脳圧制御困難な重症頭部外傷における低体温両方の適応 ー特に年齢と治療成績の観点からー

斉藤良一、堀口　崇、稲桝丈司、三島　牧、真柳圭太、黒島義明、中村芳樹 市来嵜　潔

神経外傷 27   90 - 94 2004年

共著

"Occult" ruptured cerebral aneurysms revealed by repeat angiography

Inamasu Joji, Nakamura Yoshiki, Saito Ryoichi, Horiguchi Takashi, Kuroshima Yoshiaki, Mayanagi Keita, Orii Maaya, Ichikizaki Kiyoshi

Clinical Neurology and Neurosurgery 106 （ 1 ） 33 - 37 2003年12月

ISSN  0303-8467

　概要を見る

<p>Not infrequently, cerebral angiography performed immediately after the onset of subarachnoid hemorrhage (SAH) fails to reveal any causative lesion. Although the cause of the SAH in most of these cases remains unknown, repeat angiography sometimes discloses a lesion not detected by the initial angiography. The frequency of finding a ruptured aneurysm by repeat angiography and the angiographic characteristics of such aneurysms have been investigated retrospectively. Nineteen among 316 non-traumatic SAH patients (6%) showed initially negative angiogram, and 7 of 19 patients (36%) were identified as harboring an "initially occult" aneurysm. It was possible to identify the expected cause of these initial false-negative angiograms in four of those seven patients. The aneurysm was located in the anterior communicating artery (ACoA) complex in four of the seven patients. When interpreting the angiograms of patients with SAH, neurologists and neurosurgeons should bear in mind the finding that the ACoA complex is the most frequent site of "initially occult" aneurysms. One patient had a dissecting aneurysm of the internal carotid artery, and although such lesions have been considered rare, they should be included in the differential diagnosis of SAH of unknown origin. © 2003 Elsevier B.V. All rights reserved.</p>

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Diazoxide induces delayed pre-conditioning in cultured rat cortical neurons

Kis Bela, Rajapakse Nishadi C., Snipes James A., Nagy Krisztina, Horiguchi Takashi, Busija David W.

Journal of Neurochemistry 87 （ 4 ） 969 - 980 2003年11月

ISSN  0022-3042

　概要を見る

<p>We investigated the effect of diazoxide on neuronal survival in primary cultures of rat cortical neurons against oxygen-glucose deprivation (OGD). Diazoxide pre-treatment induced delayed pre-conditioning and almost entirely attenuated the OGD-induced neuronal death. Diazoxide inhibited succinate dehydrogenase and induced mitochondrial depolarization, free radical production and protein kinase C activation. The putative mitochondrial ATP-sensitive potassium channel blocker 5-hydroxydecanoate abolished the protective effect of diazoxide while the non-selective K_ATP channel blocker glibenclamide did not. The non-selective K_ATP channel openers nicorandil and cromakalim did not improve viability. Superoxide dismutase mimetic, M40401, or protein kinase C inhibitor, chelerythrine, prevented the neuroprotective effect of diazoxide. Diazoxide did not increase reduced glutathione and manganese-superoxide dismutase levels but we found significantly higher reduced glutathione levels in diazoxide-pre-conditioned neurons after OGD. In pre-conditioned neurons free radical production was reduced upon glutamate stimulation. The succinate dehydrogenase inhibitor 3-nitropropionic acid also induced pre-conditioning and free radical production in neurons. Here, we provide the first evidence that diazoxide induces delayed pre-conditioning in neurons via acute generation of superoxide anion and activation of protein kinases and subsequent attenuation of oxidant stress following OGD. The succinate dehydrogenase-inhibiting effect of diazoxide is more likely to be involved in this neuroprotection than the opening of mitochondrial ATP-sensitive potassium channels.</p>

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Neuroprotection against hypoxia-ischemia in neonatal rat brain by novel superoxide dismutase mimetics

Shimizu Katsuyoshi, Rajapakse Nishadi, Horiguchi Takashi, Payne R. Mark, Busija David W.

Neuroscience Letters 346 （ 1-2 ） 41 - 44 2003年07月

ISSN  0304-3940

　概要を見る

<p>We investigated the effects of two new low molecular weight nonpeptidyl superoxide dismutase (SOD) mimetics (M40403/M40401; MetaPhore Pharmaceuticals) on infarct volume after hypoxia-ischemia injury (H/I) in immature rats. Animals received vehicle or different doses of M40403 or M40401 i.p. 2 h before exposure to 3 h of 8% hypoxia. The infarct volume of the hemisphere ipsilateral to carotid ligation 24 h later was 73.9±8.9% in vehicle animals (n=9), and decreased to 39.7±7.2% (P&lt;0.05, n=10) in animals treated with 3 mg/kg M40403 and to 37.2±6.4% for animals receiving 3 mg/kg M40401 (P&lt;0.05, n=8). These data indicate that the SOD mimetics M40403 and M40401 have protective effects against hypoxic-ischemic brain injury, and suggest the involvement of superoxide anion in neuronal cell injury during H/I. © 2003 Elsevier Science Ireland Ltd. All rights reserved.</p>

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Diazoxide pretreatment induces delayed preconditioning in astrocytes against oxygen glucose deprivation and hydrogen peroxide-induced toxicity

Rajapakse Nishadi, Kis Bela, Horiguchi Takashi, Snipes James, Busija David

Journal of Neuroscience Research 73 （ 2 ） 206 - 214 2003年07月

ISSN  0360-4012

　概要を見る

<p>Recent studies suggest that activation of mitochondrial ATP-sensitive potassium channels (mK_ATP) with diazoxide can protect neurons against ischemic stress. However, it is not yet known whether astrocytes, which are more resilient against ischemia, respond similarly to diazoxide. We exposed cultured astrocytes to oxygen-glucose deprivation (OGD) or hydrogen peroxide (H₂O₂) with or without pretreatment with the mK_ATP opener diazoxide. Marked decreases in astrocyte viability were evident after 9 and 12 hr of OGD [76% ± 3% (n = 50) and 60% ± 1% (n = 50)] and 400 and 600 μM H₂O₂ [40% ± 2% (n = 16) and 25% ± 2% (n = 16)], respectively, compared with no treatment (100% ± 1%). Diazoxide treatment (3 days of sequential application) dramatically reversed the negative effects of OGD and H₂O₂, resulting in complete blockade of astrocyte cell death. Effects of diazoxide were blocked by the mK_ATP blocker 5-hydroxydecanoic acid (5-HD). Furthermore, incubation of astrocytes with diazoxide resulted in loss of mitochondrial membrane potential monitored by tetramethylrhodamineethylester fluorescence. Additionally, generation of reactive oxygen species was observed in response to diazoxide, assessed using the oxidation-sensitive dye hydroethidine, and this effect was abolished by antioxidants, catalase, and a superoxide dismutase mimetic, M40401. Finally, diazoxide increased the protein level of phosphorylated protein kinase C (PKC) revealed by immunoblot analysis. Our findings demonstrate that opening of mK_ATP by diazoxide identifies a delayed preconditioning effect that is protective against two types of injury in astrocytes and that diazoxide may deliver protection via mitochondrial depolarization, free radical production, and PKC activation. © 2003 Wiley-Liss, Inc.</p>

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Effect of intra-ischemic hypothermia on the expression of c-Fos and c-Jun, and DNA binding activity of AP-1 after focal cerebral ischemia in rat brain

Akaji Kazunori, Suga Sadao, Fujino Tadahiro, Mayanagi Keita, Inamasu Joji, Horiguchi Takashi, Sato Shuzo, Kawase Takeshi

Brain Research 975 （ 1-2 ） 149 - 157 2003年06月

ISSN  0006-8993

　概要を見る

<p>It is unknown whether immediate early gene (IEG) induction and subsequent late gene regulation after ischemia is beneficial or deleterious. The aim of this study was to examine the effect of hypothermia on expression of c-Fos and c-Jun, and AP-1 DNA binding activity, after transient focal cerebral ischemia in rat brain, and clarify the role of IEGs and AP-1 after insults. Male Wistar rats underwent right middle cerebral artery occlusion for 1 h with the intraluminal suture method. During ischemia, animals were assigned to either normothermic (NT) or hypothermic (HT) groups. In the NT group, brain temperature was observed to spontaneously increase to 40°C during ischemia. In the HT group, brain temperature decreased to 30°C. Infarct volume in cortex was decreased in the HT group, compared with that in the NT group (P&lt;0.001). Increased c-Fos immunoreactivity in the cortex was observed at 3 h after reperfusion in the HT, but not the NT group, while c-Jun expression was not affected by HT treatment. There was also a significant increase in AP-1 DNA binding activity at 3 h in the HT group when compared to the NT group (P&lt;0.01). In conclusion, hypothermia decreased cerebral infarction in association with early increases in c-Fos expression and AP-1 DNA binding activity in peri-infarct cortex. It remains to be established whether such responses are a cause or consequence of cell survival, but these results clearly establish that altered transcription is a key feature of tissue spared following hypothermic focal ischemia. © 2003 Elsevier Science B.V. All rights reserved.</p>

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Postischemic hypothermia inhibits the generation of hydroxyl radical following transient forebrain ischemia in rats

Horiguchi Takashi, Shimizu Katsuyoshi, Ogino Masahiro, Suga Sadao, Inamasu Joji, Kawase Takeshi

Journal of Neurotrauma 20 （ 5 ） 511 - 520 2003年05月

ISSN  0897-7151

　概要を見る

<p>A small reduction of body temperature during reperfusion following cerebral ischemia has been known to ameliorate neuronal injury. However, the mechanisms underlying postischemic hypothermia-induced neuroprotection are poorly understood. The burst of reactive oxygen species (ROS) formation that occurs during reperfusion has been documented to be involved in ischemic neuronal degeneration. In this study, we investigated the effect of postischemic hypothermia on ROS production following transient forebrain ischemia using an in vivo microdialysis technique. Forebrain ischemia was induced by bilateral carotid artery occlusion combined with hemorrhagic hypotension for 20 min in male Wistar rats. The body temperature was kept at 37°C during ischemia and controlled at either 32°C or 37°C after reperfusion. The amount of hydroxyl radical produced in striatum was evaluated by measurement of 2,3- and 2,5-dihydroxybenzoic acid (DHBA), which is generated by salicylate hydroxylation. We also measured the extracellular concentration of xanthine, while determining striatal blood flow by the hydrogen clearance technique. In animals whose postischemic body temperature was maintained at 37°C, the levels of 2,3- and 2,5-DHBA significantly increased after reperfusion. The peak levels of 2,3- and 2,5- DHBA were 2.9-fold and 2.7-fold increased above the corresponding baseline values, respectively. Postischemic hypothermia completely inhibited the hydroxyl radical formation. Likewise, xanthine formation was also inhibited by postischemic hypothermia. In contrast, striatal cerebral blood flow was not altered by temperature modulation during reperfusion. These results suggest that inhibition of ROS production accompanied with suppression of xanthine formation is implicated in the neuroprotection of postischemic hypothermia.</p>

Opening of mitochondrial ATP-sensitive potassium channels is a trigger of 3-nitropropionic acid-induced tolerance to transient focal cerebral ischemia in rats

Horiguchi Takashi, Kis Bela, Rajapakse Nishadi, Shimizu Katsuyoshi, Busija David W.

Stroke 34 （ 4 ） 1015 - 1020 2003年04月

ISSN  0039-2499

　概要を見る

<p>Background and Purpose - The role of mitochondrial ATP-sensitive potassium channels (mitoK_ATP) in ischemic tolerance has been well documented in heart, but little work has been done in brain. To investigate the involvement of mitoK_ATP activation in chemical preconditioning in brain, we examined the effect of 5-hydroxydecanoate (5-HD), a selective mitoK_ATP blocker, on neurotoxin 3-nitropropionic acid (3-NPA)-induced ischemic tolerance to transient focal cerebral ischemia in rats. Methods - Male Wistar rats were administrated 3-NPA (20 mg/kg IP; n = 16) or vehicle (saline; n = 16) 3 days before temporary occlusion (120 minutes) of the middle cerebral artery; 5-HD (40 mg/kg IP; n = 16) was injected 20 minutes before 3-NPA administration. Infarct volumes were measured 4 days after reperfusion. To directly investigate whether chemical preconditioning activates mitoK_ATP, we tested the effect of prior incubation with 1 mmol/L 5-HD on 300 μmol/L 3-NPA-induced alterations of mitochondrial membrane potential (ΔΨ_m) in cultured neurons and astrocytes using the fluorescent dye tetramethylrhodamine ethyl ester. Results - Treatment with 3-NPA exhibited a 16% reduction (P&lt;0.05) and 23% reduction in infarct volume (P&lt;0.01) for total brain and cortex, respectively. Pretreatment with 5-HD completely abolished the neuroprotective effect of chemical preconditioning. In cultured cells, 3-NPA resulted in mitochondrial depolarization. This change of ΔΨ_m was completely blocked by 5-HD pretreatment. Conclusions - These results strongly suggest that opening of mitoK_ATP plays a key role as the trigger in the development of 3-NPA-induced ischemic tolerance in brain.</p>

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Protective effect of a new nonpeptidyl mimetic of SOD, M40401, against focal cerebral ischemia in the rat

Shimizu Katsuyoshi, Rajapakse Nishadi, Horiguchi Takashi, Payne R. Mark, Busija David W.

Brain Research 963 （ 1-2 ） 8 - 14 2003年02月

ISSN  0006-8993

　概要を見る

<p>We tested the neuroprotective effects of M40401, a new, low molecular weight (511.4 Da) maganese superoxide dismutase mimetic, against 90 min of middle cerebral artery occlusion (MCAO) in male Wistar rats. Animals received a single injection of vehicle (n=8), 1 mg/kg (n=6), or 3 mg/kg (n=7) 30 min before MCAO. Total lesion volume was reduced only in the group receiving 3 mg/kg M40401 (163.5±18.7 versus 43.4±7.0 mm³, for vehicle and M40401, respectively; P&lt;0.05), with almost complete reduction of lesion volume in the cortex but little protection in the basal ganglia. Neurological score was also improved in this group. The dose of 1 mg/kg M40401 had smaller and inconsistent effects on lesion parameters. Administration of a single dose of 3 mg/kg M40401 at 60 min of MCAO or at the end of MCAO (90 min) failed to significantly reduce lesion volume. A single dose of M40401 plus prolonged infusion into the post-MCAO period also failed to decrease lesion volume significantly. These data indicate that M40401 protects cerebral tissue from ischemic insult when administered before MCAO, probably by limiting damage mediated by detrimental actions of superoxide anion. © Elsevier Science B.V. All rights reserved.</p>

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Nitric Oxide (NO) is involved in development of cortical spreading depression (CSD)-induced ischemic tolerance to transient focal cerebral ischemia in rats

Takashi Horiguchi, K Shimizu, DW Busija

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 23(Sup-1)   S472 2003年

研究論文（国際会議プロシーディングス）, 共著

Diazoxide induces delayed preconditioning in cultured rat cortical neurons

Kis, B. Rajapakse, N. C. Snipes, J. A. Nagy, K. Horiguchi, T.; Busija, D. W.

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 23(Sup-1)   S480 2003年

研究論文（国際会議プロシーディングス）, 共著

Neuroprotection role of adenosine under hypothermia in the rat global ischemia involves inhibition of not dopamine release but delayed postischemic hypoperfusion

Horiguchi Takashi, Shimizu Katsuyoshi, Ogino Masahiro, Yamaguchi Noriyuki, Suga Sadao, Inamasu Joji, Kawase Takeshi

Brain Research 952 （ 2 ） 222 - 231 2002年10月

ISSN  0006-8993

　概要を見る

<p>Adenosine (ADO) has an important role in the ischemic brain as an endogenous neuroprotective factor. On the other hand, intraischemic hypothermia ameliorates ischemic neuronal injury. To investigate the effect of ADO during intraischemic mild hypothermia, the extracellular concentration of ADO, its metabolites, dopamine (DA), and local cerebral blood flow were measured in rat striatum during and after 20 min of global ischemia. Additionally, the histopathological outcome was estimated after 48 h of recirculation. Three experimental groups were used: (1) a normothermic group (NT) maintained at 37°C during and after ischemia; (2) a hypothermic group (HT), exposed to intraischemic hypothermia (32.0°C) and postischemic normothermia; and (3) a hypothermia plus theophylline group (HT+T), with the same temperature conditions as in the HT group, combined with intravenously administration of theophylline (10 mg/kg), an antagonist of adenosine receptor, which was given 10 min before ischemia. The level of ADO in HT was significantly higher than ADO levels in NT. In contrast, ischemic DA release was significantly inhibited in HT compared with NT. Theophylline administration had no effect on intraischemic hypothermia induced modulation of extracellular ADO and DA concentration. The postischemic delayed hypoperfusion was ameliorated in HT, and theophylline eliminated this effect in HT+T. A protective effect on histopathological outcome was observed in HT and HT+T. These results suggest that ADO plays an essential role in the inhibition of postischemic delayed hypoperfusion, but this effect is not crucial role in the protective effect induced by intraischemic hypothermia. © 2002 Elsevier Science B.V. All rights reserved.</p>

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Transient forebrain ischemia induces expression of serine/threonine protein phosphatase 1 mRNA in the vulnerable regions of gerbil brain

Horiguchi Takashi, Shima Hiroshi, Suga Sadao, Ogino Masahiro, Shimizu Katsuyoshi, Toya Shigeo, Nagao Minako, Kawase Takeshi

Neuroscience Letters 325 （ 2 ） 115 - 118 2002年06月

ISSN  0304-3940

　概要を見る

<p>Apoptosis is thought to be implicated in delayed neuronal cell death following transient forebrain ischemia. Recently, apoptosis in neurons induced by an inhibitor of serine/threonine (ser/thr) protein phosphatases (PPs) has been reported. In this study, we investigated the effect of transient forebrain ischemia on the expression of ser/thr PPs in the brain of Mongolian gerbils. At 24 h after 5-min bilateral carotid artery occlusion, Northern blotting analysis revealed the increase of PP1 mRNA expression in the vulnerable CA1 region of the hippocampus and striatum, but not in the cortex and CA3 region. In contrast, the protein level of PP1 detected by Western blotting analysis decreased in all regions. We conclude that the inhibition in PPs expression in the vulnerable regions may affect cell death after transient forebrain ischemia. © 2002 Elsevier Science Ireland Ltd. All rights reserved.</p>

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Mild hypothermia for hemispheric cerebral infarction after evacuation of an acute subdural hematoma in an infant

Inamasu Joji, Ichikizaki Kiyoshi, Matsumoto Shinji, Nakamura Yoshiki, Saito Ryoichi, Horiguchi Takashi, Kanai Ryuichi

Child's Nervous System 18 （ 3-4 ） 175 - 178 2002年04月

ISSN  0256-7040

　概要を見る

<p>The use of mild hypothermia to treat hemispheric infarction after evacuation of an acute subdural hematoma in an infant is reported. The patient, a 2-year-old boy, presented with a deteriorating level of consciousness after a fall from a tree. Computed tomography (CT) scan revealed an acute subdural hematoma on the right side with marked midline shift, and emergency evacuation of the hematoma was performed. The postoperative course was uneventful until the patient's intracranial pressure (ICP) rose and his condition deteriorated 3 days after surgery. CT scan revealed a hemispheric infarction on the injured side. Mild hypothermia was induced to control the ICP and protect the brain. While the hypothermia was effective in lowering the elevated ICP, it failed to arrest progression of the infarction. The patient was discharged with mild disability 2 months after the injury. No serious complications occurred during or after the hypothermia. Our experience indicates that hypothermia can be a useful procedure for controlling the ICP in children with severe traumatic brain injury including acute subdural hematoma, although its capability to protect the brain from severe, progressive ischemia appears to be limited.</p>

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救命救急センターにおける近赤外線分光分析装置(NIRO-300)を用いた脳酸素代謝障害の評価

堀口 崇, 斎藤 良一, 稲桝 丈司, 山本 紳一郎, 菊野 隆明, 中村 芳樹, 市来嵜 潔

日本救急医学会雑誌 （(一社)日本救急医学会）  13 （ 4 ） 174 - 182 2002年04月

ISSN  0915-924X

　概要を見る

意識レベルがJapan Coma Scaleで3桁であった14例(男9例,女5例,平均47.4歳)を対象に,近赤外線分光分析装置で測定した総ヘモグロビン濃度に対する酸素化ヘモグロビン濃度の割合を,上腕部測定での値(TA)と前額部測定での値(TB)で比較した.その結果,大脳半球に障害が及んでいない3例のみ,TBがTAより高値であった.大脳半球に障害が及んだ11例中,2例を除いてTBが減少し,TAよりも低値であった.この2例では出血に伴う血管外のヘモグロビンの影響が考えられた.各種ヘモグロビン濃度変化或いは他の検査所見と比較したところ,虚血脳における酸素代謝障害を鋭敏に捉えていることが示された.又,TBが内頸静脈酸素飽和度とよく相関しながら変化する症例も認めた

救命救急センターにおける近赤外線分光分析装置（NIRO-300）を用いた脳酸素代謝障害の評価ー第二報ー

堀口　崇、斉藤良一、稲桝丈司、山本紳一郎、菊野隆明、中村芳樹、市来嵜　潔

日本救急医学会雑誌 13   174 - 182 2002年

共著

Prolonged unilateral vasodilatation and brain edema in fulminant hepatic failure, associated with symptomatic seizure

Inamasu Joji, Nakamura Yoshiki, Yamamoto Shinichiro, Sakamoto Namiko, Saito Ryoichi, Horiguchi Takashi, Ichikizaki Kiyoshi

Clinical Neurology and Neurosurgery 104 （ 2 ） 157 - 160 2002年

ISSN  0303-8467

　概要を見る

<p>We report prolonged unilateral vasodilatation and hemispheric brain edema in a 49-year-old man with fulminant hepatic failure (FHF). The patient presented with a tonic-clonic seizure caused by a hypertensive subcortical hemorrhage in the left parietal lobe. Serial computed tomography (CT) scans showed progressive darkening of the ipsilateral hemisphere, suggesting hemispheric cerebral infarction, but the patient did not show clinical signs of deterioration. Brain magnetic resonance angiography showed dilation of the large arteries of the left hemisphere. Evaluation of cerebral blood flow 7 days postictus with single photon emission CT revealed marked ipsilateral hyperperfusion. The darkening of the hemisphere was brain edema elicited by hyperperfusion. Brain edema was reversible, disappearing 14 days postictus. Hemispheric brain edema was caused by unilateral cerebral vasodilatation and resultant hyperperfusion. Although brain edema is a major complication in FHF patients and cerebral hyperperfusion is responsible for edema formation, CT findings of these patients almost invariably show a bilateral lesion. Unilateral vasodilatation and subsequent hemispheric hyperperfusion may be due to overproduction of vasodilators, already abundant in the brains of patients with severe hepatic failure, by seizure activity. Copyright © 2002 Elsevier Science B.V.</p>

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MitoK_ATP opener, diazoxide, reduces neuronal damage after middle cerebral artery occlusion in the rat

Shimizu Katsuyoshi, Lacza Zsombor, Rajapakse Nishadi, Horiguchi Takashi, Snipes James, Busija David W.

American Journal of Physiology - Heart and Circulatory Physiology 283 （ 3 52-3 ）  2002年

ISSN  0363-6135

　概要を見る

<p>We investigated effects of diazoxide, a selective opener of mitochondrial ATP-sensitive K⁺ (mitoK_ATP) channels, against brain damage after middle cerebral artery occlusion (MCAO) in male Wistar rats. Diazoxide (0.4 or 2 mM in 30 μl saline) or saline (sham) was infused into the right lateral ventricle 15 min before MCAO. Neurological score was improved 24 h later in the animals treated with 2 mM diazoxide (13.8 ± 0.7, n = 13) compared with sham treatment (9.5 ± 0.2, n = 6, P &lt; 0.01). The total percent infarct volume (MCAO vs. contralateral side) of sham treatment animals was 43.6 ± 3.6% (n = 12). Treatment with 2 mM diazoxide reduced the infarct volume to 20.9 ± 4.8% (n = 13, P &lt; 0.05). Effects of diazoxide were prominent in the cerebral cortex. The protective effect of diazoxide was completely prevented by the pretreatment with 5-hydroxydecanoate (100 mM in 10 μl saline), a selective blocker of mitoK_ATP channels (n = 6). These results indicate that selective opening of the mitoK_ATP channel has neuroprotective effects against ischemia-reperfusion injury in the rat brain.</p>

MitoK<inf>ATP</inf> opener, diazoxide, reduces neuronal damage after middle cerebral artery occlusion in the rat

Shimizu K., Lacza Z., Rajapakse N., Horiguchi T., Snipes J., Busija D.W.

American Journal of Physiology - Heart and Circulatory Physiology 283 （ 3 52-3 ）  2002年

ISSN  03636135

　概要を見る

We investigated effects of diazoxide, a selective opener of mitochondrial ATP-sensitive K+ (mitoKATP) channels, against brain damage after middle cerebral artery occlusion (MCAO) in male Wistar rats. Diazoxide (0.4 or 2 mM in 30 μl saline) or saline (sham) was infused into the right lateral ventricle 15 min before MCAO. Neurological score was improved 24 h later in the animals treated with 2 mM diazoxide (13.8 ± 0.7, n = 13) compared with sham treatment (9.5 ± 0.2, n = 6, P < 0.01). The total percent infarct volume (MCAO vs. contralateral side) of sham treatment animals was 43.6 ± 3.6% (n = 12). Treatment with 2 mM diazoxide reduced the infarct volume to 20.9 ± 4.8% (n = 13, P < 0.05). Effects of diazoxide were prominent in the cerebral cortex. The protective effect of diazoxide was completely prevented by the pretreatment with 5-hydroxydecanoate (100 mM in 10 μl saline), a selective blocker of mitoKATP channels (n = 6). These results indicate that selective opening of the mitoKATP channel has neuroprotective effects against ischemia-reperfusion injury in the rat brain.

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MitoK_ATP opener, diazoxide, reduces neuronal damage after middle cerebral artery occlusion in the rat

Shimizu Katsuyoshi, Lacza Zsombor, Rajapakse Nishadi, Horiguchi Takashi, Snipes James, Busija David W

American Journal of Physiology - Heart and Circulatory Physiology 283 （ 3 52-3 ）  2002年

ISSN  0363-6135

　概要を見る

&lt;p&gt;We investigated effects of diazoxide, a selective opener of mitochondrial ATP-sensitive K&lt;sup&gt;+&lt;/sup&gt; (mitoK&lt;sub&gt;ATP&lt;/sub&gt;) channels, against brain damage after middle cerebral artery occlusion (MCAO) in male Wistar rats. Diazoxide (0.4 or 2 mM in 30 μl saline) or saline (sham) was infused into the right lateral ventricle 15 min before MCAO. Neurological score was improved 24 h later in the animals treated with 2 mM diazoxide (13.8 ± 0.7, n = 13) compared with sham treatment (9.5 ± 0.2, n = 6, P &lt; 0.01). The total percent infarct volume (MCAO vs. contralateral side) of sham treatment animals was 43.6 ± 3.6% (n = 12). Treatment with 2 mM diazoxide reduced the infarct volume to 20.9 ± 4.8% (n = 13, P &lt; 0.05). Effects of diazoxide were prominent in the cerebral cortex. The protective effect of diazoxide was completely prevented by the pretreatment with 5-hydroxydecanoate (100 mM in 10 μl saline), a selective blocker of mitoK&lt;sub&gt;ATP&lt;/sub&gt; channels (n = 6). These results indicate that selective opening of the mitoK&lt;sub&gt;ATP&lt;/sub&gt; channel has neuroprotective effects against ischemia-reperfusion injury in the rat brain.&lt;/p&gt;

The effect of intraischemic hypothermia on the expression of c-Fos, c-Jun and DNA binding activity of AP-1 after focal cerebral ischemia in rat brain

Akaji K, Suga S, Fujino T, Takayama H, Ochiai M, Mayanagi K, Inamasu J, Horiguchi T, Sato S, Kawase T.

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 21(Sup-1)   S428 2001年

研究論文（国際会議プロシーディングス）, 共著

Intra-ischemic hypothermia attenuates intercellular adhesion molecule-1 (ICAM-1) and migration of neutrophil

Inamasu J., Suga S., Sato S., Horiguchi T., Akaji K., Mayanagi K., Kawase T.

Neurological Research 23 （ 1 ） 105 - 111 2001年

ISSN  0161-6412

　概要を見る

<p>Adhesion of neutrophil to the endothelium and subsequent transmigration has been reported to contribute to progression of focal ischemia. Hypothermia has been known to attenuate ischemic insult through various mechanisms of action. The authors evaluated the effect of hypothermia on expression of intercellular adhesion molecule-1 (ICAM-1) protein and on transmigration of neutrophil with immunohistochemical method. Transient focal ischemia model in rats was employed, and animals received 2 h of either normothermic or hypothermic ischemia. To confirm the effectiveness of hypothermia on neuroprotection, cortical infarct area was compared between the two groups. Our results demonstrated that hypothermia reduced both the number of microvessels expressing ICAM-1 and that of neutrophils migrating into ischemic tissue. Comparison of cortical infarct area showed persistent protective effect. This study indicates that reduction of ICAM-1 expression and subsequent reduction of migrating neutrophil in hypothermia can contribute to attenuation of ischemic damage.</p>

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Interhemispheric subdural empyema in a young man [5]

Inamasu J., Horiguchi T., Saito R., Nakamura Y., Ichikizaki K., Takahashi K., Shimanouchi T.

American Journal of Emergency Medicine 19 （ 7 ） 602 - 603 2001年

ISSN  0735-6757

Delayed, but acutely progressive epidural hematoma after mild head injury [8]

Inamasu J., Nakamura Y., Saito R., Horiguchi T., Kanai R., Ichikizaki K.

American Journal of Emergency Medicine 19 （ 4 ） 324 - 325 2001年

ISSN  0735-6757

Cerebral microaneurysms found incidentally during aneurysm surgery

Inamasu J., Suga S., Horiguchi T., Akaji K., Mayanagi K., Kawase T.

Neurological Research 23 （ 4 ） 304 - 308 2001年

ISSN  0161-6412

　概要を見る

<p>Not uncommonly, cerebral microaneurysms are found incidentally during surgery for another previously diagnosed cerebral aneurysm(s). The frequency and angiographic characteristics of such incidental microaneurysms are retrospectively summarized. Seventeen patients were identified as harboring incidental microaneurysms, comprising 4.9% of the whole series. The middle cerebral artery (MCA) was the most frequent location (seven cases, 41%) of these microaneurysms. There was a tendency for MCA microaneurysms to be contiguous to a previously known, larger aneurysm at the same location. Neurosurgeons as well as interventional neuroradiologists should be aware of the possible presence of these incidental microaneurysms while treating patients with a cerebral aneurysm(s). Although the actual clinical implications of these incidental microaneurysms have not been elucidated, the few additional risks to patients already surgically exposed for the treatment of another aneurysm, along with the possible benefit of preventing their rupture and growth, would justify the surgical treatment of these microaneurysms.</p>

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重症脳損傷患者における近赤外線分光分析装置（NIRO-300）を用いた脳酸素代謝障害の評価

堀口　崇、斉藤良一、各務　宏、山本紳一郎、菊野隆明、中村芳樹、市来嵜　潔

日本救急医学会雑誌 12   1 - 10 2001年

共著

Effect of intraischemic hypothermia on intercellular adhesion molecule-1 and migration of neutrophils

Inamasu, J; Suga, S; Sato, S; Horiguchi, T; Akaji, K; Mayanagi, K; Kawase, T

ISCHEMIC BLOOD FLOW IN THE BRAIN 6   407 - 412 2001年

Post-ischemic hypothermia delayed neutrophil accumulation and microglial activation following transient focal ischemia in rats

Inamasu Joji, Suga Sadao, Sato Shuzo, Horiguchi Takashi, Akaji Kazunori, Mayanagi Keita, Kawase Takeshi

Journal of Neuroimmunology 109 （ 2 ） 66 - 74 2000年09月

ISSN  0165-5728

　概要を見る

<p>Following ischemia, inflammation has been demonstrated to be involved in the progression of the tissue damage. Intra-ischemic hypothermia has been shown to attenuate the adverse activities of neutrophils and microglia. We investigated whether neutrophil accumulation and/or microglial activation is attenuated in post-ischemic hypothermia following transient focal ischemia in rats. After 1 h of ischemia, the neutrophil accumulation and the microglial activation was evaluated immunohistochemically. Percent infarct area was compared at 1, 2, 3, 5, and 7 days after ischemia/reperfusion. In hypothermia, the neutrophil accumulation was delayed but not attenuated. In normothermia, the accumulation reached the peak at 2 days after ischemia. The peak shifted to 3 days in hypothermia. Similarly, the microglial activation was delayed in hypothermia. Comparison of the infarct area showed significant protection by hypothermia at 1 and 2 days after reperfusion. However, hypothermia failed to show significant protection after 3 days and later. These results show that the delayed neutrophil accumulation and the microglial activation can be responsible for the loss of persistent protection in post-ischemic hypothermia. (C) 2000 Elsevier Science B.V.</p>

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Effect of Intraischemic Hypothermia on Intracellular Adhesion Molecule-1 and Migration of Neutrophil

Inamasu J, Suga S, Sato S, Horiguchi T,Akaji K, Mayanagi K, Kawase T.

Ischemic Blood flow in the Brain    407 - 412 2000年

研究論文（研究会，シンポジウム資料等）, 共著

Postischemic hypothermia attenuates apoptotic cell death in transient focal ischemia in rats.

Inamasu J., Suga S., Sato S., Horiguchi T., Akaji K., Mayanagi K., Kawase T.

Acta Neurochirurgica, Supplement 76   525 - 527 2000年

ISSN  0065-1419

　概要を見る

<p>Hypothermia confers potent neuroprotection against ischemic injury. Attenuation of apoptosis by hypothermia can be one of the responsible mechanisms. In this study, in situ DNA nick-end labeling (TUNEL) and immunostaining of Bax protein were performed to evaluate the effect of postischemic hypothermia on apoptotic cell death, employing rodent transient focal ischemia. Animals received 1 hour of transient focal ischemia. Brain temperature was maintained at 37.5 +/- 0.5 degrees C during ischemia. Immediately after reperfusion, animals were assigned to either a normothermic or hypothermic group. In hypothermia, animals were cooled and brain temperature was lowered to 34.5 +/- 1.0 degrees C. Prolonged hypothermia was maintained for 16 hours and animals rewarmed. In both groups, TUNEL and immunostaining of Bax was performed. In normothermia, the number of TUNEL positive cells reached the peak at 2 days after ischemia and decreased gradually. In hypothermia, the peak was shifted to 3 days after ischemia. The number of TUNEL positive cells in hypothermia was persistently below that of normothermia. Similarly, in hypothermia, immunostaining of Bax showed attenuated immunoreactivity compared with that in normothermia. In conclusion, postischemic hypothermia reduced both the number of TUNEL positive cells and immunoreactivity of Bax, which may be one of the responsible mechanisms with which hypothermia exerts neuroprotection.</p>

院外心肺機能停止患者の転帰からみた救急救命士制度運用の地域差

鈴木昌, 堀進悟, 篠澤洋太郎, 藤島清太郎, 木村裕之, 堀口崇, 中澤堅次, 小林健二 佐々木淳一, 相川直樹

日本臨床救急医学会雑誌 3   326 - 332 2000年

共著

SIRS,ALI患者の重症度評価指標としてのAPACHE IIIスコア,PaO2/F1O2比の検討

藤島 清太郎, 篠沢 洋太郎, 堀 進悟, 青木 克憲, 木村 裕之, 横山 雅子, 堀口 崇, 高月 誠司, 鈴木 昌, 山崎 元靖, 関根 和彦, 宮武 諭, 三村 琢也, 相川 直樹

日本救命医療研究会雑誌 （日本救命医療学会）  13   119 - 124 1999年12月

ISSN  1341-6782

　概要を見る

低酸素血症が各種の重症度評価指標値に及ぼす影響を検討するため,当院救急部経由で入院した235名のSIRS患者を,低酸素血症の有無で,更に低酸素血症を伴う患者はその原因を急性肺損傷(Acute lung injury,ALI)とそれ以外で分類し,各群の重症度評価に適する指標を各々検討した.ALI患者及びALI以外の低酸素血症病態の予後は,APACHE IIIスコア,不全臓器数では適切に評価し得ず,一方低酸素血症を呈さないSIRS病態の予後評価は両指標値のいずれでも可能であった.低酸素血症を伴うSIRS病態のうち,ALIに対してはPaO2/F1O2比が重症度評価の妥当な指標と思われたが,ALI以外では予後と相関せず,新たな指標値が必要と考えられた

Intraischemic Hypothermia Attenuates Intercellular Adhesion Molecule-1 (ICAM-1) and Migration of Neutrophil Following Transient Focal Ischemia in Rats

INAMASU Joji, SUGA Sadao, AKAJI Kazunori, HORIGUCHI Takashi, SATO Shuzo, KAWASE Takeshi

Keio journal of medicine 48   A71 1999年11月

ISSN  00229717

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脳虚血におけるWater channel mRNAの発現

佐藤 周三, 赤路 和則, 稻桝 丈司, 堀口 崇, 石川 真実, 菅 貞郎, 河瀬 斌, 梅西 文範

Progress in Research on Brain Edema and ICP （脳浮腫・頭蓋内圧フォーラム）   （ 1 ） 5 - 8 1999年05月

ISSN  1344-8234

　概要を見る

脳虚血後には細胞内外の水分の移動のwater channelによる生理的制御が失われており,虚血後の細胞内外水分の移動はion channelにより移動するイオンに付随した形で受動的に行われているものと考えられた.water channelの詳細な病態生理学的な意義は不明なものの,脳虚血においては虚血後脳浮腫の進展になんらかの関与があるものと推察された

The effect of intra-ischemic hypothermia on expression of c-Fos, c-Jun and HSP after transient focal cerebral ischemia in rat brain

Akaji K, Suga S, Mayanagi K, Inamasu J, Horiguchi T, Sato S, Kawase T.

Journal of Cerebral Blood Flow and Metabolism 19(Sup-1)   S279 1999年

研究論文（国際会議プロシーディングス）, 共著

A case of traumatic shock complicated by methamphetamine intoxication.

堀口 崇

Intensive Care Med 25   758 - 760 1999年

共著

Mitochondria toxin(3-NP)脳内注入後のアポトーシス発生について

佐藤周三, 赤路和則, 稻枡丈司, 堀口崇, 菅貞郎, 河瀬斌, 近藤健男, 村上謙介, ChanP.H.

脳循環代謝 11   162 - 163 1999年

共著

ラット脳局所虚血ー再潅流モデルにおける虚血後長期低体温の脳保護効果についての考察

稲桝丈司、菅　貞郎、堀口　崇、佐藤周三、赤路和則、河瀬　斌

脳循環代謝 11   298 - 299 1999年

妊娠経過中にショックを呈した1例

山崎元靖，堀進悟，藤島清太郎，木村裕之，横山雅子，高月誠司，堀口崇，鈴木昌，関根和彦，宮武諭，三村琢也，相川直樹

日本救急医学会関東地方会雑誌 20   126 - 127 1999年

共著

大出血を伴ったマロリーワイス症候群に対してEVLが有用であった4例

関根和彦，木村裕之，山崎元靖，三村琢也，青木克憲，堀進悟，藤島清太郎，横山雅子，高月誠司，堀口崇，鈴木昌，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20 （ 26 ） 26 - 27 1999年

失神，ショックを呈し救急来院した肺微小塞栓症の1例

宮武諭，藤島清太郎，堀進悟，木村裕之，横山雅子，高月誠司，堀口崇，鈴木昌，山崎元靖，関根和彦，三村琢也，相川直樹

日本救急医学会関東地方会雑誌 20   170 - 171 1999年

共著

失神，ショックを呈し救急来院した肺微小塞栓症の1例

宮武諭，藤島清太郎，堀進悟，木村裕之，横山雅子，高月誠司，堀口崇，鈴木昌，山崎元靖，関根和彦，三村琢也，相川直樹

日本救急医学会関東地方会雑誌 20   170 - 171 1999年

共著

マジックマッシュルームによる急性中毒により自傷行為に至った1例

三村琢也，横山雅子，堀進悟，藤島清太郎，木村裕之，堀口崇，高月誠司，鈴木昌，山崎元靖，宮武諭，相川直樹

日本救急医学会関東地方会雑誌 20   26 - 27 1999年

共著

SIRS, ALI患者の重症度評価指標としてのAPACHE IIIスコア，PaO2/FIO2比の検討

藤島清太郎，篠沢洋太郎，堀進悟，青木克憲，木村裕之，横山雅子，堀口崇，高月誠司，鈴木昌，山崎元靖，関根和彦，宮武諭，三村琢也，相川直樹

日本救命医療研究会雑誌 13   119 - 124 1999年

肺炎球菌による重症敗血症の一例

鈴木昌,木村裕之,高月誠司,藤島清太郎,青木克憲,堀進悟,堀口崇,三村拓也,相川直樹

日本Shock学会誌 14   73 1999年

研究論文（研究会，シンポジウム資料等）, 共著

Postischemic hypothermia retards progression of infarct by delaying activation of microglia and neutrophil inrat transient focal ischemia model

Inamasu J, Suga S, Horiguchi T, Sato S, Akaji K, Kawase T.

Journal of Cerebral Blood Flow and Metabolism 19(Sup-1)   S538 1999年

研究論文（国際会議プロシーディングス）, 共著

postischemic hypothermia attenuates apoptotic cell death in transient focal ischemia

Inamasu J, Suga S, Sato S, Horiguchi T,Akaji K, Kawase T.

Oedema 99   122 1999年

研究論文（国際会議プロシーディングス）, 共著

CPA患者における血中アンモニア値(proceeding)

呂 彩子, 堀 進悟, 堀口 崇, 篠澤 洋太郎, 藤島 清太郎, 木村 裕之, 渡邊 茂, 佐々木 淳一, 副島 京子, 山崎 元靖, 相川 直樹

日本救命医療研究会雑誌 （日本救命医療学会）  12   41 - 42 1998年10月

ISSN  1341-6782

　概要を見る

CPAではNH3が高値を呈することが明らかとなった.このNH3上昇には代謝性アシドーシスが関与することが示された

Analysis of abnormal findings observed on brain MRI T 2 weighted image in a system for the detection of asymptomatic brain disease in 1,200 cases

Horiguchi Takashi, Yoshida Kazunari, Sato Syuzo, Mizukami Masahiro, Kawase Takeshi, Toya Shigeo

Brain and Nerve 50 （ 9 ） 821 - 826 1998年09月

ISSN  0006-8969

　概要を見る

<p>In this study we described the significance of asymptomatic cerebral infarction (ACI) and periventricular hyperintensity (PVH) observed on brain MRI in a system for detection of asymptomatic brain disease with 1,200 cases. The risk factors (RF), population in each age bracket of ACt and PVH, among groups with hypertension (HTG) and without RF (no-RFG), were investigated. The RF of ACI were hypertension (HT), diabetes mellitus (DM), and aging. Without DM, those are common RF of PVH. The population of PVH and ACI with PVH increased with aging in no-RFG. On the other hand, only the population of ACI with PVH increased with aging in HTG. The rate of these abnormal findings in HTG was significantly higher than that in no-RFG. In addition, HT accelerated the occurence of these findings by 10-20 years. When patients were over 60 years old, ACI increased rapidly. Accordingly, we concluded that (1) PVH and ACI had a common background. (2) Long term follow up concerning the incidence of ACI in the group with only PVH was necessary. (3) It was desirable that treatment for RF should be effected before the age of sixty.</p>

脳ドックにおいて発見されるMRI T2強調画像異常高信号域の臨床的意義について　1,200例の検討

堀口 崇, 吉田 一成, 佐藤 周三, 水上 公宏, 河瀬 斌, 戸谷 重雄

脳と神経 （(株)医学書院）  50 （ 9 ） 821 - 826 1998年09月

ISSN  0006-8969

　概要を見る

脳ドック受診者1,200名を対象にMRIで発見される無症候性脳梗塞(ACI)と,び漫性白質病変(PVH)の臨床的意義を明らかにする目的で,危険因子(RF)と各所見の年齢層別分布を検討した.ACIのRFは高血圧(HT),糖尿病,加齢であり,PVHのRFは糖尿病を除きACIと一致した.RFのない群では,ACIを伴わないPVH及びPVHを伴うACIが加齢と共に増加していたが,HT群ではACIを伴わないPVHも減少し,PVHを伴うACIのみが増加した.HT群では,これらの所見が占める割合が有意に高く,しかも,10〜20年若年層にも認められた.更に,PVHを伴うACIは60歳以上で急速に増加した.以上から, 1)ACIとPVHは共通の背景因子を持つ, 2)PVHとACIの発生率に関する長期経過観察が必要である, 3)HTは,PVH及びACIのRFであり,その治療は60歳代迄に行うことが望ましいことが示唆された

くも膜下出血に対する脳低体温療法の有効性と問題点の検討

堀口 崇, 菅 貞郎, 真柳 圭太, 石森 久嗣, 河瀬 斌

脳卒中の外科 = Surgery for cerebral stroke 27 1998年06月

ISSN  09145508

Plasma cell granuloma extending from the extracranial to the intracranial space associated with Epstein-Barr virus infection

Fukunaga Atsushi, Yoshida Kazunari, Otani Mitsuhiro, Ogawa Yoshihiro, Horiguchi Takashi, Ishihara Masayuki, Toya Shigeo, Kawase Takeshi

Neurologia Medico-Chirurgica 38 （ 5 ） 292 - 296 1998年05月

ISSN  0387-2572

　概要を見る

<p>A 70-year-old male presented with a plasma cell granuloma extending from the extracranial to the intracranial space. Findings of preoperative magnetic resonance imaging and intraoperative observation indicated that the lesion extended from the temporal muscle to the subarachnoid space, penetrating the frontal bone. The subarachnoid lesion was composed of neutrophils indicating the presence of acute or subacute inflammation. The final diagnosis of the resected tumor was plasma cell granuloma. High levels of antibodies against Epstein-Barr (EB) virus in the cerebrospinal fluid and the immunohistochemical demonstration of EB nuclear antigens in the plasma cell granuloma suggested that EB virus infection was associated with the development of plasma cell granuloma in this patient.</p>

硝酸薬と失神

堀口 崇

セラピューティック・リサーチ 19   301 - 302 1998年

共著

CPA患者における血中アンモニア値

呂彩子，堀進悟，堀口崇，篠澤洋太郎，藤島清太郎，木村裕之，渡邊茂，佐々木淳一，副島京子，山崎元靖，相川直樹

日本救命医療研究会雑誌 12   41 - 43 1998年

特異な血行動態とアシドーシスを呈した外傷性ショックの1例

堀口崇,堀進悟,篠澤洋太郎,藤島清太郎,木村裕之,佐々木淳一,横山雅子,高月誠司,鈴木昌,山崎元靖,上田敏彦,相川直樹

日本Shock学会誌 13   74 1998年

研究論文（研究会，シンポジウム資料等）, 共著

Plasma cell granuloma extending from the extracranial to the intracranial space associated with Epstein-Barr virus infection - Case report

福永 篤志

NEUROLOGIA MEDICO-CHIRURGICA （一般社団法人 日本脳神経外科学会）  38 （ 5 ） 292 - 296 1998年

ISSN  04708105

　概要を見る

頭蓋内外に進展した形質細胞肉芽腫の1例を経験したので報告する。症例は70歳男性、右前頭部の皮下腫瘤および痙攣発作を主訴に来院した。MRIおよびCTにて側頭筋から頭蓋骨を貫通し側頭葉へと及ぶ腫瘤を認め手術にて全摘した。腫瘤は高分化な形質細胞からなり、くも膜下腔には好中球の浸潤を認めた。免疫染色を行いポリクローナル性を確認し、形質細胞肉芽腫と診断した。また、髄液中のEB virus抗体価が上昇し、形質細胞の一部にEBNA陽性細胞を認めたことから、EB virusによる感染の既往が示唆された。今回の症例は、形質細胞肉芽腫の発生とEB virus感染とが関連づけられた興味深い1例である。

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• CiNii Research

Hypothermia attenuates expression of intracellular adhesion molecule-1 protein in transient focal middle cerebral artery occlusion model in rats

Inamasu J, Suga S, Horiguchi T, Sato S, Ogino M, Kawase T

Journal of Cerebral Blood Flow and Metabolism 17(Sup-1)   S702 1997年

研究論文（国際会議プロシーディングス）, 共著

未破裂巨大脳動脈瘤における母動脈近位部閉塞術の長期予後

島崎　賢仁、河瀬　斌、堀口　崇、小林正人、石原雅行

脳卒中の外科 25   365 - 369 1997年

共著

脳ドックにおける加齢に伴うＭＲＩ所見の変化

堀口　崇、吉田一成、佐藤周三、水上公宏、河瀬　斌

医用電子と生体工学周期特別号 35   18 - 18 1997年

研究論文（研究会，シンポジウム資料等）, 共著

Beneficial effect of postischemic hypothermia on transient forebrain ischemia in rats evaluated by alteration in postischemic cerebral blood flow and hydroxyl radical production

Horiguchi T, Suga S, Shimizu K, Ogino M, Inamasu J, Kawase T

Journal of Cerebral Blood Flow and Metabolism 17(Sup-1)   S35 1997年

研究論文（国際会議プロシーディングス）, 共著

A successful case of hypertrophic cranial pachymeningitis treated by optic nerve decompression

Horiguchi Takashi, Gotoh Kazuhiro, Yoshida Kazunari, Toya Shigeo

Neurological Surgery 24 （ 3 ） 281 - 285 1996年03月

ISSN  0301-2603

　概要を見る

<p>A successful direct operation in a case of hypertrophic cranial pachymeningitis (HCP) is described. A 51-year-old male was admitted with right visual disturbance. CT scanning revealed a mass lesion in the right middle cranial fossa extending into the right orbita. From MRI it was ascertained that this mass lesion consisted of thickening of the skull base dura. The effect of steroids was transient and his visual disturbance was rapidly increasing. A direct operation was performed consisting of partial dissection of the thickening dura and decompression of the right optic nerve. Histological diagnosis showed HCP. After surgery his symptoms dramatically improved. The etiology, and natural course and treatment of HCP are well reported in the literature. In the present case the etiology was not clear, but there was a possible relationship with intraorbital pseudotumor or multifocal fibrosclerosis. The reported occasional transitory effect of steroids on HCP and a poor prognosis for visual acuity are common traits in these patients. The authors thus feel that a direct operation should be immediately carried out when the effect of steroids on visual disturbances associated with HCP is judged transient.</p>

視神経減圧術が著効した慢性肥厚性脳硬膜炎の1例

堀口 崇, 後藤 和宏, 吉田 一成

Neurological Surgery （(株)医学書院）  24 （ 3 ） 281 - 285 1996年03月

ISSN  0301-2603

　概要を見る

51歳男.ステロイドの効果が一過性であり視神経減圧術が著効した,視力障害で発症した肥厚性脳硬膜炎の1例.原因疾患の究明と平行して薬物療法を行い,その効果が認められない或いは,一過性であった場合,神経症状改善の為の直達手術を考慮すべきである

[-A successful case of hypertrophic cranial pachymeningitis treated by optic nerve decompression].

Horiguchi T, Gotoh K, Yoshida K, Toya S

No shinkei geka. Neurological surgery 24 （ 3 ） 281 - 5 1996年03月

ISSN  0301-2603

The effect of transient ischemia on the expression of serine/threonine protein phosphatase in the gerbil brain

Horiguchi T, Suga S, Ogino M, Shimizu K, Yamaguchi N, Kawase T, Toya S

Journal of Cerebral Blood Flow and Metabolism 15(Sup-1)   S116 1995年

研究論文（国際会議プロシーディングス）, 共著

Influence of hypothermia both during and after ischemia on extracellular concentration of adenosine, dopamine and the metabolites

Horiguchi T, Suga S, Ogino M, Shimizu K, Yamaguchi N, Kawase T, Toya S

Journal of Cerebral Blood Flow and Metabolism 15   S240 1995年

研究論文（国際会議プロシーディングス）, 共著