基本情報

所属

• 北海道大学病院　脳・神経・感覚器科

職名

• 講師

学位

• 医学博士（2011年03月 北海道大学）

Researcher ID

• U-9482-2018

J-Global ID

• 201801015563980074

研究キーワード

• 脳卒中   手術教育   脳血管外科   脳血管障害   脳神経外科   

研究分野

• ライフサイエンス / 医用システム
• ライフサイエンス / 神経科学一般
• ライフサイエンス / 脳神経外科学

担当教育組織

•  修士課程　医学院
•  博士課程　医学院

職歴

• 2021年12月 - 現在 北海道大学病院 脳神経外科 講師・病棟医長
• 2021年04月 - 2021年11月 北海道大学病院 脳神経外科 講師・外来医長
• 2018年04月 - 2021年03月 北海道大学病院 脳神経外科 助教・外来医長
• 2017年04月 - 2018年03月 札幌麻生脳神経外科病院 脳神経外科
• 2015年04月 - 2017年03月 カルガリー大学 Department of Clinical Neurosciences 研究員
• 2012年10月 - 2015年03月 北海道大学病院 脳神経外科 客員臨床助教
• 2010年04月 - 2015年03月 手稲渓仁会病院 脳神経外科 医長
• 2003年04月 - 2010年03月 北海道大学病院 医員

学歴

• 2008年04月 - 2011年03月   北海道大学大学院   医学研究科   脳神経外科学
• 1997年04月 - 2003年03月   筑波大学   医学専門学群

所属学協会

• 日本神経内視鏡学会   日本てんかん外科学会   日本脳神経外科救急学会   日本てんかん学会   日本脳神経血管内治療学会   日本脳神経外傷学会   脳神経外科手術と機器学会   日本再生医療学会   日本頭蓋底外科学会   日本コンピュータ外科学会   日本脳卒中の外科学会   日本脳卒中学会   日本脳神経外科学会   スパズム・シンポジウム   

研究活動情報

論文

• Preservation of Enlarged Mastoid Emissary Vein during Microvascular Decompression for Trigeminal Neuralgia Accompanied by Abnormal Venous Drainage: A Technical Case Report

  Taku SUGIYAMA, Miki FUJIMURA

  NMC Case Report Journal 10 139 - 143 2023年12月31日 [査読有り][通常論文]
  
• 特殊な血管性病変とその治療 解離性脳動脈瘤

  杉山拓, 藤村幹

  Clinical Neuroscience 41 10 1363 - 1365 (株)中外医学社 2023年10月
• neuroGPT-X: toward a clinic-ready large language model

  Edward Guo, Mehul Gupta, Sarthak Sinha, Karl Rössler, Marcos Tatagiba, Ryojo Akagami, Ossama Al-Mefty, Taku Sugiyama, Philip E. Stieg, Gwynedd E. Pickett, Madeleine de Lotbiniere-Bassett, Rahul Singh, Sanju Lama, Garnette R. Sutherland

  Journal of Neurosurgery 1 - 13 2023年10月01日 [査読有り][通常論文]
   

  OBJECTIVE The objective was to assess the performance of a context-enriched large language model (LLM) compared with international neurosurgical experts on questions related to the management of vestibular schwannoma. Furthermore, another objective was to develop a chat-based platform incorporating in-text citations, references, and memory to enable accurate, relevant, and reliable information in real time. METHODS The analysis involved 1) creating a data set through web scraping, 2) developing a chat-based platform called neuroGPT-X, 3) enlisting 8 expert neurosurgeons across international centers to independently create questions (n = 1) and to answer (n = 4) and evaluate responses (n = 3) while blinded, and 4) analyzing the evaluation results on the management of vestibular schwannoma. In the blinded phase, all answers were assessed for accuracy, coherence, relevance, thoroughness, speed, and overall rating. All experts were unblinded and provided their thoughts on the utility and limitations of the tool. In the unblinded phase, all neurosurgeons provided answers to a Likert scale survey and long-answer questions regarding the clinical utility, likelihood of use, and limitations of the tool. The tool was then evaluated on the basis of a set of 103 consensus statements on vestibular schwannoma care from the 8th Quadrennial International Conference on Vestibular Schwannoma. RESULTS Responses from the naive and context-enriched Generative Pretrained Transformer (GPT) models were consistently rated not significantly different in terms of accuracy, coherence, relevance, thoroughness, and overall performance, and they were often rated significantly higher than expert responses. Both the naive and content-enriched GPT models provided faster responses to the standardized question set than expert neurosurgeon respondents (p < 0.01). The context-enriched GPT model agreed with 98 of the 103 (95%) consensus statements. Of interest, all expert surgeons expressed concerns about the reliability of GPT in accurately addressing the nuances and controversies surrounding the management of vestibular schwannoma. Furthermore, the authors developed neuroGPT-X, a chat-based platform designed to provide point-of-care clinical support and mitigate the limitations of human memory. neuroGPT-X incorporates features such as in-text citations and references to enable accurate, relevant, and reliable information in real time. CONCLUSIONS The present study, with its subspecialist-level performance in generating written responses to complex neurosurgical problems for which evidence-based consensus for management is lacking, suggests that context-enriched LLMs show promise as a point-of-care medical resource. The authors anticipate that this work will be a springboard for expansion into more medical specialties, incorporating evidence-based clinical information and developing expert-level dialogue surrounding LLMs in healthcare.
• Possible Delayed Foreign Body Reactions against Titanium Clips and Coating Materials after Unruptured Cerebral Aneurysm Surgery.

  Ryota Tatezawa, Taku Sugiyama, Shuho Gotoh, Takafumi Shindo, Hiroshi Ikeda, Masaaki Hokari, Katsumi Takizawa, Naoki Nakayama, Miki Fujimura

  Neurologia medico-chirurgica 2023年08月30日 

  Delayed foreign body reactions to either or both clipping and coating materials have been reported in several small series; however, studies in the titanium clip era are scarce. This study aims to survey the contemporary status of such reactions to titanium clips and coating materials. Among patients who received a total of 2327 unruptured cerebral aneurysmal surgeries, 12 developed delayed intraparenchymal reactions during outpatient magnetic resonance imaging (MRI) follow-up. A retrospective investigation was conducted. The patients' average age was 58.6 (45-73) years, and 11 were women. The aneurysms were located in the middle cerebral artery (n = 7), internal carotid artery (n = 4), or anterior communicating artery (AComA, n = 1). In 10 patients, additional coating with tiny cotton fragments was applied to the residual neck after clipping with titanium clips; however, only the clipping with titanium clips was performed in the remaining two. The median time from surgery to diagnosis was 4.5 (0.3-60) months. Seven (58.3%) patients were asymptomatic, and three developed neurological deficits. MRI findings were characterized by a solid- or rim-enhancing lobulated mass adjacent to the clip with surrounding parenchymal edema. In 11 patients, the lesions reduced in size or disappeared; however, in one patient, an AComA aneurysm was exacerbated, necessitating its removal along with optic nerve decompression. In conclusion, cotton material is a strongly suspected cause of delayed foreign body reactions, and although extremely rare, titanium clips alone may also induce such a reaction. The prognosis is relatively good with steroid therapy; however, caution is required when the aneurysm is close to the optic nerve, as in AComA aneurysms.
• Tissue Acceleration as a Novel Metric for Surgical Performance During Carotid Endarterectomy.

  Taku Sugiyama, Masaki Ito, Hiroyuki Sugimori, Minghui Tang, Toshitaka Nakamura, Katsuhiko Ogasawara, Hitoshi Matsuzawa, Naoki Nakayama, Sanju Lama, Garnette R Sutherland, Miki Fujimura

  Operative Neurosurgery (Hagerstown, Md.) 2023年07月04日 [査読有り][通常論文]
   

  BACKGROUND AND OBJECTIVES: Gentle tissue handling to avoid excessive motion of affected fragile vessels during surgical dissection is essential for both surgeon proficiency and patient safety during carotid endarterectomy (CEA). However, a void remains in the quantification of these aspects during surgery. The video-based measurement of tissue acceleration is presented as a novel metric for the objective assessment of surgical performance. This study aimed to evaluate whether such metrics correlate with both surgeons' skill proficiency and adverse events during CEA. METHODS: In a retrospective study including 117 patients who underwent CEA, acceleration of the carotid artery was measured during exposure through a video-based analysis. Tissue acceleration values and threshold violation error frequencies were analyzed and compared among the surgeon groups with different surgical experience (3 groups: novice, intermediate, and expert). Multiple patient-related variables, surgeon groups, and video-based surgical performance parameters were compared between the patients with and without adverse events during CEA. RESULTS: Eleven patients (9.4%) experienced adverse events after CEA, and the rate of adverse events significantly correlated with the surgeon group. The mean maximum tissue acceleration and number of errors during surgical tasks significantly decreased from novice, to intermediate, to expert surgeons, and stepwise discriminant analysis showed that the combined use of surgical performance factors could accurately discriminate between surgeon groups. The multivariate logistic regression analysis revealed that the number of errors and vulnerable carotid plaques were associated with adverse events. CONCLUSION: Tissue acceleration profiles can be a novel metric for the objective assessment of surgical performance and the prediction of adverse events during surgery. Thus, this concept can be introduced into futuristic computer-aided surgeries for both surgical education and patient safety.
• Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability.

  Haruto Uchino, Masaki Ito, Kikutaro Tokairin, Ryota Tatezawa, Taku Sugiyama, Ken Kazumata, Miki Fujimura

  Neurosurgical review 46 1 119 - 119 2023年05月11日 [査読有り][通常論文]
   

  A cortical hyperintensity on fluid-attenuated inversion recovery images (FLAIR cortical hyperintensity (FCH)) is an abnormal finding after revascularization surgery for moyamoya disease. This study aimed to investigate the pathophysiology of FCH through genetic analyses of RNF213 p.R4810K polymorphism and perioperative hemodynamic studies using single-photon emission computed tomography. We studied 96 hemispheres in 65 adults and 47 hemispheres in 27 children, who underwent combined direct and indirect revascularization. Early or late FCH was defined when it was observed on postoperative days 0-2 and 6-9, respectively. FCH scores (range: 0-6) were evaluated according to the extent of FCH in the operated hemisphere. FCHs were significantly more prevalent in adult patients than pediatric patients (early: 94% vs. 78%; late: 97% vs. 59%). In pediatric patients, FCH scores were significantly improved from the early to late phase regardless of the RNF213 genotype (mutant median [IQR]: 2 [1-5] vs. 1 [0-2]; wild-type median: 4 [0.5-6] vs. 0.5 [0-1.75]). In adults, FCH scores were significantly improved in patients with the wild-type RNF213 allele (median: 4 [2-5.25] vs. 2 [2, 3]); however, they showed no significant improvement in patients with the RNF213 mutation. FCH scores were significantly higher in patients with symptomatic cerebral hyperperfusion than those without it (early median: 5 [4, 5] vs. 4 [2-5]; late median: 4 [3-5] vs. 3 [2-4]). In conclusion, the RNF213 p.R4810K polymorphism was associated with prolonged FCH, and extensive FCH was associated with symptomatic cerebral hyperperfusion in adult patients with moyamoya disease.
• Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study.

  Makoto Mizushima, Masaki Ito, Noriyuki Fujima, Haruto Uchino, Taku Sugiyama, Miki Fujimura

  Neurologia medico-chirurgica 63 7 304 - 312 2023年04月20日 [査読有り][通常論文]
   

  Although postoperative neurological events due to brain compression by the swollen temporal muscle are a rare complication, the chronological volume changes of the temporal muscle pedicle and their clinical impact have not yet been documented. This prospective observational study aimed to investigate the chronological volume changes in the temporal muscle pedicle in Moyamoya disease (MMD). Eighteen consecutive combined revascularization procedures using the temporal muscle were performed for symptomatic MMD in 2021. The postoperative pedicle volume was quantified using repeated computed tomography images on postoperative days (PODs) 0, 1, 7, 14, and 30. Postoperative neurological events with radiological evaluations and collateral development evaluated using magnetic resonance angiography obtained 6 months after surgery were studied. On average, the postoperative temporal muscle pedicle volume was most significantly increased by as much as 112% ± 9.6% on POD 7 (P < 0.001) and decreased by as little as 52% ± 21% on POD 30 (P < 0.0001) relative to POD 0. One exceptional patient (overall incidence, 5.6%) demonstrated postoperative transient neurological events due to brain compression by the swollen temporal muscle with decreased focal cerebral blood flow in the adjacent cortical area. The postoperative collateral development via direct and indirect revascularizations was confirmed in 16 (89%) and 12 (67%) hemispheres, respectively. All patients, except for one rebleeding case, showed independent outcomes at the mean latest follow-up period on 290 ± 96 days after surgery. Our observations confirmed the temporal profile of muscle pedicle volume changes after combined revascularization. Through routine attempts to avoid the unfavorable effects of temporal muscle swelling, combined revascularization can provide favorable outcomes in symptomatic MMD.
• Comparison of Access Route for Endovascular Treatment by Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRA and Contrast-Enhanced MRA

  Satoshi Kobayashi, Toshiya Osanai, Taku Sugiyama, Noriyuki Fujima, Ryo Takagi, Isao Yokota, Akiyoshi Hamaguchi, Toshitaka Nakamura, Kazutoshi Hida, Miki Fujimura

  Journal of Neuroendovascular Therapy 2023年 [査読有り][通常論文]
  
• Late-onset obstructive hydrocephalus associated with occipital encephalocele with large skull defect successfully treated by endoscopic third ventriculostomy

  Yuki Munekata, Taku Sugiyama, Yuki Ueda, Makoto Mizushima, Hiroaki Motegi, Miki Fujimura

  Child's Nervous System 2022年07月29日 [査読有り][通常論文]
  
• Outcomes of combined revascularization surgery for moyamoya disease without preoperative cerebral angiography.

  Tomohiro Okuyama, Masahito Kawabori, Masaki Ito, Taku Sugiyama, Ken Kazumata, Miki Fujimura

  World neurosurgery 2022年06月21日 [査読有り][通常論文]
   

  OBJECTIVE: Cerebral angiography is the gold standard for diagnosing moyamoya disease (MMD), whereas magnetic resonance (MR) imaging/angiography is becoming more popular in the field of cerebrovascular disease due to its low invasiveness. Although there are concerns about using only MR imaging/angiography for preoperative analysis of MMD, considering the underestimation of pre-existing transdural collateral circulations and dangerous collaterals related to the risk of hemorrhage, we retrospectively reviewed our 10-year experience of MRI-first diagnosis and analyzed the perioperative outcomes. METHODS: We analyzed 160 consecutive direct/indirect combined revascularization procedures for MMD preoperatively assessed using MR imaging/angiography alone. Perioperative complications were assessed for up to 2 weeks after surgery. Locations of the lesions responsible for complications were further classified into the surgical field, the ipsilateral hemisphere outside the surgical field, and the contralateral hemisphere. RESULTS: Sixty-four revascularization procedures were performed in 38 children, and 96 procedures were performed in 68 adults. There was no difference in the incidence of perioperative ischemic complications between adults (6.3%) and pediatric patients (4.7%), but hemorrhagic complications were more frequently observed in adults (7.3%) than in children (0%) (P<0.05). There was no specific lesion deviation for ischemic complications; however, hemorrhagic complications predominantly occurred in the surgical field. CONCLUSIONS: Direct/indirect combined revascularization surgery based on our preoperative diagnostic protocol with the MR-first strategy resulted in favorable outcomes in pediatric MMD patients with relatively low complication rates. However, the validity of the MR-first diagnostic protocol should be further evaluated in adult patients with MMD.
• Moyamoya Disease Associated with a Deficiency of Complement Component 6.

  Masaru Kato, Yuki Kudo, Masanao Hatase, Naohisa Tsuchida, Shuhei Takeyama, Taku Sugiyama, Miki Fujimura, Ichiro Yabe, Hiroshi Tsujimoto, Yasuo Fukumori, Norimitsu Inoue, Tatsuya Atsumi

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 31 8 106601 - 106601 2022年06月16日 [査読有り][通常論文]
   

  OBJECTIVES: Complement component 6 (C6) deficiency is a very rare genetic defect that leads to significantly diminished synthesis, secretion, or function of C6. In the current report, we demonstrate a previously undescribed, homozygous missense mutation in exon 17 of the C6 gene (c.2545A>G p.Arg849Gly) in a 35-year-old Japanese woman with moyamoya disease and extremely low levels of CH50 (<7.0 U/mL). MATERIALS AND METHODS: The complement gene analysis using hybridization capture-based next generation sequencing was performed. CH50 was determined in patient's plasma mixed with plasma from a healthy donor or purified human C6 protein. Western blot was performed on patient's plasma using polyclonal antibodies against C6, with healthy donor's plasma and purified human C6 protein as positive controls while C6-depleted human serum as a negative control. The carriage of ring finger protein 213 variant (c.14576G>A p.Arg4859Lys), a susceptibility gene for moyamoya disease, was examined by direct sequencing. RESULTS: CH50 mixing test clearly showed a deficiency pattern, being rescued by addition of only 1% healthy donor's plasma or 1 μg/mL purified human C6 protein (1/50-1/100 of physiological concentration). Western blot revealed the absence of C6 protein in the patient's plasma, confirming a quantitative deficiency of C6. The ring finger protein 213 variant was not detected. CONCLUSIONS: Our data implies that unrecognized complement deficiencies would be harbored in cerebrovascular diseases with unknown etiologies.
• Spontaneous Obliteration of a Dissecting Aneurysm of Recurrent Artery of Heubner Monitored by Serial Magnetic Resonance Vessel Wall Imaging.

  Asuka Nakazaki, Masaki Ito, Masanori Isobe, Takeshi Takahashi, Taichi Nomura, Fumiaki Fujihara, Toyohiko Isu, Taku Sugiyama, Toshiya Osanai, Miki Fujimura

  Asian journal of neurosurgery 17 2 331 - 336 2022年06月 

  Aneurysms of the recurrent artery of Heubner (RAH) are known to be one of the uncommon cerebral aneurysms, predominantly presenting with bleeding symptoms. Previously, nine cases of the RAH aneurysms have been reported, all of which were treated surgically or endovascularly and most cases developed postoperative cerebral infarct in the ipsilateral caudate nucleus. Herein, we report a man presenting with transient ischemic attack due to diffuse cerebral vasospasm from a minor non-disabling subarachnoid hemorrhage (SAH) from an RAH aneurysm. He visited our hospital 7 days after the first experience of a thunderclap headache complaining with transient unilateral motor weakness and thin SAH in the right sylvian fissure. Diagnostic catheter angiography revealed a dissecting fusiform aneurysm (8 mm in size) originating from the left RAH contralateral to the thin SAH. Contrast-enhanced magnetic resonance vessel wall imaging (MR-VWI) helped to identify the ruptured nature of the RAH aneurysm. Owing to his delayed ischemic condition after minor SAH, he was conservatively treated with serial MR-VWI monitoring. The aneurysm was spontaneously obliterated with an asymptomatic lacunar infarct in the ipsilateral caudate nucleus in a month. Together, this case was considered as the dissecting aneurysm of RAH with a favorable outcome after the conservative management. Although long-term follow-up is mandatory because the disappearance of the vessel wall enhancement does not necessarily secure the permanent cure of the lesion, serial MR-VWI is helpful to diagnose the ruptured nature and monitor its chronological change in combination with conventional radiological imaging techniques.
• Diagnostic Value of Vessel Wall Imaging to Determine the Timing of Extracranial-Intracranial Bypass for Moyamoya Syndrome Associated with Active Sjögren's Syndrome: A Case Report.

  Takafumi Shindo, Masaki Ito, Taku Sugiyama, Tomohiro Okuyama, Michihito Kono, Tatsuya Atsumi, Miki Fujimura

  Journal of neurological surgery. Part A, Central European neurosurgery 2022年04月22日 [査読有り]
   

  BACKGROUND: Sjögren's syndrome is a chronic autoimmune disorder that predominantly affects exocrine organs. It is characterized by an organ-specific infiltration of lymphocytes. The involvement of the major cerebral arteries in Sjögren's syndrome has rarely been reported. A recent study reported a case of successful extracranial‒intracranial (EC‒IC) bypass without complications, even in the active inflammatory state, although the optimal timing of such a bypass remains unclear. CASE DESCRIPTION: We here report the case of a 43-year-old woman presenting with acute ischemic stroke due to progressive middle cerebral artery (MCA) occlusion and signs of primary Sjögren's syndrome. During intensive immunosuppressive therapy for active Sjögren's syndrome, the patient was monitored using contrast-enhanced magnetic resonance vessel wall imaging (MR-VWI). A couple of intravenous cyclophosphamide injections combined with a methylprednisolone pulse and antiplatelet therapy, resulted in clear resolution of vessel wall enhancement, which suggested remission of inflammatory vasculitis. Nevertheless, she still experienced a transient ischemic attack due to decreased regional cerebral blood flow by MCA occlusion, as demonstrated by the conventional time-of-flight MR angiography and single-photon emission computed tomography. Considering the increased risk of further stroke, the decision was made to perform EC-IC bypass as a treatment of hemodynamic impairment medically uncontrollable. Her postoperative course was uneventful without further repeated TIAs, and continued immunosuppressive therapy for Sjögren's syndrome provided effective management. CONCLUSIONS: Our findings emphasize the diagnostic value of contrast-enhanced MR-VWI in monitoring the effect of immunosuppressive therapy for the major cerebral artery vasculitis and in determining the timing of EC‒IC bypass as a 'rescue' treatment for Moyamoya syndrome associated with active Sjögren's syndrome.
• Efficacy of the MRA-based road mapping of the para-aortic access route before mechanical thrombectomy in patients with acute ischemic stroke

  Satoshi Kobayashi, Toshiya Osanai, Noriyuki Fujima, Akiyoshi Hamaguchi, Taku Sugiyama, Toshitaka Nakamura, Kazutoshi Hida, Miki Fujimura

  Cerebrovascular Diseases Extra 12 1 47 - 52 2022年03月17日 [査読有り][通常論文]
   

  INTRODUCTION: The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. MATERIALS AND METHODS: We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization ("puncture to recanalization time") and the time from the admission to recanalization ("door to recanalization time"), between the groups. RESULTS: MRA-based road mapping significantly reduced the "puncture to recanalization time" (52.0 min vs. 70.0 min; p = 0.019) and the "door to recanalization time" (146 min vs. 183 min; p = 0.013). CONCLUSION: MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.
• Current Concepts and Perspectives on Brain Arteriovenous Malformations: A Review of Pathogenesis and Multidisciplinary Treatment

  Taku Sugiyama, Giovanni Grasso, Fabio Torregrossa, Miki Fujimura

  World Neurosurgery 159 314 - 326 2022年03月 [査読有り][招待有り]
  
• Rescue extracranial-intracranial bypass for ischemic stroke secondary to progressive human immunodeficiency virus-associated vasculopathy

  Makoto Mizushima, Taku Sugiyama, Katsuki Eguchi, Monami Tarisawa, Kikutaro Tokairin, Masaki Ito, Daigo Hashimoto, Ichiro Yabe, Miki Fujimura

  Journal of Neurological Surgery Part A: Central European Neurosurgery 2022年02月22日 [査読有り][通常論文]
   

  BACKGROUND: Human immunodeficiency virus (HIV) associated vasculopathy can cause ischemic cerebral stroke; however, there is limited evidence on optimal management. Herein, we report a case of acute ischemic stroke due to progressive internal carotid artery (ICA) stenosis in an HIV-positive patient. Superficial temporal artery to middle cerebral artery (STA-MCA) bypass, in addition to the best medical treatments, prevented stroke progression. CLINICAL DESCRIPTION: A 39-year-old man with HIV infection presented with a sudden onset of aphasia and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left basal ganglia and concentric thickening of the vessel wall in the terminal portion of the bilateral ICAs. Despite maximal medical treatments for HIV-associated vasculopathy and possible opportunistic infections, bilateral ICA stenoses progressed, leading to a second hemodynamic stroke event. Because tissue plasminogen activator treatment failed, we performed STA-MCA bypass. A significant improvement in neurologic symptoms and cerebral blood flow was observed after surgery. No further stroke events occurred during the continuation of medical treatments. CONCLUSION: This is the first case of STA-MCA bypass performed in a patient with recurrent ischemic stroke caused by HIV-associated vasculopathy. Although further evidence is needed, such treatment options can shed new light on the management of progressive HIV-associated vasculopathy, which is refractory to maximal medical treatment.
• Impact of RNF213 founder polymorphism (p.R4810K) on the postoperative development of indirect pial synangiosis after direct/indirect combined revascularization surgery for adult Moyamoya disease.

  Masaki Ito, Masahito Kawabori, Taku Sugiyama, Kikutaro Tokairin, Ryota Tatezawa, Haruto Uchino, Ken Kazumata, Kiyohiro Houkin, Miki Fujimura

  Neurosurgical review 45 3 2305 - 2313 2022年02月07日 [査読有り][通常論文]
   

  Direct superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis combined with indirect pial synangiosis provides favorable surgical collaterals for Moyamoya disease (MMD), especially in adults; however, factors leading to the development of each direct and indirect collateral are not well documented.We aimed to investigate the association between RNF213 founder polymorphism (p.R4810K) and each direct and indirect collateral development. By qualitative and quantitative evaluations of direct and indirect surgical collaterals using time-of-flight MR angiography, postoperative development of each type of bypass was evaluated independently into two categories. Multivariate logistic regression analysis was performed to study the contributing factors for the development of each surgical collateral. Excellent development of postoperative direct and indirect bypass was observed in 65 hemispheres (70%) by qualitative evaluation, which was confirmed by quantitative evaluation. Multivariate logistic regression analysis of excellent indirect bypass development revealed a significant positive correlation with the p.R4810K (odds ratio, OR4.0; 95%-confidence interval, CI 1.2-16), advanced MR angiographic stage (OR9.5; 95%CI 1.7-73), and preoperative middle meningeal artery caliber (OR6.8; 95%CI 1.8-35), but a significant negative correlation was found with the excellent direct bypass development (OR0.17; 95%CI 0.03-0.75). No significant correlation was observed between excellent direct bypass development and the p.R4810K (OR0.95; 95%CI 0.37-2.4).In conclusion, excellent development of indirect collaterals after STA-MCA anastomosis combined with indirect pial synangiosis occurs more frequently in adult MMD with the RNF213 founder polymorphism, suggesting a role of the p.R4810K variant for marked in-growth of indirect collaterals and the utility of preoperative genetic analysis.
• 【最新臨床脳卒中学(第2版)下-最新の診断と治療-】脳梗塞総論 慢性期治療 EC-ICバイパス術

  杉山 拓, 藤村 幹

  日本臨床 80 増刊2 最新臨床脳卒中学(下) 109 - 113 (株)日本臨床社 2022年02月
• もやもや病 ―治療の現状と研究課題について―

  藤村 幹, 伊東 雅基, 杉山 拓, 川堀 真人, 長内 俊也

  Japanese Journal of Neurosurgery 31 9 579 - 585 2022年
• 脳動脈瘤開頭手術の責務

  中山 若樹, 伊藤 康裕, 杉山 拓, 月花 正幸, 丸一 勝彦

  Japanese Journal of Neurosurgery 31 2 87 - 97 2022年 [査読有り][招待有り]
  
• Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery

  Taku Sugiyama, Tod Clapp, Jordan Nelson, Chad Eitel, Hiroaki Motegi, Naoki Nakayama, Tsukasa Sasaki, Kikutaro Tokairin, Masaki Ito, Ken Kazumata, Kiyohiro Houkin

  Operative Neurosurgery 20 3 289 - 299 2021年03月 [査読有り][通常論文]
   

  BACKGROUND: Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display. OBJECTIVE: To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery. METHODS: A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons' hand-drawn presurgical illustrations. RESULTS: The VR session effectively enhanced surgeons' understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons' presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts. CONCLUSION: Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons' understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.
• Use of magnetic resonance venography for inferior petrosal sinus sampling.

  Kikutaro Tokairin, Toshiya Osanai, Noriyuki Fujima, Kinya Ishizaka, Hiroaki Motegi, Yukitomo Ishi, Hiraku Kameda, Taku Sugiyama, Ken Kazumata, Naoki Nakayama

  The journal of vascular access 23 3 1129729821997263 - 1129729821997263 2021年02月24日 [査読有り]
   

  BACKGROUND: Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing's disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. METHODS: Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group (N = 8) and no-MRV group (N = 11) before IPSS. RESULTS: There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group (p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. CONCLUSIONS: Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.
• Vulnerability to shear stress caused by altered peri-endothelial matrix is a key feature of Moyamoya disease.

  Muneaki Matsuo, Satomi Nadanaka, Minami Soga, Taku Sugiyama, Shota Serigano, Kenjiro Shimano, Fumio Ichinose, Takuji Nakamura, Toshiyuki Maeda, Kiyohiro Houkin, Takumi Era, Hiroshi Kitagawa

  Scientific reports 11 1 1552 - 1552 2021年01月15日 [査読有り]
   

  Moyamoya disease (MMD) is characterized by progressive bilateral stenotic changes in the terminal portion of the internal carotid arteries. Although RNF213 was identified as a susceptibility gene for MMD, the exact pathogenesis remains unknown. Immunohistochemical analysis of autopsy specimens from a patient with MMD revealed marked accumulation of hyaluronan and chondroitin sulfate (CS) in the thickened intima of occlusive lesions of MMD. Hyaluronan synthase 2 was strongly expressed in endothelial progenitor cells in the thickened intima. Furthermore, MMD lesions showed minimal staining for CS and hyaluronan in the endothelium, in contrast to control endothelium showing positive staining for both. Glycosaminoglycans of endothelial cells derived from MMD and control induced pluripotent stem cells demonstrated a decreased amount of CS, especially sulfated CS, in MMD. A computational fluid dynamics model showed highest wall shear stress values in the terminal portion of the internal carotid artery, which is the predisposing region in MMD. Because the peri-endothelial extracellular matrix plays an important role in protection, cell adhesion and migration, an altered peri-endothelial matrix in MMD may contribute to endothelial vulnerability to wall shear stress. Invading endothelial progenitor cells repairing endothelial injury would produce excessive hyaluronan and CS in the intima, and cause vascular stenosis.
• Intraoperative Early Venous Filling Phenomenon as an Intrinsic Sign of the Local Hemodynamic Change after Revascularization Surgery in a Patient with Adult Moyamoya Disease: Implications of a Potential Arteriovenous Shunt.

  Kikutaro Tokairin, Taku Sugiyama, Masaki Ito, Miki Fujimura

  NMC case report journal 8 1 755 - 760 2021年 [査読有り][通常論文]
   

  After revascularization surgery for patients with moyamoya disease (MMD), local and global hemodynamic changes occur intraoperatively and in the early postoperative period. Local cerebral hyperperfusion and watershed shift ischemia are well-known perioperative pathologies after revascularization for MMD, but early venous filling phenomenon is markedly rare. We report the case of a 19-year-old woman with hemorrhagic-onset MMD who presented with grand mal seizure and subarachnoid hemorrhage. She underwent superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis combined with indirect pial synangiosis on the affected hemisphere. Intraoperatively, notable early arterial blood filling in the fine cortical vein was observed around the site of anastomosis right after the STA-MCA anastomosis under the surgical microscope and fluorescence indocyanine green video angiography. Recovery of consciousness after general anesthesia was normal, although she exhibited a focal seizure 1 hour later. Postoperative magnetic resonance imaging was not remarkable, and cerebral hemodynamics significantly improved in the acute stage after surgical revascularization. Considering the intrinsic vulnerability of the microvascular anatomy of MMD, the present case is notable because early venous filling was observed intraoperatively. This phenomenon suggests the existence of a potential arteriovenous shunt as an underlying pathology of MMD, but its implications in the early postoperative course should be further verified in a larger number of MMD patients undergoing surgical revascularization.
• 家族性地中海熱に併発し，頭蓋内出血で発症し，その後自然消退したレンズ核線条体動脈瘤の1例

  Asuka Nakazaki, Taku Sugiyama, Ryota Tatezawa, Hiroyuki Kono, Yutaka Morishima, Toshiya Osanai, Naoki Nakayama, Ken Kazumata

  Brain and Nerve 73 1 89 - 93 2021年01月 [査読有り]
   

  Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.
• Vascular Smooth Muscle Cell Derived from IPS Cell of Moyamoya Disease - Comparative Characterization with Endothelial Cell Transcriptome.

  Kikutaro Tokairin, Shuji Hamauchi, Masaki Ito, Ken Kazumata, Taku Sugiyama, Naoki Nakayama, Masahito Kawabori, Toshiya Osanai, Kiyohiro Houkin

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 29 12 105305 - 105305 2020年09月23日 [査読有り][通常論文]
   

  BACKGROUND: Moyamoya disease (MMD) is an occlusive cerebrovascular disease, causing stroke in children and young adults with unknown etiology. The fundamental pathology is fibrocellular intimal thickening of cerebral arteries, in which vascular smooth muscle cells (VSMCs) are observed as one of the major cell types. Although the characteristics of circulating smooth muscle progenitor cells have been previously reported, the VSMCs are poorly characterized in MMD. We aimed to characterize VSMCs in MMD using induced pluripotent stem cell (iPSC)-technology. METHODS: We differentiated VSMCs from neural crest stem cells (NCSCs) using peripheral blood mononuclear cell-derived iPSCs and compared biological and transcriptome features under naïve culture conditions between three independent healthy control (HC) subjects and three MMD patients. VSMC transcriptome profiles were also compared to those of endothelial cells (ECs) differentiated from the same iPSCs. RESULTS: Homogeneous spindle-shaped cells differentiated from iPSCs exhibited smooth muscle cell marker expressions, including α-smooth muscle actin (αSMA, 82.3 ± 6.7% and 81.0 ± 6.7%); calponin (91.3 ± 2.1% and 90.9 ± 1.3%); myosin heavy chain-11 (MYH11, 96.9 ± 0.7% and 97.1 ± 0.3%) without significance of differences between the two groups. Real-time PCR showed few PECAM1 and CD34 gene expressions in both groups, indicating features of differentiated VSMCs. There were no significant differences in cellular proliferation (p = 0.45), migration (p = 0.60), and contractile abilities (p = 0.96) between the two groups. Transcriptome analysis demonstrated similar gene expression profiles of VSMCs in HC subjects and MMD patients with six differentially expressed genes (DEGs); while ECs showed a distinct transcriptome profile in MMD patients with 120 DEGs. The Wnt-signaling pathway was a significant pathway in VSMCs. CONCLUSIONS: This is the first study that established VSMCs from NCSCs using MMD patient-derived iPSCs and demonstrated similar biological function and transcriptome profile of iPSC-derived VMSCs in MMD patients and HC subjects under naïve single culture condition. Comparative transcriptome features between iPSC-derived VSMCs and ECs, displaying distinct transcriptome in the ECs, suggested that pathological traits can be driven by naïve ECs predominantly and VSMCs may require specific environmental factors in MMD, which provides novel insight into the pathophysiology of MMD. Our iPSC derived VSMC model can contribute to further investigations of diagnostic and therapeutic target of MMD in addition to the current iPSC derived EC model.
• Microsurgical Findings of Pial Arterial Feeders in Intracranial Dural Arteriovenous Fistulae: A Case Series

  Michinari Okamoto, Taku Sugiyama, Naoki Nakayama, Satoshi Ushikoshi, Ken Kazumata, Toshiya Osanai, Kikutaro Tokairin, Yusuke Shimoda, Kiyohiro Houkin

  Operative Neurosurgery 19 6 691 - 700 2020年07月27日 [査読有り][通常論文]
   

  Abstract Background: Pial arterial feeders in an intracranial dural arteriovenous fistula (dAVF) are risk factors for both ischemic and hemorrhagic complications during endovascular embolization. Microsurgery in dAVF with pial arterial feeders has rarely been reported. Objective: To assess our original experience with microsurgery for dAVF with pial arterial feeders by investigating surgical findings and outcomes. Methods: In 40 patients with intracranial dAVF who underwent microsurgery, we found eight patients who had pial arterial feeders. A retrospective review was conducted. Results: The locations of the dAVFs were as follows: tentorium, 2 patients; Galenic system, 1; straight sinus, 1; torcula, 1; transverse sinus, 1; ethmoid, 1; and convexity, 1. Preoperative angiography revealed that the pial arterial feeders originated from the middle cerebral artery in two patients, the anterior cerebral artery in one, the posterior cerebral artery in two, and the posterior medial choroidal artery in one. Of note, in two patients (6.7%), feeders from the superior cerebellar artery were determined to be angiographically occult during preoperative examination and were detected through careful intraoperative observation and arachnoid dissection. In five cases, the additional obliteration of the pial arterial feeders and/or more distal cortical venous drainers after the simple disconnection of proximal cortical drainers was necessary to cure the dAVF. Finally, all shunts were cured with only one minor complication. Conclusion: Although microsurgical results were acceptable, the surgeon should be aware of the presence of pial arterial feeders even after the simple disconnection of cortical venous drainage. Angiographically occult feeders may also exist.
• Neuroprotective effects of combination therapy of regional cold perfusion and hemoglobin-based oxygen carrier administration on rat transient cerebral ischemia.

  Yasuhiro Ito, Takeo Abumiya, Teruyuki Komatsu, Ryosuke Funaki, Masayuki Gekka, Kota Kurisu, Taku Sugiyama, Masahito Kawabori, Toshiya Osanai, Naoki Nakayama, Ken Kazumata, Kiyohiro Houkin

  Brain research 1746 147012 - 147012 2020年07月09日 [査読有り][通常論文]
   

  Regional cold perfusion and hemoglobin-based oxygen carrier administration both exert neuroprotective effects against cerebral ischemia reperfusion injury. We herein investigated whether the combination of these two therapies leads to stronger neuroprotective effects. Combination therapy was performed with the regional perfusion of cold HemoAct, a core-shell structured hemoglobin-albumin cluster, in a rat transient middle cerebral artery occlusion model. The effects of combination therapy, the intra-arterial administration of 10 °C HemoAct (10H) initiated at the onset of reperfusion, were compared with those of monotherapies, the intra-arterial administration of 10 °C saline (10S) and 37 °C HemoAct (37H), and an untreated control under the condition of 2-hour ischemia/24-hour reperfusion. The durability of therapeutic effects and the therapeutic time window of combination therapy were assessed based on comparisons with the 10H and control groups. Significantly better neurological findings and smaller infarct volumes were observed in the three treated (10S, 37H, and 10H) groups than in the control group. Among the 3 treated groups, only the 10H group showed significant improvements over the control group in the other items examined, including cerebral blood flow reduction, brain edema, and protein extravasation. The significant therapeutic effects of combination therapy on neurological disabilities and infarct volumes were confirmed at least until 7 days after reperfusion. Furthermore, combination therapy ameliorated neurological disabilities and hemorrhagic transformation in rats subjected to 4- and 5-hour ischemia/24-hour reperfusion. Since therapeutic effects may be expected until at least 5 h of complete ischemia and reperfusion, this combination therapy is a promising neuroprotective strategy against severe ischemic stroke.
• Development of a Deep Learning-Based Algorithm to Detect the Distal End of a Surgical Instrument

  Hiroyuki Sugimori, Taku Sugiyama, Naoki Nakayama, Akemi Yamashita, Katsuhiko Ogasawara

  Applied Sciences 10 12 4245 - 4245 2020年06月20日 [査読有り][通常論文]
  
  ダウンロード
• Neuroendoscope-Assisted Aneurysm Trapping for Ruptured Intraventricular Aneurysms in Moyamoya Disease Patients: A Case Report.

  Kikutaro Tokairin, Ken Kazumata, Shuho Gotoh, Taku Sugiyama, Hiroyuki Kobayashi

  World neurosurgery 2020年05月31日 [査読有り][通常論文]
   

  BACKGROUND: Intracranial hematomas associated with abnormal collateral vessels are observed in certain populations of adult patients with moyamoya disease (MMD). Of these, intraventricular hematomas resulting from rupture of intraventricular aneurysms, which are formed along an abnormal peripheral choroidal artery, are sometimes detected and could be severe. No appropriate treatment option for these ruptured aneurysms has been well established to date. Therefore, in this report, we describe the case of an MMD patient with an intraventricular hematoma resulting from a ruptured intraventricular aneurysm arising along the abnormal collateral vessels near the lateral ventricular wall, which was successfully treated using a neuroendoscope. CASE DESCRIPTION: A 53-year-old female with MMD had presented with an intraventricular hematoma. The patient had already undergone bilateral, combined direct/indirect cerebral revascularization surgery three years prior. Digital subtraction angiography revealed an aneurysm along the abnormal collateral choroidal artery near the posterior horn of the left lateral ventricle. A neuroendoscopic technique was applied to approach and treat the aneurysm; this was performed successfully by trapping using aneurysm clips without intraoperative or postoperative complications. CONCLUSIONS: Neuroendoscopic aneurysm trapping using aneurysm clips is a treatment option for an intraventricular aneurysm that causes an intraventricular hematoma in patients with MMD. This technique is minimally invasive and offers good visibility of the surgical field.
• Combined structural and diffusion tensor imaging detection of ischemic injury in moyamoya disease: relation to disease advancement and cerebral hypoperfusion.

  Ken Kazumata, Kikutaro Tokairin, Masaki Ito, Haruto Uchino, Taku Sugiyama, Masahito Kawabori, Toshiya Osanai, Khin Khin Tha, Kiyohiro Houkin

  Journal of neurosurgery 134 3 1 - 10 2020年04月03日 [査読有り][通常論文]
   

  OBJECTIVE: The microstructural integrity of gray and white matter is decreased in adult moyamoya disease, suggesting covert ischemic injury as a mechanism of cognitive dysfunction. Establishing a microstructural brain imaging marker is critical for monitoring cognitive outcomes following surgical interventions. The authors of the present study determined the pathophysiological basis of altered microstructural brain injury in relation to advanced arterial occlusion, cerebral hypoperfusion, and cognitive function. METHODS: The authors examined 58 patients without apparent brain lesions and 30 healthy controls by using structural MRI, as well as diffusion tensor imaging (DTI). Arterial occlusion in each hemisphere was classified as early or advanced stage based on MRA and posterior cerebral artery (PCA) involvement. Regional cerebral blood flow (rCBF) was measured with N-isopropyl-p-[123I]-iodoamphetamine SPECT. Furthermore, cognitive performance was examined using the Wechsler Adult Intelligence Scale, Third Edition and the Trail Making Test (TMT). Both voxel- and region of interest-based analyses were performed for groupwise comparisons, as well as correlation analysis, using parameters such as cognitive test scores; gray matter volume; fractional anisotropy (FA) of association fiber tracts, including the inferior frontooccipital fasciculus (IFOF) and superior longitudinal fasciculus (SLF); PCA involvement; and rCBF. RESULTS: Compared to the early stages, advanced stages of arterial occlusion in the left hemisphere were associated with a lower Performance IQ (p = 0.031), decreased anterior cingulate volumes (p = 0.0001, uncorrected), and lower FA in the IFOF, cingulum, and forceps major (all p < 0.01, all uncorrected). There was no significant difference in rCBF between the early and the advanced stage. In patients with an advanced stage, PCA involvement was correlated with a significantly lower Full Scale IQ (p = 0.036), cingulate volume (p < 0.01, uncorrected), and FA of the left SLF (p = 0.0002, uncorrected) compared to those with an intact PCA. The rCBF was positively correlated with FA of the SLF, IFOF, and forceps major (r > 0.34, p < 0.05). Global gray matter volumes were moderately correlated with TMT part A (r = 0.40, p = 0.003). FA values in the left SLF were moderately associated with processing speed (r = 0.40, p = 0.002). CONCLUSIONS: Although hemodynamic compensation may mask cerebral ischemia in advanced stages of adult moyamoya disease, the disease progression is detrimental to gray and white matter microstructure as well as cognition. In particular, additional PCA involvement in advanced disease stages may impair key neural substrates such as the cingulum and SLF. Thus, combined structural MRI and DTI are potentially useful for tracking the neural integrity of key neural substrates associated with cognitive function and detecting subtle anatomical changes associated with persistent ischemia, as well as disease progression.
• 基本をマスター 脳神経外科手術のスタンダード 頭蓋内硬膜動静脈瘻に対する開頭手術

  杉山 拓

  脳神経外科速報 30 2 150 - 158 (株)メディカ出版 2020年02月 [査読無し][招待有り]
   

  ＜POINT 1＞開頭術の役割を考慮し、血管内治療や定位放射線治療をも含めた総合的な治療戦略が重要。＜POINT 2＞硬膜動静脈瘻手術の基本は、脳に逆流する静脈流出路の遮断である。＜POINT 3＞手術では、詳細な画像検討と部位に応じた適切なアプローチ選択をすることが肝要。(著者抄録)
• Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review.

  Taku Sugiyama, Naoki Nakayama, Satoshi Ushikoshi, Ken Kazumata, Michinari Okamoto, Masaki Ito, Toshiya Osanai, Yusuke Shimoda, Kazuki Uchida, Daisuke Shimbo, Yasuhiro Ito, Katsuyuki Asaoka, Toshitaka Nakamura, Satoshi Kuroda, Kiyohiro Houkin

  Neurosurgical Review 44 1 435 - 450 2020年01月02日 [査読有り][通常論文]
   

  Although microsurgery is an established treatment modality for intracranial dural arteriovenous fistula (dAVF), data regarding the perioperative complication rate, cure rate, and long-term outcomes remain scarce. The aims of this study were to describe our original experience with microsurgery, including the surgical complications and pitfalls, and conduct a systematic review of the relevant literature. A multicenter cohort of patients with dAVF treated by microsurgery was retrospectively assessed. In addition, the PubMed database was searched for published studies involving microsurgery for dAVF, and the complication rate, cure rate, and long-term outcomes were estimated. The total number of patients in our multicenter series and published articles was 553 (593 surgeries). The overall rates of transient complications, permanent complications, death, and incomplete treatment were 11.4, 4.0, 1.2, and 6.5%, respectively. A favorable outcome was achieved for 90.1% patients, even though almost half of the patients presented with intracranial hemorrhage. Of note, the incidence of recurrence was only one per 8241 patient-months of postoperative follow-up. Surgeries for anterior cranial fossa dAVF were associated with a lower complication rate, whereas those for tentorial dAVF were associated with higher complication and incomplete treatment rates. The complication and incomplete treatment rates were lower with simple disconnection of cortical venous drainage than with radical occlusion/resection of dural shunts. Our findings suggest that the cure rate, complication rates, and outcomes of microsurgery for dAVF are acceptable; thus, it could be a feasible second-line treatment option for dAVF. However, surgeons should be aware of the specific adverse events of microsurgery.
• Brain Structure, Connectivity, and Cognitive Changes Following Revascularization Surgery in Adult Moyamoya Disease

  Ken Kazumata, Khin Khin Tha, Kikutaro Tokairin, Masaki Ito, Haruto Uchino, Masahito Kawabori, Taku Sugiyama

  NEUROSURGERY 85 5 E943 - E952 2019年11月 [査読有り][通常論文]
   

  BACKGROUND: The effect of the combined direct/indirect revascularization surgery in Moyamoya disease has not been evaluated sufficiently with regard to cognitive function, brain microstructure, and connectivity.OBJECTIVE: To investigate structural and functional changes following revascularization surgery in patients with moyamoya disease (MMD) through a combined analysis of brain morphology, microstructure, connectivity, and neurobehavioral data.METHODS: Neurobehavioral and neuroimaging examinations were performed in 25 adults with MMD prior to and >12 mo after revascularization surgery. Cognitive function was investigated using the Wechsler Adult Intelligence Scale-III, Trail-Making Test, Wisconsin Card Sorting Test, Continuous Performance Test, Stroop test, and Wechsler Memory Scale. We assessed white matter integrity using diffusion tensor imaging, brain morphometry using magnetization-prepared rapid gradient-echo sequences, and brain connectivity using resting-state functional magnetic resonance imaging (MRI).RESULTS: Cognitive examinations revealed significant changes in the full-scale intelligence quotient (IQ), performance IQ(PIQ), perceptual organization (PO), processing speed, and Stroop test scores after surgery (P <.05). Enlargement of the lateral ventricle, volume reductions in the corpus callosum and subcortical nuclei, and cortical thinning in the prefrontal cortex were also observed (P <.05). Fractional anisotropy in the white matter tracts, including the superior longitudinal fasciculus, increased 2 to 4 yr after surgery, relative to that observed in the presurgical state (P <.05). Resting-state brain connectivity was increased predominantly in the fronto-cerebellar circuit and was positively correlated with improvements in PIQ and PO (P <.05).CONCLUSION: Revascularization surgery may improve processing speed and attention in adult patients with MMD. Further, multimodal MRI may be useful for detecting subtle postsurgical brain structural changes, reorganization of white matter tracts, and brain connectivity alterations.
• Association of cognitive function with cerebral blood flow in children with moyamoya disease.

  Ken Kazumata, Kikutaro Tokairin, Taku Sugiyama, Masaki Ito, Haruto Uchino, Toshiya Osanai, Masahito Kawabori, Naoki Nakayama, Kiyohiro Houkin

  Journal of neurosurgery. Pediatrics 1 - 7 2019年10月11日 [査読有り][通常論文]
   

  OBJECTIVE: The cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions. METHODS: In this prospective, observational, single-center study, 21 children (mean age 10 ± 3.0 years, range 5-14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children-Fourth Edition at the initial diagnosis. rCBF was measured using [123I] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined. RESULTS: The mean full-scale intelligence quotient (FIQ) was 101.8 ± 12.5 (range 76-125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI - WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 ± 5.3 ml/100 g/min, right 65.3 ± 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 ± 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance. CONCLUSIONS: Although average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.
• A Pilot Study on Measuring Tissue Motion During Carotid Surgery Using Video-Based Analyses for the Objective Assessment of Surgical Performance.

  Taku Sugiyama, Toshitaka Nakamura, Yasuhiro Ito, Kikutaro Tokairin, Ken Kazumata, Naoki Nakayama, Kiyohiro Houkin

  World Journal of Surgery 43 9 2309 - 2319 2019年09月 [査読有り][通常論文]
   

  BACKGROUND: The 'gentle' handling of tissue (i.e., 'respect for tissue') is a fundamental aspect of surgical performance and learning. To date, there have been no methodological assessments that quantitatively measure 'gentleness.' Therefore, the aims of this study were (1) to propose a novel metric for gentle surgical maneuvers, (2) to validate the feasibility of this methodology, and (3) to explore safer surgical techniques through this methodology. METHODS: Using surgical video-based motion software, the motion of the carotid artery around plaque was analyzed and quantified during a carotid endarterectomy. Kinematic parameters (minimum and maximum acceleration, and maximum and mean velocity) were compared among the surgical tasks and techniques, as well as between novice and expert surgeons. RESULTS: The surgical tasks of dissecting the common carotid artery, passing the proximal vessel loops, and ligating vessels showed the highest absolute values of kinematic parameters. Dissections perpendicular to the line of the internal carotid artery tended to show higher kinematic parameters than those in the parallel direction, with blunt dissections typically higher than sharp dissections. The kinematic parameters of novice surgeons were significantly higher than those of experts, and receiver operating curve analysis showed a strong discriminative power. CONCLUSION: This study shows that tissue motion parameters could be a novel and feasible surrogate marker for the objective assessment on the 'gentleness' of surgical performance. Future studies should be performed to further elucidate the relationship on the direct correlation between tissue kinematic data and clinical outcomes or surgical adverse events.
• 一流術者のココが知りたい 手術のコツとピットフォール 椎骨動脈‐後下小脳動脈瘤(VA‐PICA AN)の開頭術

  杉山拓

  脳神経外科速報 29 3 255‐261  2019年03月10日 [査読無し][招待有り]
  
• Long-term outcomes for pediatric patients with brain arteriovenous malformations treated with Gamma Knife radiosurgery, Part 2: The incidence of cyst formation, encapsulated hematoma, and radiation-induced tumor.

  Hasegawa T, Kato T, Naito T, Tanei T, Torii J, Ishii K, Tsukamoto E, Hatanaka KC, Sugiyama T

  World neurosurgery 126 e1526 - e1536 2019年03月 [査読有り][通常論文]
   

  OBJECTIVE: Long-term data about the incidence of late adverse radiation effects (AREs) in pediatric brain arteriovenous malformations (AVMs) treated with Gamma Knife radiosurgery (GKRS) are lacking. This study addresses the incidence of late AREs, including cyst formation (CF), chronic encapsulated hematoma (CEH), and radiation-induced tumor, in pediatric patients with AVM treated with GKRS. METHODS: This is a single-institutional study involving pediatric patients with AVM who underwent GKRS between 1991 and 2014. Among 201 pediatric patients with AVM (age ≤15 years), 189 who had at least 12 months of follow-up were assessed in this study. The median treatment volume was 2.2 cm3, and the median marginal dose was 20 Gy. RESULTS: The mean follow-up period was 136 months. During the follow-up period, symptomatic radiation-induced perilesional edema was found in 5 patients (3%), CFs in 7 patients (4%), CEHs in 7 patients (4%), and radiation-induced tumors in 2 patients (1%). The cumulative incidences of late AREs including CF, CEH, and radiation-induced tumor were 1.2% at 5 years, 5.2% at 8 years, 6.1% at 10 years, 7.2% at 15 years, and 17.0% at 20 years. In the multivariate analysis, treatment volume alone was a significant factor for late AREs (P < 0.001; hazard ratio, 1.111). CONCLUSIONS: GKRS is a reasonable treatment option for pediatric AVMs to prevent future intracranial hemorrhages, particularly in the eloquent regions. However, considerable attention should be paid to late AREs such as CFs, CEHs, and radiation-induced tumors because of longer life expectancy in pediatric patients.
• Forces of tool-tissue interaction to assess surgical skill level

  Taku Sugiyama, Sanju Lama, Liu Shi Gan, Yaser Maddahi, Kourosh Zareinia, Garnette R. Sutherland

  JAMA Surgery 153 3 234 - 242 2018年03月01日 [査読有り][通常論文]
   

  IMPORTANCE The application of optimal forces between surgical instruments and tissue is fundamental to surgical performance and learning. To date, this force has not been measured clinically during the performance of microsurgery. OBJECTIVES To establish a normative catalog of force profiles during the performance of surgery, to compare force variables among surgeons with different skill levels, and to evaluate whether such a force-based metric determines or differentiates skill level. DESIGN, SETTING, AND PARTICIPANTS Through installation of strain gauge sensors, a force-sensing bipolar forceps was developed, and force data were obtained from predetermined surgical tasks at the Foothills Medical Centre, University of Calgary, a tertiary care center that serves Southern Alberta, Canada. Sixteen neurosurgeons (3 groups: novice, intermediate, and experienced) performed surgery on 26 neurosurgical patients with various conditions. Normative baseline force ranges were obtained using the force profiles (mean and maximum forces and force variability) from the experienced surgeons. Standardized force profiles and force errors (high force error [HFE], low force error [LFE], and force variability error [FVE]) were analyzed and compared among surgeons with different skill levels. MAIN OUTCOMES AND MEASURES Each trial of the forceps usewas termed successful or unsuccessful. The force profiles and force errors were analyzed and compared. RESULTS This study included 26 patients (10 [38%] male and 16 [62%] female mean [SD] age, 43 [15] years) undergoing neurosurgery by 16 surgeons (6 in the novice group, 5 in the intermediate group, and 5 in the experienced group). Unsuccessful trial-incomplete significantly correlated with LFE and FVE, and unsuccessful trial-bleeding correlated with HFE and FVE. The force strengths exerted by novice surgeons were significantly higher than those of experienced surgeons (0.74 vs 0.00 P < .001), and force variability decreased from novice (0.43) to intermediate (0.28) to experienced (0.00) surgeons however, these differences varied among surgical tasks. The rate of HFE and FVE inversely correlated with surgeon level of experience (HFE, 0.27 for novice surgeons, 0.12 for intermediate surgeons, and 0.05 for experienced surgeons FVE, 0.16 for novice surgeons, 0.10 for intermediate surgeons, and 0.05 for experienced surgeons). The rate of LFE significantly increased in intermediate (0.12) and novice (0.10) surgeons compared with experienced surgeons (0.04 P < .001). There was no difference in LFE between intermediate and novice surgeons. Stepwise discriminant analysis revealed that combined use of these error rates could accurately discriminate the groups (87.5%). CONCLUSIONS AND RELEVANCE Force-sensing bipolar forceps and force analysis may help distinguish surgeon skill level, which is particularly important as surgical education shifts to a competency-based paradigm.
• Forces of Tool-Tissue Interaction to Assess Surgical Skill Level (vol 153, pg 234, 2017)

  Sugiyama, T., Lama, S., Gan, L. S., Maddahi, Y., Zareinia, K., Sutherl, , G. R.

  Jama Surgery 153 3 292 - 292 2018年
• Tool-Tissue Interaction Forces in Brain Arteriovenous Malformation Surgery

  Taku Sugiyama, Liu Shi Gan, Kourosh Zareinia, Sanju Lama, Garnette R. Sutherland

  World Neurosurgery 102 221 - 228 2017年06月 [査読有り][通常論文]
   

  OBJECTIVE: Surgical resection of a brain arteriovenous malformation (AVM) poses a technical challenge because of the fragility and number of small feeding and draining vessels around the nidus. Acquiring knowledge of the optimal force applied to such tissue is important in surgical performance and education. METHODS: A force-sensing bipolar forceps was developed through installation of strain gauge sensors, and force profiles were obtained from 2 AVM surgeries. The force data associated with vessel injury, unsuccessful trial, was compared with that from successful trials. Receiver operating curve analysis was used for determining optimal force threshold and evaluating the discriminative accuracy of measurement. RESULTS: Force data from 519 trials was collected, of which 16 (3.1%) were unsuccessful. The mean and maximum forces in successful trials were 0.23 +/- 0.06 N and 0.35 +/- 0.11 N compared with unsuccessful trials of 0.33 +/- 0.05 N and 0.53 +/- 0.11 N, respectively (P < 0.001). There was a strong association of mean and maximum force peaks with unsuccessful trials as reflected by the area under the curve of 0.91 and 0.87, respectively. Threshold analysis showed that the rate of unsuccessful trials and error forces tended to increase with surgical time. CONCLUSIONS: Excessive force at the tool tip may result in injury to fragile vessels during AVM surgery. A quantifiable metric through force sensing instruments can detect and predict the occurrence of such injury. Such an instrument may be ideal for resident training and evaluation.
• A Force-Sensing Bipolar Forceps to Quantify Tool–Tissue Interaction Forces in Microsurgery

  Zareinia K, Maddahi Y, Gan LS, Ghasemloonia A, Lama S, Sugiyama T, Sutherland GR

  IEEE/ASME Transactions on Mechatronics 21 5 2365 - 2377 2016年10月 [査読有り][通常論文]
   

  The ability to exert an appropriate amount of force on brain tissue during surgery is an important component of instrument handling. It allows surgeons to achieve the surgical objective effectively while maintaining a safe level of force in tool-tissue interaction. At the present time, this knowledge, and hence skill, is acquired through experience and is qualitatively conveyed from an expert surgeon to trainees. These forces can be assessed quantitatively by retrofitting surgical tools with sensors, thus providing a mechanism for improved performance and safety of surgery, and enhanced surgical training. This paper presents the development of a force-sensing bipolar forceps, with installation of a sensory system, that is able to measure and record interaction forces between the forceps tips and brain tissue in real time. This research is an extension of a previous research where a bipolar forceps was instrumented to measure dissection and coagulation forces applied in a single direction. Here, a planar forceps with two sets of strain gauges in two orthogonal directions was developed to enable measuring the forces with a higher accuracy. Implementation of two strain gauges allowed compensation of strain values due to deformations of the forceps in other directions (axial stiffening) and provided more accurate forces during microsurgery. An experienced neurosurgeon performed five neurosurgical tasks using the axial setup and repeated the same tasks using the planar device. The experiments were performed on cadaveric brains. Both setups were shown to be capable of measuring real-time interaction forces. Comparing the two setups, under the same experimental condition, indicated that the peak and mean forces quantified by planar forceps were at least 7% and 10% less than those of axial tool, respectively; therefore, utilizing readings of all strain gauges in planar forceps provides more accurate values of both peak and mean forces than axial forceps. Cross-correlation analysis between the two force signals obtained, one from each cadaveric practice, showed a high similarity between the two force signals.
• Treatment of Recurrent Intracranial Aneurysms After Clipping: A Report of 23 Cases and a Review of the Literature

  Masaaki Hokari, Ken Kazumara, Naoki Nakayama, Satoshi Ushikoshi, Taku Sugiyama, Katsunori Asaoka, Kazuki Uchida, Daisuke Shimbo, Koji Itamoto, Yuka Yokoyama, Masanori Isobe, Tetsuaki Imai, Toshiya Osanai, Kiyohiro Houkin

  WORLD NEUROSURGERY 92 434 - 444 2016年08月 [査読有り][通常論文]
   

  OBJECTIVE: There are no established treatment strategies for aneurysms that recur after clipping. In this study, we present cases of patients who experienced recurrent aneurysms after clipping and subsequently underwent surgical intervention. METHODS: Between 2004 and 2015, we surgically treated 23 aneurysms that recurred at a previously clipped site. Patient characteristics and clinical history were retrospectively reviewed. RESULTS: Patients included 19 women and 4 men 45-81 years old. Aneurysms recurred 3-31 years (mean, 15.4 years) after the initial operation. For 18 cases, the first clinical presentation was a subarachnoid hemorrhage; aneurysms were incidentally diagnosed in 5 patients. Aneurysm locations were as follows: 9 on the internal carotid artery; 4 on the middle cerebral artery; 7 on the anterior communicating artery; 2 on the distal anterior cerebral artery; and 1 on the basilar artery. The reasons for retreatment included subarachnoid hemorrhage (n = 9) and aneurysm regrowth detected on follow-up examinations (n = 14). Endovascular treatment was performed in 10 cases, and direct surgery was performed in 13 cases (clipping in 8, clipping or trapping with bypass in 5). Various complex vascular reconstructions, including high-flow bypass and intracranial-intracranial in situ bypass, were performed for recurrent aneurysms. CONCLUSIONS: In our experience, coil embolization is a safe and effective procedure for treating recurrent aneurysms. When cases are unsuitable for coil embolization, surgical treatment often requires neurosurgeons not only to overcome the general technical difficulty of reoperative clipping but also to perform challenging vascular reconstruction.
• 【治療困難な動脈瘤の手術】クリッピング困難な内頸動脈瘤に対するバイパス併用手術

  杉山 拓, 中山 若樹, 数又 研, 新保 大輔, 月花 正幸, 内田 和希, 穂刈 正昭, 浅岡 克行, 板本 孝治, 寳金 清博

  脳卒中の外科 44 3 183 - 188 (一社)日本脳卒中の外科学会 2016年05月 [査読有り][招待有り]
   

  クリッピング困難な内頸動脈瘤に対してバイパス併用手術を行った50例の治療成績について検討した。その結果、1)41例で良好な転帰が得られていたが、術後に出血性合併症を1例、虚血性合併症を8例で認められた。2)合併率を部位別に検討すると、Segment 1で5.2%、Segment 2で16.7%、Segment 3で55.6%と、Segment 3で合併症が多く認められた。一方、単変量解析でみた、術後の合併症に関係する因子としては、性別と動脈瘤の部位が有意にあり、特に動脈瘤の部位で強い相関が示された。だが、多変量解析ではいずれの因子も有意と判定されなかった。
• Mitral valve repair for endocarditis can be performed 3 days after repair of a bleeding mycotic brain aneurysm

  Ryushi Maruyama, Akira Yamada, Taku Sugiyama, Kosuke Ujihira, Naritomo Nishioka, Yutaka Iba, Eiichiro Hatta, Yoshihiko Kurimoto, Katsuyuki Asaoka, Katsuhiko Nakanishi, Keisuke Sakai

  JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 151 4 E59 - E61 2016年04月 [査読有り][通常論文]
  
• Reappraisal of Microsurgical Revascularization for Anterior Circulation Ischemia in Patients with Progressive Stroke.

  Taku Sugiyama, Ken Kazumata, Katsuyuki Asaoka, Toshiya Osanai, Daisuke Shimbo, Kazuki Uchida, Yuka Yokoyama, Naoki Nakayama, Kouji Itamoto, Kiyohiro Houkin

  World Neurosurgery 84 6 1579 - 88 2015年12月 [査読有り][通常論文]
   

  BACKGROUND: Intravenous thrombolysis using tissue plasminogen activator and endovascular treatment for acute ischemic stroke is becoming an established standard therapy. However, there is no consensus in the treatment of patients who are suffering from progressive neurologic symptoms in the later stages. The purpose of this study was to evaluate the safety and efficacy of microsurgical revascularization in such patients with progressive stroke. METHODS: We retrospectively reviewed the clinical and radiological records of 14 consecutive patients with progressive stroke who underwent emergency open surgery for anterior circulation occlusion within 7 days after onset. Surgical candidates were carefully selected on the basis of symptom severity, diffusion-weighted imaging, and perfusion study. Superficial temporal artery to middle cerebral artery bypass was applied for atherosclerotic occlusion, and microsurgical embolectomy was applied for embolic occlusion. RESULTS: Superficial temporal artery to middle cerebral artery bypass was performed in 12 patients, microsurgical embolectomy in 1, and the combination of these modalities in 1. As a result, complete revascularization was achieved in all patients. The National Institutes of Health Stroke Scale scores significantly improved after surgery (at third postoperative day, P < 0.05; at 14th postoperative day, P < 0.01). A favorable outcome (modified Rankin Scale 0-2) was achieved in 12 of the 14 (85.7%) patients. Minor intracerebral hemorrhage occurred in 1 patient and hyperperfusion syndrome occurred in 1 patients; however, the patients subsequently recovered without additional treatment. CONCLUSIONS: Microsurgical revascularization is a feasible treatment option for patients with progressive stroke due to anterior circulation major vessel occlusion.
• 基本をマスター 脳神経外科手術のスタンダード 破裂症例の手術における脳動脈瘤周囲操作の基本

  杉山 拓

  脳神経外科速報 25 11 1140 - 1147 (株)メディカ出版 2015年11月 [査読無し][招待有り]
   

  ＜POINT 1＞動脈瘤を破裂させないような手技の習得が大切であるが、一方で、"今破裂したらどうするか"を常に考えながら手術戦略を構築する。＜POINT 2＞選択枝を減らさぬように、多くのテクニックの引き出しを習得するのが大切である。＜POINT 3＞バイパスのドナー、頸部での内頸動脈確保など、安全のために可能な準備は怠らないようにする。(著者抄録)
• 脳膿瘍治療中に発症したメトロニダゾール脳症の2例

  横山 由佳, 浅岡 克行, 杉山 拓, 内田 和希, 新保 大輔, 小林 聡, 板本 孝治

  No shinkei geka. Neurological surgery 43 10 927 - 932 2015年10月01日 [査読有り][通常論文]
   

  Metronidazole is a widely used antibiotic against anaerobic bacteria and protozoa. We report two cases of metronidazole-induced encephalopathy (MIE) during treatment of a brain abscess with metronidazole. The patients developed mental disturbance, and brain MRI showed reversible signals on DWI, FLAIR, and T2. Case 1: A 48-year-old woman was admitted to our hospital with a cerebellar abscess. We initiated treatment with oral metronidazole. After taking the medication, she developed mental disturbance, and her brain MRI showed a hyperintensity within the corpus callosum. We suspected metronidazole toxicity and discontinued metronidazole treatment. The symptoms resolved rapidly within a week, and the hyperintensity on the MRI disappeared. Case 2: A 22-year-old man was admitted to our hospital with a brain abscess. We initiated treatment with oral metronidazole. On day 38, he developed mental disturbance, and his MRI showed hyperintensities within the bilateral dentate nuclei and corpus callosum. These symptoms were consistent with MIE. After cessation of metronidazole, his symptoms and abnormal MRI signals completely disappeared.
• Histologically confirmed case of cerebral vasculitis associated with Crohn's disease - a case report

  Masayuki Gekka, Taku Sugiyama, Masafumi Nomura, Yasutaka Kato, Hiroshi Nishihara, Katsuyuki Asaoka

  BMC NEUROLOGY 15 169  2015年09月 [査読有り][通常論文]
   

  Background: Extraintestinal manifestations in Crohn's disease (CD) are frequent and well recognized. However, neurological involvement secondary to CD is rare, and there have been few histologically confirmed cases of cerebral vasculitis secondary to CD. Case presentation: A 58-year-old left-handed man with a history of refractory CD who had fever of over 38 degrees C, progression of CD symptoms, and Gerstmann's syndrome consulted our hospital. Laboratory data showed elevation of C-reactive protein (CRP) and hypoproteinemia. T2-weighted magnetic resonance imaging (MRI) revealed a right parietal high-intensity lesion. Catheter angiography showed segmental multiple narrowing and occlusion in the distal part of the middle cerebral artery and anterior cerebral artery. Angiography also revealed multiple venous occlusions in the affected parietal area. To confirm the diagnosis, the patient underwent open biopsy, and histological examination revealed cerebral vasculitis. The patient was then started on high-dose prednisolone (60 mg/day) in addition to his previous therapy, which included mesalazine, adalimumab, and azathioprine. CRP elevation, hypoproteinemia, and gastrointestinal symptoms immediately improved after starting this treatment. Neurological status improved simultaneously with CD symptom improvement, and follow-up brain MRI revealed a reduction in the size of the right parietal lobe lesion. He returned to normal status and was discharged from our hospital 5 weeks after admission. Conclusion: This is an important case of histologically confirmed cerebral vasculitis associated with CD. The clinical course of our case clearly illustrates the relevance of the occurrence of cerebral vasculitis and the exacerbation of CD.
• Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report

  Yukitomo Ishi, Katsuyuki Asaoka, Hiroyuki Kobayashi, Hiroaki Motegi, Taku Sugiyama, Yuka Yokoyama, Sumire Echizenya, Koji Itamoto

  SPRINGERPLUS 4 565  2015年09月 [査読有り][通常論文]
   

  Introduction: Fourth ventricle outlet obstruction (FVOO) is a rare cause of obstructive hydrocephalus. We describe a case of idiopathic FVOO that was successfully treated with endoscopic third ventriculostomy (ETV). Case report: A 3-year old boy without any remarkable medical history presented with a headache and vomiting. Computed tomography (CT) images, which had incidentally been taken 2 years previously due to a minor head injury, showed no abnormality. Magnetic resonance imaging on admission showed tetra-ventricular hydrocephalus associated with the dilatation of the fourth ventricle outlets, without any obstructive lesions. However, CT ventriculography, involving contrast medium injection through a ventricular catheter, suggested mechanical obstruction of the cerebrospinal fluid (CSF) at the fourth ventricle outlets. Thus, the patient was diagnosed with FVOO and ETV was performed; the hydrocephalus was subsequently resolved. Although hydrocephalus recurred 1 year postoperatively, re-ETV for the highly stenosed fenestration successfully resolved this condition. Conclusions: ETV should be considered for FVOO treatment, particularly in idiopathic cases without CSF malabsorption.
• Case report: Trigeminal neuralgia caused by a minute meningioma with hyperostosed suprameatal tubercle

  Yukitomo Ishi, Katsuyuki Asaoka, Taku Sugiyama, Yuka Yokoyama, Kazuyoshi Yamazaki, Sumire Echizenya, Koji Itamoto, Kohei Echizenya

  Case Reports in Neurology 7 2 167 - 172 2015年05月13日 [査読有り][通常論文]
   

  Cerebellopontine angle tumors might occasionally provoke trigeminal neuralgia but are usually large enough to be diagnosed radiographically. We present a case of trigeminal neuralgia caused by a very small meningioma covering the suprameatal tubercle that displayed hyperostosis at the entrance of Meckel's cave and was not obvious on routine magnetic resonance (MR) images. A 72-year-old woman with intractable trigeminal neuralgia in the left V3 territory was referred to our institution. Preoperative imaging studies revealed that the left trigeminal nerve was medially distorted at the entrance of Meckel's cave by a laterally seated bone bulge covered by a minute enhanced lesion. Trigeminal nerve decompression surgery was performed via a retrosigmoid intradural suprameatal approach. We found a small meningioma that had compressed and flattened the trigeminal nerve root at the entrance of Meckel's cave, which was grossly and totally removed by suprameatal tubercle resection. There was no vascular compression of the trigeminal nerve root. The trigeminal neuralgia ceased completely after the operation. Accurate preoperative determination of the causative pathologies is essential to achieve adequate surgical results after microvascular decompression for neurovascular compression syndrome. Because conventional MR sequences are inadequate for the precise interpretation of complex neurovascular anatomy in the cerebellopontine angle and such small tumors can be overlooked on routine MR studies, high-resolution thin-slice MR examinations and careful radiological interpretations are required for correct diagnosis and treatment.
• 受傷後早期に吸収された乳児急性硬膜外血腫の1例

  伊師 雪友, 浅岡 克行, 杉山 拓, 越前谷 すみれ, 横山 由佳, 板本 孝治

  Neurological Surgery 43 4 352 - 356 (株)医学書院 2015年04月 [査読有り][通常論文]
   

  症例は0歳7ヵ月男児で、母親に抱かれていたが、1mの高さからフローリングの床に転落し、右側頭部を打撲した。頭部CTで右側頭骨骨折と少量の硬膜下血腫を指摘され、さらに2時間後のCTで血腫の増大を認めた。意識清明、麻痺などの明らかな巣症状は認めず、啼泣はみられるが意識レベルの著変はなかった。受傷1時間後のCTでは右頭頂骨に逆Y字の線状骨折を認め、一部骨弁は外側へわずかに偏移していた。また、骨折部の直下に少量の硬膜外血腫を認め2時間後のCTで厚さ11mmに増大した。神経症状を頻回に観察しつつ保存的に経過観察した。受傷3日後、硬膜外血腫増大がないことを確認し自宅退院となった。受傷18日後にCTで硬膜外血腫および皮下血腫は消失し、触診上も皮下血腫ははっきり触れなくなった。全経過を通して、明らかな神経症状は出現しなかった。日常生活動作も受傷前と著変なく、3ヵ月後の外来受診で成長・発達とも問題がないことから後遺症はないと考えられた。
• 【最新臨床脳卒中学[下]-最新の診断と治療-】脳出血各論 被殻出血 被殻出血の病態

  杉山 拓, 中山 若樹

  日本臨床 72 増刊7 最新臨床脳卒中学(下) 341 - 344 (株)日本臨床社 2014年10月 [査読無し][招待有り]
  
• 「超」入門クリッピング・脳血行再建術

  Taku Sugiyama

  2014年04月01日
• 脳卒中で発症したreversible cerebral vasoconstriction syndromeの3例

  伊師 雪友, 杉山 拓, 越前谷 すみれ, 横山 由佳, 浅岡 克行, 板本 孝治

  No shinkei geka. Neurological surgery 42 2 129 - 136 2014年02月 [査読有り][通常論文]
  
• 【CEA(高位病変)】CEAにおける高位頸動脈病変へのアプローチ

  杉山 拓, 数又 研, 浅岡 克行, 横山 由佳, 板本 孝治

  脳卒中の外科 41 2 83 - 88 (一社)日本脳卒中の外科学会 2013年03月 [査読有り][招待有り]
  
• "Isolated carotid bifurcation" and vertebral-carotid artery bypass for common carotid artery occlusion

  Ken Kazumata, Katsuyuki Asaoka, Yuka Yokoyama, Taku Sugiyama, Sadahiro Kaneko, Kouji Itamoto

  Neurologia Medico-Chirurgica 53 3 179 - 182 2013年03月 [査読有り][通常論文]
   

  Symptomatic common carotid artery (CCA) occlusion is relatively rare, and requires an elaborate vascular reconstruction procedure with which many neurosurgeons are unfamiliar. We describe a case of CCA occlusion managed by vertebral artery (VA)-internal carotid artery (ICA) saphenous vein interposition graft. An 80-year-old man presented with deterioration of consciousness, transient aphasia, and severe right hemiparesis. Angiography revealed proximal occlusion of the left CCA with concomitant patent ICA. Cerebral blood flow measurement using iodine-123 N-isopropyl-p-iodoamphetamine and single photon emission computed tomography showed corresponding hemodynamic insufficiency of the left hemisphere. The patient underwent a novel revascularization procedure, in which the saphenous vein was used as an interposition graft between the V3 segment of the VA and the left proximal ICA. Postoperative course was uneventful, and patency of the bypass graft was confirmed. VA-ICA bypass with interposition graft is an alternative treatment option for symptomatic proximal CCA occlusion.
• Occipital-posterior cerebral artery bypass via the occipital interhemispheric approach

  Taku Sugiyama

  Surgical Neurology International 4 90  2013年 [査読有り][通常論文]
  
• Transplanted bone marrow stromal cells protect neurovascular units and ameliorate brain damage in stroke-prone spontaneously hypertensive rats

  Masaki Ito, Satoshi Kuroda, Taku Sugiyama, Katsuhiko Maruichi, Masahito Kawabori, Naoki Nakayama, Kiyohiro Houkin, Yoshinobu Iwasaki

  NEUROPATHOLOGY 32 5 522 - 533 2012年10月 [査読有り][通常論文]
   

  This study was aimed to assess whether bone marrow stromal cells (BMSC) could ameliorate brain damage when transplanted into the brain of stroke-prone spontaneously hypertensive rats (SHR-SP). The BMSC or vehicle was stereotactically engrafted into the striatum of male SHR-SP at 8 weeks of age. Daily loading with 0.5% NaCl-containing water was started from 9 weeks. MRIs and histological analysis were performed at 11 and 12 weeks, respectively. Wistar-Kyoto rats were employed as the control. As a result, T2-weighted images demonstrated neither cerebral infarct nor intracerebral hemorrhage, but identified abnormal dilatation of the lateral ventricles in SHR-SP. HE staining demonstrated selective neuronal injury in their neocortices. Double fluorescence immunohistochemistry revealed that they had a decreased density of the collagen IV-positive microvessels and a decreased number of the microvessels with normal integrity between basement membrane and astrocyte end-feet. BMSC transplantation significantly ameliorated the ventricular dilatation and the breakdown of neurovascular integrity. These findings strongly suggest that long-lasting hypertension may primarily damage neurovascular integrity and neurons, leading to tissue atrophy and ventricular dilatation prior to the occurrence of cerebral stroke. The BMSC may ameliorate these damaging processes when directly transplanted into the brain, opening the possibility of prophylactic medicine to prevent microvascular and parenchymal-damaging processes in hypertensive patients at higher risk for cerebral stroke.
• 【側頭葉とその周辺の解剖と手術II】Transsylvian approachに必要な解剖学的知識

  数又 研, 横山 由佳, 杉山 拓, 浅岡 克行, 金子 貞洋, 月花 正幸, 板本 孝治

  脳神経外科ジャーナル 21 9 680 - 687 日本脳神経外科コングレス 2012年09月 [査読有り][招待有り]
  
• 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 （３）未破裂中大脳動脈瘤の外科治療

  川堀 真人, 数又 研, 大西 浩介, 杉山 拓, 伊東 雅基, 中山 若樹, 寳金 清博

  脳神経外科 40 8 731 - 740 (株)医学書院 2012年08月 [査読有り][招待有り]
   

  2000〜2011年の未破裂中大脳動脈瘤の手術成績が報告されている論文をPubMed(英文)、J-stage(和文)により検索し、開頭clipping術に関する21件1323例を抽出し解析した。21件のcase seriesにおけるmorbidityは0.0〜26.1%に分布していた。開頭術により合併症を呈した例は54例集積され、平均4.1%と算出された。瘤サイズ別では7mm以下が1.48%、15mm前後が5.93%、25mm以上が27.8%で、死亡は1例のみであった。中大脳動脈領域の虚血性合併症の出現率は2.1%、穿通枝領域では1.3%、術後1週間以降に生じたvasospasmは0.7%、静脈性梗塞は0.7%であった。巨大動脈瘤、血栓化動脈瘤、serpentine aneurysm、コイル塞栓術後の再処理などのcomplex aneurysmsは64例報告され、合併症は15例(23.4%)にみられた。稀な合併症としてはclipに関連するslip out、voaospasm、動脈瘤再増大・血栓化、ビオボンドによる遅発性動脈閉塞などが報告されていた。
• Giant Calcified Thrombosed Varices Secondary to a Pial Arteriovenous Fistula Associated With Hereditary Hemorrhagic Telangiectasia -Case Report of Surgical Removal-

  Taku Sugiyama, Naoki Nakayama, Shunsuke Terasaka, Satoshi Kuroda, Kiyohiro Houkin

  NEUROLOGIA MEDICO-CHIRURGICA 52 7 506 - 509 2012年07月 [査読有り][通常論文]
   

  A 28-year-old woman presented with an unusual case of giant thrombosed varix with calcified walls that had mass effects secondary to a pial single-channel arteriovenous fistula (AVF) associated with hereditary hemorrhagic telangiectasia (HHT). She consulted our hospital for chronic headache. She had been diagnosed with HHT based on genetic testing when her 3-year-old son presented with subarachnoid hemorrhage due to spinal AVF. Imaging studies revealed pial single-channel AVF with multiple varices. The varices in the right frontal lobe were over 6 cm in diameter and had laminar thromboses and calcified walls. Because of the mass effect, direct surgical flow disconnection was performed followed by removal of the varices using an internal decompression technique. Postoperatively, the patient was discharged with no neurological symptoms and no longer suffered chronic headache. Intracerebral varices are occasionally associated with high-flow AVF, and usually treated by interrupting the feeding arteries leaving the varices intact. This extremely rare case of intracerebral giant thrombosed varices with calcified wall and mass effect indicates that surgical removal of varices should be considered.
• 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 （２）未破裂前大脳動脈瘤の外科治療

  杉山 拓, 寳金 清博, 伊東 雅基, 穂刈 正昭, 中山 若樹, 数又 研, 黒田 敏

  脳神経外科 40 6 555 - 565 (株)医学書院 2012年06月 [査読有り][招待有り]
  
• Intracerebral, but not intravenous, transplantation of bone marrow stromal cells enhances functional recovery in rat cerebral infarct: An optical imaging study

  Masahito Kawabori, Satoshi Kuroda, Taku Sugiyama, Masaki Ito, Hideo Shichinohe, Kiyohiro Houkin, Yuji Kuge, Nagara Tamaki

  NEUROPATHOLOGY 32 3 217 - 226 2012年06月 [査読有り][通常論文]
   

  Recent studies have indicated that bone marrow stromal cells (BMSC) may improve neurological function when transplanted into an animal model of CNS disorders, including cerebral infarct. However, there are few studies that evaluate the therapeutic benefits of intracerebral and intravenous BMSC transplantation for cerebral infarct. This study was aimed to clarify the favorable route of cell delivery for cerebral infarct in rats. The rats were subjected to permanent middle cerebral artery occlusion. The BMSC were labeled with near infrared (NIR)-emitting quantum dots and were transplanted stereotactically (1 x 10(6) cells) or intravenously (3 x 10(6) cells) at 7 days after the insult. Using in vivo NIR fluorescence imaging technique, the behaviors of BMSC were serially visualized during 4 weeks after transplantation. Motor function was also assessed. Immunohistochemistry was performed to evaluate the fate of the engrafted BMSC. Intracerebral, but not intravenous, transplantation of BMSC significantly enhanced functional recovery. In vivo NIR fluorescence imaging could clearly visualize their migration toward the cerebral infarct during 4 weeks after transplantation in the intracerebral group, but not in the intravenous, group. The BMSC were widely distributed in the ischemic brain and some of them expressed neural cell markers in the intracerebral group, but not in the intravenous group. These findings strongly suggest that intravenous administration of BMSC has limited effectiveness at clinically relevant timing and intracerebral administration should be chosen for patients with ischemic stroke, although further studies would be warranted to establish the treatment protocol.
• Review of Past Research and Current Concepts on the Etiology of Moyamoya Disease

  Kiyohiro Houkin, Masaki Ito, Taku Sugiyama, Hideo Shichinohe, Naoki Nakayama, Ken Kazumata, Satoshi Kuroda

  NEUROLOGIA MEDICO-CHIRURGICA 52 5 267 - 277 2012年05月 [査読有り][通常論文]
   

  Research on moyamoya disease has progressed remarkably in the past several decades. Indeed, many new facts concerning the epidemiology of the disease have been revealed and surgical treatments have been drastically improved. However, despite extensive research, the mechanism of moyamoya disease is still unknown. Consequently, the cardinal treatment of this disease has not yet been developed. For further clarification of its etiology, innovative studies are therefore indispensable. The aim of this paper is to review research on the pathogenesis of moyamoya disease to identify milestones in the direction of its true solution. Many hypotheses of the pathogenesis of moyamoya disease have been proposed in the past half century, including infection (viral and bacterial), autoimmune disorders, proteins abnormality, and gene abnormality. Some of these are now considered to be historical achievements. Others, however, can be still subjected to contemporary research. Currently, several genetic abnormalities are considered to offer the most probable hypothesis. In addition, interesting papers have been presented on the role of the endothelial progenitor cell on the pathogenesis of moyamoya disease. Intuitively, however, it appears that a single theory cannot always explain the pathogenesis of this disease adequately. In other words, the complex mechanism of several factors may comprehensively explain the formation of moyamoya disease. The "double hit hypothesis" is probably the best explanation for the complicated pathology and epidemiology of this disease.
• 【もやもや病】もやもや病の病態、診断と治療 最近の知見と今後の課題

  黒田 敏, 杉山 拓, 川堀 真人, 笹森 徹, 栗栖 宏多, 内野 晴登, 七戸 秀夫, 中山 若樹, 宝金 清博

  脳卒中の外科 40 2 77 - 82 (一社)日本脳卒中の外科学会 2012年03月 [査読有り][招待有り]
  
• Therapeutic effects of intra-arterial delivery of bone marrow stromal cells in traumatic brain injury of rats--in vivo cell tracking study by near-infrared fluorescence imaging.

  Toshiya Osanai, Satoshi Kuroda, Taku Sugiyama, Masahito Kawabori, Masaki Ito, Hideo Shichinohe, Yuji Kuge, Kiyohiro Houkin, Nagara Tamaki, Yoshinobu Iwasaki

  Neurosurgery 70 2 435 - 44 2012年02月 [査読有り][通常論文]
   

  BACKGROUND: A noninvasive and effective route of cell delivery should be established to yield maximal therapeutic effects for central nervous system (CNS) disorders. OBJECTIVE: To elucidate whether intra-arterial delivery of bone marrow stromal cells (BMSCs) significantly promotes functional recovery in traumatic brain injury (TBI) in rats. METHODS: Rat BMSCs were transplanted through the ipsilateral internal carotid artery 7 days after the onset of cortical freezing injury. The BMSCs were labeled with fluorescent dye, and in vivo optical imaging was employed to monitor the behaviors of cells for 4 weeks after transplantation. Motor function was assessed for 4 weeks, and the transplanted BMSCs were examined using immunohistochemistry. RESULTS: In vivo optical imaging and histologic analysis clearly demonstrated that the intra-arterially injected BMSCs were engrafted during the first pass without systemic circulation, and the transplanted BMSCs started to migrate from the cerebral capillary bed to the injured CNS tissue within 3 hours. Intra-arterial BMSC transplantation significantly promoted functional recovery after cortical freezing injury. A subgroup of BMSCs expressed the phenotypes of neurons, astrocytes, and endothelial cells around the injured neocortex 4 weeks after transplantation. CONCLUSION: Intra-arterial transplantation may be a valuable option for prompt, noninvasive delivery of BMSCs to the injured CNS tissue, enhancing functional recovery after TBI. In vivo optical imaging may provide important information on the intracerebral behaviors of donor cells by noninvasive, serial visualization.
• Bone Marrow-Derived Endothelial Progenitor Cells Participate in the Initiation of Moyamoya Disease

  Taku Sugiyama, Satoshi Kuroda, Naoki Nakayama, Shinya Tanaka, Kiyohiro Houkin

  Neurologia medico-chirurgica 51 11 767 - 773 2011年11月 [査読有り][通常論文]
   

  The mechanisms through which moyamoya disease occurs and progresses remain unknown. Recent studies have indicated the involvement of circulating endothelial progenitor cells (EPCs) in the development of moyamoya disease. This study directly investigated the participation of EPCs in moyamoya disease, using specimens of the supraclinoid internal carotid artery collected from two adult patients. The specimens were stained with primary antibodies against CD34, CD133, and vascular endothelial growth factor receptor-2 (VEGFR2) to localize the circulating EPCs in the thickened intima of occlusive arterial lesion. The CD34- and VEGFR2-positive cells were densely found in the thickened intima of occlusive arterial lesion, particularly clustered in the superficial layer of thickened intima. However, the number of CD34- and CD133-positive cells was very small. The CD34-positive cells also expressed von Willebrand factor on the surface of thickened intima and were also positive for a-smooth muscle actin in the deeper layer. These findings suggest that circulating EPCs may be involved in the development of occlusive arterial lesion in moyamoya disease.
• Validity of Bone Marrow Stromal Cell Expansion by Animal Serum-Free Medium for Cell Transplantation Therapy of Cerebral Infarct in Rats-A Serial MRI Study

  Masaki Ito, Satoshi Kuroda, Taku Sugiyama, Hideo Shichinohe, Yukari Takeda, Mitsufumi Nishio, Takao Koike, Kiyohiro Houkin

  TRANSLATIONAL STROKE RESEARCH 2 3 294 - 306 2011年09月 [査読有り][通常論文]
   

  This study was aimed to test the hypothesis that human bone marrow stromal cells (hBMSC) expanded in fetal calf serum (FCS)-free, platelet lysate (PL)-containing medium would retain their capacity of migration, survival, and neural differentiation when transplanted into the infarct brain, using serial in vivo magnetic resonance imaging (MRI). Cell growth kinetic analysis revealed that hBMSC maintain their proliferative activity when cultured either in conventional FCS-containing medium or FCS-free, PL-containing medium. Subsequently, hBMSC were labeled with a superparamagnetic iron oxide agent and were stereotactically transplanted into the ipsilateral striatum of rats at 7 days after permanent middle cerebral artery occlusion. Serial MRI performed over 8 weeks revealed that they retain their migratory capacity towards the cerebral infarct. Moreover, double fluorescence immunohistochemistry also revealed that they preserve their capacity of differentiation into the neural cells in the peri-infarct area. The hBMSC expanded in the FCS-free, PL-containing medium retain their capacity of migration, survival, and differentiation when stereotactically transplanted into the infarct brain. The present findings strongly suggest the clinical utility of PL as a substitute to expand autologous hBMSC for cerebral infarct in the future.
• Biological Features of Human Bone Marrow Stromal Cells (hBMSC) Cultured with Animal Protein-Free Medium-Safety and Efficacy of Clinical Use for Neurotransplantation

  Hideo Shichinohe, Satoshi Kuroda, Taku Sugiyama, Masaki Ito, Masahito Kawabori, Mitsufumi Nishio, Yukari Takeda, Takao Koike, Kiyohiro Houkin

  TRANSLATIONAL STROKE RESEARCH 2 3 307 - 315 2011年09月 [査読有り][通常論文]
   

  The donor cell culture in animal serum-free medium is quite important for the clinical application of cell transplantation therapy. This study was aimed to test the hypothesis that the human bone marrow stromal cells (hBMSC) expanded with fetal calf serum (FCS)-free, platelet lysate (PL)-containing medium retain their biological features favoring central nervous system regeneration. The hBMSC were cultured with 5% PL or 10% FCS. Their phenotypes were analyzed with flow cytometry, and their production of growth factors was quantified with enzyme-linked immunosorbent assay. Their capacity of neural differentiation was verified by immunocytochemistry. There was no significant difference in morphology and cell surface marker between the hBMSC-FCS and hBMSC-PL. Both of them were positive for CD44, CD90, CD105, and CD166 and were negative for CD34, CD45, and CD271. The production of human brain-derived neurotrophic factor, human hepatocyte growth factor, human beta-nerve growth factor, and human platelet-derived growth factor-BB did not differ between the two groups, although the hBMSC-PL produced significantly more amount of TGF-beta 1 than the hBMSC-FCS. There was no significant difference in their in vitro differentiation into the neurons and astrocytes between the two groups. The hBMSC expanded with PL-containing medium retain their biological capacity of neural differentiation and neuroprotection. The PL may be a clinically valuable and safe substitute for FCS in expanding the hBMSC for cell therapy.
• Middle Cerebral-Anterior Cerebral-Radial Artery Interposition Graft Bypass for Proximal Anterior Cerebral Artery Aneurysm-Case Report

  Ken Kazumata, Katsuyuki Asaoka, Yuka Yokoyama, Toshiya Osanai, Taku Sugiyama, Kouji Itamoto

  NEUROLOGIA MEDICO-CHIRURGICA 51 9 661 - 663 2011年09月 [査読有り][通常論文]
   

  A 74-year-old man underwent pterional craniotomy to treat a left proximal anterior cerebral artery (ACA) aneurysm. The orifice of the aneurysm was located at the origin of the proximal segment of the ACA, and the right A(1) segment of ACA was hypoplastic. After failed attempts at neck plasty with fenestrated clips, trapping and bypass were performed. Superficial temporal to left frontopolar artery bypass was performed to secure minimal blood supply. The radial artery (RA) was then harvested, and middle cerebral artery (MCA) to A(1) segment of the ACA bypass was performed using the RA interposition graft. Trapping of the aneurysm was successfully achieved without ischemic event. Intracranial-intracranial bypass has been employed in the treatment of complex cerebral aneurysm in an increasing number of selected patients. The present case shows that MCA-ACA-RA interposition graft bypass is an effective procedure to provide blood supply to the ACA territory if a proximal A(1) lesion requires trapping with incompetent contralateral A(1).
• 【動脈解離と脳卒中】後下小脳動脈解離 解離性後下小脳動脈の病理

  横山 由佳, 数又 研, 浅岡 克行, 杉山 拓, 板本 孝治

  The Mt. Fuji Workshop on CVD 29 185 - 186 (株)にゅーろん社 2011年07月 [査読有り][通常論文]
   

  解離性脳動脈瘤は一般に口径の大きい血管に好発することから、発症機序としてhemodynamic stressの関与を推測しやすいが、前大脳動脈や後下小脳動脈といった小動脈にも解離性動脈瘤は発症することが知られている。今回、このような小動脈に発生する脳血管解離のメカニズムを検討する目的で、解離性後下小脳動脈瘤の自験4例について病理像の解析を行った。その結果、本症はspontaneous coronary artery dissectionの類縁疾患である可能性が示唆された。
• Primary Central Nervous System Mucosa-Associated Lymphoid Tissue Lymphoma-Case Report

  Yuuta Kamoshima, Yutaka Sawamura, Taku Sugiyama, Shigeru Yamaguchi, Kiyohiro Houkin, Kanako Kubota

  NEUROLOGIA MEDICO-CHIRURGICA 51 7 527 - 530 2011年07月 [査読有り][通常論文]
   

  A 55-year-old woman presented with an extremely rare primary central nervous system mucosa-associated lymphoid tissue (MALT) lymphoma manifesting as seizure and was subsequently diagnosed with dural MALT lymphoma in the cranium. Magnetic resonance imaging revealed a left frontal dural mass with peritumoral edema. Histological examination of the dural mass confirmed MALT lymphoma and revealed infiltration of small cells with irregular nuclear borders and expression of a B cell marker (CD20) but absence of CD5, CD10, CD23, and cyclinD1. Reactive T-cell infiltration was also seen. Subsequently, local irradiation (40 Gy/20 fractions) was performed. Magnetic resonance imaging showed complete remission just after irradiation was completed. There was no evidence of systemic MALT lymphoma. There has been no recurrence for 3 years without additional therapy.
• Therapeutic impact of human bone marrow stromal cells expanded by animal serum-free medium for cerebral infarct in rats

  Taku Sugiyama, Satoshi Kuroda, Yukari Takeda, Mitsufumi Nishio, Masaki Ito, Hideo Shichinohe, Takao Koike

  Neurosurgery 68 6 1733 - 1742 2011年06月 [査読有り][通常論文]
   

  Background: The donor cell culture in animal serum-free medium is important for the clinical application of cell transplantation therapy. Recently, human-derived platelet lysate (PL) gained interest as a substitute for fetal calf serum (FCS), but there are no studies that evaluate the validity of human bone marrow stromal cells (hBMSCs) expanded with PL-containing medium for central nervous system disorders. Objective: To test the hypothesis that hBMSCs expanded with FCS-free, PL-containing medium can promote functional recovery after cerebral infarct. Methods: hBMSCs were cultured in the FCS- or PL-containing medium. Cell-growth kinetics were analyzed. The vehicle or hBMSCs was stereotactically transplanted into the ipsilateral striatum of the rats subjected to permanent middle cerebral artery occlusion 7 days after the insult. Motor function was assessed for 8 weeks, and the fate of transplanted hBMSCs was examined using immunohistochemistry. Results: There was no significant difference in hBMSC expansion between the 2 groups. Transplantation of hBMSCs expanded with the FCS- or PL-containing medium equally promoted functional recovery compared with the vehicle group. Histological analysis revealed that there were no significant differences in their migration, survival, and neural differentiation in the infarct brain between the 2 groups. Conclusion: hBMSCs expanded with PL-containing medium retained their capacity of migration, survival, and differentiation and significantly promoted functional recovery when stereotactically transplanted into the infarct brain. The PL may be a clinically valuable and safe substitute for FCS in expanding hBMSCs to regenerate the infarct brain. Copyright © 2011 by the Congress of Neurological Surgeons.
• Near-infrared fluorescence labeling allows noninvasive tracking of bone marrow stromal cells transplanted into rat infarct brain.

  Taku Sugiyama, Satoshi Kuroda, Toshiya Osanai, Hideo Shichinohe, Yuji Kuge, Masaki Ito, Masahito Kawabori, Yoshinobu Iwasaki

  Neurosurgery 68 4 1036 - 47 2011年04月 [査読有り][通常論文]
   

  BACKGROUND: Noninvasive imaging techniques would be needed to validate the therapeutic benefits of cell transplantation therapy for central nervous system disorders. OBJECTIVE: To evaluate whether near-infrared (NIR)-emitting fluorescence tracer, quantum dots, would be useful to noninvasively visualize the bone marrow stromal cells (BMSC) transplanted into the infarct brain in living animals. METHODS: Rat BMSCs were labeled with QD800. In vitro and in vivo conditions to visualize NIR fluorescence were precisely optimized. The QD800-labeled BMSCs were stereotactically transplanted into the ipsilateral striatum of the rats subjected to permanent middle cerebral artery occlusion 7 days after the insult. Using the NIR fluorescence imaging technique, the behaviors of BMSCs were serially visualized during the 8 weeks after transplantation. RESULTS: NIR fluorescence imaging could noninvasively detect the NIR fluorescence emitted from the transplanted BMSCs engrafted in the peri-infarct neocortex through the scalp up to 8 weeks after transplantation. The intensity gradually increased and reached the peak at 4 weeks. The results were supported by the findings on ex vivo NIR fluorescence imaging and histological analysis. CONCLUSION: NIR fluorescence imaging is valuable in monitoring the behaviors of donor cells in the rodent brain. The results would allow new opportunities to develop noninvasive NIR fluorescence imaging as a modality to track the BMSCs transplanted into the brain.
• Dural Opening/Removal for Combined Petrosal Approach: Technical Note

  Shunsuke Terasaka, Katsuyuki Asaoka, Hiroyuki Kobayashi, Taku Sugiyama, Shigeru Yamaguchi

  SKULL BASE-AN INTERDISCIPLINARY APPROACH 21 2 123 - 127 2011年03月 [査読有り][通常論文]
   

  Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbe. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach.
• 眼窩先端部症候群で発症し内頸動脈浸潤した副鼻腔真菌症の3症例

  杉山 拓, 黒田 敏, 中山 若樹, 寳金 清博

  脳神経外科 39 2 155 - 161 (株)医学書院 2011年02月 [査読有り][通常論文]
   

  症例1:83歳男。肝細胞癌、糖尿病の既往があり、抗悪性腫瘍薬を内服中であった。左眼周囲痛、複視、視力低下が出現し、頭部MRIで副鼻腔から眼窩、側頭筋、海綿静脈洞部にかけて広範な浸潤性病変を認め、切開排膿・上顎洞開放術を行い、組織中にアスペルギルスが同定された。同日右麻痺、失語が出現し、MRIで左中大脳動脈領域に脳梗塞を認め、点滴治療で改善せず転院となった。症例2:72歳女。再生不良性貧血にてステロイド投与中であった。左上顎歯の抜歯後に潰瘍形成、発熱があり、β-Dグルカンの上昇を認め抗真菌薬が投与された。1ヵ月後より左顔面のしびれ・痛み、左視力低下が出現し、更に右麻痺も生じ、MRIで左中大脳動脈領域に低吸収域を、脳血管撮影で左内頸動脈に狭窄病変を認めた。急性期治療を行ったが、症状および画像所見の悪化を認め、麻痺出現後14日目に死亡した。症例3:62歳男。右上顎洞炎にて開放術を受け、アスペルギルス症の診断で抗真菌薬を投与中であった。徐々に右眼窩周囲痛、眼球突出、複視が出現し、眼窩内容物摘出、ステロイドパルス療法を受けたが、1ヵ月後に右眼窩内より動脈性出血が生じ、脳血管撮影で右内頸動脈に動脈瘤を認めた。トラッピングおよび動脈吻合術を施行し、出血のコントロールは得られたが、脳梗塞を合併して左麻痺を後遺した。
• 脳血管外科手術における術中インドシアニングリーン蛍光血管撮影の応用 : 時間軸投影マップの有用性

  伊東 雅基, 黒田 敏, 中山 若樹, 安田 宏, 杉山 拓, 穂刈 正昭, 磯部 正則, 寶金 清博

  脳卒中の外科 = Surgery for cerebral stroke 39 1 40 - 47 (一社)日本脳卒中の外科学会 2011年01月31日 [査読有り][通常論文]
   

  2009年8〜12月の間に術中インドシアニングリーン(ICG)蛍光管撮影を実施した脳血管外科手術11件(動脈瘤頸部クリッピング術5件、脳動静脈奇形摘出術3件、内頸動脈内膜剥離術2件、もやもや病手術1件)を対象に、新しいFLOW800システムによる術中ICG蛍光管撮影の応用について検討した。その結果、1)これまでの蛍光血管撮影の観察では、血行動態に関しては血流の停滞・緩徐な血流・順行性あるいは逆行性のスムーズな血流など定性的な評価に留まっていたが、FLOW800システムでは蛍光血管撮影から得られる蛍光強度と蛍光描出時間の関係から半定量的な解析が可能となった。2)問題点としては蛍光血管撮影の原理から得られる流体情報は実際の血流そのものではなく、蛍光の描出速度であり、ICGの投与方法や撮像条件により蛍光強度は強く影響されることが示唆された。したがって、「血管の描出速度は血流速度と比例するが、一致はしないかもしれない」という点に注意が必要と言える。
• 脳卒中に対する骨髄間質細胞移植研究の現状と課題

  黒田 敏, 七戸 秀夫, 杉山 拓, 伊東 雅基, 川堀 真人, 千葉 泰弘, 長内 俊也, 丸一 勝彦, 宝金 清博, 岩崎 喜信

  脳卒中 32 6 532 - 537 日本脳卒中学会 2010年11月25日 [査読有り][通常論文]
   

  第35回日本脳卒中学会 シンポジウム1 総説
• ヒト骨髄間質細胞の安全で効率的な培養法 骨髄間質細胞移植による中枢神経再生の臨床応用にむけて

  伊東 雅基, 黒田 敏, 杉山 拓, 七戸 秀夫, 武田 紫, 西尾 充史, 小池 隆夫, 寶金 清博

  再生医療 9 3 385 - 392 (株)メディカルレビュー社 2010年08月 [査読有り][通常論文]
   

  近年、脳梗塞や脊髄損傷などの不可逆的中枢神経損傷に対して、多分化能を有する骨髄間質細胞(bone marrow stromal cell:BMSC)を移植することで失われた神経機能を回復させる試みが数多くの研究者により報告されている。BMSCは自己骨髄から比較的容易に採取可能で、最も早く臨床応用が期待されている体性幹細胞の1つである。今後の幅広い臨床応用を考慮した場合、安全かつ効率的に必要なBMSCを供給可能な培養法の確立が急務である。BMSCの特性を失うことなく安全かつ効率的に培養するための研究について、中枢神経再生分野での現状、最近の新しい知見について概説する。(著者抄録)
• Noninvasive transplantation of bone marrow stromal cells for ischemic stroke: preliminary study with a thermoreversible gelation polymer hydrogel.

  Toshiya Osanai, Satoshi Kuroda, Hiroshi Yasuda, Yasuhiro Chiba, Katsuhiko Maruichi, Masaaki Hokari, Taku Sugiyama, Hideo Shichinohe, Yoshinobu Iwasaki

  Neurosurgery 66 6 1140 - 7 2010年06月 [査読有り][通常論文]
   

  OBJECTIVE: Recent studies have indicated that bone marrow stromal cells (BMSCs) have the potential to improve neurological function when transplanted into animal models of cerebral infarct. However, it is still undetermined how the BMSCs should be transplanted to obtain the most efficient therapeutic benefits safely. The aim of this study was to assess whether a thermoreversible gelation polymer (TGP) hydrogel acts as a noninvasive, valuable scaffold in BMSC transplantation for infarct brain. METHODS: The mice were subjected to permanent middle cerebral artery occlusion. Vehicle, BMSC suspension, or the BMSC-TGP construct was transplanted onto the ipsilateral intact neocortex at 7 days after the insult. Neurological symptoms were assessed throughout the experiments. The fate of the transplanted BMSC was examined 8 weeks after transplantation with immunohistochemistry. RESULTS: TGP hydrogel completely disappeared and provoked no inflammation in the host brain. Many transplanted cells were widely engrafted in the ipsilateral cerebrum, including the dorsal neocortex adjacent to the cerebral infarct in the BMSC-TGP construct-treated mice. Their number was significantly larger than in the BMSC-treated mice. The majority were positive for both NeuN and MAP2 and morphologically simulated the neurons. CONCLUSION: The findings suggest that surgical transplantation of tissue-engineered BMSCs onto the intact neocortex enhances the engraftment of donor cells around the cerebral infarct. These data may be useful in developing a noninvasive but efficient paradigm in neural tissue engineering. TGP hydrogel can be a promising candidate for valuable scaffolds in BMSC transplantation for central nervous system disorders because of its unique biochemical properties.
• 中枢神経再生におけるバイオイメージング

  杉山 拓, 伊東 雅基, 七戸 秀夫, 黒田 敏

  再生医療 9 2 257 - 263 (株)メディカルレビュー社 2010年05月 [査読有り][通常論文]
   

  細胞移植を中心とした中枢神経再生は臨床応用の段階を迎えつつある。同一個体内で経時的に評価しうるバイオイメージングは、移植細胞のモニタリングやホスト側の神経機能評価を行う上で、不可欠なものであり、今後も更なる研究の展開が必要である。本稿では、これまでに展開されてきた移植細胞の標識、モニタリングの手法を、それぞれのモダリティの特徴とともに、最新の知見を織り交ぜて紹介する。(著者抄録)
• Bone marrow stromal cells and bone marrow-derived mononuclear cells: which are suitable as cell source of transplantation for mice infarct brain?

  Hideo Shichinohe, Satoshi Kuroda, Katsuhiko Maruichi, Toshiya Osanai, Taku Sugiyama, Yasuhiro Chiba, Ayumi Yamaguchi, Yoshinobu Iwasaki

  Neuropathology : official journal of the Japanese Society of Neuropathology 30 2 113 - 22 2010年04月 [査読有り][通常論文]
   

  There are few studies that denote whether bone marrow stromal cells (BMSC) and bone marrow-derived mononuclear cells (MNC) show the same therapeutic effects, when directly transplanted into the infarct brain. This study therefore aimed to compare their biological properties and behaviors in the infarct brain. Mouse BMSC were harvested and cultured. Mouse MNC were obtained through centrifugation techniques. Their cell markers were analyzed with FACS analysis. The MNC (10(6) cells; n = 10) or BMSC (2 x 10(5) cells; n = 10) were stereotactically transplanted into the ipsilateral striatum of the mice subjected to permanent middle cerebral artery occlusion at 7 days after the insult. Their survival, migration, and differentiation in the infarct brain were precisely analyzed using immunohistochemistry 4 weeks after transplantation. The MNC were positive for CD34, CD45, CD90, but were negative for Sca-1. The BMSC were positive for CD90 and Sca-1. The transplanted BMSC, but not MNC, extensively migrated into the peri-infarct area. Approximately 20% of the transplanted BMSC expressed a neuronal marker, NeuN in the infarct brain, although only 1.4% of the transplanted MNC expressed NeuN. These findings strongly suggest that there are large, biological differences between MNC and BMSC as cell sources of regenerative medicine for ischemic stroke.
• Bone Marrow Stromal Cell Transplantation Attenuates Cognitive Dysfunction due to Chronic Cerebral Ischemia in Rats

  Hideo Shichinohe, Satoshi Kuroda, Taku Sugiyama, Masaki Ito, Masahito Kawabori

  DEMENTIA AND GERIATRIC COGNITIVE DISORDERS 30 4 293 - 301 2010年 [査読有り][通常論文]
   

  Aims: This study was aimed to elucidate if bone marrow stromal cells (BMSC) could ameliorate cognitive dysfunction due to chronic cerebral ischemia when transplanted into the brain. Methods: The BMSC were harvested from green fluorescence protein (GFP)-expressing mice. Wistar rats were subjected to bilateral common carotid artery (CCA) ligation. The BMSC (4 x 10(5) cells) or vehicle were stereotactically injected into the right striatum 24 h after the insult. Cognitive function was evaluated with the Morris water maze task after 3 and 5 weeks. Histological analysis was performed after 6 weeks. Results: Cognitive function was significantly impaired in the vehicle-transplanted animals, when compared with the non-CCA-ligation animals. BMSC transplantation significantly improved it. The BMSC were widely distributed in the ischemic brain, including the neocortex, white matter and hippocampus, and some of them expressed the phenotypes of neurons, astrocytes and endothelium. They also significantly ameliorated white matter damage. Conclusions: These findings strongly suggest that the BMSC may have the potential to attenuate white matter injury and improve cognitive dysfunction due to chronic cerebral ischemia. The present results would shed light on the potential of a novel strategy, cell therapy against ischemia-related cognitive dysfunction. Copyright (C) 2010 S. Karger AG, Basel
• 脳腫瘍の画像と病理 出血発症の鞍上部腫瘍性病変

  杉山 拓, 寺坂 俊介, 小林 浩之

  脳神経外科ジャーナル 18 7 538 - 544 日本脳神経外科コングレス 2009年07月 [査読無し][通常論文]
  
• 内頸動脈閉塞を伴う巨大脳底動脈先端部近傍動脈瘤の外科治療

  佐藤 正夫, 上山 博康, 黒岩 輝壮, 中村 俊孝, 瀧澤 克己, 浅岡 克行, 原田 洋一, 山下 圭一, 航 晃仁, 杉山 拓, 谷川 緑野

  脳卒中の外科 36 4 265 - 270 (一社)日本脳卒中の外科学会 2008年07月 [査読有り][通常論文]
   

  一側内頸動脈閉塞に伴い脳底動脈及びその近傍に生じた巨大動脈瘤の4症例(症例1;69歳女性動・脈瘤径13mm大、症例2;54歳男性・25mm大、症例3;65歳女性・30mm大、症例4;55歳女性・25mm大)を呈示し解説した。治療は全例でhemodynamic stressを軽減し血流の改善目的で内頸動脈閉塞側にEC-RA-M2 bypass術施行後にクリッピングを行った。クリッピングに際しては全例で脳底動脈先端部とその近傍が広く展開できるanterior temporal approach用い、母動脈の確保は問題なく行えた。内頸動脈閉塞側とクリッピング側が異なる症例4は二期的手術を行ったが他の3例では一期的に手術を行った。予後では、症例3で術後10年目にもともと血管拡張がみられた脳底動脈先端部に動脈瘤を生じ現在徐々に増大を続けており、不完全クリップに終わった症例4は、再手術の同意が得られず術後4年目にクモ膜下出血にて死亡した。以上より、巨大動脈瘤に対して橈骨動脈を用いて血行再建後にクリッピングを行い当初は良好な成績が得られたが、長期間の注意深い経過観察が必要と考えられた。
• 側頭筋浸潤を示す頭蓋Langerhans cell histiocytosisの1例

  鴨嶋 雄大, 澤村 豊, 杉山 拓, 山口 秀, 岩崎 喜信, 久保田 加奈子

  脳神経外科 36 5 435 - 439 2008年05月 [査読有り][通常論文]
   

  A 9-year-old boy presented a painful right painful parietal mass that rapidly enlarged within a month. He had no other symptom of infection or malignancy. Laboratory findings were normal, Plain skull X ray demonstrated a "punched-out" lesion in the right parietal bone. Magnetic resonance (MR) imaging revealed a 4 x 4 x 3 cm mass centered in the right parietal bone which was enhanced after administration of a contrast material. In addition, as well as the mass region, the pericranial soft tissue was densely enhanced. The parietal bone mass was soft and successfully removed. Histological examination disclosed Langerhans cell histiocytosis (LCH) infiltrating the temporal muscle. MR imaging is useful for diagnosis of LCH of the skull with soft tissue involvement.
• ニカルジピン持続脳槽灌流のスパズム予防効果と灌流液のdeliveryを考慮した手術工夫

  遠山 義浩, 小林 延光, 杉山 拓, 伊東 雅基, 村井 宏, 馬渕 正二

  脳血管攣縮 23 81 - 85 スパズム・シンポジウム事務局 2008年02月 [査読有り][通常論文]
  
• 脳血管攣縮の予防のためのnicardipine持続脳槽灌流療法の効果と灌流液のdeliveryを考慮した手術における工夫

  遠山 義浩, 杉山 拓, 伊東 雅基, 村井 宏, 馬渕 正二

  脳卒中の外科 35 3 174 - 180 (一社)日本脳卒中の外科学会 2007年05月 [査読有り][通常論文]
   

  クモ膜下出血で発症した破裂脳動脈瘤16例に対し直達手術後、nicardipine持続脳槽灌流療法を行い、脳血管攣縮における有用性について検討した。その結果、1)血管撮影上、軽度の血管攣縮が5例(31%)に認められたが、症候性攣縮例はみられなかった。2)主幹動脈の拡張率はそれぞれC1;115±19%、M1;113±23%、A1;117±26%であった。3)発症3ヵ月後の予後は、mRSでgrade 0が9例(56%)、grade 1が2例(13%)、grade 2が1例(6%)、grade 3が3例(19%)、grade 4が0%、grade 5が1例(6%)、grade 6が0%であった。以上、これらのことからも、nicardipine持続脳槽灌流療法はくも膜下出血後の脳血管攣縮の予防として有効な治療法になりうる可能性が示唆された。
• PCAの血行再建を併用した動脈瘤治療

  原田 洋一, 中村 俊孝, 瀧澤 克己, 佐藤 正夫, 浅岡 克行, 航 晃仁, 山下 圭一, 杉山 拓, 黒岩 輝壮, 上山 博康

  脳卒中の外科 35 2 101 - 106 (一社)日本脳卒中の外科学会 2007年03月 [査読有り][通常論文]
   

  後大動脈(PCA)に発生する動脈瘤の治療のために、親動脈閉塞(PAO)が数多く行われているが、副側枝の血流が乏しい症例などではPCAの血行再建が必要になる。PCAに発生した血栓化型・巨大動脈瘤の3症例に対して血行再建を併用した直達手術を行った。症例1は左PCA(P2)の部分血栓化大型動脈瘤と診断され、バルーンカテーテルによる閉塞試験(BOT)でtolerableを示さなかった。症例2は左P2部の紡錘状血栓化動脈瘤であった。症例3は左P1-P2部の血栓化巨大動脈瘤であった。症例2、3はBOTを行わなかったが、積極的な虚血予防・massの軽減と穿通枝温存のため3例ともPCAの血行再建を併用した。combined approach経由で動脈瘤末梢に浅側頭動脈-PCAバイパス形成とトラッピングを行った。いずれも精神脱落症状はなく、日常生活を送っている。

書籍

• Neurosurgical Robotics

  (担当:分担執筆)
  Humana New York, NY 2020年11月 (ISBN: 9781071609927)
• 1361専門家による私の治療

  猿田, 享男, 北村, 惣一郎 (担当:分担執筆範囲:くも膜下出血)
  日本医事新報社 2019年07月 (ISBN: 9784784946518) 1525p
• 疾患別 臨床脳血管解剖テキスト: Hybrid Neurosurgeonのための (脳神経外科速報2018年増刊)

  大宅 宗一, 遠藤 英徳 (担当:分担執筆範囲:VA-PICAの開頭術)
  メディカ出版 2018年09月 (ISBN: 4840463093) 272 96-107

  
• 脳と頭蓋底の血管系アトラス : 臨床解剖のバリエーション

  Grand, Walter, Hopkins, L. N., Siddiqui, Adnan H., Mocco, J, 宝金, 清博, 中山, 若樹 (担当:共訳)
  医学書院 2018年 (ISBN: 9784260034579) xi, 291p
• 1336専門家による 私の治療 2017-18年度版

  猿田 享男, 北村 惣一郎 (担当:分担執筆範囲:くも膜下出血)
  日本医事新報社 2017年08月 (ISBN: 4784946500) 1776 578-580

  
• Mastering Intracranial Microvascular Anastomoses -Basic Techniques and Surgical Pearls

  Taku Sugiyama (担当:単著)
  Medicus Shuppan 2017年07月 209 

  "For the success of intracranial bypass surgeries!!." An essential textbook on the techniques of cerebral revascularization surgery. Introducing a method of actual training to prepare for practice. You can watch training and surgery videos with Online Videos.
• Cell therapy against cerebral stroke : comprehensive reviews for translational researches and clinical trials

  Houkin Kiyohiro, Abe Koji, Kuroda Satoshi 
  Springer 2017年 (ISBN: 9784431560579)
• 脳血行再建術

  上山博康, 宝金清博, 数又 研, 中山 若樹, 杉山 拓 (担当:共著)
  中外医学社 2016年04月 (ISBN: 4498029518) 197

  
• 内頚動脈瘤(ICA Aneurysm)のすべて-近位部(cavernous-paraclinoid): シミュレーションで経験する手術・IVR/92本のWEB動画付き (脳神経外科速報EX部位別に学ぶ脳動脈瘤シリーズ)

  杉山 拓, 中山 若樹, 宝金 清博, 井川 房夫, 宮地 茂 (担当:分担執筆範囲:内頚動脈瘤の特徴と手術 IC anterior wall (bypass併用))
  メディカ出版 2015年02月 (ISBN: 4840453330) 258 65-70

  
• 内頚動脈瘤(ICA Aneurysm)のすべて-遠位部(supraclinoid): シミュレーションで経験する手術・IVR/50本のWEB動画付き (脳神経外科速報EX部位別に学ぶ脳動脈瘤シリーズ)

  杉山 拓, 中山 若樹, 宝金 清博, 井川 房夫, 宮地 茂 (担当:分担執筆範囲:シミュレーションと手術の実際)
  メディカ出版 2015年02月 (ISBN: 4840453349) 250 148-151

  
• バイパス術のすべて (新NS NOW 1)

  杉山 拓, 宝金 清博, 森田 明夫 (担当:分担執筆範囲:血管吻合手術を確実に行うためのセットアップ)
  メジカルビュー社 2015年02月 (ISBN: 4758315612) 193 42-49

  
• 「超」入門 クリッピング・脳血行再建術: 脳血管障害手術まるわかり 全術式のWEB動画付き

  杉山 拓 (担当:単著)
  メディカ出版 2014年03月 (ISBN: 4840448949) 228

  
• 整容脳神経外科Update−きれいなキズアトを目指して (NS NOW No.13)

  杉山 拓, 宝金 清博, 寺本 明 (担当:分担執筆範囲:脳血管外科ー頭蓋内外血行再建術)
  メジカルビュー社 2011年01月 (ISBN: 4758311927) 187 66-76

  
• Molecular Imaging for Integrated medical Therapy and Drug Development

  杉山 拓 (担当:分担執筆)
  Springer 2010年 (ISBN: 9784431980735)

その他活動・業績

• 高齢者における頚動脈内膜剥離術の臨床的特徴および治療成績の検討

  池田寛, 杉山拓, 伊東雅基, 内野晴登, 長内俊也, 藤村幹 日本老年脳神経外科学会プログラム・抄録集 36th 2023年
• 地域医療と脳血管外科:高齢患者に対する血行再建術に着目して

  藤村幹, 伊東雅基, 内野晴登, 杉山拓 日本老年脳神経外科学会プログラム・抄録集 36th 2023年
• 成人もやもや病のMRA末梢動脈信号強度と間接血行発達度の関連

  内野晴登, 伊東雅基, 杉山拓, 川堀真人, 長内俊也, 藤村幹 日本脳神経CI学会総会プログラム・抄録集 46th 2023年
• 亜急性期〜慢性期脳虚血病態の治療 脳血管動脈硬化性疾患に対する亜急性/慢性期EC-ICバイパスの現代的適応

  杉山 拓, 伊東 雅基, 内野 晴登, 長内 俊也, 川堀 真人, 藤村 幹 脳循環代謝 34 (1) 74 -74 2022年10月
• 成人もやもや病の術前MRA末梢動脈描出と間接血行発達度との関連

  内野 晴登, 伊東 雅基, 杉山 拓, 川堀 真人, 藤村 幹 脳循環代謝 34 (1) 122 -122 2022年10月
• 血行再建術後も再出血を繰り返す側副血行路末梢性動脈瘤を伴う成人出血型もやもや病の治療

  伊東 雅基, 内野 晴登, 杉山 拓, 長内 俊也, 川堀 真人, 藤村 幹 脳循環代謝 34 (1) 124 -124 2022年10月
• 【病変部位と症状がリンクする脳動脈図鑑】プロローグ なぜ、脳動脈を覚えるのか

  杉山 拓 Brain Nursing 38 (3) 361 -366 2022年05月
• 組織の動きと変形に着目した映像解析と手術安全支援システム開発

  杉山 拓 医科学応用研究財団研究報告 39 93 -98 2022年02月
• 三次元融合画像による術前シミュレーションが有効であった脳幹部海綿状血管腫の一例

  大木聡悟, 茂木洋晃, 澤谷亮佑, 岡本迪成, 越前谷すみれ, 杉山拓, 山口秀, 藤村幹 日本脳腫瘍の外科学会プログラム・抄録集 27th 2022年
• 成人もやもや病に対する直接・間接複合血行再建術後のバイパス路発達の術前要因

  伊東雅基, 内野晴登, 川堀真人, 杉山拓, 数又研, 宝金清博, 藤村幹 日本分子脳神経外科学会プログラム・抄録集 22nd 2022年
• 高齢者虚血型もやもや病の疫学と治療

  藤村幹, 伊東雅基, 杉山拓, 遠藤英徳, 冨永悌二 日本老年脳神経外科学会プログラム・抄録集 35th (CD-ROM) 2022年
• 血管修復術を要した頸部穿通性外傷の2例

  杉山 拓, 月花 正幸, 数又 研, 藤村 幹 日本脳神経外傷学会プログラム・抄録集 45回 228 -228 2022年01月
• 多発性脳内出血で発症し急激な経過で脳死に至ったT細胞性急性リンパ性白血病(T-ALL)

  長祐子, 澤井彩織, 原和也, 寺下友佳代, 杉山未奈子, 平林真介, 真部淳, 杉山拓, 方波見謙一, 浜崎和朗 日本小児科学会雑誌 126 (2) 2022年
• RNF213創始者変異は成人もやもや病複合血行再建術後の間接バイパス路発達に寄与する

  伊東 雅基, 川堀 真人, 杉山 拓, 東海林 菊太郎, 舘澤 諒大, 内野 晴登, 数又 研, 寳金 清博, 藤村 幹 脳循環代謝 33 (1) 94 -94 2021年11月
• 脳梗塞:急性期治療 進行性虚血性脳卒中に対するEC-ICバイパス術

  杉山 拓, 伊東 雅基, 長内 俊也, 藤村 幹 脳循環代謝 33 (1) 73 -73 2021年11月
• 破裂脳動脈瘤コイル塞栓術後に遅発性のコイル突出を認めた1例

  舘澤 諒大, 長内 俊也, 東海林 菊太郎, 伊東 雅基, 進藤 崇史, 中崎 明日香, 杉山 拓, 藤村 幹 脳血管内治療 6 (Suppl.) S248 -S248 2021年11月
• びまん性脳血管攣縮による一過性脳虚血発作で発症したHeubner動脈瘤破裂の自然消失 症例報告

  中崎 明日香, 伊東 雅基, 磯部 正則, 藤原 史明, 井須 豊彦, 野村 太一, 数又 研, 長内 俊也, 杉山 拓, 藤村 幹 脳血管内治療 6 (Suppl.) S249 -S249 2021年11月
• 一時的血流遮断下のDistal Filter protectionの元、CASPERを用いたCarotid artery stentingの術後DWI陽性率についての検討

  長内 俊也, 東海林 菊太郎, 杉山 拓, 伊東 雅基, 小林 聡 脳血管内治療 6 (Suppl.) S287 -S287 2021年11月
• RNF213創始者変異は成人もやもや病複合血行再建術後の間接バイパス路発達に寄与する

  伊東 雅基, 川堀 真人, 杉山 拓, 東海林 菊太郎, 舘澤 諒大, 内野 晴登, 数又 研, 寳金 清博, 藤村 幹 脳循環代謝 33 (1) 94 -94 2021年11月
• 【何が違って何が同じ?なぜその違いが出る?本質が知りたい!脳神経外科手術 基本手技のバリエーション 手術のWEB動画55本付き】(第1章)手術の基本コンセプトと技術 マイクロ操作 器具の使い方のバリエーション(脳べらを積極的に使う?極力使わない?/吸引管、ハサミはどのように使い分ける?) 「脳べら積極派」の立場から

  月花 正幸, 杉山 拓 脳神経外科速報 (2021増刊) 65 -68 2021年10月 

  ＜POINT＞■脳べらを適切にセッティングすることにより、術者の両手の自由な動きが可能になる。■一般的に、脳葉を手前に浮かせるような意識で、牽引することが大切である場合が多い。■脳べらの牽引に加えて、非利き手の吸引管にて局所的なテンションを追加し術野展開をしていくのがコツである。(著者抄録)
• 【何が違って何が同じ?なぜその違いが出る?本質が知りたい!脳神経外科手術 基本手技のバリエーション 手術のWEB動画55本付き】(第1章)手術の基本コンセプトと技術 アプローチ MCA、IC-PC動脈瘤のアプローチ(pterional or subfrontal?その適応とコンセプト/母血管の取り方) 「Pterional派」の立場から

  月花 正幸, 杉山 拓 脳神経外科速報 (2021増刊) 98 -102 2021年10月 

  ＜POINT＞■Dictal transsylvian approachは、subfrontal approachに比較して、より広い術野の確保が可能で、より側方からアプローチするため、retrocarotid spaceへの十分な視野が確保できる。■後方向きのIC-PC動脈瘤は特に良い適応であり、脳底動脈瘤へ応用可能なアプローチである。■IC-PC動脈瘤では、retrocarotid spaceからPcomの走行を視認することが重要であり、これにより理想的なclippingが可能になる。(著者抄録)
• AIDS治療中に脳梗塞で発症し、原因検索に苦慮した中枢神経限局性血管炎の1例

  足澤 萌奈美, 江口 克紀, 阿部 恵, 岩田 育子, 松島 理明, 橋本 大吾, 杉山 拓, 矢部 一郎 NEUROINFECTION 26 (2) 48 -48 2021年09月
• 治療法の再整理とアップデートのために専門家による私の治療 くも膜下出血

  杉山 拓, 寳金 清博 日本医事新報 (5067) 38 -39 2021年06月
• In Reply: Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery.

  Taku Sugiyama Operative neurosurgery (Hagerstown, Md.) 2021年04月07日
• AIDS治療中に脳梗塞で発症し,原因検索に苦慮した中枢神経限局性血管炎の1例

  足澤萌奈美, 江口克紀, 阿部恵, 岩田育子, 松島理明, 橋本大吾, 杉山拓, 矢部一郎 Neuroinfection (Web) 26 (2) 2021年
• もやもや病に対するバイパス術と実臨床における疾患感受性遺伝子RNF213の意義

  藤村幹, 伊東雅基, 杉山拓, 内野晴登, 東海林菊太郎 日本分子脳神経外科学会プログラム・抄録集 21st 2021年
• 私の治療 くも膜下出血

  杉山拓, 寳金清博 週刊日本医事新報 (5067) 2021年
• Early Developments, Current Systems, and Future Directions

  Taku Sugiyama, Sanju Lama, Hamidreza Hoshyarmanesh, Amir Baghdadi, Garnette R. Sutherl Neurosurgical Robotics 193 -227 2020年11月10日 [査読無し][招待有り]
  
• DeFrictorによる経動脈的塞栓術についての検討

  長内 俊也, 東海林 菊太郎, 今井 哲秋, 杉山 拓, 中山 若樹, 数又 研, 寳金 清博 脳血管内治療 5 (Suppl.) 68 -68 2020年11月
• 急性期血行再建術における非造影MRAによるアクセスルートの有用性

  小林 聡, 長内 俊也, 中山 若樹, 数又 研, 杉山 拓, 藤間 憲幸, 濱口 明巧, 中村 俊孝, 飛騨 一利 脳血管内治療 5 (Suppl.) 23 -23 2020年11月
• 最重症くも膜下出血(WFNS Grade V)に対するコイル塞栓術の治療成績

  東海林 菊太郎, 長内 俊也, 杉山 拓, 数又 研, 中山 若樹 脳血管内治療 5 (Suppl.) 53 -53 2020年11月
• Measuring Tissue Motion During Carotid Endarterectomy Using Video-based Analyses

  Taku Sugiyama, Masaki Ito, Ken Kazumata, Naoki Nakayama, Kiyohiro Houkin Stroke 51 (Suppl_1) 2020年02月 [通常論文]
  
• Predicting Outcome of Acute Ischemic Stroke With Cancer-Related Coagulopathy by Machine-Learning Based Feature-Engineering

  Masaki Ito, Satoshi Kuroda, Hidetsugu Asanoi, Taku Sugiyama, Takafumi Shindo, Hiroyuki Kohno, Fumiaki Fujihara, Kimiya Sakamoto, Toyohiko Isu, Masanori Isobe Stroke 51 (Suppl_1) 2020年02月 [査読有り][通常論文]
  
• 最重症くも膜下出血(WFNS Grade V)に対するコイル塞栓術の治療成績

  東海林菊太郎, 長内俊也, 杉山拓, 数又研, 中山若樹 脳血管内治療(Web) 5 (Supplement) 2020年
• Onyxを用いた硬膜動静脈瘻に対する塞栓術

  牛越 聡, 下田 裕介, 長内 俊也, 中山 若樹, 杉山 拓 脳血管内治療 4 (Suppl.) S163 -S163 2019年11月
• Tentorial dural AVFの治療戦略

  下田 祐介, 森島 穣, 牛越 聡, 長内 俊也, 杉山 拓, 中山 若樹 脳血管内治療 4 (Suppl.) S98 -S98 2019年11月 [査読無し][通常論文]
  
• 【脳神経外科キャリアビジョン Subspecialty:私の選択】ようこそ、私たちのsubspecialtyへ 脳血管外科 手術の圧倒的美しさ、脳血管内治療との二刀流

  新保 大輔, 杉山 拓 脳神経外科速報 29 (10) 1034 -1037 2019年10月 [査読無し][通常論文]
  
• Tentrial dural AVFの治療戦略

  下田 祐介, 岡本 迪成, 牛越 聡, 長内 俊也, 中山 若樹, 杉山 拓, 宝金 清博 脳血管内治療 3 (Suppl.) S192 -S192 2018年11月 [査読無し][通常論文]
  
• 片眼の視力低下を契機に発見された若年者の内頸動脈-眼動脈瘤の1例

  白枝 友子, 新明 康弘, 和田 莉奈, 鈴木 佳代, 中村 佳代子, 杉山 拓, 寳金 清博, 陳 進輝, 石田 晋 神経眼科 35 (増補1) 75 -75 2018年11月 [査読無し][通常論文]
  
• 開頭手術と血管内治療の選択 1 脳動脈瘤 椎骨動脈‐後下小脳動脈瘤

  杉山拓, 中山若樹, 白川学 脳神経外科速報 96‐107 2018年09月25日 [査読無し][通常論文]
  
• 【Hybrid Neurosurgeonのための疾患別臨床脳血管解剖テキスト】(第1章)開頭手術と血管内治療の選択 脳動脈瘤 VA-PICA VA-PICAの開頭手術

  杉山 拓, 中山 若樹 脳神経外科速報 (2018増刊) 96,98,100,102,104,106 -96,98,100,102,104,106 2018年09月 [査読無し][通常論文]
   

  ＜開頭手術のポイント(まとめ)＞(1)OA-PICAバイパスを想定し、OAの解剖、剥離法を習得する(2)Transcondylar approachを習得する(3)クリッピングの際には、下位脳神経に留意する(著者抄録)
• Incorrect Data Presentation and Figure Citations

  Taku Sugiyama JAMA Surgery 2018年03月01日
• 文献抄録 Complementing operating room teaching with video-based coaching/Long-term efficacy and safety of carotid artery stenting versus endarterectomy:A meta-analysis of randomized controlled trials

  杉山 拓 Neurological Surgery 脳神経外科 46 (2) 173 -173 2018年02月10日
• In vivo cell tracking techniques for applications in central nervous system disorders

  Taku Sugiyama, Satoshi Kuroda, Kiyohiro Houkin Cell Therapy against Cerebral Stroke: Comprehensive Reviews for Translational Researches and Clinical Trials 101 -110 2017年01月01日 [査読無し][招待有り]
   

  Cell therapy is expected to promote functional recovery in various kinds of central nervous system disorders. Many studies show beneficial effects of cell therapy, and several clinical studies have already been initiated worldwide. Although these results are encouraging, several problems remain, including elucidating the therapeutic mechanisms, treatment timing, optimal cell dose, type of cells, and cell delivery route. For further optimization of this therapy, it is essential to develop in vivo cell tracking techniques. Longitudinal and serial analyses of the fate of transplanted cells are quite important for solving these problems. There are several cell labeling techniques and imaging modalities, including magnetic resonance imaging, nuclear imaging, and optical imaging. However, any single imaging modality has its own distinct advantages and drawbacks. Proper understanding of each technique’s characteristics is crucial for successful in vivo imaging. In this chapter, we present a literature survey of cell tracking techniques used in clinical settings and laboratories and introduce recent advances in this field.
• 何でもお悩み相談 脳卒中Q&A 手術記録の絵は必要なの?

  杉山 拓 脳神経外科速報 27 (1) 71 -71 2017年01月 [査読無し][通常論文]
  
• ハイブリッド手術室を使用した直視下頸動脈穿刺による脳血管内治療の経験

  新保 大輔, 内田 和希, 穂刈 正昭, 杉山 拓, 浅岡 克行, 板本 孝治 脳血管内治療 1 (Suppl.) S216 -S216 2016年11月 [査読無し][通常論文]
  
• 【ひとこと解説とイラストで概要をつかむ!脳神経疾患のからくり25】 脳血管に問題が起こったもの 高血圧性脳出血

  杉山 拓 Brain Nursing 31 (5) 448 -449 2015年05月 [査読無し][通常論文]
  
• 【ひとこと解説とイラストで概要をつかむ!脳神経疾患のからくり25】 脳血管に問題が起こったもの 頸動脈狭窄症 内頸動脈狭窄症

  杉山 拓 Brain Nursing 31 (5) 452 -453 2015年05月 [査読無し][通常論文]
  
• 急性期脳底動脈閉塞に対する脳血管内治療症例におけるDWIスコアの検討

  内田 和希, 新保 大輔, 小林 聡, 杉山 拓, 横山 由佳, 板本 孝治, 浅岡 克行 JNET: Journal of Neuroendovascular Therapy 8 (6) 230 -230 2014年12月 [査読無し][通常論文]
  
• 進行する症候性頸動脈高度狭窄症に対しstaged angioplastyが奏功した1例

  新保 大輔, 内田 和希, 小林 聡, 杉山 拓, 横山 由佳, 浅岡 克行, 板本 孝治 JNET: Journal of Neuroendovascular Therapy 8 (6) 428 -428 2014年12月 [査読無し][通常論文]
  
• CEA術中のMEP/SEP/NIRSモニタリングの経験

  新保 大輔, 杉山 拓, 小林 聡, 横山 由佳, 内田 和希, 浅岡 克行, 板本 孝治 脳循環代謝 26 (1) 199 -199 2014年11月 [査読無し][通常論文]
  
• 【大事なことだけギュギュッと凝縮!脳神経疾患&治療 まるわかり帳】 治療編 開頭クリッピング術

  杉山 拓, 中山 若樹 Brain Nursing 30 (4) 362 -365 2014年04月 [査読無し][通常論文]
  
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第14回) 静脈洞近傍のapproach、開頭、体位

  杉山 拓 脳神経外科速報 24 (3) 282 -291 2014年03月 [査読無し][招待有り]
   

  ＜静脈洞近傍の開頭のポイント＞1 部位に応じたさまざまな適切な体位を覚える.2 静脈洞損傷を避ける開頭方法,手技を押さえる.3 硬膜切開時には,常にbridging veinに注意を払う.4 骨表のlandmarkは参考になるものの,静脈洞の走行にはvariationがあるため,1例ごとに十分な画像検討を行うことで,より安全に手術が可能になる.(著者抄録)
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第13回) 前交通動脈瘤のclipping 破裂症例に対するinterhemispheric approach編

  杉山 拓 脳神経外科速報 24 (2) 162 -175 2014年02月 [査読無し][招待有り]
   

  ＜破裂前交通動脈瘤のinterhemispheric approachでの手術ポイント＞1 重症例でくも膜下血腫量が多い症例は,開頭を大きく行い,脳室ドレナージなどで脳圧をコントロールする.くも膜下血腫は可及的に洗浄する.2 原則的に3red step方式で半球間裂の剥離を行うが,動脈瘤周辺では,動脈瘤の向きに応じたsafe wayを学ぶことが必要.前方向き動脈瘤は特に注意.3 上向き,後方向きの動脈瘤では,clippingの際にhypothalamic arteryの温存が問題になる.4 temorary clip, tentative clipを併用し,時に動脈瘤を完全剥離することも必要になる.(著者抄録)
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第12回) 前大脳動脈瘤のclipping pterional approach編

  杉山 拓 脳神経外科速報 24 (1) 48 -58 2014年01月 [査読無し][招待有り]
   

  ＜前大脳動脈瘤のpterional approachでの手術のポイント＞1 前交通動脈瘤は,原則的にinterhemispheric approachを習得する必要があるが,pterional approachが適切な症例もある.2 開頭は前頭蓋底側に拡大する.広くシルビウス裂を開放してから,前頭葉を挙上する.3 反対側視神経と前頭葉底面は剥離しない状態で前頭葉を挙上することにより,半球間裂の開放はしやすくなる.4 A1やICA先端部の動脈瘤は,穿通枝の温存が鍵になり,術野の展開には習熟が必要になる.(著者抄録)
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第11回) 内頸動脈瘤のclipping

  杉山 拓 脳神経外科速報 23 (12) 1336 -1348 2013年12月 [査読無し][招待有り]
   

  ＜内頸動脈瘤手術のポイント＞1 必ず,頸部の頸動脈をマーキングし,消毒野に入れて行う,必要があれば,頸部でICAを確保する.2 側頭葉を後外側へ牽引し,retrocarotid spaceを展開する方法を覚える(anterior temporal approach).3 動脈瘤の剥離やclippingの際,動脈瘤内圧を減らすことを怠らずに行うことが大切.4 破裂症例の場合は,側頭葉の展開の順序を考える.5 内頸動脈瘤clippingを安全に行うには多くの経験を要する.慎重すぎるくらいの心構えで行う.(著者抄録)
• 【神経症候群(第2版)-その他の神経疾患を含めて-】血管障害 その他 もやもや病(ウィリス動脈輪閉塞症)

  杉山 拓, 寳金 清博, 数又 研, 伊東 雅基, 中山 若樹 日本臨床 別冊 (神経症候群I) 347 -351 2013年12月 [査読無し][招待有り]
  
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第10回) 中大脳動脈瘤のclipping(応用編)

  杉山 拓 脳神経外科速報 23 (11) 1220 -1230 2013年11月 [査読無し][招待有り]
   

  ＜中大脳動脈瘤クリッピング術のポイント＞1 重症くも膜下出血例では,いかに脳圧をコントロールするかを考える.2 大きめの開頭,脳室ドレナージ,脳内血腫除去,終板の開放など,臨機応変に対応する.3 sylvian hematomaは,可能な限り摘出する習慣をつける.4 short M1上向きの動脈瘤は,特殊なexposureの知識が必要になる.(著者抄録)
• もやもや病の病態における、循環血液中の血管内皮前駆細胞の意義

  七戸 秀夫, 杉山 拓, 濱内 祝嗣, 数又 研, 中山 若樹, 寳金 清博, 黒田 敏 脳循環代謝 25 (1) 148 -148 2013年11月 [査読無し][通常論文]
  
• How do you teach master Neurosurgicalテクニック? 続・脳血管障害入門編(第9回) 中大脳動脈瘤のclipping(基礎編)

  杉山 拓 脳神経外科速報 23 (10) 1102 -1111 2013年10月 [査読無し][招待有り]
   

  ＜中大脳動脈瘤クリッピング術のポイント＞1 破裂例では,アプローチは安全路(safe way)を考えて戦術的に行う.2 ふだんから,血管造影で最終術野を想像する習慣をつける.絵に描くと自分のわからない部分がわかる.3 動脈瘤は,大部分がbifurcation typeであり,perpendicular closure lineで対応できるケースが多い.4 動脈瘤は手順を考え,freeにする習慣をつける.(著者抄録)
• 「特発性」が示唆されたfourth ventricle outlet obstructionの治療例

  伊師 雪友, 小林 浩之, 茂木 洋晃, 浅岡 克行, 杉山 拓, 越前谷 すみれ, 横山 由佳, 板本 孝治 小児の脳神経 38 (1) 122 -122 2013年04月 [査読有り][通常論文]
  
• Impaired Cerebrovascular Reactivity to Acetazolamide in Parent Arterial Territory of Major Artery Aneurysms in Adult Patients with Moyamoya Disease

  Masaki Ito, Kiyohiro Houkin, Yoshimasa Niiya, Haruto Uchino, Shoji Mabuchi, Naoki Nakayama, Ken Kazumata, Hideo Shichinohe, Taku Sugiyama, Nobuaki Ishii, Mikio Nomura STROKE 44 (2) 2013年02月 [査読有り][通常論文]
  
• 文献抄録 Very urgent carotid endarterectomy confers increased procedural risk

  杉山 拓 Neurological Surgery 脳神経外科 40 (9) 847 -847 2012年09月10日
• もやもや病の病態と治療 最新の知見 もやもや病の病態における、循環血液中の血管内皮前駆細胞の意義

  七戸 秀夫, 黒田 敏, 杉山 拓, 寳金 清博 脳循環代謝 23 (2) 106 -106 2012年09月 [査読無し][通常論文]
  
• ラット脳梗塞亜急性期モデルに対する骨髄間質細胞の直接投与と経静脈投与 : 光イメージングによる検討

  川堀 真人, 黒田 敏, 杉山 拓, 七戸 秀夫, 宝金 清博, 久下 裕司, 玉木 長良 北海道醫學雜誌 = Acta medica Hokkaidonensia 87 (4) 205 -205 2012年08月01日 [査読無し][通常論文]
  
• ラット脳凍結損傷モデルに対する骨髄間質細胞の経動脈的移植 : 生体蛍光イメージング法による評価

  長内 俊也, 黒田 敏, 七戸 秀夫, 杉山 拓, 久下 裕司, 宝金 清博, 玉木 長良, 岩崎 喜信 北海道醫學雜誌 = Acta medica Hokkaidonensia 87 (4) 206 -206 2012年08月01日 [査読無し][通常論文]
  
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第8回)(最終回) はじめてのInterhemispheric Approach(後編) 半球間裂の剥離からクリッピングまで

  杉山 拓 脳神経外科速報 22 (6) 652 -663 2012年06月 [査読無し][招待有り]
   

  ＜半球間裂剥離のポイント＞1 剥離手順は、3step方式を大切にする 2 脳べら、ハサミ、吸引管のやわらかいタッチの使い方を覚える 3 苦しくても、焦らず、粛々と粘り強い気持ちで行う 4 動脈瘤周りでは、常に破裂動脈瘤を想定して、母血管確保や剥離の手順を考える。(著者抄録)
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第7回) はじめてのInterhemispheric Approach(前編) 両側前頭開頭から嗅神経剥離まで

  杉山 拓 脳神経外科速報 22 (5) 542 -549 2012年05月 [査読無し][招待有り]
   

  ＜両側前頭葉開頭のポイント＞1 前頭蓋底が露出するような開頭を心掛ける.2 開頭時から硬膜損傷をしないように注意し,嗅神経の剥離と固定は,なるべく早い段階で行う.3 前頭洞は開放しても,多くの場合は感染率を上げるものではないが,閉鎖処置は適切に行う必要ある.4 Bridging veinを温存するように常に配慮する.(著者抄録)
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第6回) はじめての浅側頭動脈(STA)の剥離

  杉山 拓 脳神経外科速報 22 (4) 420 -428 2012年04月 [査読無し][招待有り]
   

  ＜Bypass術時のSTA剥離のポイント＞1 STAは余計な結合織を残さずに外膜直上で剥離する。2 STAは、wetな状態を保ち、閉塞しないように常に配慮する。3 STAの捻れないような配置と、適切なrecipientの選択が手術成功の鍵。4 閉創時にも、STAのkinkingなどに常に配慮する。(著者抄録)
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第5回) はじめての血管吻合 トレーニングから実践へ

  杉山 拓 脳神経外科速報 22 (3) 282 -291 2012年03月 [査読無し][招待有り]
   

  ＜はじめての血管吻合実践におけるポイント＞1 練習は必須,実践経験後にも,精度の向上を目指して継続して練習を行うべき.2 練習はさまざまな方法・道具があるが,課題意識を持って行うことが重要.3 実践では,術野のセッティングに重点を置く.4 はじめての実践では,愛護的な操作と,確実に内膜同士を接合させることに集中する.5 指導医は,適切な症例と吻合環境を提供するのが望ましい.(著者抄録)
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第4回) はじめてのCEA(後編) 内シャントの挿入から内膜剥離まで

  杉山 拓 脳神経外科速報 22 (2) 164 -172 2012年02月 [査読無し][招待有り]
   

  ＜内シャントチューブ挿入のポイント＞1 血管撮影で外頸動脈の分岐,病変の広がりを詳細に検討する.2 常に十分(すぎるくらい)な術野で行う3 とにかく手順を模倣し覚える(指の使い方まで).4 万が一のときにも,落ち着いて,ゆっくり行う.(著者抄録)
• Dynamic Changes in Cardiac Performance and Fluid Shift in Neurogenic Stunned Myocardium after Subarachnoid Hemorrhage

  Yuka Yokoyama, Ken Kazumata, Katsuyuki Asaoka, Taku Sugiyama, Kazuyoshi Yamazaki, Sumire Echizenya, Kouji Itamoto CEREBROVASCULAR DISEASES 34 22 -22 2012年 [査読無し][通常論文]
  
• Full Exposure of Ruptured Cerebral Aneurysm Preceding Clip Application: A Novel Surgical Concept and Its Advantages in 118 Case Series

  Naoki Nakayama, Kiyohiro Houkin, Tatsuya Ishikawa, Masaaki Hokari, Ken Kazumata, Masaki Ito, Taku Sugiyama, Hiroshi Yasuda CEREBROVASCULAR DISEASES 34 20 -20 2012年 [査読有り][通常論文]
  
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第3回) はじめてのCEA(前編) 術前精査からアプローチまで

  杉山 拓 脳神経外科速報 22 (1) 40 -48 2012年01月 [査読無し][招待有り]
   

  ＜内頸動脈分岐部へのアプローチのポイント＞1CEAは術前から精査を漏れなく行い、できる準備はすべてする。2とにかく無血の術野を心がける。3常に十分(すぎるくらい)な術野を展開する。4頸動脈を動かさないように愛護的に操作する。特に狭窄部位の剥離は最後に行う。(著者抄録)
• 外傷性凝固系異常が頭蓋内血腫へ与える影響について

  横山 由佳, 数又 研, 浅岡 克行, 杉山 拓, 金子 貞洋, 月花 正幸, 板本 孝治 日本脳神経外科救急学会プログラム・抄録集 17回 109 -109 2012年01月 [査読無し][通常論文]
  
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第2回) はじめてのシルビウス裂の開放

  杉山 拓 脳神経外科速報 21 (12) 1338 -1346 2011年12月 [査読無し][招待有り]
   

  ＜シルビウス裂開放のポイント＞1 まず、術者の姿勢を正し、道具の持ち方を不自然にしないようにする。2 SSVはvariationが多いので、どこから剥離してどういった術野になるか、多くの手術(ビデオ)を見てイメージを作る。3 やわらかく脳べらを使う。4 常に静脈と軟膜を温存する習慣を身につける。(著者抄録)
• How do you teach master Neurosurgicalテクニック? 脳血管障害入門編(第1回) 手術セットアップから前頭側頭開頭まで

  杉山 拓 脳神経外科速報 21 (11) 1216 -1223 2011年11月 [査読無し][招待有り]
   

  ＜脳血管手術における前頭側頭開頭のポイント＞1 多くの方法があるが,それぞれの手術コンセプトをきちんと理解して行う.2 STAは必要な分は皮弁に残す.3 前頭葉と側頭葉が1:1の比率で出るように開頭する.4 とにかく出血のないきれいな術野を作る.(著者抄録)
• もやもや病の病態と治療 最新の知見 もやもや病の病態における、循環血液中の血管内皮前駆細胞の意義

  七戸 秀夫, 黒田 敏, 杉山 拓, 寳金 清博 脳循環代謝 23 (1) 97 -97 2011年11月 [査読無し][通常論文]
  
• 原発性CNS粘膜関連リンパ組織リンパ腫(Primary CNS mucosa-associated lymphoid tissue lymphoma)

  鴨嶋 雄大, 澤村 豊, 寺坂 俊介, 杉山 拓, 小林 浩之, 山口 秀, 茂木 洋晃, 久保田 佳奈子, 宝金 清博 Brain Tumor Pathology 28 (Suppl.) 137 -137 2011年05月 [査読有り][通常論文]
  
• Transplanted Bone Marrow Stromal Cells Protect Neurovascular Units and Ameliorate Brain Damage in Stroke-Prone Spontaneously Hypertensive Rats

  Masaki Ito, Satoshi Kuroda, Taku Sugiyama, Katsuhiko Maruichi, Masahito Kawabori, Hideo Shichinohe, Kiyohiro Houkin STROKE 42 (3) E94 -E95 2011年03月 [査読無し][通常論文]
  
• Bone Marrow Stromal Cell Transplantation Attenuates Cognitive Dysfunction Due to Chronic Cerebral Ischemia in Rats

  Hideo Shichinohe, Satoshi Kuroda, Taku Sugiyama, Masaki Ito, Masahito Kawabori STROKE 42 (3) E68 -E68 2011年03月 [査読無し][通常論文]
  
• Sylvian fissureの基本的な微小外科解剖

  数又研, 浅岡克行, 板本孝治, 長内俊也, 杉山拓, 横山由佳 脳神経外科ジャーナル 20 (Supplement) 2011年
• Merciレトリーバー導入に向けた当院での血行再建療法

  長内 俊也, 牛越 聡, 数又 研, 杉山 拓, 横山 由佳, 浅岡 克行, 板本 孝治 JNET: Journal of Neuroendovascular Therapy 4 (4) 295 -295 2010年11月 [査読無し][通常論文]
  
• Platelet lysateを用いたヒト骨髄間質細胞培養 安全な中枢神経再生の臨床応用を目指して

  七戸 秀夫, 黒田 敏, 杉山 拓, 伊東 雅基, 川堀 真人, 西尾 充史, 武田 紫, 小池 隆夫, 寳金 清博 脳循環代謝 22 (1) 128 -128 2010年11月 [査読無し][通常論文]
  
• 血清を用いずに培養したヒト骨髄間質細胞のラット脳梗塞モデルへの移植およびMRIによる移植細胞追跡

  伊東 雅基, 黒田 敏, 杉山 拓, 七戸 秀夫, 武田 紫, 西尾 充史, 小池 隆雄, 寶金 清博 脳循環代謝 22 (1) 128 -128 2010年11月 [査読無し][通常論文]
  
• 17.出血発症の鞍上部腫瘍性病変(脳腫瘍の画像と病理)

  杉山 拓, 寺坂 俊介, 小林 浩之 脳神経外科ジャーナル 19 (2) 102 -106 2010年10月20日 [査読無し][通常論文]
  
• Bone Marrow Stromal Cells and Bone Marrow-derived Mononuclear Cells: Which Are Suitable as Cell Source of Transplantation for Mice Infarct Brain?

  Hideo Shichinohe, Satoshi Kuroda, Katsuhiko Maruichi, Toshiya Osanai, Taku Sugiyama, Yasuhiro Chiba, Ayumi Yamaguchi, Yoshinobu Iwasaki STROKE 41 (4) E232 -E232 2010年04月 [査読無し][通常論文]
  
• ヒト骨髄間質細胞(hBMSC)のラット脳梗塞における治療効果の検討

  杉山拓, 黒田敏, 七戸秀夫, 伊東雅基, 川堀真人, 武田紫, 西尾充史 再生医療 9 2010年
• ラット大脳凍結損傷モデルへの骨髄間質細胞の動注移植

  長内 俊也, 黒田 敏, 千葉 泰弘, 丸一 勝彦, 杉山 拓, 安田 宏, 七戸 秀夫, 岩崎 喜信 日本神経外傷学会プログラム・抄録集 32回 043 -043 2009年04月 [査読無し][通常論文]
  
• 骨髄間質細胞(BMSC)の移植はびまん性軸策損傷(DAI)による高次脳機能障害を改善する 11C-FMZ PET/CTを用いた検討

  丸一 勝彦, 黒田 敏, 千葉 泰弘, 長内 俊也, 穂刈 正昭, 杉山 拓, 七戸 秀夫, 岩崎 喜信 日本神経外傷学会プログラム・抄録集 32回 045 -045 2009年04月 [査読無し][通常論文]
  
• 長波長蛍光物質で標識した骨髄間質細胞(BMSC)の頭蓋内蛍光イメージング

  杉山拓, 黒田敏, 長内俊也, 千葉泰弘, 丸一勝彦, 七戸秀夫, 久下裕司, 岩崎喜信 日本脳神経外科学会総会抄録集(CD-ROM) 68th 2009年
• マウス骨髄由来単核細胞の脳虚血モデルへの移植-移植ソースとしての骨髄間質細胞との比較

  七戸秀夫, 黒田敏, 丸一勝彦, 長内俊也, 杉山拓, 千葉泰弘, 山口明弓, 岩崎喜信 日本脳神経外科学会総会抄録集(CD-ROM) 68th 2009年
• Eloquent area脳動静脈奇形の手術におけるCompact typeとDiffuse typeとでの摘出戦略

  中山若樹, 安田宏, 杉山拓, 黒田敏, 石川達哉 日本脳神経外科学会総会抄録集(CD-ROM) 68th ROMBUNNO.2G-O051-03 2009年 [査読無し][通常論文]
  
• シロスタゾールによる頸動脈内膜剥離術後のプラーク増大の抑制効果

  藤本 真, 吉本 哲之, 白坂 智英, 善積 威, 山内 亨, 杉山 拓, 山口 秀, 徳田 耕一, 金子 貞男, 柏葉 武, 村木 睦子 日本脳神経外科学会総会CD-ROM抄録集 67回 2J -05 2008年10月
• 選択的STA-MCA bypass術、いわゆるpin-point bypassの有用性

  杉山 拓, 吉本 哲之, 山口 秀, 白坂 智英, 藤本 真, 善積 威, 山内 亨, 徳田 耕一, 金子 貞男 日本脳神経外科学会総会CD-ROM抄録集 67回 3J -01 2008年10月 [査読無し][通常論文]
  
• 治療困難な高度石灰化を伴う頸動脈分岐部nearly occlusion病変の血行再建術

  吉本 哲之, 杉山 拓, 山口 秀, 白坂 智英, 藤本 真, 善積 威, 山内 亨, 徳田 耕一, 金子 貞男 日本脳神経外科学会総会CD-ROM抄録集 67回 3J -04 2008年10月 [査読無し][通常論文]
  

受賞

• 2020年04月 新潟大学脳研究所 令和2年度新潟大学脳研究所共同研究費補助金
  
• 2019年12月 鈴木謙三記念医科学応用研究財団 令和元年度（第39回）調査研究助成
   

  受賞者: 杉山 拓
• 2014年12月 かなえ医薬振興財団 第43回かなえ医薬振興財団 海外留学助成
   

  受賞者: 杉山 拓

共同研究・競争的資金等の研究課題

• 多次元先端映像解析を駆使した顕微鏡手術「複雑性」の解明

  日本学術振興会：科学研究費助成事業 基盤研究(C)

  研究期間 : 2021年04月 -2026年03月 

  代表者 : 杉山 拓, 中山若樹, 杉森博行, 松澤等, 小笠原克彦, 藤村幹, 伊東雅基
• もやもや病のエピゲノム血液バイオマーカー探索ー血漿microRNAの包括的検証ー

  日本学術振興会：科学研究費助成事業 基盤研究(B)

  研究期間 : 2021年04月 -2024年03月 

  代表者 : 伊東 雅基, 佐藤 典宏, 矢部 一郎, 寳金 清博, 藤村 幹, 杉山 拓, 内野 晴登, 中山 若樹, 数又 研, 東海林 菊太郎, 浜内 祝嗣
• 教師なし深層学習を用いたMR画像の病変検出システムの開発

  日本学術振興会：科学研究費助成事業 基盤研究(C)

  研究期間 : 2021年04月 -2024年03月 

  代表者 : 松澤 等, 中山若樹, 杉山拓, 浦川貴朗
• もやもや病患者における前頭葉機能低下に対する 認知機能トレーニングの確立

  日本学術振興会：科学研究費助成事業 基盤研究(C)

  研究期間 : 2021年04月 -2023年03月 

  代表者 : 澤村 大輔, Tha KhinKhin, 境 信哉, 数又 研, 杉山拓

   

  今年度は研究実施計画書の通り、健常者におけるトレーニングの効果を行動学的変化より検証した研究、またその結果に基づいて実施した脳機能評価としてのresting-state fMRIおよび脳構造評価としてのdiffusion imagingを用いて脳の可塑的変化を評価した研究の論文を執筆し、現在投稿中である。 この論文は前年度の報告に加え、diffusion imagingによる脳構造変化の抽出、またこの構造的変化に基づくresting-state fMRIの追加解析を行った。結果として、認知機能に関連する皮質領域、小脳を中心とした領域にトレーニング由来の構造的変化が生じたことが推察された。特に構造的変化が生じたと推察される右頭頂葉皮質領域、またこの領域を中心とするFrontoparietal network、小脳虫部が認知機能トレーニングに伴う神経可塑的変化に関連している可能性を示唆したものである。
  もやもや病患者のリクルートは、コロナ禍の影響により滞っていたが、現在はリクルートを開始することができている。現在は研究分担者とリクルートについての会議を開催し、できる限り早期に目標症例数を達成できるよう連携を強化することで合意を得ている。
• 抗酸化作用を付与した人工酸素運搬体による脳梗塞治療法の開発

  日本学術振興会：科学研究費助成事業 基盤研究(C)

  研究期間 : 2020年04月 -2022年03月 

  代表者 : 鐙谷 武雄, 小松 晃之, 中山 若樹, 川堀 真人, 数又 研, 寳金 清博, 長内 俊也, 伊東雅基, 杉山拓

   

  ヘモグロビン1分子にアルブミン3分子を共有結合させた形の人工酸素運搬体であるHemoActは、我々の先行研究で脳虚血再灌流モデル（糸栓子による中大脳動脈閉塞）において良好な脳保護効果を示した。今回の研究では、このHemoActに抗酸化物質である白金ナノ粒子(PtNP)を結合させ、抗酸化作用を付加したPtNP-HemoActを使用し、抗酸化作用の上乗せにより、さらに強い脳保護効果を発揮しうるかを検討することを目的としている。初年度はPtNP-HemoActの合成において、PtNPとHemoActの混合比を調整するのに時間を要したが、現在は至適の混合比が得られ、本年度は安定的な製剤作成が可能となった。また、本年度は虚血再灌流モデルラットの作製については複数名のものが安定したモデル作成をできる段階に達してきている。これにより、実験の進行を加速化できる状態となったが、新型コロナウイルスの市中感染拡大により大学施設の行動指針がレベル3の制限がかかり、動物実験室が使えなくなる事態となってしまった。このため、パイロット実験の進行が遅れてしまい、今年度の終盤にやっと初めての投与実験が可能となった。先行研究のHemoAct投与量と同量（1.2g/6ml/㎏）のPtNP-HemoActを2時間虚血24時間再灌流のラットに経動脈的、もしくは経静脈的に投与してその治療効果を検討した。まだ若干数ではあるが、経動脈投与、経静脈投与とも無治療のコントロールラットに比べて梗塞巣が小さくなる傾向にあった。
• 脳動脈瘤破裂機構解明へ向けた分子生物学的・血行力学的統合解析と新規薬剤治療の開拓

  日本学術振興会：科学研究費助成事業 基盤研究(C)

  研究期間 : 2019年04月 -2020年03月 

  代表者 : 中山 若樹, 伊東 雅基, 杉山 拓, 寳金 清博

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