Department of Neuro endovascular Therapy

Introduction

Patient care at our department

Cerebral aneurysm

• When a cerebral aneurysm ruptures, you get subarachnoid bleeding. Sometimes you may feel ill with a strong headache, or feel ill, lose consciousness and fall. Most patients with a subarachnoid hemorrhage will be brought to the hospital by ambulance. The patient's condition is determined comprehensively, and in addition to information such as the shape and position of the aneurysm, they will determine whether catheter treatment can be performed. Approximately 70% of patients with an aneurysm can be treated with a catheter.
• An aneurysm that is diagnosed in a "brain dock"(medical checkup of the brain by examination with MRI、MRA、etc.) is called an unruptured cerebral aneurysm. It is said that if the size is more than 5 mm then it is better to consider preventive surgery in order to prevent future ruptures, but we will discuss how to deal with this with the patient, taking into account the patient's individual lifestyle and health condition.
• Our hospital is equipped with a state-of-the-art vascular imaging device. We also conduct pre-operative simulations using high definition three-dimensional image diagnosis and "3D printer."

Dural arteriovenous fistula

This is a disease where an artery and a vein are directly connected by the strong film (dura mater) which covers the brain. This is not originally a disease of the brain, but it may adversely affect the brain because the veins of the brain and the veins of the dura mater are connected. In addition to the "knowledge", "skill" and "treatment experience," "three-dimensional image diagnosis" with one of the "latest vascular imaging device" is indispensable for treatment. Our responsible physicians have extensive experience in the treatment of dural arteriovenous fistula (about 150 cases).

Cerebral arteriovenous malformation

This is an innate cerebrovascular disease where arteries and veins are connected in the brain tissue. A part of the blood vessel might rupture and cause a cerebral hemorrhage. Although this disease cannot be cured with catheter treatment alone, we are very adept at treating by specifying the damaged part of the blood vessel by doing a three-dimensional image diagnosis using virtual reality and stopping the bleeding with a catheter.

Carotid artery stenosis

A disease where garbage (plaque) collects in the arteries of the neck around the back of the jaw and the inside of the blood vessel becomes narrow is called carotid artery stenosis. It is currently thought that treatment by medicine is the best, but when the blood vessel has become considerably narrowed or the narrowing progresses, the blood vessel can be expanded by a catheter treatment. It is important to improve lifestyle and treat hypertension and hypercholesterolemia after the catheter treatment, and we will continue to support them after surgery.

Cerebral infarction

When the blood vessels of the brain become clogged, the brain cells have a lack of oxygen, and the patient may not be able to move their limbs or they become inarticulate. This disease is called a cerebral infarction. If a narrow blood vessel becomes clogged, it is best to treat it with a drip or a medicine you can swallow, but when a large blood vessel is clogged, the blood vessel can be expanded using a balloon catheter and a stent, because it is not possible to treat it well with medicine alone. In addition, if a blood clot breaks free from the heart to the brain, such as from arrhythmia (atrial fibrillation), a stent-type thrombus removal device or a thrombus-suction catheter can be used to resume flow in the clogged blood vessels.

Main diseases

The following are the diseases and the treatments that can be handled in our department.

Cerebral aneurysms

The best treatment for an unruptured cerebral aneurysm is the improvement of lifestyle, including lowering blood pressure and not smoking. First, we will discuss how to improve their lifestyle. However, if the size is large or the shape is distorted and there is a high risk of rupture, we may recommend surgical treatment. Most cerebral aneurysms can be treated with catheter surgery thanks to advances in medical equipment, so please contact us. The physician in charge of our department is the 1 of 40 flow diverter physicians in nation, and 1 of only two in Saitama Prefecture.

Carotid artery stenosis

The best treatment for carotid artery stenosis is the improvement of lifestyle, including lowering blood pressure and not smoking. In many cases, it will be sufficient to improve lifestyle and treat with medicine. However, if the blood vessel becomes narrower rapidly, even if the lifestyle is improved, and if it becomes considerably narrow, then surgical treatment will be necessary. Surgical methods include direct surgery with carotid endarterectomy and cervical stent implantation via catheter therapy. Although we determine in advance which treatment is suitable by performing MRI etc., most cases can be handled with catheter treatment, so please talk to us.

Cerebrovascular obstruction within 8 hours of onset

It is easy for a clot to form in the heart if there is an arrhythmia such as atrial fibrillation. When a blood clot that has flown from the heart obstructs a blood vessel, half of the body may suddenly stop working or they may not be able to form words. Previously, when the patient had reached such a state, only about 30% were able to recover, but it is now possible for 60% to 80% to recover and be able to walk by performing a catheter treatment and sucking and removing the blood clot. Please call an ambulance immediately if you notice sudden paralysis. If you call the paramedics, they can transport you to a facility like ours that allows us to perform catheter treatment, so feel free to trust the ambulance team.

Dural arteriovenous fistula

The strong membrane that wraps around the brain is called the dura mater, and the disease where the arteries and veins that nourish the dura mater are connected is called dural arteriovenous fistula. It is necessary to advance treatment by combining radiation therapy and direct surgery in order to do the treatment, and we have a three-dimensional understanding of the complex vascular construction and develop a patient-specific treatment plan as well as the technique for inducing a catheter into the narrow blood vessels. Please consult with us because this is a disease that requires both a state-of-the-art vascular imaging device and rich treatment experience.

Cerebral arteriovenous malformation

The disease where the arteries and veins are connected inside the brain is called cerebral arteriovenous malformation. Either craniotomy or radiation therapy treatment will be necessary in order to fully cure this disease. Catheter treatment is done to assist these treatments. For example, it is possible to cure a cerebral arteriovenous malformation by radiotherapy without craniotomy, especially if you find a place where it seems to be easy to rapture and if you treat that part with a catheter.

Target Symptoms

• Patients who can receive catheter treatment at our Department of Neuro-endovascular Therapy are mostly, (1) People brought to the hospital by ambulance with symptoms such as sudden consciousness disorder or paralysis, or (2) People who visit us because cerebrovascular disease was found by accident without any symptoms during a medical checkup of the brain. For this reason, there may be no specific symptoms in patients who are subject to catheter treatment.
• Many cerebrovascular diseases such as cerebral aneurysms, epidural arteriovenous fistulas, and carotid artery stenosis have come to be treated with catheters. Please come to consult about whether catheter treatment is necessary and whether it is possible if you find a disease in the blood vessels of the brain or the neck.

Treatment results

Medical staff

Name	Job Title	Position	Specialized Field	Credentials
庄島　正明 (Shoujima　Masaaki)	Professor(Department of Neurosurgery)	Director,Center of Neuro endovascular Therapy	Cerebral aneurysms Carotid artery stenosis Dural arteriovenous fistula	The Japan Neurosurgical Society認定医 Japan Stroke Society認定脳卒中専門医 Japanese Society for Neuroendovascular Therapy指導医 Japanese Society of Biorheology director
野村　恭一 (Nomura　Kyouichi)	Professor(Department of Neurology)	Deputy Hospital Director Chief of Clinical Services, Department of Neurology	immunologic neurological diseases peripheral neurological disorders Blood purification therapy	Japanese Society for Neuroimmunology director Japanese Society for Apheresis director Japanese Peripheral Nerve Society director Japanese Society of Neurology councilor The Japan Stroke Society認定脳卒中専門医
松居　徹 (Matsui　Tooru)	Professor(Department of Neurosurgery)	Deputy Hospital Director Chief of Clinical Services, Department of Neurosurgery	cerebrovascular disorders Skull base tumors Spinal cord disease	The Japan Neurosurgical Society認定医 Japan Stroke Society認定脳卒中専門医 Japanese Society on Surgery for Cerebral Stroke技術指導医
傳法　倫久 (Denbou　Tomohisa)	Associate Professor(Department of Neurology)	Manager of Outpatient Services,Department of Neurology	cerebrovascular disorders Neuroendovascular Therapy 脳卒中急性期画像	Japan Stroke Society councilor・専門医 Japanese Society of Neurology専門医・指導医 Japanese Society for Neuroendovascular Therapy専門医 Member of Cardiovascular Stroke Society of Japan Member of the Japan Academy of Neurosonology
印東　雅大 (Indou　Masahiro)	Assistant Professor(Department of Neurosurgery)	Manager of Outpatient Services,Department of Neurosurgery	Cerebrovascular disorders(Aneurysms/Arteriovenous malformation/Carotid artery stenosis/Moyamoya disease in adults and children etc.) Skull base tumors（Meningioma/Schwannoma/転移性脳腫瘍） Cerebrovascular treatment	The Japan Neurosurgical Society認定医 Japanese Society on Surgery for Cerebral Stroke技術指導医 Japanese Society for Neuroendovascular Therapy専門医 Japan Stroke Society認定脳卒中専門医
田島　孝士 (Tajima　Takashi)	Instructor(Department of Neurology)		Cerebrovascular treatment cerebrovascular disorders Clinical Neurology	Fellow of the Japanese Society of Internal Medicine (FJSIM)・指導医 Japanese Society of Neurology専門医 Member of Japan Stroke Society Member of Japanese Society of Neurological Therapeutics Member of Japanese Society for Neuroendovascular Therapy

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