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• 1998年03月   札幌医科大学   医学博士

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• ライフサイエンス   脳神経外科学   脳血管障害

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• 札幌医科大学   医学部医学科 脳神経外科学講座   講師  

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• 脳血管障害

• 脳卒中

• 脳神経外科

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• Computational Fluid Dynamics Analysis Features in Aneurysm Development in Rats.

  Shoichi Komura, Katsuya Komatsu, Takeshi Mikami, Yukinori Akiyama, Sangnyon Kim, Rei Enatsu, Hiroshi Nagahama, Nobuhiro Mikuni

  Neurologia medico-chirurgica   63 ( 6 ) 250 - 257  2023年06月  [国内誌]

  　概要を見る

  The investigation of how to control the development and growth of cerebral aneurysms is important for the prevention of subarachnoid hemorrhage. Although there have been several types of research studies on computational fluid dynamics (CFD) analysis of brain aneurysm development and growth, there has been no unified interpretation of the CFD analysis results. The purpose of this study is to clarify the characteristics of CFD analysis results related to the development of cerebral aneurysms using an animal model. Nineteen rat models of cerebral aneurysms were created, and the CFD analysis results between the cerebral aneurysm group [n = 10; the aneurysm was observed on magnetic resonance angiography (MRA) within 10 weeks after aneurysm induction surgery] and the nonaneurysm group (n = 9) were compared. All aneurysms were confirmed on the proximal segment of the left cerebral artery (P1), and the cross-sectional area and curvature of the left P1 were evaluated together. In the cerebral aneurysm group, there was a decrease in wall shear stress (WSS) that is consistent with the location of the aneurysm compared to the nonaneurysm group. The cross-sectional area of the left P1 gradually increased in the aneurysm group but not in the nonaneurysm group. The mean curvature in the entire left P1 was higher in the aneurysm group than in the nonaneurysm group. This study revealed that the development of cerebral aneurysms is due to changes in vascular morphology, namely, an increase in vessel diameter and a high curvature, and a decreased WSS consistent with the site of aneurysm development using this animal model.

  DOI PubMed

• Microbleeds Due to Reperfusion Enhance Early Seizures after Carotid Ligation in a Rat Ischemic Model.

  Takuro Saito, Takeshi Mikami, Tsukasa Hirano, Hiroshi Nagahama, Rei Enatsu, Katsuya Komatsu, Satoshi Okawa, Yukinori Akiyama, Nobuhiro Mikuni

  Neurologia medico-chirurgica   63 ( 6 ) 228 - 235  2023年06月  [国内誌]

  　概要を見る

  Impaired reperfusion in ischemic brain disease is a condition that we are increasingly confronted with owing to recent advances in reperfusion therapy. In the present study, rat models of reperfusion were investigated to determine the causes of acute seizures using magnetic resonance imaging (MRI) and histopathological specimens. Rat models of bilateral common carotid artery ligation followed by reperfusion and complete occlusion were created. We compared the incidence of seizures, mortality within 24 h, MRI, and magnetic resonance spectroscopy (MRS) to evaluate ischemic or hemorrhagic changes and metabolites in the brain parenchyma. In addition, the histopathological specimens were compared with those observed on MRI. In multivariate analysis, the predictive factors of mortality were seizure (odds ratios (OR), 106.572), reperfusion or occlusion (OR, 0.056), and the apparent diffusion coefficient value of the striatum (OR, 0.396). The predictive factors of a convulsive seizure were reperfusion or occlusion (OR, 0.007) and the number of round-shaped hyposignals (RHS) on susceptibility-weighted imaging (SWI) (OR, 2.072). The incidence of convulsive seizures was significantly correlated with the number of RHS in the reperfusion model. RHS on SWI was confirmed pathologically as microbleeds in the extravasation of the brain parenchyma and was distributed around the hippocampus and cingulum bundle. MRS analysis showed that the N-acetyl aspartate level was significantly lower in the reperfusion group than in the occlusion group. In the reperfusion model, RHS on SWI was a risk factor for convulsive seizures. The location of the RHS also influenced the incidence of convulsive seizures.

  DOI PubMed

• Transcranial electrical stimulation technique for induction of unilateral motor evoked potentials.

  Shoto Yamada, Rei Enatsu, Shu Ishikawa, Yusuke Kimura, Katsuya Komatsu, Tomohiro Chaki, Yukinori Akiyama, Takeshi Mikami, Nobuhiro Mikuni

  Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology   150   194 - 196  2023年06月  [国際誌]

  　概要を見る

  OBJECTIVE: Transcranial electrical stimulation motor evoked potentials (TES-MEP) are widely used to monitor motor function; however, broad current spread and induced body movement are limitations of this technique. We herein report a localized stimulation technique for TES-MEP that induces unilateral MEP responses. METHODS: The stimulation of C1(+)-C4(-) or C2(+)-C3(-) was performed to induce right- or left-sided muscle contraction, respectively, in 70 patients. Electromyography was recorded by placing electrodes on the bilateral abductor pollicis brevis (APB) and abductor hallucis (AH) muscles. Stimulation conditions were regulated in the range to induce unilateral muscle contractions contralateral to the anodal stimulation. The thresholds and amplitudes of TES-MEP were retrospectively analyzed. RESULTS: The thresholds of APB were lower than those of AH in 47 patients, AH thresholds were lower than those of APB in 6 patients, and both APB and AH started to respond at the same intensity in 15 patients. This technical stimulation induced contralateral limb contractions with a suprathreshold stimulation of 129.4 ± 35.6 mA (mean ± standard deviation) in 68 patients (97%). Amplitudes in the suprathreshold stimulation of APB and AH responses were 727.5 ± 695.7 and 403.3 ± 325.7 μV, respectively. CONCLUSIONS: The C1(+)-C4/C2(+)-C3(-) stimulation in TES-MEP enables a localized stimulation to induce unilateral MEP responses. SIGNIFICANCE: Our stimulation technique enables the stable and safe monitoring of unilateral limbs, and contributes to the reliable monitoring of motor function in neurosurgery.

  DOI PubMed

• Validity of Preoperative Screening Before Open-Heart Surgery in Reduction of Perioperative Ischemic Stroke.

  Katsuya Komatsu, Takeshi Mikami, Yusuke Kimura, Yukinori Akiyama, Nobuyoshi Kawaharada, Nobuhiro Mikuni

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   31 ( 8 ) 106584 - 106584  2022年08月  [国際誌]

  　概要を見る

  OBJECTIVES: Cerebrovascular event after open-heart surgery is a critical complication and contributes to poor prognosis, including increased mortality. The purpose of this study is to investigate the appropriate preoperative risk assessment and monitoring for reducing the risk of ischemic stroke after open-heart surgery. MATERIALS AND METHODS: 184 patients who underwent surgery for valvular heart disease were included in this study. Near-infrared oxygen saturation monitoring (INVOS system) was performed during open-heart surgery. For the purpose of perioperative stroke risk assessment, we evaluated the clinical and radiological factors of the group that underwent preoperative consultation and the group that did not, and of the patients with and without postoperative ischemic stroke. RESULTS: Preoperative consultation was performed in 60 cases. Large vessel steno-occlusive disease was found in nine cases, of which three had undergone revascularization surgery. Cerebral infarction developed in four cases, all of which had no large vessel steno-occlusive disease. There was no significant association between the development of postoperative ischemic stroke and presence of large vessel steno-occlusive disease. Preoperative baseline INVOS value was significantly low in the ischemic stroke group (49.5 ± 12.5) compared to the non-ischemic stroke group (66.8 ± 10.0), (P = 0.012). CONCLUSIONS: In open-heart surgery for valvular heart disease, low preoperative baseline INVOS values were associated with cerebral ischemic stroke after surgery. The combination of appropriate preoperative screening for large vessel steno-occlusive disease and measurement of INVOS could be used as a simple and useful method in screening for the risk of ischemic stroke after open-heart surgery.

  DOI PubMed

• Macrohistory of Moyamoya Disease Analyzed Using Artificial Intelligence

  Tomoyoshi Kuribara, Yukinori Akiyama, Takeshi Mikami, Katsuya Komatsu, Yusuke Kimura, Yasuhiro Takahashi, Kyoya Sakashita, Ryohei Chiba, Nobuhiro Mikuni

  Cerebrovascular Diseases ( S. Karger AG )    1 - 14  2022年02月

  　概要を見る

  <b><i>Introduction:</i></b> Moyamoya disease is characterized by progressive stenotic changes in the terminal segment of the internal carotid artery and the development of abnormal vascular networks called moyamoya vessels. The objective of this review was to provide a holistic view of the epidemiology, etiology, clinical findings, treatment, and pathogenesis of moyamoya disease. A literature search was performed in PubMed using the term “moyamoya disease,” for articles published until 2021. <b><i>Results:</i></b> Artificial intelligence (AI) clustering was used to classify the articles into 5 clusters: (1) pathophysiology (23.5%); (2) clinical background (37.3%); (3) imaging (13.2%); (4) treatment (17.3%); and (5) genetics (8.7%). Many articles in the “clinical background” cluster were published from the 1970s. However, in the “treatment” and “genetics” clusters, the articles were published from the 2010s through 2021. In 2011, it was confirmed that a gene called Ringin protein 213 (<i>RNF213)</i> is a susceptibility gene for moyamoya disease. Since then, tremendous progress in genomic, transcriptomic, and epigenetic profiling (e.g., methylation profiling) has resulted in new concepts for classifying moyamoya disease. Our literature survey revealed that the pathogenesis involves aberrations of multiple signaling pathways through genetic mutations and altered gene expression. <b><i>Conclusion:</i></b> We analyzed the content vectors in abstracts using AI, and reviewed the pathophysiology, clinical background, radiological features, treatments, and genetic peculiarity of moyamoya disease.

  DOI

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• もやもや病の再灌流時における電気生理学的変化

  能代将平, 三上毅, 大瀧雅文, 長峯隆, 松橋眞生, 三國信啓

  脳循環代謝(Web)   28 ( 1 )  2016年

  J-GLOBAL

• 診療放射線技師の文武両道 高画質と低被曝 低線量4D-CT Angiographyにおける血管描出改善を目的とした新たなアプリケーションの開発

  平野 透, 飯星 智史, 宮田 圭, 三角 昌吾, 本間 修一, 池田 佳弘, 堤 高志, 鰐渕 昌彦, 三上 毅, 長濱 宏史, 櫻井 祐樹, 鈴木 淳平

  JNET: Journal of Neuroendovascular Therapy ( (NPO)日本脳神経血管内治療学会 )  9 ( 6 ) S450 - S450  2015年11月

• NIH Stroke Scaleを用いるAdvanced OSCEの実施と工夫―8年間807名の受験を振り返る―

  齊藤正樹, 齊藤正樹, 山本和利, 山本和利, 米増保之, 小松克也, 三上毅, 外山祐一郎, 鈴木秀一郎, 松村晃寛, 寺本篤史, 寺本篤史, 射場浩介, 三國信啓, 寳金清博, 有山静香, 橋本諭, 下濱俊

  医学教育 ( (一社)日本医学教育学会 )  46 ( Suppl. ) 177 - 177  2015年07月

  J-GLOBAL

• 【イメージテクノロジーの進歩と脳卒中治療】脳循環代謝イメージングの進歩 ASL法によるもやもや病術後過灌流の診断

  杉野 寿哉, 飯星 智史, 三上 毅, 長濱 宏史, 原田 邦明, 寶金 清博, 三國 信啓

  The Mt. Fuji Workshop on CVD ( (株)にゅーろん社 )  30   51 - 55  2012年07月

  　概要を見る

  血行再建術を施行したもやもや病20例21側(男11名、女9名、4〜60歳)を対象に、術後急性期にASL(動脈スピンラベル)法と123I-IMP-SPECTを併用し過灌流評価を行った。ASL法はFAIRによる評価が15例15側、pCASLによる評価が5例6側であった。過灌流症候群を呈したのは3例で、FAIRでの評価が2例、pCASLでの評価は1例であった。FAIRとSPECTの術側/非術側(O/N)比は相関があり、過灌流症候群を呈した2例はFAIRとSPECTのO/N比は増加しており、過灌流の検出が可能であった。また、pCASLで過灌流症候群を呈した1例でもpCASLとSPECTのO/N比は増加しており、過灌流の検出が可能であった。ASL法はもやもや病に対する血行再建術後の過灌流評価に有用であると考えられた。

• Pseudo Continuous ASL(PCASL)法を用いたCBF評価

  飯星 智史, 長濱 宏史, 原田 邦明, 杉野 寿哉, 三上 毅, 小柳 泉, 三國 信啓

  CI研究 ( 日本脳神経CI学会 )  33 ( 3-4 ) 167 - 173  2012年03月

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• ﾊﾞｲﾎﾟｰﾗﾋﾟﾝｾｯﾄ

  三上 毅, 宝金清博, 浅原智彦

  特許権

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• 中枢神経Glymphatic systemの機能解明と新たな認知症治療薬の開発

  基盤研究(C)

  研究期間:

  2021年04月

  -

  2024年03月

   

  秋山 幸功, 三上 毅, 三國 信啓, 石合 純夫

  　研究概要を見る

  Glymphatic systemの機能障害は様々な脳疾患を引き起こすと考えられている。とくに認知機能には大きな影響を与えると考えられており、その治療法の開発を行う。 方法：マウスを用いてGlymphatic systemのdrainage部分である静脈の閉塞モデルの作成を行い、その認知機能障害の進行、程度を評価する。静脈は側副血行路が発達していることが多いため、両側内・外頚静脈閉塞モデルを作成する予定である。 モデル作成後動物用7.0 Tesla-MRIを用いて静脈のうっ滞、MR spectroscopyにて脳実質内代謝産物の定量を行う。 結果：静脈結紮モデルを安定して作成することに成功した。静脈非閉塞のコントロールモデルと比較して、頭蓋内静脈の拡大を認め、眼球の突出などが認められたモデルも存在し、頭蓋内圧亢進状態が得られた。 考察：両側内・外頚静脈閉塞モデルは頭蓋内圧亢進モデルとして確立できるものと考えられ、今後頭蓋内圧亢進状態が高次機能へどのように影響を与えるか、また、髄液ドレナージなどによる頭蓋内圧降下療法がその高次機能障害を抑制できるか評価したいと考えている。

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