脳血管内治療部

2023年05月19日現在

部長から皆さまへ

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

診療内容

脳神経領域に関わる、脳動脈瘤、脳血管奇形、硬膜動静脈瘻、脳梗塞、頚動脈狭窄・脳血管疾患全般の外科的診療
カテーテルによる脳血管内手術、開頭手術に対応するHybrid 手術室を駆使した外科的治療と脳血管内治療の融合
脳卒中診療では、Hybrid手術を利用した、診断、検査、治療、治療後の脳血流評価まで一括して可能にする「One stop service Stroke Care」の確立
医工連携を基盤とした産学共同連携を利用した基礎および臨床研究。
新しい治療機器の開発

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。

当診療科の得意分野・特色

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。

未破裂脳動脈瘤について

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

Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies.
Greving JP, Wermer MJ, Brown RD Jr, Morita A, Juvela S, Yonekura M, Ishibashi T, Torner JC, Nakayama T, Rinkel GJ, Algra A.
Lancet Neurol. 2014 Jan;13(1):59-66.
Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group.
Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown RD Jr, Connolly ES Jr, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H, Kirkpatrick PJ, Knuckey N, Koivisto T, Lanzino G, Lawton MT, Leroux P, McDougall CG, Mee E, Mocco J, Molyneux A, Morgan MK, Mori K, Morita A, Murayama Y, Nagahiro S, Pasqualin A, Raabe A, Raymond J, Rinkel GJ, Rüfenacht D, Seifert V, Spears J, Steiger HJ, Steinmetz H, Torner JC, Vajkoczy P, Wanke I, Wong GK, Wong JH, Macdonald RL.
Stroke. 2014 May;45(5):1523-30.
Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes.
Hetts SW, Turk A, English JD, Dowd CF, Mocco J, Prestigiacomo C, Nesbit G, Ge SG, Jin JN, Carroll K, Murayama Y, Gholkar A, Barnwell S, Lopes D, Johnston SC, McDougall C; Matrix and Platinum Science Trial Investigators.
AJNR Am J Neuroradiol. 2014 Apr;35(4):698-705.
Risk Analysis of Unruptured Intracranial Aneurysms: Prospective 10-Year Cohort Study. Murayama Y, Takao H, Ishibashi T, Saguchi T, Ebara M, Yuki I, Arakawa H, Irie K, Urashima M, Molyneux AJ.
Stroke. 2016 Feb;47(2):365-71.
ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms.
Backes D, Rinkel GJE, Greving JP, Velthuis BK, Murayama Y, Takao H, Ishibashi T, Igase M, terBrugge KG, Agid R, Jääskeläinen JE, Lindgren AE, Koivisto T, von Und Zu Fraunberg M, Matsubara S, Moroi J, Wong GKC, Abrigo JM, Igase K, Matsumoto K, Wermer MJH, van Walderveen MAA, Algra A, Vergouwen MDI.
Neurology. 2017 Apr 25;88(17):1600-1606.

3Dプリンターで作成した動脈瘤モデルとカスタムメイドカテーテル

診療スタッフ

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、森　良介、菅　一成、畑岡　俊介、長山　剛太、佐野　透

治療実績

脳血管内手術・脳動脈瘤　治療件数　年次推移

手術件数

脳血管内手術　分類	2018年	2019年	2020年	2021年	2022年
破裂脳動脈瘤塞栓術	16	11	8	7	11
未破裂脳動脈瘤塞栓術	164	160	132	141	137
脳動静脈奇形	5	14	4	5	7
脊髄血管奇形塞栓術(脊髄硬膜動静脈瘻含む)	5	0	0	1	1
硬膜動静脈瘻塞栓術（脊髄は含まず）	8	14	13	16	14
直接型頚動脈海綿静脈洞瘻塞栓術	2	2	1	0	2
頭蓋内腫瘍塞栓術	10	13	18	1	0
頭頚部病変塞栓術	3	0	2	15	9
その他塞栓術		2	2	2	6
頚動脈ステント留置術	20	27	12	1	3
頭蓋外血管形成術/ステント留置術（CAS以外）	0	1	0	21	14
頭蓋内血管形成術/ステント留置術	3	0	1	1	1
脳動脈再開通療法	21	20	17	1	0
脳血管攣縮治療	1	1	1	18	21
その他血管内治療	3	0	0	7	3
脳血管内手術　総計	261	265	211	237	229

発表論文 (2019-2021)

Nguyen TN, Haussen DC, Qureshi MM, Yamagami H, Fujinaka T, Mansour OY, Abdalkader M, Frankel M, Qiu Z, Taylor A, Lylyk P, Eker OF, Mechtouff L, Piotin M, Lima FO, Mont'Alverne F, Izzath W, Sakai N, Mohammaden M, Al-Bayati AR, Renieri L, Mangiafico S, Ozretic D, Chalumeau V, Ahmad S, Rashid U, Hussain SI, John S, Griffin E, Thornton J, Fiorot JA, Rivera R, Hammami N, Cervantes-Arslanian AM, Dasenbrock HH, Vu HL, Nguyen VQ, Hetts S, Bourcier R, Guile R, Walker M, Sharma M, Frei D, Jabbour P, Herial N, Al-Mufti F, Ozdemir AO, Aykac O, Gandhi D, Chugh C, Matouk C, Lavoie P, Edgell R, Beer-Furlan A, Chen M, Killer-Oberpfalzer M, Pereira VM, Nicholson P, Huded V, Ohara N, Watanabe D, Shin DH, Magalhaes PS, Kikano R, Ortega-Gutierrez S, Farooqui M, Abou-Hamden A, Amano T, Yamamoto R, Weeks A, Cora EA, Sivan-Hoffmann R, Crosa R, Mohlenbruch M, Nagel S, Al-Jehani H, Sheth SA, Lopez Rivera VS, Siegler JE, Sani AF, Puri AS, Kuhn AL, Bernava G, Machi P, Abud DG, Pontes-Neto OM, Wakhloo AK, Voetsch B, Raz E, Yaghi S, Mehta BP, Kimura N, Murakami M, Lee JS, Hong JM, Fahed R, Walker G, Hagashi E, Cordina SM, Roh HG, Wong K, Arenillas JF, Martinez-Galdamez M, Blasco J, Rodriguez Vasquez A, Fonseca L, Silva ML, Wu TY, John S, Brehm A, Psychogios M, Mack WJ, Tenser M, Todaka T, Fujimura M, Novakovic R, Deguchi J, Sugiura Y, Tokimura H, Khatri R, Kelly M, Peeling L, Murayama Y, Winters HS, Wong J, Teleb M, Payne J, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Uno M, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Morimoto M, Iida J, Saini V, Yavagal D, Bushnaq S, Huang W, Linfante I, Kirmani J, Liebeskind DS, Szeder V, Shah R, Devlin TG, Birnbaum L, Luo J, Churojana A, Masoud HE, Lopez CY, Steinfort B, Ma A, Hassan AE, Al Hashmi A, McDermott M, Mokin M, Chebl A, Kargiotis O, Tsivgoulis G, Morris JG, Eskey CJ, Thon J, Rebello L, Altschul D, Cornett O, Singh V, Pandian J, Kulkarni A, Lavados PM, Olavarria VV, Todo K, Yamamoto Y, Silva GS, Geyik S, Johann J, Multani S, Kaliaev A, Sonoda K, Hashimoto H, Alhazzani A, Chung DY, Mayer SA, Fifi JT, Hill MD, Zhang H, Yuan Z, Shang X, Castonguay AC, Gupta R, Jovin TG, Raymond J, Zaidat OO, Nogueira RG; SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO); Japanese Society of Vascular and Interventional Neurology Society (JVIN). Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. Stroke Vasc Neurol. 2021 Mar 26:svn-2020-000695. doi: 10.1136/svn-2020-000695. Epub ahead of print. PMID: 33771936; PMCID: PMC8006491.
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.
Michishita S, Ishibashi T, Yuki I, Urashima M, Karagiozov K, Kodama T, Kan I, Nishimura K, Kato N, Ikemura A, Murayama Y. Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment. Interv Neuroradiol. 2021 Feb 21:1591019921996886. doi: 10.1177/1591019921996886. Epub ahead of print. PMID: 33615875.
Kato N, Yuki I, Otani K, Ishibashi T, Kakizaki S, Nagayama G, Maruyama F, Ikemura A, Kan I, Kodama T, Abe Y, Murayama Y. Flow Diverter Apposition in Patients with Large or Giant Intracranial Aneurysms Evaluated on Three-Dimensional Fusion Images Acquired by High-Resolution Cone-Beam Computed Tomography and Digital Subtraction Angiography. World Neurosurg. 2021 Mar;147: e388-e395. doi: 10.1016/j.wneu.2020.12.068. Epub 2021 Jan 7. PMID:33359518.
Kato N, Nishimura K, Sonoda S, Kakizaki S, Nagayama G, Aoki K, Maruyama F, Ikemura A, Kan I, Kodama T, Kaku S, Yuki I, Ishibashi T, Otani K, Murayama Y. Comparison of Clinical Outcomes After Stent-Assisted Coiling with 3 Types of Self-Expanding Laser-Cut Stents in Patients with Wide-Necked Intracranial Aneurysms. World Neurosurg. 2021 Feb;146:e701-e707. doi: 10.1016/j.wneu.2020.10.166. Epub 2020 Nov 9. PMID: 33181375.
Kato N, Yuki I, Hataoka S, Dahmani C, Otani K, Abe Y, Kakizaki S, Nagayama G, Maruyama F, Ikemura A, Kan I, Kodama T, Ishibashi T, Murayama Y. 4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations. J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105327. doi:10.1016/j.jstrokecerebrovasdis.2020.105327. Epub 2020 Sep 28. PMID: 32992207.
Yanagisawa T, Zhang H, Suzuki T, Kamio Y, Takizawa T, Morais A, Chung DY, Qin T, Murayama Y, Faber JE, Patel AB, Ayata C. Sex and Genetic Background Effects on the Outcome of Experimental Intracranial Aneurysms. Stroke. 2020 Oct;51(10):3083-3094. doi: 10.1161/STROKEAHA.120.029651. Epub 2020 Sep 11. PMID:32912097; PMCID: PMC7530050.
Kan I, Karagiozov K, Ito S, Sato S, Murayama Y. Microcatheter Originating Debris during Neuroendovascular Procedures: Mechanism of Dislodgement and Its Prevention. AJNR Am J Neuroradiol. 2020 Oct;41(10):1879-1881. doi:10.3174/ajnr.A6723. Epub 2020 Aug 27. PMID: 32855184; PMCID: PMC7661062.
Kakizaki S, Ishibashi T, Kato N, Kan I, Nishimura K, Murayama Y. Complete Obliteration of a Foramen Magnum Dural Arteriovenous Fistula by Microsurgery After Failed Endovascular Treatment Using Onyx: Case Report and Literature Review. World Neurosurg. 2020 Dec;144:43-49. doi: 10.1016/j.wneu.2020.08.077. Epub 2020 Aug 15. PMID: 32805464.
Nita CI, Suzuki T, Itu LM, Mihalef V, Takao H, Murayama Y, Sharma P, Redel T, Rapaka S. An Automated Workflow for Hemodynamic Computations in Cerebral Aneurysms. Comput Math Methods Med. 2020 Jun 17;2020:5954617. doi: 10.1155/2020/5954617. PMID: 32655681; PMCID: PMC7317611.
Sakai K, Komatsu T, Iguchi Y, Takao H, Ishibashi T, Murayama Y. Reliability of Smartphone for Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study. J Med Internet Res. 2020 Jun 9;22(6):e15893. doi: 10.2196/15893.PMID: 32515744; PMCID: PMC7312257.
Pan J, Chartrain AG, Scaggiante J, Spiotta AM, Tang Z, Wang W, Pradilla G, Murayama Y, Mori R, Mocco J, Kellner CP. A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques. Oper Neurosurg (Hagerstown). 2020 Jun 1;18(6):710-720. doi: 10.1093/ons/opz308. PMID: 31625580.
Ozono I, Ikawa F, Hidaka T, Yoshiyama M, Matsuda S, Michihata N, Kobata H, Murayama Y, Sato A, Kato Y, Sano H, Yamaguchi S, Kurisu K. Risk Factor for Poor Outcome in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage Based on Post Hoc Analysis of the Modified WFNS Scale Study. World Neurosurg. 2020 Sep;141:e466-e473. doi: 10.1016/j.wneu.2020.05.196. Epub 2020 May 29. PMID: 32474089.
Kodama T, Yoshihara A, Goel I, Sekino M, Kuwahata A, Yoshimori A, Murayama Y, Ishihara K, Ekdahl KN, Nilsson B, Teramura Y. Identification of Metal-Binding Peptides and Their Conjugation onto Nanoparticles of Superparamagnetic Iron Oxides and Liposomes. ACS Appl Mater Interfaces. 2020 Jun 3;12(22):24623-24634. doi: 10.1021/acsami.0c06138. Epub 2020 May 19. PMID: 32375468.
Maruyama F, Ishibashi T, Kato N, Karagiozov K, Kan I, Kodama T, Murayama Y.“Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients.” Interv Neuroradiol. 2021 Jan 7:1591019920987345. doi: 10.1177/1591019920987345. Online ahead of print.
Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms.
Ikemura A, Ishibashi T, Otani K, Yuki I, Kodama T, Kan I, Kato N, Murayama Y.AJNR Am J Neuroradiol. 2020 Feb;41(2):286-292. doi: 10.3174/ajnr.A6386. Epub 2020 Jan 30.
Rupture Risk of Small Unruptured Intracranial Aneurysms in Japanese Adults.
Suzuki T, Takao H, Rapaka S, Fujimura S, Ioan Nita C, Uchiyama Y, Ohno H, Otani K, Dahmani C, Mihalef V, Sharma P, Mohamed A, Redel T, Ishibashi T, Yamamoto M, MurayamaY.Stroke. 2020 Feb;51(2):641-643. doi: 10.1161/STROKEAHA.119.027664. Epub 2019 Dec 9.
Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization.
Kan I, Ishibashi T, Sakuta K, Fujimura S, Yuki I, Kaku S, Kodama T, Kato N, Nishimura K, Aoki K, Sasaki Y, Karagiozov K, Murayama Y.World Neurosurg. 2020 Feb;134:e731-e738. doi: 10.1016/j.wneu.2019.10.179. Epub 2019 Nov 5.
A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques.
Pan J, Chartrain AG, Scaggiante J, Spiotta AM, Tang Z, Wang W, Pradilla G, Murayama Y, Mori R, Mocco J, Kellner CP.Oper Neurosurg (Hagerstown). 2019 Oct 18. pii: opz308. doi: 10.1093/ons/opz308. [Epub ahead of print]
Evaluation of Balloon Test Occlusion Before Therapeutic Carotid Artery Occlusion: Flat Detector Computed Tomography Cerebral Blood Volume Imaging versus Single-Photon Emission Computed Tomography.
Ikemura A, Yuki I, Otani K, Ishibashi T, Dahmani C, Ebara M, Abe Y, Kajiwara I, Watanabe M, Murayama Y.World Neurosurg. 2020 Jan;133:e522-e528. doi: 10.1016/j.wneu.2019.09.077. Epub 2019 Sep 21.
Combination of high-resolution cone beam computed tomography and metal artefact reduction software: a new image fusion technique for evaluating intracranial stent apposition after aneurysm treatment.
Yuki I, Ishibashi T, Dahmani C, Kato N, Ikemura A, Abe Y, Otani K, Kodama T, Kan I, Nishimura K, Murayama Y.BMJ Case Rep. 2019 Sep 17;12(9). pii: e230687. doi: 10.1136/bcr-2019-230687.
Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT.
Kato N, Yuki I, Ishibashi T, Ikemura A, Kan I, Nishimura K, Kodama T, Kaku S, Abe Y, Otani K, Murayama Y.J Neurointerv Surg. 2020 Feb;12(2):192-196. doi: 10.1136/neurintsurg-2019-014966. Epub 2019 Aug 12.
Extending statistical learning for aneurysm rupture assessment to Finnish and Japanese populations using morphology, hemodynamics, and patient characteristics.
Detmer FJ, Hadad S, Chung BJ, Mut F, Slawski M, Juchler N, Kurtcuoglu V, Hirsch S, Bijlenga P, Uchiyama Y, Fujimura S, Yamamoto M, Murayama Y, Takao H, Koivisto T, Frösen J, Cebral JR.Neurosurg Focus. 2019 Jul 1;47(1):E16. doi: 10.3171/2019.4.FOCUS19145.
Computational fluid dynamics as a risk assessment tool for aneurysm rupture.
Murayama Y, Fujimura S, Suzuki T, Takao H.
Neurosurg Focus. 2019 Jul 1;47(1):E12. doi: 10.3171/2019.4.FOCUS19189.
Common Data Elements for Subarachnoid Hemorrhage and Unruptured Intracranial Aneurysms: Recommendations from the Working Group on Subject Characteristics.
Bijlenga P, Morita A, Ko NU, Mocco J, Morel S, Murayama Y, Wermer MJH, Brown RD Jr; Unruptured Cerebral Aneurysms and SAH CDE Project Investigators.Neurocrit Care. 2019 Jun;30(Suppl 1):20-27. doi: 10.1007/s12028-019-00724-5.
Noninvasive Vagus Nerve Stimulation Prevents Ruptures and Improves Outcomes in a Model of Intracranial Aneurysm in Mice.
Suzuki T, Takizawa T, Kamio Y, Qin T, Hashimoto T, Fujii Y, Murayama Y, Patel AB, Ayata C.
Stroke. 2019 May;50(5):1216-1223. doi: 10.1161/STROKEAHA.118.023928.PMID:
Decreased wall shear stress at high-pressure areas predicts the rupture point in ruptured intracranial aneurysms.
Suzuki T, Stapleton CJ, Koch MJ, Tanaka K, Fujimura S, Suzuki T, Yanagisawa T, Yamamoto M, Fujii Y, Murayama Y, Patel AB.J Neurosurg. 2019 Mar 15:1-7. doi: 10.3171/2018.12.JNS182897. [Epub ahead of print]
Intravenous 3-Dimensional Digital Subtraction Angiography During Surgical Treatment of Intracranial Aneurysm.
Kan I, Kato N, Otani K, Abe Y, Ishibashi T, Murayama Y.World Neurosurg. 2019 Jun;126:533-536. doi: 10.1016/j.wneu.2019.02.160. Epub 2019 Mar 9.
Accuracy of Length of Virtual Stents in Treatment of Intracranial Wide-Necked Aneurysms.
Nishimura K, Otani K, Mohamed A, Dahmani C, Ishibashi T, Yuki I, Kaku S,Takao H, Murayama Y.Cardiovasc Intervent Radiol. 2019　Aug;42(8):1168-1174. doi: 10.1007/s00270-019-02230-9. Epub 2019 May 10. PubMed PMID: 31076839; PubMed Central PMCID: PMC6597734.
Extracranial-Intracranial Bypass for Cerebral Vasculitis After Graft-Versus-Host Disease: Case Report and Review of the Literature.
Nakayama Y, Kamio Y, Kato N, Murayama Y. World Neurosurg. 2019 Mar;123:193-196. doi:10.1016/j.wneu.2018.11.256. Epub 2018 Dec 18. Review. PubMed PMID: 30576821.