Tatsuya Ishikawa

Research Institute for Brain and Blood Vessels-Akita, Akita, Akita, Japan

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Publications (104)121.18 Total impact

  • No shinkei geka. Neurological surgery 09/2014; 42(9):829-835. · 0.13 Impact Factor
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    ABSTRACT: IntroductionTakotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcome have not been studied. The purpose of this study was to investigate the TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH.Methods We retrospectively analyzed 46 consecutive postoperative SAH patients who developed TCM. Patients were divided into two groups of echocardiographic left ventricular ejection fraction (LVEF)¿<¿40% (TCM with left ventricular (LV) dysfunction) and LVEF ¿40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution, in parallel with serial measurements of echocardiographic parameters and blood biochemical markers.ResultsTranspulmonary thermodilution-derived cardiac function index (CFI) was significantly correlated with (LVEF) (r¿=¿0.82, P¿<¿0.0001). The CFI between day 0 to day 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ¿40% (P¿<¿0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF¿<¿40%) (area under the curve: 0.85¿±¿0.02; P¿<¿0.001). A CFI value of¿<¿4.2 min¿1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. The CFI¿<¿4.2 min¿1 was associated with delayed cerebral ischemia (DCI) (odds ratio (OR), 2.14; 95% confidence interval (CI), 1.33¿2.86; P¿=¿0.004) and poor 3-month functional outcome on modified Rankin Scale of 4¿6 (OR, 1.87; 95% CI, 1.06¿3.29; P¿=¿0.02). An extravascular lung water index (ELWI)¿>¿14 mL/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR, 2.10; 95% CI, 1.11¿3.97; P¿=¿0.04).Conclusions Prolonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in patients with SAH suffering from TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes of the cardiopulmonary function in directing proper post-SAH treatment.
    Critical care (London, England) 08/2014; 18(4):482. · 4.72 Impact Factor
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    ABSTRACT: It is controversial whether taking antiplatelet agents (APs) or anticoagulant agents (ACs) could influence clinical outcome after intracerebral hemorrhage (ICH).
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2014;
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    ABSTRACT: Recent clinical data suggest that postoperative hemodynamic profile and fluid management may differ in aneurysmal subarachnoid hemorrhage patients depending on the treatment option: surgical clipping or endovascular coiling. Our aim was to determine the differences in hemodynamic parameters between the 2 modalities using an advanced transpulmonary thermodilution technique. We studied 73 consecutive aneurysmal subarachnoid hemorrhage patients treated with either clipping or coiling. Transpulmonary thermodilution was established for monitoring cardiac index, global end-diastolic volume index (GEDI), and extravascular lung water index (ELWI). Blood biochemical markers were sampled in parallel. Hypovolemia (GEDI: 656±72 vs. 713±40 mL/m; P=0.0001) and elevated plasma brain natriuretic peptide (114.0±56.7 vs. 68.6±47.4 pg/mL; P=0.0004) were evident on initial measurements in the clipping group. The number of fluid challenges until normalization of GEDI and ROC-based prediction of the responders (GEDI≥10%) during vasospasm risk period (day 4 to 14 of ictus) were less with coiling than with clipping (P<0.05). Therapy-related pulmonary edema was detected only in the clipping group (8%, n=3). Although length of intensive care unit stay was shorter in the coiling group (P=0.016), incidences of delayed ischemia (13% vs. 11%; P=0.50) and poor functional outcome on modified Rankin Scale score 4 to 6 at 1 month (37% vs. 46%; P=0.30) were not statistically different. Surgical clipping is associated with higher cardiac output and hypovolemia in the early postoperative stage and poorer preload responsiveness to volume therapy during the vasospasm risk period compared with endovascular coiling.
    Journal of neurosurgical anesthesiology 04/2014; · 2.41 Impact Factor
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    ABSTRACT: Strategic cervical internal carotid occlusion is employed either temporarily or permanently in various neurosurgical procedures. The aim of the present study was to assess changes in cortical arterial pressure during cervical internal carotid cross-clamping before and after the placement of radial artery (RA) graft bypass in the treatment of complex carotid artery aneurysms. Perfusion pressure of the middle cerebral artery (MCA) was assessed in 22 patients with complex carotid aneurysm treated with RA graft bypass. Regional cerebral blood flow was assessed postoperatively using single-photon computed tomography. Mean cortical blood pressure (mcBP) was found to be 48.2 ± 24.2 and 97.0 ± 24.0 % of baseline after clamping the cervical internal carotid artery and opening the RA graft bypass, respectively. Cerebral perfusion pressure estimated by the mcBP failed to sustain a critical limit of greater than 70 mmHg under craniotomy in 16 out of 20 (80 %) patients. There was an inverse correlation in mcBP between the baseline and after the placement of the RA graft bypass (r = 0.66, P < 0.005). Postoperative regional cerebral blood flow in the MCA territory on the ipsilateral side of the aneurysm was 97 ± 7 % of that of the contralateral side after internal carotid artery (ICA) ligation combined with RA graft bypass. Substantial pressure reductions in cerebral cortical arteries were observed during the cervical internal carotid cross-clamping. Perfusion pressure in peripheral cortical arteries after the placement of the RA graft bypass was comparable to the state before ICA clamping.
    Neurosurgical Review 04/2014; · 1.97 Impact Factor
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    ABSTRACT: The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but the effects of EGDT on clinical outcomes are still unclear. This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy. This study included 160 patients treated within 24 hours after subarachnoid hemorrhage, randomized to receive either (1) EGDT guided by preload volume and cardiac output monitored by transpulmonary thermodilution (treatment group) or (2) standard therapy guided by fluid balance or central venous pressure, assisted by uncalibrated less-invasive cardiac output monitoring during hyperdynamic therapy in patients with clinical or radiological indications of DCI (control group). DCI determined by clinical or radiological findings and functional outcome determined by the modified Rankin Scale score at 3 months were compared between groups. For all clinical grades combined, there were no significant differences in the rates of DCI (33% versus 42%; P=0.33) or modified Rankin Scale score of 0 to 3 at 3 months (67% versus 57%; P=0.22) between the 2 groups. For patients with poor clinical grade, those who received EGDT had a significantly lower rate of DCI (5% versus 14%; P=0.036), modified Rankin Scale score of 0 to 3 at 3 months (52% versus 36%; P=0.026), and shorter length of intensive care unit stay (14 versus 17 days; P=0.043) than those who received standard therapy. EGDT is beneficial for reducing DCI and improving postoperative functional outcome in patients with poor clinical grade. http://www.clinicaltrials.gov. Unique identifier: UMIN000007509.
    Stroke 04/2014; · 6.16 Impact Factor
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    ABSTRACT: Object Although combined direct and indirect anastomosis in patients with moyamoya disease immediately increases cerebral blood flow, the surgical procedure is more complex. Data pertinent to the postoperative complications associated with combined bypass are relatively scarce compared with those associated with indirect bypass. This study investigated the incidence and characteristics of postoperative stroke in combined bypass and compared them with those determined from a literature review to obtain data from a large population. Methods A total of 358 revascularization procedures in 236 patients were retrospectively assessed by reviewing clinical charts and radiological data. PubMed was searched for published studies on surgical treatment to determine the incidence of postoperative complications in a larger population. Results Seventeen instances of postoperative stroke were observed in 16 patients (4.7% per surgery, 95% CI 2.8%-7.5%). Postoperative stroke was more frequent (7.9% per surgery) in adults than in pediatric patients (1.7% per surgery, OR 4.07, 95% CI 1.12-14.7; p < 0.05). Acute progression of stenoocclusive changes were identified in the major cerebral arteries (anterior cerebral artery, n = 3; middle cerebral artery, n = 1; posterior cerebral artery, n = 2). The postoperative stroke rate was comparable with that (5.4%) determined from a literature search that included studies reporting more than 2000 direct/combined procedures. No differences in the stroke rates between the direct/combined and indirect procedures were found. In the literature review, direct/combined bypass was more often associated with excellent revascularization (angiographic opacification greater than two-thirds) than indirect bypass (p < 0.05). Conclusions This experience of 358 consecutive procedures is one of the largest series for which the postoperative stoke rate for direct/combined bypass performed with a unified strategy has been reported. A systematic review confirmed that the postoperative stroke rate for the direct/combined procedure was comparable to that for the indirect procedure.
    Journal of Neurosurgery 03/2014; · 3.15 Impact Factor
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    ABSTRACT: Intraoperative qualitative indocyanine green (ICG) angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA-MCA anastomosis.
    Surgical Neurology International 01/2014; 5:135. · 1.18 Impact Factor
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    ABSTRACT: Internal trapping in which the dissecting aneurysm is occluded represents reliable treatment to prevent rebleeding of ruptured vertebral artery (VA) dissecting aneurysms. Various methods of internal trapping are available, but which is most appropriate for preventing both recanalization of the VA and procedural complications is unclear.
    Surgical Neurology International 01/2014; 5:150. · 1.18 Impact Factor
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    ABSTRACT: Distal anterior inferior cerebellar artery(AICA)aneurysms are rare, so its pathogenesis and treatment remain controversial. Here, we report the unique pathogenesis of a ruptured aneurysm in this area that was based on anomalous components as well as partial dissection of the arterial wall. A 61-year-old woman presented to our hospital with sudden headache and nausea. On admission, neurological examination revealed slight consciousness disturbance. Computed tomography(CT)of the head showed a clotted subarachnoid hemorrhage(SAH)that was dominant in the right cerebellopontine and prepontine cistern. Three-dimensional CT angiography detected an irregular fusiform aneurysm 4.5×3.2mm in size in the distal portion of the AICA. The patient underwent trapping without distal vascular reconstruction by the lateral suboccipital approach. After surgery, she experienced right hearing disturbance and ipsilateral facial palsy that were considered to be caused by vasogenic edema at the cerebellar peduncle that resulted from the initial SAH damage. Pathology revealed an aneurysmal wall with anomalous components and arterial dissection in the arterial wall. To our knowledge, only one article has reported the histological findings of a distal AICA aneurysm. Based on the pathology of this case, these findings may suggest a useful treatment strategy for this rare aneurysm.
    No shinkei geka. Neurological surgery 01/2014; 42(1):41-46. · 0.13 Impact Factor
  • Jun Tanabe, Tatsuya Ishikawa, Junta Moroi, Akifumi Suzuki
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    ABSTRACT: The study aims were to clarify safe duration for temporary vessel occlusion of the internal carotid artery (ICA) during aneurysm surgery as exactly as possible. We examined safe time duration (STD), where brain tissue exposed to ischemia will never fall into even the ischemic penumbra using intraoperative motor-evoked potential (MEP). In 45 patients, temporary occlusion of the ICA was performed with MEP. We measured STD as the duration of temporary vessel occlusion during which MEP changes did not occur. To estimate average STD, we calculated the 95% confidence interval for the population mean from sample data for STD in patients with MEP changes and in patients without changes. In the proximal-control group, 4 of 38 patients (10.5%) developed intraoperative MEP changes. In 4 patients, the time to MEP change (i.e. STD) was 6.0 ± 2.5 min. STD was 3.8 ± 1.6 min in the 34 patients without changes. The average STD was 4.0 ± 0.6 min. In the trap group (proximal and distal flow control), five of seven patients (60.0%) experienced intraoperative MEP changes (STD, 2.3 ± 1.0 min). All patients in the trap group who developed MEP changes showed involvement of the anterior choroidal artery (AchA) in the trapped segment. Average STD was 2.3 ± 1.1 min when trapping involving the AchA. Although the study is preliminary based on the limited number of the patients, the 95% upper confidence limit for average STD was 4.6 min when the ICA was occluded proximal to the aneurysm, 3.4 min when the ICA was trapped involving the AchA.
    Surgical Neurology International 01/2014; 5:47. · 1.18 Impact Factor
  • No shinkei geka. Neurological surgery 08/2013; 41(8):711-716. · 0.13 Impact Factor
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    ABSTRACT: BACKGROUND: and Importance: The falcine sinus is an embryonic vessel that connects the superior and inferior sagittal sinusesandmostly closes after birth. Although some cases of persistent falcine sinus have beenreported, duralarteriovenous fistula(dAVF) associated with the falcine sinus has not previouslybeen reported. CLINICAL PRESENTATION:: A 60-year-old man presented with asymptomatic dAVFs on digital subtraction angiography. The dAVFs were mainly fed by the cortical branch of the left anterior cerebral artery and drained into the falcine sinus. Intraoperatively, all veins drainingin a retrograde manner into cortical veins were obstructed. However, cortical venous reflux didnot disappear before removal of the falxcerebri, including the falcine sinus and inferior sagittal sinus. In this case, we consideredfalcine sinus dAVFas equivalent to olfactory groove dAVF, sincethe medial olfactory artery,in its role as a common feeding artery in olfactory groove dAVF, is a rudiment of the anterior cerebral artery as the main feeding artery in this case.Intraoperative findings and the surgical specimen revealed a small vessel network in the falxcerebri communicating with the falcine and inferior sagittal sinuses, which was considered to represent a falcine venous plexus not as a vessel anomaly. CONCLUSION:: Extensive removal of the falxcerebri including the falcine sinus or complete endovascular obliteration of the whole falcine sinus as early as possible represents an important strategy in the surgical treatment of falcine sinus dAVF.
    Neurosurgery 04/2013; · 2.53 Impact Factor
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    ABSTRACT: We retrospectively investigated surgical immediate and long-term overall results after clipping of the unruptured aneurysms. Between 1991 and 2008, 166 patients underwent neck clipping of unruptured saccular aneurysms at our institute. Patients were subsequently followed to clarify the occurrence of subarachnoid hemorrhage (SAH), and stroke other than SAH, aneurysm recurrence, cerebrovascular death, all-cause death, and risk factors. Surgical complication was noted in 14 patients (8.4 %) and surgical morbidity in two patients (1.2 %). Of 164 patients except for these two patients who suffered surgical morbidity, we could obtain more than 3 years follow-up information for 144 patients (87.8 %). There were 49 men and 95 women. The mean age was 58.5 years, and mean follow-up period was 7.9 years. Eight cases had died during follow-up (hepatic insufficiency in one, renal insufficiency in one, suicide in one, intracerebral hemorrhage (ICH) in two, SAH in one, and pneumonia after stroke in two). Therefore, the cause of death was stroke and late effects of stroke. Twelve symptomatic cerebrovascular events (cerebral infarction in seven, ICH in four, and SAH in one) occurred in ten patients. Consequently, annual risk of SAH after clipping of unruptured aneurysms was 0.085 %. Besides, annual risk of stroke in those patients was 1.06 %, and this incidence was higher than that in the general population. Although this study confirmed the good surgical result, annual risk of stroke after clipping of unruptured aneurysms was much higher than that in the general population. The long-term periodic examination to detect recurrent aneurysms and appropriate management to prevent stroke should be performed for patients with surgically treated unruptured aneurysm.
    Neurosurgical Review 04/2013; · 1.97 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Clinical significance of silent microbleeds is unknown in moyamoya disease. This study was aimed to clarify the incidence, locations, and longitudinal course. METHODS: This prospective cohort study included 78 nontreated patients with moyamoya disease. The incidence and locations of silent microbleeds were evaluated on T2*-weighted MRI. MR examinations were repeated every 6 or 12 months during a mean follow-up period of 43.1 months. RESULTS: T2*-weighted MRI identified silent microbleeds in 17 (29.3%) of 58 adult patients with moyamoya disease, but in none of 20 pediatric patients. During follow-up periods, de novo silent microbleeds developed in 4 (6.9%) of 58 adult patients. Hemorrhagic stroke occurred in 4 patients (6.9%), all of who had silent microbleeds on initial examination. The presence of silent microbleeds was a significant predictor for subsequent hemorrhagic stroke in adult moyamoya disease (P<0.001). CONCLUSIONS: Careful and long-term follow-up of silent microbleeds would be essential to improve their outcome in adult patients with moyamoya disease.
    Stroke 12/2012; · 6.16 Impact Factor
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    ABSTRACT: The supreme anterior communicating artery (SAcom) is a very rare anomaly that appears as a communicating artery between the anterior cerebral arteries (ACAs). This anomaly was first reported by Laitinen and Snellman in 1960. They described the SAcom as a connection between both pericallosal bifurcations. They also suggest that the SAcom may be an embryological remnant and a cause of aneurysm formation. A distal ACA aneurysm can be associated with the SAcom. In this case report, we describe a ruptured fusiform aneurysm originating from the SAcom. We treated the patient by trapping the SAcom along with the aneurysm. This is the first case report regarding a ruptured fusiform aneurysm originating from the SAcom itself.
    No shinkei geka. Neurological surgery 12/2012; 40(12):1101-5. · 0.13 Impact Factor
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    ABSTRACT: Background: Visual loss following craniotomy is a serious postoperative complication in which elevation of ocular pressure during retraction of the skin flap may cause retinal ischemia. We reported that continuous monitoring of extraocular pressure with the FlexiForce sensor may avoid excessive skin flap retraction during craniotomy and thus prevent ocular complications. Methods: Between January 2008 and December 2011, we analyzed data from 46 consecutive patients for whom continuous monitoring of extraocular pressure with FlexiForce sensor was performed. This sensor continuously displays the compressive force, allowing surgeons to check values on the monitor at any time. An alarm sounds if 50 gf is exceeded. We analyzed the temporal course of extraocular pressure and the relationship with patient characteristics. Result: No visual complications were encountered in this patient series. Maximum compressive force during craniotomy was 35.8±27.2 gf, with increases typically seen when surgeons used hooks or drills. However, due to the alarm, no prolonged periods of high force were noted in any patient. Effective methods for reducing force were: (1) taking off hooks on the compressive side; (2) changing the direction of hook tension; and (3) placing cushions such as gauze under the side of the skin flap. Maximum compressive force during microsurgery was 21.8±18.4 gf, and correlated with the beginning force of microsurgery. Conclusion: Compressive force was greatly reduced compared to the force reported previously. The etiologies of visual disability are not fully understood, but this sensor may be helpful in reducing extraocular compression.
    No shinkei geka. Neurological surgery 12/2012; 40(12):1071-7. · 0.13 Impact Factor
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    ABSTRACT: Monitoring of cardiac output (CO) is important for promising safe approach to goal-directed hemodynamic therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of ongoing monitoring modalities. We examined the clinical utility of less-invasive management using an uncalibrated arterial pressure waveform-derived cardiac output (APCO) monitor with refined algorithm (Third-generation FloTrac/Vigileo, Edwards, Irvine, CA, USA) during hyperdynamic therapy for post-SAH DCI, compared with transpulmonary thermodilution (PiCCO, Pulsion, Munich, Germany) as a reference technique. Forty-five patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed clinical deterioration attributable to DCI were investigated. Validation of the APCO-derived cardiac index (CI) during dobutamine-induced hyperdynamic therapy was compared with a reference CI analyzed by transpulmonary thermodilution in 20 patients. In a subsequent trial of 48 cases, the overall clinical results from patients managed with each device were compared. The APCO underestimated CI with an overall bias ± SD of 0.33 ± 0.26 L/min/m(2) compared with transpulmonary thermodilution, resulting in an error of 14.9%. The trends of CI for both techniques at each dobutamine dose were similar (r(2)= 0.77; P < 0.0001). No statistically significant differences were observed between the device groups for frequencies of neurological improvement, cerebral infarction, cardiopulmonary complications, or functional outcomes at 3 months. These data suggest that the refined APCO tends to underestimate CI compared with reference transpulmonary thermodilution during hyperdynamic therapy with dobutamine for reversing DCI, but may be acceptable in this select category of patients to obtain comparable clinical results.
    Surgical Neurology International 01/2012; 3:99. · 1.18 Impact Factor
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    ABSTRACT: Surgical placement of a ventriculoperitoneal shunt (VPS) is the main strategy to manage hydrocephalus. However, the failure rate associated with placement of ventricular catheters remains high. A hybrid operating room, equipped with a flat-panel detector digital subtraction angiography system containing C-arm cone-beam computed tomography (CB-CT) imaging, has recently been developed and utilized to assist neurosurgical procedures. We have developed a novel technique using intraoperative fluoroscopy and a C-arm CB-CT system to facilitate accurate placement of a VPS. Using this novel technique, 39 consecutive ventricular catheters were placed accurately, and no ventricular catheter failures were experienced during the follow-up period. Only two patients experienced obstruction of the VPS, both of which occurred in the extracranial portion of the shunt system. Surgical placement of a VPS assisted by flat panel detector CT-guided real-time fluoroscopy enabled accurate placement of ventricular catheters and was associated with a decreased need for shunt revision.
    Surgical Neurology International 01/2012; 3:119. · 1.18 Impact Factor
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    ABSTRACT: Neurogenic pulmonary edema (NPE) as a systemic consequence early after aneurysmal subarachnoid hemorrhage (SAH) sometimes complicates perioperative and postoperative fluid management and increases the risk of a poor outcome. This is the first report to demonstrate the ability of a bedside transpulmonary thermodilution device to trace physiological patterns consistent with current theories regarding the mechanism and course of post-SAH NPE. Three SAH patients admitted within 4 hours of ictus and diagnosed as having NPE were studied. Cardiac output, global end-diastolic volume (GEDV), extravascular lung water, and pulmonary vascular permeability index (PVPI) were measured by the transpulmonary thermodilution immediately after the diagnosis. Biochemical makers relating to stress and fluid regulation were also sampled. In all cases, extravascular lung water was abnormally high on initial measurement, in which an elevation of plasma catecholamine and B-type natriuretic peptide was detected. The fluid distribution of each patient was characterized by either (1) high PVPI and low GEDV without cardiac dysfunction (permeability edema); or (2) low cardiac output and high GEDV accompanied by transient cardiac dysfunction without PVPI elevation (hydrostatic edema). Although the volume status of 2 patients normalized by day 4 and was successfully managed with routine fluid therapy, a patient categorized initially with permeability edema complicated with hydrostatic edema due to heart failure and pneumonia showed a poor outcome. Our clinical experience suggests that the present monitoring system is capable of distinguishing different etiologies for pulmonary edema complicating SAH that may assist with fluid management decisions.
    Journal of neurosurgical anesthesiology 12/2011; 24(3):203-8. · 2.41 Impact Factor

Publication Stats

665 Citations
121.18 Total Impact Points

Institutions

  • 2010–2014
    • Research Institute for Brain and Blood Vessels-Akita
      Akita, Akita, Japan
  • 2003–2012
    • Hokkaido University
      • Department of Neurosurgery
      Sapporo-shi, Hokkaido, Japan
  • 2006
    • Teine Keijinkai Hospital
      Sapporo, Hokkaidō, Japan
    • Saitama Medical University
      • Department of Neurosurgery
      Saitama, Saitama-ken, Japan
  • 2002
    • Japan Red Cross Fukuoka Hospital
      Hukuoka, Fukuoka, Japan