研究者詳細 - 竹内　和人

論文 - 竹内　和人

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Trautmann-focused mastoidectomy for a simple, safe presigmoid approach: technical note 国際誌

Tanahashi, K; Uda, K; Araki, Y; Takeuchi, K; Choo, J; Chalise, L; Motomura, K; Ohka, F; Wakabayashi, T; Natsume, A

JOURNAL OF NEUROSURGERY 134 巻 ( 3 ) 頁： 843 - 847 2021年3月

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

The presigmoid approach (PSA) is selected to obtain more lateral access to cerebellopontine angle tumors, brainstem cavernous malformations, or vertebrobasilar artery aneurysms than the standard retrosigmoid approach. However, mastoidectomy for the PSA can be considered time-consuming and to carry a higher risk of complications due to the anatomical complexity of the region. The authors established a method of minimized mastoidectomy focused on exposing Trautmann’s triangle as the corridor for the PSA while maximizing procedural simplicity and safety and maintaining a sufficient operative view. The authors present their method of minimized mastoidectomy in a cadaver dissection and operative cases, showing potential as a useful option for the PSA.

DOI： 10.3171/2020.1.JNS193179

Importance of Hydrostatic Pressure and Irrigation Hemostasis in Neuroendoscopic Surgery

Ishikawa, T; Takeuchi, K; Yamamoto, T; Nagata, Y; Natsume, A

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 2 ) 頁： 117 - 123 2021年2月

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

Recently neurosurgical operations have been carried out with water irrigation such as endoscopic third ventriculostomy and tumor resections in ventricles. Water irrigation is one of several published methods that promote hemostasis; however, not enough experimental evidence exists on its efficacy. In this study, we investigate whether hydrostatic pressure and persistent irrigation promote hemostasis in neuroendoscopic surgery. We dissected tails of 12–16-week-old C57BL/6 male mice at 5 mm proximal from the tip and checked for bleeding times under dry and wet conditions at pressures of 0 cmH2 O, 10 cmH2 O, 15 H2 O, and 20 cmH2 O without persistent irrigation to bleeding point and 10 cmH2 O with persistent irrigation. We then examined the dissected edge with hematox-ylin–eosin staining and measured the size of vessels. The average bleeding time of each group is as follows: dry: 203.4 sec, wet: 164.4 sec, 5 cmH2 O: 138.6 sec, 10 cmH2 O: 104.6 sec (P <0.001), 20 cmH2 O: 56 sec (P <0.001), and 10 cmH2 O with persistent irrigation: 72.8 sec (P <0.01 compared to 10 cmH2 O without persistent irrigation). The maximum caliber of mice’s tail artery was 50–60 μm. Hydrostatic pressure and irrigation are important factors contributing to hemostasis.

DOI： 10.2176/nmc.oa.2020-0278

Novel Endoscopic Technique for Inserting a Sheath into a Slit Ventricle: The Water-Slide Technique 国際誌

Yamamoto, T; Takeuchi, K; Nagata, Y; Mizuno, A; Wakabayashi, T

WORLD NEUROSURGERY 145 巻頁： 1 - 4 2021年1月

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

Background: The efficacy and safety of endoscopic procedures for slit ventricle syndrome (SVS) have been presented in recent studies. However, inserting a sheath into a target ventricle is essential in the beginning of endoscopic procedures for SVS, and this maneuver is challenging owing to the quite narrow ventricular space. We report a novel flexible endoscopic technique, the water-slide technique, that can effectively guide a sheath into a slit ventricle without the use of other adjunctive devices, such as a neuronavigation system and an ultrasound machine. Methods: Ten endoscopic procedures using the water-slide technique were performed in 9 patients with SVS. All patients had undergone ventriculoperitoneal shunt placement. Using the technique, the sheath was first placed on the flexible endoscope. The endoscope was then inserted into the lateral ventricle along the tract around the pre-existing ventricular catheter with irrigation of artificial cerebrospinal fluid via the working channel of the endoscope. After the endoscope reached the ventricle, the sheath was inserted into the ventricle along the endoscope. The endoscope was then used as a stylet. The endoscopic procedure was performed afterward. Continuous irrigation of artificial cerebrospinal fluid via the working channel is important when using this technique. Results: In all cases, the sheath was successfully introduced to the slit ventricle without the use of adjunctive devices. There were no postoperative complications correlated with the maneuver. Conclusions: This novel endoscopic technique is effective and safe for inserting a sheath into a target ventricle in the management of SVS.

DOI： 10.1016/j.wneu.2020.08.206

A Case of Primary Leptomeningeal Lymphoma Presenting with Hydrocephalus Characterized by Disproportionately Large Fourth Ventricle.

Nohira S, Shimato S, Yamanouchi T, Takeuchi K, Yamamoto T, Ito M, Kato K, Nishizawa T

NMC Case Report Journal 8 巻 ( 1 ) 頁： 399 - 404 2021年

Fully Endoscopic Transcylinder Trans-Magendie Foraminal Approach for Fourth Ventricular Cavernoma: A Technical Case Report 国際誌

Nagata, Y; Takeuchi, K; Yamamoto, T; Mizuno, A; Wakabayashi, T

WORLD NEUROSURGERY 142 巻頁： 104 - 107 2020年10月

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

Background: Neuroendoscopy offers wide and close surgical views with fine illumination, even in deep surgical sites. Furthermore, transcylinder surgery has the advantage that a tubular retractor can protect critical neurovascular structures in the surgical corridor. These advantages of neuroendoscopy and transcylinder surgery can contribute to safer and less invasive surgical approaches for deep-seated fourth ventricular lesions, for which various critical neurovascular structures exist along the surgical route. Case Description: A 54-year-old man with a fourth ventricular cavernoma underwent tumor resection via the endoscopic transcylinder trans-Magendie foraminal approach. A 6.8-mm transparent sheath (cylinder) was introduced into the fourth ventricle via the foramen of Magendie without incisions in the inferior medullary velum or the tela choroidea, resulting in the minimal retraction of and trauma to critical neurovascular structures in the surgical corridor. Under the view of a 2.7-mm rigid neuroendoscope, the lesion was completely removed with preservation of a venous anomaly on the ventral side of the aqueduct of Sylvius. Neuroendoscopy could offer a fine surgical view even under continuous irrigation with artificial cerebrospinal fluid; it prevented collapse of the fourth ventricle and facilitated anatomic understanding by the surgeons. The postoperative course was uneventful. Conclusions: Our novel approach can be an effective surgical option for fourth ventricular lesions with minimal cerebellar retraction and injury.

DOI： 10.1016/j.wneu.2020.06.171

機能性下垂体腺腫に対するsupratotal resectionの有用性

永田雄一, 竹内和人, 水野晃宏, 尾上剛史, 高木博史, 有馬寛

日本内分泌学会雑誌 96 巻 ( 2 ) 頁： 509 - 509 2020年10月

閉塞性水頭症により認知機能低下をきたした一例

毛利尚裕, 橋詰淳, 竹内和人, 熱田直樹, 勝野雅央

臨床神経学 60 巻 ( 10 ) 頁： 720 - 720 2020年10月

下垂体、下垂体近傍病変術後低ナトリウム血症の解析

竹内和人, 永田雄一, 山本太樹, 水野晃宏, 若林俊彦

日本内分泌学会雑誌 96 巻 ( 1 ) 頁： 266 - 266 2020年8月

経鼻内視鏡手術における閉創法の工夫

永田雄一, 竹内和人, 山本太樹, 水野晃宏, 若林俊彦

日本内分泌学会雑誌 96 巻 ( Suppl.HPT ) 頁： 38 - 39 2020年8月

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

著者等は内視鏡下経鼻経蝶形骨手術(TSS)における硬膜閉創法のアルゴリズムとして、conventional TSSでは腫瘍摘出腔への脂肪充填および硬膜縫合を行い、硬膜欠損を伴わないextended TSSでは腹部から採取した遊離脂肪片を用いたshoelace closure、硬膜欠損を伴うextended TSSでは遊離腹直筋膜片の硬膜へのpatch縫合+硬膜外での脂肪片貼付+硬性再建を原則としている。今回、その妥当性について検討するため、2013～2019年にTSSを行った383例の術後髄液漏発生率について調査した。手術法の内訳はconventional TSSが278例、extended TSSが105例で、術後髄液瘻は計7例(発生率1.8%)であり、この数値は他報告(1.2～2.2%)と同程度で良好な成績と考えられた。

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下垂体腺腫に対する手術操作と中枢性尿崩症の発生についての検討

永田雄一, 竹内和人, 山本太樹, 水野晃宏, 若林俊彦

日本内分泌学会雑誌 96 巻 ( 1 ) 頁： 238 - 238 2020年8月

下垂体腺腫における手術操作と術後中枢性尿崩症の発生についての検討

永田雄一, 竹内和人, 山本太樹, 水野晃宏, 若林俊彦

日本内分泌学会雑誌 96 巻 ( Suppl.HPT ) 頁： 40 - 41 2020年8月

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

当院で2017年2月～2019年10月に内視鏡下経鼻経蝶形骨手術を行った下垂体腺腫59例を対象とし、手術手技と術後中枢性尿崩症(DI)発生との関連性を調べ、DIをきたしやすい因子について検討した。その結果、腺腫の鞍上進展が強く手術で頭蓋内操作を要した症例ではDI発生率が有意に高かった。一方、手術手技のうち「腺腫の被膜外摘出」はDI発生の危険因子ではなかったことから、特に機能性下垂体腺腫において完全な腫瘍摘出を目指す意味での「被膜外摘出」は有用な手技であると考えられた。

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下垂体機能温存を目的とした頭蓋咽頭腫摘出への挑戦

竹内和人, 永谷哲也, 渡邉督, 岸田悠吾, 永田雄一, 山本太樹, 水野晃宏, 若林俊彦

日本内分泌学会雑誌 96 巻 ( Suppl.HPT ) 頁： 8 - 10 2020年8月

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

頭蓋咽頭腫の外科治療では腫瘍摘出率の向上と機能温存との両立が求められ、これまで内分泌機能の温存を目的とした下垂体組織・下垂体茎の温存が試みられてきたが、下垂体茎を温存しても下垂体機能は維持されないことが多い。上下垂体動脈(SHA)は視神経と下垂体茎を栄養する血管であり、内視鏡下拡大経鼻経蝶形骨手術(extended eTSS)はSHA・視神経下面・下垂体茎などを一視野に収めることが可能である。今回、当院と関連施設で2009～2019年にextended eTSSを施行した頭蓋咽頭腫69例のうち、初回手術例で、かつ術前に内分泌機能が維持され、術中に下垂体茎が温存され、術中映像を確認できた14例を対象とし、SHA infundibular branchが両側とも温存された群(6例)、片側温存群(5例)、温存不可群(3例)に分け、術後の下垂体前葉機能および後葉機能について群間比較した。結果、前葉機能は両側温存群の4例(67%)が術後も維持されたのに対し、片側温存群と温存不可群では全例に機能低下があり、有意な群間差を認めた。後葉機能は両側温存群の5例(83%)、片側温存群の2例(40%)、温存不可群の1例(33%)で維持され、有意な群間差は認めなかった。

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Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Kawabata, T; Takeuchi, K; Nagata, Y; Ishikawa, T; Choo, J; Wakabayashi, T

NEUROLOGIA MEDICO-CHIRURGICA 60 巻 ( 7 ) 頁： 351 - 359 2020年7月

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

An isolated fourth ventricle (IFV) is characterized by fourth ventricular dilation due to obstruction of its inlet and outlet. A disproportionately large communicating fourth ventricle (DLCFV) is a rare subtype of IFV, characterized by dilation of the fourth ventricle, regardless of the size of the lateral ventricles, with no apparent obstruction of the cerebral aqueduct. To our knowledge, this is the first case series describing endoscopic diagnosis and treatment strategy for DLCFV. We retrospectively reviewed six cases of DLCFV in which endoscopic surgery was performed at our institution and affiliated facilities between June 2013 and March 2017. DLCFV was diagnosed using radiographic imaging and intraoperative endoscopy. We also conducted a PubMed search and included only original studies related to DLCFV treatment written in English in our review of the literature. Endoscopic third ventriculostomy (ETV) was performed in all patients. Additional endoscope-assisted placement of a fourth ventriculoperitoneal (VP) shunt was performed in two patients who could not be managed with ETV alone because of severe adhesion of the interpeduncular cistern due to subarachnoid hemorrhage (SAH). The patients’ symptoms and the size of the fourth ventricle improved with surgical treatment, without complications. Endoscopic surgery for DLCFV appears to be a safe and effective treatment. Based on our treatment strategy, ETV is the first-line treatment for DLCFV. Endoscope-assisted placement of the fourth VP shunt can be treatment for severe adhesion of the interpeduncular cistern.

DOI： 10.2176/nmc.oa.2019-0299

Steroid-responsive recurrent tumefactive demyelination with multiple petechial hemorrhages along non-displaced medullary veins 国際誌

Tsuboi, T; Harada, Y; Suzuki, M; Ando, T; Atsuta, N; Ohka, F; Takeuchi, K; Taoka, T; Ohba, S; Nakaguro, M; Abe, M; Nakashima, I; Yoshida, M; Katsuno, M

CLINICAL NEUROLOGY AND NEUROSURGERY 193 巻頁： 105764 - 105764 2020年6月

<i>H3F3A</i> mutant allele specific imbalance in an aggressive subtype of diffuse midline glioma, H3 K27M-mutant 国際誌

Maeda, S; Ohka, F; Okuno, Y; Aoki, K; Motomura, K; Takeuchi, K; Kusakari, H; Yanagisawa, N; Sato, S; Yamaguchi, J; Tanahashi, K; Hirano, M; Kato, A; Shimizu, H; Kitano, Y; Yamazaki, S; Yamashita, S; Takeshima, H; Shinjo, K; Kondo, Y; Wakabayashi, T; Natsume, A

ACTA NEUROPATHOLOGICA COMMUNICATIONS 8 巻 ( 1 ) 頁： 8 - 8 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Acta Neuropathologica Communications

Diffuse midline glioma, H3 K27M-mutant is a lethal brain tumor located in the thalamus, brain stem, or spinal cord. H3 K27M encoded by the mutation of a histone H3 gene such as H3F3A plays a pivotal role in the tumorigenesis of this type of glioma. Although several studies have revealed comprehensive genetic and epigenetic profiling, the prognostic factors of these tumors have not been identified to date. In various cancers, oncogenic driver genes have been found to exhibit characteristic copy number alterations termed mutant allele specific imbalance (MASI). Here, we showed that several diffuse midline glioma, H3 K27M-mutant exhibited high variant allele frequency (VAF) of the mutated H3F3A gene using droplet digital polymerase chain reaction (ddPCR) assays. Whole-genome sequencing (WGS) revealed that these cases had various copy number alterations that affected the mutant and/or wild-type alleles of the H3F3A gene. We also found that these MASI cases showed a significantly higher Ki-67 index and poorer survival compared with those in the lower VAF cases (P < 0.05). Our results indicated that the MASI of the H3F3A K27M mutation was associated with the aggressive phenotype of the diffuse midline glioma, H3 K27M-mutant via upregulation of the H3 K27M mutant protein, resulting in downregulation of H3K27me3 modification.

DOI： 10.1186/s40478-020-0882-4

トルコ鞍部病変に対する経鼻内視鏡術後低ナトリウム血症の検討

竹内和人, 永田雄一, 山本太樹, 若林俊彦

日本内分泌学会雑誌 95 巻 ( 3 ) 頁： 1106 - 1106 2020年1月

機能性下垂体腺腫に対する経鼻手術の工夫

永田雄一, 竹内和人, 山本太樹, 若林俊彦

日本内分泌学会雑誌 95 巻 ( 3 ) 頁： 1102 - 1102 2020年1月

Endoscopic-assisted paramedian infratentorial supracerebellar approach for pineal cyst - How I do it Video clip. 国際誌

Tanaka R, Takeuchi K, Ansari A, Sasaki K, Miyatani K, Yamada Y, Kawase T, Kato Y, Horiguchi A

Surgical neurology international 11 巻頁： 336 - 336 2020年

Preservation of Olfactory Function Following Endoscopic Single-Nostril Transseptal Transsphenoidal Surgery 国際誌

Kawabata, T; Takeuchi, K; Nagata, Y; Ishikawa, T; Choo, J; Sato, Y; Tambara, M; Teranishi, M; Wakabayashi, T

WORLD NEUROSURGERY 132 巻頁： E665 - E669 2019年12月

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: Olfactory dysfunction is a significant postoperative complication related to endoscopic transsphenoidal surgery (TSS). This study aimed to determine the impact of endoscopic TSS on olfactory function. Methods: We conducted a prospective study of 32 patients with sellar or parasellar tumors who were treated with endoscopic TSS between December 2013 and October 2016. TSS was performed via a right transseptal approach. We performed the Toyota and Takagi olfactometer test and the venous olfaction test for the evaluation of olfactory function preoperatively and at 1 and 3 months postoperatively. Results: The results of the Toyota and Takagi test showed that olfactory function deteriorated in 4 of 32 (12.5%) patients 1 month postoperatively and improved to preoperative baseline levels in all patients 3 months after the procedure. Olfactory function deteriorated in 1 of 31 (3.2%) patients 3 months after the procedure. The venous olfaction test revealed no response in 1 of 31 (3.2%) patients 1 month postoperatively, with no improvement 3 months after the procedure. Conclusions: Endoscopic single-nostril transseptal TSS for sellar or parasellar tumor resection has minimal impact on olfactory function.

DOI： 10.1016/j.wneu.2019.08.051

Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery 国際誌

Ishikawa, T; Takeuchi, K; Nagata, Y; Choo, J; Kawabata, T; Ishizaki, T; Wakabayashi, T

JOURNAL OF NEUROSURGERY 131 巻 ( 5 ) 頁： 1625 - 1631 2019年11月

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

OBJECTIVE Transsphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results. METHODS All patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect. RESULTS There were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito's grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively. CONCLUSIONS Dural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.

DOI： 10.3171/2018.4.JNS18366

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論文 - 竹内　和人