記述言語：英語   出版者・発行元：一般社団法人 日本脳神経外科学会  

Postoperative hematoma formation is one of the most life-threatening complications associated with giant pituitary adenomas, and various surgical methods have been proposed to mitigate this risk. This study aims to report our surgical outcomes in patients with giant pituitary adenomas and to identify risk factors associated with postoperative hematoma formation. We retrospectively reviewed 45 patients with giant pituitary adenomas who underwent surgical treatment. The surgical approaches included conventional transsphenoidal surgery in 24 patients, extended transsphenoidal surgery in 9, and simultaneous combined transsphenoidal surgery and transcranial surgery in 12. Intracapsular resection was performed in 28 patients, while extracapsular resection was carried out in 17 patients. Postoperative hematoma formation was observed in 17 patients; among them, 2 experienced neurological deterioration and subsequently required reoperation for hematoma evacuation. The mean maximum tumor diameter was significantly larger in patients with postoperative hematoma (54 mm) compared to those without (45.3 mm) (p = 0.008). Other tumor characteristics were not significantly associated with postoperative hematoma formation. Combined transsphenoidal surgery and transcranial surgery were more frequently performed in patients who developed postoperative hematoma (p = 0.007), whereas extracapsular resection was more common in those without hematoma (p = 0.001). However, these differences in postoperative hemorrhage incidence among surgical techniques may have been substantially influenced by selection bias. Giant pituitary adenomas with extensive intracranial extension and involvement of critical neurovascular structures remain challenging to manage regardless of the surgical approach. Nevertheless, it is essential to tailor surgical strategies to individual cases to minimize postoperative complications.

DOI： 10.2176/jns-nmc.2025-0106

Open Access

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PubMed

CiNii Research

記述言語：英語   出版者・発行元：Seizure  

Purpose: This study aimed to evaluate the efficacy and safety of intravenous perampanel (IV-PER) in routine clinical practice. Methods: Patients who received IV-PER at Nagoya University Hospital or one of the 21 affiliated institutions between June 2024 and March 2025 were included. Indications for IV-PER included treatment for epileptic seizures, particularly acute symptomatic seizures, and prophylactic use before or after surgery. The primary endpoint was the seizure suppression rate within 7 days of treatment initiation, and the secondary endpoint was the incidence of adverse events (AEs). Clinical data were recorded daily, and blood tests were conducted within 2 weeks of administration. Enrolled patients were categorized into three groups based on the underlying etiology: cerebrovascular disease (CD), brain tumor (BT), and traumatic brain injury (TBI). Treatment efficacy and safety were assessed across these groups. Results: Of the 237 patients, 74, 116, and 47 were classified into the CD, BT, and TBI groups, respectively. The overall seizure suppression rate within 7 days was 89.0 %. Rates by group were 87.8 % (CD), 96.6 % (BT), and 72.3 % (TBI). When stratified by indication, the rates were 99.3 % for prophylactic use, 69.4 % for focal seizures, and 74.4 % for generalized seizures. Regarding AEs, somnolence was reported in 3 patients and irritability in one. Laboratory abnormalities included anemia, elevated liver enzymes, elevated creatine kinase, and hyponatremia. A total of 71 patients experienced one of these. Conclusions: This large multicenter prospective registry demonstrates that IV-PER can be safely used for seizure management during the 7-day acute phase in real-world clinical settings.

DOI： 10.1016/j.seizure.2025.07.023

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PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_11

Open Access

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_75

Open Access

CiNii Research

記述言語：英語   出版者・発行元：World Neurosurgery  

Surgical interventions for arachnoid cysts and glioependymal cysts primarily focus on cyst decompression and establishing communication with cerebrospinal fluid spaces. However, a standardized surgical strategy for symptomatic convexity cysts lacking surrounding cerebrospinal fluid space is still lacking due to the limited number of cases. This systematic review aims to evaluate surgical interventions for symptomatic convexity cysts and proposes a safe and effective treatment approach we have developed. A systematic review of the literature was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Surgical techniques were categorized into cystoperitoneal shunt, cyst excision, cyst fenestration, cyst ventriculostomy, and several uniquely modified methods. Using a method different from these previous reports, we performed endoscopic cystoventricular stenting via burr hole in 3 cases of convexity cysts. While traditional methods have proven effective, cystoperitoneal shunt may lead to malfunction, infection, and subdural hematoma; wall excision is invasive and increases morbidity risks. Fenestration and cystoventriculostomy have also reported cases of recurrence. Other methods also pose issues, including off-label use of instruments and inadequate consideration for removal. The method we performed for placing the stent catheter with multiple side holes demonstrated long-term effectiveness. Furthermore, the surgery was conducted with the patient fully awake, and the use of electrical stimulation mapping enabled preservation of higher neurocognitive functions, including language, working memory, and spatial cognition, at the puncture site. This novel approach offers advantages such as minimally invasive procedure, preservation of safe brain function, and long-term patency. Further studies are warranted to validate these findings and improve surgical strategies for convexity cysts.

DOI： 10.1016/j.wneu.2024.10.031

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PubMed

記述言語：英語  

DOI： 10.2196/80678

Open Access

Web of Science

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

<p>脳幹部海綿状血管奇形（BCM）治療における内視鏡利用の報告は，少数の症例報告に留まっている．内視鏡は，深部でも広く明るい視野が得られることから，深部病変であるBCMに対しても有効と考え，積極的に利用してきた．</p><p>内視鏡治療を応用したBCM症例 32例（中脳 7例，橋 22例，延髄 3例）を後方視的に検討した．脳幹内部への進入ルートは，2 point methodを基本として主に近傍のsafe entry zoneを利用した．5例で経鼻術，27例で開頭術による摘出が行われた．そのうち25例で，手術corridorの確保目的に細径シリンダーが用いられた．30例（93.8％）でGTRが得られた．術後合併症は5例で認められた．術前平均KPS 62.2に対し，手術3カ月後は84.4であり，改善 26例，不変 5例，悪化 1例であった．また，1例で手術半年後に遅発性パーキンソン症候群を合併し，KPSの低下が認められた．</p><p>一般的に，BCMに対する外科治療は，顕微鏡下に行われている．本研究における内視鏡下手術の治療成績は，既報と比較して良好な神経予後を示している．内視鏡を用いることで，手術経路の最小化と水中下手術が可能となり，これにより従来にないアプローチ方法を確立することができた．内視鏡の特徴的な手術法である水中での内部観察は，残存病変や止血の確認に非常に有効であった．内視鏡の利用には欠点も存在するため，さまざまな機器の開発，機器操作法の改良を行っている．内視鏡利用は，いまだ発展途上ではあるが，BCMに対する有用性・安全性が支持された．</p>

DOI： 10.2335/scs.53.108

Open Access

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本脳神経外科学会  

DOI： 10.2176/jns-nmc.2024-0057

Open Access

PubMed

CiNii Research

記述言語：英語   出版者・発行元：Child S Nervous System  

Background: Periventricular pediatric low-grade gliomas (pLGG) present a surgical challenge due to their deep-seated location, accessibility, and relationship with the subcortical network connections. Minimally invasive parafascicular approaches with tubular brain retractors (port brain surgery) have emerged, in recent years, as an alternative to conventional microsurgical and endoscopic approaches for removal of periventricular tumors. Objectives: To describe the minimally invasive approach with tubular brain retractors for periventricular pLGG, its technique, applications, safety, and efficacy. Methods: In this article, we describe the port brain surgery techniques for periventricular pLGG as performed in different centers, with different commercialized tubular retractor systems. Illustrative cases followed by a literature review are analyzed, with a detailed description of different approaches or techniques, comparing their advantages and disadvantages with contemporary microsurgical and endoscopic approaches. Conclusions: The port brain surgery with micro-exoscopic vision and endoscopic assistance, for the treatment of deep-seated lesions such as periventricular pLGG, is an alternative for achieving a functionally safe—gross total or subtotal—tumor resection, obtaining adequate tissue for pathological examination. This technique could offer a new dimension for a less-invasive, safe, and effective access to deep-seated tumors, offering the possibility to lower morbidity in experienced hands.

DOI： 10.1007/s00381-024-06417-5

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PubMed

DOI： 10.1016/j.wneu.2018.11.017

DOI： 10.18999/nagjms.76.1-2.73

Open Access

DOI： 10.1007/s00701-012-1473-3