研究者詳細 - 竹内　和人

論文 - 竹内　和人

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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

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 Open Access

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

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

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

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

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

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

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. Open Access

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

NMC case report journal 9 巻 ( 0 ) 頁： 77 - 82 2022年

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

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

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 <sup>18</sup>F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and <sup>11</sup>C-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

脊椎脊髄疾患における3Dプリンター活用の実際と現状 Open Access

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

Sellar arachnoid cystに対する経鼻内視鏡手術 Open Access

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

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。

DOI： 10.1507/endocrine.97.s.hpt_49

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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 Open Access

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

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。

DOI： 10.1507/endocrine.97.s.hpt_16

Open Access

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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 Open Access

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

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

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

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

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

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 Open Access

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 cmH<inf>2</inf> O, 10 cmH<inf>2</inf> O, 15 H<inf>2</inf> O, and 20 cmH<inf>2</inf> O without persistent irrigation to bleeding point and 10 cmH<inf>2</inf> 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 cmH<inf>2</inf> O: 138.6 sec, 10 cmH<inf>2</inf> O: 104.6 sec (P <0.001), 20 cmH<inf>2</inf> O: 56 sec (P <0.001), and 10 cmH<inf>2</inf> O with persistent irrigation: 72.8 sec (P <0.01 compared to 10 cmH<inf>2</inf> 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

Impending Blindness by Obstructive Hydrocephalus Intractable to Endoscopic Third Ventriculostomy: Case Report Open Access

Shirasaka N., Yasuda M., Takeuchi K., Ito K., Funai M., Maruga Y., Totsuka T., Hasegawa Y., Miyasaki A., Negoro M.

SN Comprehensive Clinical Medicine 3 巻 ( 2 ) 頁： 759 - 764 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：SN Comprehensive Clinical Medicine

Endoscopic third ventriculostomy (ETV) has been accepted for obstructive hydrocephalus (OH). We herein present a case of OH and optic nerve sheath edema (ONSE). Although ETV was successful, ONSE worsened. Discussion is focused on the relationship among intracranial hypertension (IH), ETV, and ONSE. The patient was a 19-year-old woman with complaints of headache and emesis. Papilledema was prominent. Radiological examination showed OH as an aqueductal tumor. Endoscopic tumorectomy and ETV were accomplished. Although headache and emesis disappeared, papilledema persisted. On the 4th day, the patient lost light perception. On magnetic resonance imaging, the third ventricular stroma and aqueduct were patent. Nevertheless, ONSE was prominent. After lumbar drainage, her vision was restored. Finally, ventriculoperitoneal shunting was performed, following which ONSE disappeared. IH is not always accompanied by ONSE. However, once it occurs, it may act separately from IH, and ETV may even exacerbate ONSE due to alteration of cerebrospinal fluid (CSF) flow into the chiasmatic cistern. In the optic nerve sheath, CSF pressure is not easily transmitted across different areas; this should explain the dissociation between ONSE and other symptoms of IH. Furthermore, we suggest that ONSE and acute optic dysfunction should be considered an independent crisis as “hydronervus opticus.”

DOI： 10.1007/s42399-020-00688-0

Open Access

Scopus

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. Open Access

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 Open Access

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

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