論文 - 竹内　和人

術中所見はラトケ嚢胞、されど病理は頭蓋咽頭腫

永田 雄一, 竹内 和人, 棚橋 邦明, 佐々木 博勇, 原田 英幸, 井下 尚子, 齋藤 竜太

Brain Tumor Pathology   39 巻 ( Suppl. ) 頁： 110 - 110   2022年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脳腫瘍病理学会  

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A novel endoscopic ventriculocisternostomy and stenting technique with a transparent acryl puncture needle for a trapped temporal horn: a technical report and literature review 国際誌

Yamamoto, T; Takeuchi, K; Nagata, Y; Mizuno, A; Harada, H; Saito, R

NEUROSURGICAL REVIEW   45 巻 ( 2 ) 頁： 1783 - 1789   2022年4月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgical Review  

Trapped temporal horn is a rare type of noncommunicating focal hydrocephalus, and no standard treatment has been established yet for trapped temporal horn. Recent studies have shown the efficacy of endoscopic ventriculocisternostomy by opening the choroidal fissure; however, some surgical complications were reported during the procedure. Thus, we aimed to report a novel endoscopic ventriculocisternostomy and stenting technique for trapped temporal horn. In this technique, a 5.8-mm transparent acryl puncture needle with a 2.7-mm 0° rigid endoscope was used to open the choroidal fissure. It can fenestrate the choroidal fissure under real-time endoscopic observation of the critical neurovascular structures over the choroidal fissure. Moreover, the dull tip of the needle is less likely to injure the critical neurovascular structures, resulting in safer ventriculocisternostomy than the previously reported technique. Then, a stent is placed along the tract to prevent future obstruction of the stoma. Six trapped temporal horns in four patients were treated using the technique. All the patients showed improved symptoms with no surgical complications. None of the patients showed recurrence of trapped temporal horn during the mean follow-up period of 39.3 months. The combination of endoscopic ventriculocisternostomy and stenting with a transparent acryl puncture needle is a safe and effective treatment option for trapped temporal horn.

DOI： 10.1007/s10143-021-01634-x

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Challenging direct bypass surgery for very young children with moyamoya disease: technical notes 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

NEUROSURGICAL REVIEW   45 巻 ( 2 ) 頁： 1799 - 1807   2022年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgical Review  

Cerebral revascularization for moyamoya disease (MMD) is an effective treatment for improving cerebral ischaemia and preventing rebleeding. Although direct bypass surgery is commonly performed on older children and adults, it is challenging in very young children due to the high difficulty level of the procedure. The subjects were MMD patients under 3 years of age on whom surgery was performed by a single surgeon (Y.A.). Preoperative clinical findings, information related to direct bypass surgery, bypass patency, and the incidence of postoperative stroke were investigated. Combined revascularization, including direct bypass surgery, was performed on 3 MMD patients (3 sides) under 3 years of age. The average diameter of the grafts used in direct bypass was 0.8 mm. The average recipient diameter was 0.8 ± 0.17 (range 0.6–1) mm. In all cases, the anastomotic procedure was completed using 11–0 monofilament nylon thread, and patency was confirmed. Direct bypass for MMD patients under 3 years old is technically challenging. However, despite the anatomical differences between very young children and elderly individuals, direct bypass surgery could certainly be completed. In addition, a rapid recovery from cerebral blood flow insufficiency could yield a promising neurological outcome.

DOI： 10.1007/s10143-021-01685-0

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Risk Factors for Cerebral Infarction Early After Revascularization in Children Younger than 5 Years with Moyamoya Disease 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

WORLD NEUROSURGERY   160 巻   頁： E220 - E226   2022年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：World Neurosurgery  

Objective: Cerebral revascularization is necessary for pediatric patients younger than 5 years with moyamoya disease (MMD). However, they have a high risk of developing cerebral infarction early after surgery. This study aimed to analyze the risk factors for developing cerebral infarction among these patients. Methods: The charts of 21 consecutive patients with MMD (39 surgeries) younger than 5 years who had undergone revascularization at our hospital were retrospectively analyzed. Because cerebral infarction occurring within 1 month after surgery was the primary end point, other clinical information was evaluated, including each surgical procedure. Multivariate analysis of the risk factors for postoperative cerebral infarction was performed. Results: Cerebral infarction occurred after 7 of 39 surgeries (17.9%). Of the 39 surgeries, 23 (59%) included direct and indirect combined revascularization. The incidence of cerebral infarction did not differ significantly between the combined (21.7%) and indirect (12.5%) groups (P = 0.46). Logistic regression showed no association between the revascularization procedure and the occurrence of cerebral infarction after surgery (P = 0.3). However, younger age at surgery was correlated with a higher risk of developing cerebral infarction in the early postoperative period (P = 0.05). Conclusions: No differences were found in the risk of developing cerebral infarction early after surgery as a result of surgical procedures. However, younger patients had higher postoperative risk. Further multicenter research should examine this issue for young pediatric patients with moyamoya at high risk of developing cerebral infarction.

DOI： 10.1016/j.wneu.2021.12.115

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Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal

Nagata, Y; Takeuchi, K; Sasaki, H; Mizuno, A; Harada, H; Tanahashi, K; Araki, Y; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA   62 巻 ( 4 ) 頁： 203 - 208   2022年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本脳神経外科学会  

Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, se-cure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent colla-gen matrix. The collagen matrix harvested from this area was pathologically examined; neovasculari-zation and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, ne-ovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.

DOI： 10.2176/jns-nmc.2021-0355

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3D培養法を用いた新規下垂体腺腫オルガノイドモデルの作成

佐々木 博勇, 竹内 和人, 棚橋 邦明, 永田 雄一, 水野 晃宏, 原田 英幸, 須賀 英隆, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( 1 ) 頁： 329 - 329   2022年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

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頭蓋咽頭腫術後下垂体機能温存に上下垂体動脈血流が重要である

竹内 和人, 永田 雄一, 水野 晃宏, 佐々木 博勇, 原田 英幸, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( 1 ) 頁： 309 - 309   2022年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

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機能性下垂体腺腫に対する外科治療 術前評価から根治切除に向けて

永田 雄一, 竹内 和人, 棚橋 邦明, 佐々木 博勇, 水野 晃宏, 原田 英幸, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( 1 ) 頁： 278 - 278   2022年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

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小児頭蓋咽頭腫の長期成績からみた課題と展望 小児頭蓋咽頭腫に対する神経内視鏡治療の実際と展望

竹内 和人, 永田 雄一, 加藤 美穂子, 佐々木 博勇, 齋藤 竜太

小児の脳神経   47 巻 ( 2 ) 頁： 201 - 201   2022年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本小児神経外科学会  

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Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case 国際誌

Araki Y., Yokoyama K., Uda K., Kanamori F., Mamiya T., Takayanagi K., Ishii K., Nishihori M., Takeuchi K., Tanahashi K., Nagata Y., Tanei T., Nishimura Y., Izumi T., Saito R.

Journal of Neurosurgery: Case Lessons   3 巻 ( 12 )   2022年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Neurosurgery: Case Lessons  

BACKGROUND Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA). OBSERVATIONS A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18. LESSONS Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.

DOI： 10.3171/CASE21704

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Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case 国際誌

Araki Y., Yokoyama K., Uda K., Kanamori F., Kurimoto M., Shiba Y., Mamiya T., Takayanagi K., Ishii K., Nishihori M., Takeuchi K., Tanahashi K., Nagata Y., Nishimura Y., Okamoto S., Sumitomo M., Izumi T., Saito R.

Journal of Neurosurgery: Case Lessons   3 巻 ( 3 )   2022年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Neurosurgery: Case Lessons  

BACKGROUND Transient neurological deficits (TNDs) develop after cerebral revascularization in patients with moyamoya disease (MMD). The authors report a rare pediatric MMD case with extensive decreased cerebral blood flow (CBF) and prolonged TNDs after combined revascularization. OBSERVATIONS A 9-year-old boy presented with transient left upper limb weakness, and MMD was diagnosed. A right-sided combined surgery was performed. Two years after the surgery, frequent but transient facial (right-sided) and upper limb weakness appeared. The left internal carotid artery terminal stenosis had progressed. Therefore, a left combined revascularization was performed. The patient’s motor aphasia and right upper limb weakness persisted for approximately 10 days after surgery. Magnetic resonance angiography showed that the direct bypass was patent, but extensive decreases in left CBF were observed using single photon emission tomography. With adequate fluid therapy and blood pressure control, the neurological symptoms eventually disappeared, and CBF improved. LESSONS The environment of cerebral hemodynamics is heterogeneous after cerebral revascularization for MMD, and the exact mechanism of CBF decreases was not identified. TNDs are significantly associated with the onset of stroke during the early postoperative period. Therefore, appropriate treatment is desired after determining complex cerebral hemodynamics using CBF studies.

DOI： 10.3171/CASE21628

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¹¹C-methionine- and ¹⁸F-FDG-PET double-negative metastatic brain tumor from lung adenocarcinoma with paradoxical high ¹⁸F-FDG uptake: A case report 国際誌

Tanahashi K., Hirano M., Chalise L., Tsugawa T., Okumura Y., Hase T., Ohka F., Motomura K., Takeuchi K., Nagata Y., Nakahara N., Hashimoto N., Saito R.

Surgical Neurology International   13 巻   頁： 372 - 372   2022年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Neurology International  

Background: Imaging with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and 11C-methionine (MET)-PET can delineate primary and metastatic brain tumors. Lesion size affects the sensitivity of both scans and histopathological features can also influence FDG-PET, but the effects on MET-PET have not been elucidated. Case Description: We report an unusual case of metastatic brain tumors without accumulation of FDG or MET, contrasting with high FDG uptake in the primary lung lesion. The brain lesions were identified as adenocarcinoma with a more mucus-rich background, contributing to the indistinct accumulation of both FDG and MET. Conclusion: Histopathological characteristics can affect both MET and FDG accumulation, leading to findings contradicting those of the primary lesion.

DOI： 10.25259/SNI_264_2022

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The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease 国際誌

Araki Y., Yokoyama K., Uda K., Kanamori F., Mamiya T., Takayanagi K., Ishii K., Shintai K., Nishihori M., Tsukada T., Takeuchi K., Tanahashi K., Nagata Y., Nishimura Y., Tanei T., Nagashima Y., Muraoka S., Izumi T., Seki Y., Saito R.

Surgical Neurology International   13 巻   頁： 511 - 511   2022年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Neurology International  

Background: The aim of this study was to investigate the association between early postoperative slow flow in bypass grafts and preoperative focal cerebral blood flow (CBF) in patients who underwent combined surgery for moyamoya disease (MMD). Methods: The subjects were 18 patients (22 surgeries) who underwent single photon emission computed tomography (SPECT) before surgery. The CBF value of the middle cerebral artery territory was extracted from the SPECT data, and the value relative to the ipsilateral cerebellar CBF (relative CBF, or RCBF) was calculated. The association between RCBF and early postoperative slow flow in the bypass graft was investigated. In addition, the correlation between the revascularization effect and preoperative RCBF was analyzed. Results: In four of 22 surgeries (18.2%), slow flow in the bypass graft was identified in the early postoperative period. Preoperative RCBF in the slow flow and patent groups was 0.86 ± 0.15 and 0.87 ± 0.15, respectively, with no significant difference (P = 0.72). The signal intensity of four slow-flowed bypasses was improved in all cases on magnetic resonance angiography images captured during the chronic phase (mean of 3.3 months postoperatively). The revascularization scores were 2 ± 0.82 and 2.1 ± 0.68 in the slow flow and patent groups, respectively, and did not differ significantly (P = 0.78). A significant correlation was not observed between preoperative RCBF and the revascularization effect. Conclusion: No significant association was observed between preoperative RCBF and early postoperative slow flow in bypass grafts in patients with MMD undergoing combined surgery. Given the high rate of improved depiction of slow-flowed bypass in the chronic postoperative phase, the conceptual significance of an opportune surgical intervention is to maintain CBF by supporting the patient's own intracranial-extracranial conversion function.

DOI： 10.25259/SNI_772_2022

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Case of a Pregnant Woman with Capillary Hemangioma of the Parasellar Region.

Ishikawa T, Takeuchi K, Nagata Y, Ito K, Yamamoto T, Kabeya R

NMC Case Report Journal   9 巻 ( 0 ) 頁： 77 - 82   2022年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   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.2021-0326

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脊椎脊髄疾患における3Dプリンター活用の実際と現状

永島 吉孝, 西村 由介, 赤堀 翔, 竹内 和人, 宇田 憲司, 伊藤 洋, 齋藤 竜太

脊髄外科   36 巻 ( 3 ) 頁： 296 - 301   2022年

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.36.296

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Sellar arachnoid cystに対する経鼻内視鏡手術

永田 雄一, 竹内 和人, 山本 太樹, 水野 晃宏, 永谷 哲也, 齋藤 竜太

日本内分泌学会雑誌   97 巻 ( Suppl.HPT ) 頁： 49 - 51   2021年9月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

内視鏡下経鼻術(TSS)を行ったSellar arachnoid cyst(sAC)14例17手術(男性5例、女性9例、平均年齢49.6歳)の手術成績を報告した。初回手術例は13例、再発例は1例で、術前症状は視機能障害13例、動眼神経麻痺1例、汎下垂体前葉機能低下2例であり、嚢胞最大径は平均26.9mmであった。手術法はconventional TTS:9手術、extended TTS:8手術で、下垂体柄を温存しつつ可及的な嚢胞開窓を行い、視機能障害と動眼神経麻痺は全例改善した。TSSはsACに対して安全かつ有用な外科的治療法であり、術前画像や術中所見に基づいて下垂体柄と下垂体組織を温存するよう嚢胞開窓を行うことで、良好な術後下垂体機能が期待できる。また、下垂体柄が嚢胞前方に位置する症例は術後再発をきたしやすく、手術法の工夫や注意深いフォローアップが必要である。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01160&link_issn=&doc_id=20210929320015&doc_link_id=%2Fcs6hypop%2F2021%2F0097s1%2F016%2F0049-0051%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs6hypop%2F2021%2F0097s1%2F016%2F0049-0051%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

内視鏡下経鼻頭蓋底手術後の再建戦略 失敗症例から学ぶDuragenの適応と限界

竹内 和人, 永田 雄一, 山本 太樹, 原田 英幸, 齋藤 竜太

日本内分泌学会雑誌   97 巻 ( Suppl.HPT ) 頁： 16 - 18   2021年9月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

新規再建材料であるDuragenを用いた経鼻頭蓋底手術後再建120症例を対象として、Duragenの適応と限界について検討した。再建方法は通常法77例(通常再建法73例、靴紐再建法4例)、拡大法43例(靴紐再建法30例、パッチワーク再建法13例)で、このうち自家組織を用いずにDuragen単独で再建した症例は通常法45例、拡大法9例であり、Duragen単独再建群の1例(1.9%)に術後髄液漏を認めたため、再手術を行った。髄液漏再建手術時に採取したDuragenの病理組織学的検討では、inlay graftとして硬膜内に留置されたものには線維芽細胞、新生血管がみられたが、onlay graftとして硬膜外に留置されたものには新生血管はなく癒着も弱かった。硬膜欠損の少ない症例や硬膜焼灼のない症例はDuragen単独での再建が有効と考えられた。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01160&link_issn=&doc_id=20210929320005&doc_link_id=10.1507%2Fendocrine.97.S.HPT_16&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.97.S.HPT_16&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

A new primate model of hypophyseal dysfunction 国際誌

Kawabata, T; Suga, H; Takeuchi, K; Nagata, Y; Sakakibara, M; Ushida, K; Ozone, C; Enomoto, A; Kawamoto, I; Itagaki, I; Tsuchiya, H; Arima, H; Wakabayashi, T

SCIENTIFIC REPORTS   11 巻 ( 1 ) 頁： 10729 - 10729   2021年5月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

For pituitary regenerative medicine, the creation of a hypophyseal model in monkeys is necessary to conduct future preclinical studies; however, previous studies reported that hypophysectomy in monkeys is not always safe or satisfactory. This study aimed to create a hypophyseal dysfunction model in a cynomolgus monkey using a safer surgical technique and establish the protocol of pituitary hormone replacement therapy for this model. Surgical resection of the pituitary gland of a 7.8-year-old healthy adult cynomolgus male monkey weighing 5.45 kg was performed to create a hypophyseal dysfunction model for future regenerative studies. Endoscopic transoral transsphenoidal surgery was used to perform hypophysectomy under navigation support. These procedures were useful for confirming total removal of the pituitary gland without additional bone removal and preventing complications such as cerebrospinal fluid leakage. Total removal was confirmed by pathological examination and computed tomography. Hypopituitarism was verified with endocrinological examinations including stimulation tests. Postoperatively, the monkey’s general condition of hypopituitarism was treated with hormone replacement therapy, resulting in long-term survival. The success of a minimally invasive and safe surgical method and long-term survival indicate the creation of a hypophyseal dysfunction model in a cynomolgus monkey; hence, this protocol can be employed in the future.

DOI： 10.1038/s41598-021-90209-3

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機能性下垂体腺腫に対する前葉peel off resectionの意義

永田 雄一, 水野 晃宏, 竹内 和人

日本内分泌学会雑誌   97 巻 ( 1 ) 頁： 256 - 256   2021年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本内分泌学会  

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神経内視鏡の発展 "内視鏡でもできる"から"内視鏡ならできる"へ

竹内 和人

小児の脳神経   46 巻 ( 2 ) 頁： 109 - 109   2021年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本小児神経外科学会  

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