Shunsuke Kakino

Intracellular localization of cyclin B1 during the cell cycle in glioma cells.

We investigated cyclin B1 expression during the cell cycle in human glioma cells cultured under asynchronous growing condition by two cytometry techniques: flow cytometry (FCM) and laser scanning cytometry (LSC). FCM analysis revealed the specific accumulation of cyclin B1 in G2/M phase with a wide intercellular variation (Dunphy WG: Trend Cell Biol 4:202-207, 1994). It is noteworthy that LSC, which is characterized by rapid quantitative analysis followed by imaging, allows morphological observation of the intracellular distribution of cyclin B1 as a function of cell cycle position cell by cell (Hunter T: Cell 75:839-841, 1993). Cyclin B1 was virtually undetectable in cells from G0/G1 phase to mid S phase, but became visible in the cytoplasm in late S phase. As cells proceeded within G2 phase, the level of cyclin B1 rapidly increased in the perinuclear region of the cytoplasm, but cyclin B1 was still faintly present in the nucleus. Cyclin B1 appeared in the nucleus at the mitotic phase. Then the nuclear membrane was disrupted and cyclin B1 was distributed evenly in the cell. The level of cyclin B1 was maximum in metaphase. However, it abruptly degraded at the end of metaphase, and subsequently G1 cells were cyclin B1 negative.

Serum inflammatory adhesion molecules and high-sensitivity C-reactive protein correlates with delayed ischemic neurologic deficits after subarachnoid hemorrhage

BACKGROUND The purpose of the present study was to investigate the relationship between serum concentrations of the immunoglobulin-like superfamily, selectins, hsCRP, and the development of DIND in patients with aneurysmal SAH. METHODS Serum ICAM-1, VCAM-1, E-selectin, P-selectin, L-selectin, and hsCRP were measured in 33 patients with SAH who underwent aneurysmal clipping within 48 hours of the onset of symptoms. Serum samples were obtained during the early period (day 0) and the late period (day 7). RESULTS The serum concentrations of ICAM-1 (P = .009), VCAM-1 (P = .0383) and hsCRP (P = .0014) during the early period were significantly higher in patients with SAH than in control patients. Further, serum hsCRP concentration during the late period was significantly higher in patients with SAH than in control patients (P = 0033). Finally, serum concentrations of ICAM-1, VCAM-1, and hsCRP during the early (P = .0055, P = .0266, and P = .0266) and late (P = .0423, P = .0041, and P = .0004) period were significantly higher in patients with DIND than in patients without DIND. CONCLUSIONS Serum levels of ICAM-1, VCAM-1 and hsCRP during the early and late period following SAH correlate with DIND.

Revascularization and parent artery occlusion for giant internal carotid artery aneurysms in the intracavernous portion using intraoperative monitoring of cerebral hemodynamics

OBJECTIVE:Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass). METHODS:Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected. RESULTS:Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients. CONCLUSION:Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.

Cognitive function and anxiety before and after surgery for asymptomatic unruptured intracranial aneurysms in elderly patients.

BACKGROUND The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) will likely increase as the general population ages. The goal of the present study was to prospectively assess cognitive function and anxiety before and after surgical repair of asymptomatic UIAs in patients ≥ 70 years. METHODS A total of 28 patients ≥ 70 years with UIAs underwent cognitive testing using the Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale (WMS), and the Rey-Osterrieth Complex Figure test (ROCF) 1 month before and 1 month after surgery. All patients also underwent anxiety testing at these time points using the State-Trait Anxiety Inventory. RESULTS Group-rate analysis demonstrated that the performance intelligence quotient (IQ) and ROCF recall trial scores were significantly increased postoperatively, whereas there were no postoperative differences in verbal IQ, WMS, and ROCF copy trial scores. State anxiety scores were significantly decreased postoperatively, but there was no change in trait anxiety scores. Furthermore, a significant negative correlation was observed between changes in state anxiety scores and preoperative verbal IQ, performance IQ, and WMS. None of the patients developed postoperative cognitive functional impairments as demonstrated by event-rate analysis. CONCLUSIONS Surgical treatment of UIAs does not impair cognitive function and results in improvement in state anxiety in elderly patients.

Cerebrospinal fluid adrenomedullin concentration correlates with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage.

Background: Adrenomedullin (AM), a vasorelaxant peptide, is secreted into the cerebrospinal fluid (CSF) from the choroid plexus and can exert natriuretic effects in the kidney. CSF AM concentration is elevated 7–10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentrations correlate with hyponatremia and delayed ischemic neurological deficits (DIND) after SAH. Methods: CSF and plasma concentrations of AM, brain natriuretic peptide, and atrial natriuretic peptide concentrations were measured in 32 patients with SAH who underwent aneurysmal clipping within 48 h of onset. CSF and blood samples were obtained from these patients during the early period (days 1–3, day 0 being regarded as the day of SAH onset) and the late period (days 8–10). Results: In all patients, AM concentration during the early and late periods was significantly higher in the CSF than in the plasma (p = 0.0028 and p < 0.0001). In addition, CSF AM concentration was significantly higher during the late period than during the early period (p < 0.0001). Hyponatremia (plasma sodium <135 mmol/l) was present in 11 patients (34.4%) during the late period, and DIND developed in 6 patients (19%) between day 5 and day 13. Logistic regression analysis demonstrated that late-period CSF AM concentration correlated with hyponatremia and DIND (95% CI: 1.003–1.069, p = 0.0074 and 95% CI: 1.003–1.052, p = 0.0108). Conclusions: The present study demonstrated that CSF AM during the late period following SAH correlates with hyponatremia and DIND.

Symptomatic occlusion at the origin of the vertebral artery treated using external carotid artery–cervical vertebral artery bypass with interposed saphenous vein graft

BACKGROUND Symptomatic atherosclerotic steno-occlusive diseases of the vertebrobasilar artery portend a poor prognosis and high risk of stroke recurrence despite medical therapy. We describe 5 medically refractory patients with occlusion at the origin of the VA and the distal portion of the cervical VA perfused via muscular collateral vessels who underwent ECA-cervical VA (V(2) segment) bypass with interposed SVG. METHODS The ECA was isolated through a linear incision along the anterior portion of the sternocleidomastoid muscles. The ECA was either laterally or medially retracted, the longus colli muscle was dissected, and the anterior wall of the foramen transversarium was partially removed, which exposed the cervical VA. Each end of the SVG was anastomosed to both the VA and the ECA in a side-to-end fashion. RESULTS Surgery proceeded smoothly in all patients without any new neurologic postoperative deficits. Postoperative cerebral angiography demonstrated that the anastomosis was patent. None of the patients developed further brain ischemic events during follow-up periods ranging from 13 to 114 months (mean, 62 months) after surgery. CONCLUSION The ECA-cervical VA bypass with interposed SVG is useful when the VA is occluded at the origin and when the distal portion of the cervical VA is perfused via muscular collateral vessels of patients with medically refractory ischemic events in the vertebrobasilar territory.

Clinical and angiographic long-term outcomes of vertebral artery–subclavian artery transposition to treat symptomatic stenosis of vertebral artery origin

OBJECT Although angioplasty and stent placement for vertebral artery (VA)-origin stenosis have been performed using endovascular techniques, a high likelihood of restenosis has been observed in the long term. Therefore, the authors assessed the long-term clinical and angiographic outcomes in patients after VA-subclavian artery (SA) transposition. METHODS Thirty-six patients (31 men, 5 women; mean age 64.3 years, range 46-76 years) underwent clinical evaluation (modified Rankin Scale [mRS]) and cervical angiographic evaluation preoperatively and within 1 month of and 6 months after VA-SA transposition undertaken to treat symptomatic stenosis of VA origin. RESULTS Postoperative neurological deficits due to intraoperative brain ischemia did not occur, and MR imaging demonstrated no new postoperative ischemic lesions in any of the patients. One patient died of acute myocardial infarction 2 months after surgery and another developed a left thalamic hemorrhage (mRS score of 5) at 42 months postsurgery. None of the remaining 34 patients experienced further ischemic events, and the mRS score in all of these patients remained unchanged during a mean follow-up period of 54 months. The degree of VA-origin stenosis (preoperative mean 84%) was reduced to < or = 30% after surgery (mean 2%). Long-term follow-up angiography in 29 patients (81%) revealed the absence of restenosis, defined as > 50% luminal narrowing, in all of them. CONCLUSIONS The clinical and angiographic long-term outcomes demonstrated here suggest that VA-SA transposition will be useful in patients with symptomatic stenosis of VA origin.

Easy Dissection of the Interhemispheric Fissure for Treatment of the Anterior Communicating Artery Aneurysm by the Pterional Approach

BACKGROUND When the fundus of an aneurysm is superiorly or posteriorly directed or the anterior communicating artery (ACoA) is located far from the sphenoidal plane, wide dissection of the interhemispheric fissure is needed to expose the ACoA aneurysm. METHODS When the thickened arachnoid membrane covering the dorsal surface of the ipsilateral optic nerves is dissected through the pterional approach, the dissection must not be performed beyond the midline of the optic chiasm. As a result, the undissected arachnoid membrane becomes tense and is easily cut down toward the interhemispheric fissure. We have used this technique in 24 patients in whom the ACoA aneurysm projected superiorly or posteriorly. RESULTS The gyrus rectus was resected in four patients with ruptured aneurysm because the aneurysmal domes were partially buried in the ipsilateral gyri recti. In the remaining patients, the aneurysmal dome was fully exposed without gyrus rectus resection. CONCLUSIONS The present technique is helpful to dissect the interhemispheric fissure easily and widely by the pterional approach and to expose the ACoA aneurysm adequately.

Ruptured cerebral fusiform aneurysm with mucopolysaccharide deposits in the tunica media in a patient with Marfan syndrome.

Although aortic or cardiac complications are common in patients with Marfan syndrome, the presence of an intracranial aneurysm is comparatively rare. In this study, the authors report on their experience with resection of a ruptured fusiform aneurysm of the posterior cerebral artery in a 30-year-old woman with Marfan syndrome. Microscopic examination of the resected tissue showed many Alcian blue-staining deposits, consistent with the presence of mucopolysaccharide in the tunica media and focal fragmentation of the internal elastic lamina.

Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: Technical note

The subtemporal approach with division of the posterior communicating artery (PcomA) is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA) interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.