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2024年04月01日 現在
脳血管内手術は血管の中に極微細のカテーテルを頭蓋内血管まで挿入し、レントゲン透視下に血管の内部から脳血管障害(脳卒中)やある種の脳腫瘍等を治療する新しい分野です。従来の開頭方法による手術では治療困難であった様々な疾患が、この方法によって治療可能となってきました。慈恵医大脳血管内治療部では脳血管障害を中心に最先端の診療および研究を行っています。現在、脳血管内治療部では以下のような病気に対する治療を行っています。
診療部長/教授 村山 雄一
くわしくは脳血管内治療センターホームページをご覧ください。
脳動脈瘤に対しては従来からのコイル塞栓術のみならずフローダイバーターと呼ばれる新しい網目の細かなステント留置術など最新の低侵襲治療を手がけております。脳梗塞に対する急性期血栓回収術や、脳梗塞の原因となる頚部頚動脈狭窄症に対する頚動脈ステント留置術(CAS)も積極的に行っています。また脳動静脈奇形や硬膜動静脈瘻は診療部長である村山が開発に携わった脳動静脈奇形に対する液体塞栓物質であるOnyxを用いた治療により、根治生の高い治療を目指しています。現在国内最大規模総勢9名の脳血管内治療専門医(内 脳血管内治療指導医3名)が診療に従事し、安全性と技術力の高い治療を提供しています。
脳ドックなどで偶然発見される未破裂脳動脈瘤が増えています。当院では全国から年間600−700例の新規患者さんが紹介受診されますが、最も重要なことは、破裂の危険は個々の動脈瘤によって異なり、動脈瘤の場所や大きさによっては保存的治療でも破裂することなく一生そのままの方が多数いらっしゃることです。当院では2003年以降で6,000例以上の未破裂脳動脈瘤を診断しておりますが、さまざまな破裂リスクの評価を行い治療の適応を慎重に検討しています。
実際に治療を行ったのは約30%です。治療の際は患者さんの画像データから実物大動脈瘤モデルを3Dプリンターで作成し、より安全な治療を心がけております。また塞栓コイルやステントなどの医療機器開発も積極的に行っています。破裂のリスクが低いと判断した患者さんは定期検診で経過をみております。当科における破裂のリスク解析研究は海外からも高い評価を得、さまざまな国際研究に参加しております。未破裂脳動脈瘤が発見されて不安を抱えているかたは一度ご相談ください。
参考文献
3Dプリンターで作成した動脈瘤モデルとカスタムメイドカテーテル
診療部長 |
村山 雄一 |
---|---|
診療副部長 |
石橋 敏寛 |
診療医員 |
加藤 直樹、菅 一成、畑岡 峻介、長山 剛太、佐野 透、府賀 道康、榎本 弘幸、石川 耕平、中山 陽介 |
脳血管内手術 分類 | 2019年 | 2020年 | 2021年 | 2022年 | 2023年 |
---|---|---|---|---|---|
破裂脳動脈瘤塞栓術 | 11 | 8 | 7 | 11 | 18 |
未破裂脳動脈瘤塞栓術 | 160 | 132 | 141 | 137 | 146 |
脳動静脈奇形 | 14 | 4 | 5 | 7 | 2 |
脊髄血管奇形塞栓術(脊髄硬膜動静脈瘻含む) | 0 | 0 | 1 | 1 | 1 |
硬膜動静脈瘻塞栓術(脊髄は含まず) | 14 | 13 | 16 | 14 | 14 |
直接型頚動脈海綿静脈洞瘻塞栓術 | 2 | 1 | 0 | 2 | 0 |
頭蓋内腫瘍塞栓術 | 13 | 18 | 1 | 0 | 5 |
頭頚部病変塞栓術 | 0 | 2 | 15 | 9 | 14 |
その他塞栓術 | 2 | 2 | 2 | 6 | 0 |
頚動脈ステント留置術 | 27 | 12 | 1 | 3 | 14 |
頭蓋外血管形成術/ステント留置術(CAS以外) | 1 | 0 | 21 | 14 | 1 |
頭蓋内血管形成術/ステント留置術 | 0 | 1 | 1 | 1 | 0 |
脳動脈再開通療法 | 20 | 17 | 1 | 0 | 16 |
脳血管攣縮治療 | 1 | 1 | 18 | 21 | 0 |
その他血管内治療 | 0 | 0 | 7 | 3 | 2 |
脳血管内手術 総計 | 265 | 211 | 237 | 229 | 221 |
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- Kato N, Ishibashi T, Maruyama F, Otani K, Kakizaki S, Nagayama G, Ikemura A, Hataoka S, Kan I, Kodama T, Murayama Y. Clinical outcomes of procedures combining endovascular embolization with a direct surgical approach in a hybrid operating room for the treatment of refractory dural arteriovenous fistulas. Surg Neurol Int. 2021 Aug 30;12:439. doi: 10.25259/SNI4862021. PMID: 34513202; PMCID: PMC8422465.
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- Takao H, Sakai K, Mitsumura H, Komatsu T, Yuki I, Takeshita K, Sakuta K, Ishibashi T, Sakano T, Yeh Y, Karagiozov K, Fisher M, Iguchi Y, Murayama Y. A Smartphone Application as a Telemedicine Tool for Stroke Care Management. Neurol Med Chir (Tokyo). 2021 Apr 15;61(4):260-267. doi: 10.2176/nmc.oa.2020-0302. Epub 2021 Mar 12. PMID: 33716234; PMCID: PMC8048116.
- Takao H, Sakai K, Mitsumura H, Komatsu T, Yuki I, Takeshita K, Sakuta K, Ishibashi T, Sakano T, Yeh Y, Karagiozov K, Fisher M, Iguchi Y, Murayama Y. A Smartphone Application as a Telemedicine Tool for Stroke Care Management. Neurol Med Chir (Tokyo). 2021 Mar 12. doi: 10.2176/nmc.oa.2020-0302. Epub ahead of print. PMID: 33716234.
- Ishibashi T, Maruyama F, Kan I, Sano T, Murayama Y. Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone. Surg Neurol Int. 2021 Mar 2;12:85. doi:10.25259/SNI8582020. PMID: 33767889; PMCID: PMC7982113.
- Sakai K, Sato T, Komatsu T, Mitsumura H, Iguchi Y, Ishibashi T, Murayama Y, Takeshita K, Takao H. Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy. Neurol Sci. 2021 Feb 26:1?6. doi: 10.1007/s10072-021-05132-2. Epub ahead of print. PMID: 33638012; PMCID: PMC7908941.
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