研究者詳細 - 竹内　和人

論文 - 竹内　和人

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Peel-off resection of the pituitary gland for functional pituitary adenomas: pathological significance and impact on pituitary function 国際誌

Nagata, Y; Takeuchi, K; Yamamoto, T; Ishikawa, T; Kawabata, T; Shimoyama, Y; Inoshita, N; Wakabayashi, T

PITUITARY 22 巻 ( 5 ) 頁： 507 - 513 2019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：Pituitary

Purpose: Functional pituitary adenomas (FPAs) lacking a well-defined pseudocapsule can invade the adjacent pituitary gland. In such situations, peel-off resection of the adjacent pituitary gland after selective adenomectomy might lead to complete tumor removal, resulting in optimal endocrinological outcomes. Here, we present the significance of peel-off resection of the pituitary gland in patients with FPA in whom complete extracapsular tumor removal cannot be achieved. Methods: We performed a retrospective review of 21 patients with FPA who underwent transsphenoidal surgery (TSS). After selective adenomectomy, peel-off resection of the adjacent pituitary gland was performed in 13 patients because complete extracapsular resection could not be achieved, while peel-off resection was not performed in the remaining 8 patients because complete extracapsular resection was accomplished. The clinical outcomes of these groups were compared. The pituitary tissues obtained by peel-off resection were pathologically examined for tumor cells. Results: Early postoperative biochemical remission was achieved in 20 patients (95.2%). Anterior pituitary functions were not aggravated postoperatively in any patient: however, transient diabetes insipidus (DI) occurred in 2 patients. There were no statistically significant differences in the clinical outcomes of the two groups. A pseudocapsule was pathologically detected in the adjacent anterior pituitary even in patients in whom no pseudocapsule was intraoperatively detected. Tumor cells were pathologically detected in 7 (58.3%) of 12 pituitary tissues examined. Conclusions: Peel-off resection of the pituitary gland, which can remove a small tumor cell remnant in the adjacent pituitary, might maximize the effectiveness of TSS with minimal impact on postoperative pituitary function.

DOI： 10.1007/s11102-019-00980-w

高齢非機能性下垂体腺腫における手術成績の検討

川端哲平, 竹内和人, 山本太樹, 石崎友崇, 永田雄一, 若林俊彦

日本内分泌学会雑誌 95 巻 ( Suppl.HPT ) 頁： 45 - 47 2019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

当院で2012～2018年に初発非機能性下垂体腺腫に対して内視鏡下経鼻的経蝶形骨手術を行った78例のうち、65歳以上の33例を高齢群、65歳未満の45例を若年群とし、手術成績を群間比較した。全摘出できた割合は高齢群70%、若年群73%で有意差は認めなかった。術前にみられた症状の改善率は、頭痛が高齢群100%、若年群78%、視機能障害がそれぞれ91%、97%、下垂体前葉機能障害がそれぞれ17%、45%であり、高齢群は下垂体前葉機能障害の改善率が低かった。術後合併症の発生頻度は、低Na血症が高齢群33%、若年群7%、一過性尿崩症がそれぞれ9%、9%、永続的尿崩症がそれぞれ3%、9%、下垂体前葉機能低下がそれぞれ3%、2%、認知機能低下がそれぞれ3%、0%、廃用症候群がそれぞれ3%、0%であり、高齢群は低Na血症の発生頻度が有意に高かった。

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Endoscopic clipping of intraventricular aneurysms using the "wet-field" technique 国際誌

Takeuchi, K; Handa, T; Chu, J; Wada, K; Wakabayashi, T

JOURNAL OF NEUROSURGERY 131 巻 ( 1 ) 頁： 104 - 108 2019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：Journal of Neurosurgery

Intraventricular hemorrhage and intracerebral aneurysms are relatively frequent complications associated with moyamoya disease. Prevention of aneurysm rerupture is important because it significantly decreases the morbidity and mortality rates. Aneurysms arising distal to collateral flow are sometimes observed in patients with intraventricular hemorrhage; however, the treatment of these aneurysms remains challenging because of their deep-seated location in the brain and accompanying narrow surgical corridor. The authors describe a neuroendoscopic aneurysm clipping technique performed in 2 cases using a small-diameter tubular retractor for intraventricular aneurysms of the distal lateral posterior choroidal artery. In this technique, the surgical field was continuously irrigated with artificial CSF to keep the ventricle size intact, and aneurysm clipping was performed through a tubular retractor that was introduced with neuronavigational guidance. The patients' postoperative courses were uneventful, and CT angiography revealed complete clipping of the aneurysms and patent parent arteries. Endoscopic clipping using a tubular retractor is an effective and less invasive alternative for treating intraventricular aneurysms. The wet-field endoscopic technique is performed in an aqueous field and maintains an intact ventricle size, allowing for a clear surgical view and a wider, enhanced surgical field.

DOI： 10.3171/2018.1.JNS172393

Removal of the Medial Wall of the Cavernous Sinus for Functional Pituitary Adenomas: A Technical Report and Pathologic Significance 国際誌

Nagata, Y; Takeuchi, K; Yamamoto, T; Ishikawa, T; Kawabata, T; Shimoyama, Y; Wakabayashi, T

WORLD NEUROSURGERY 126 巻頁： 53 - 58 2019年6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: Removal of the medial wall of the cavernous sinus (MW) is challenging for neurosurgeons. We describe a practical method of endoscopic MW removal via endonasal transsphenoidal approach to minimalize intraoperative blood loss and postoperative morbidities. We also present the pathologic significance of this technique for functional pituitary adenomas (FPAs). Methods: We performed MW removal in patients with FPA with no well-defined pseudocapsule and a tumor in direct contact with the MW. The MW was judged to have tumor invasion based on the intraoperative appearance, and it was removed regardless of the appearance of MW involvement. Intraoperative findings and postoperative clinical, endocrinologic, and pathologic outcomes were retrospectively reviewed. Results: Fourteen patients underwent MW removal for FPA, including 12 patients with acromegaly and 2 with Cushing disease. Mean intraoperative blood loss was 170 mL (range, 32–400 mL), and none of the patients required blood transfusion. Among the 7 patients without intraoperative apparent MW involvement, 4 (57.1%) had pathologically confirmed tumor invasion into the MW (occult invasion). Biochemical remission by surgery alone was achieved in 13 patients (92.9%). Transient oculomotor palsy occurred in 1 patient (7.1%). Conclusions: Occult tumor invasion into the MW was often detected in patients with FPA without a well-defined pseudocapsule but in direct contact with the MW. Our technique can enhance the effectiveness of surgery with minimal postoperative morbidities.

DOI： 10.1016/j.wneu.2019.02.134

斜台内腫瘤を呈した多発性骨髄腫の一例

景山卓, 竹内和人, 下山芳江, 足立佳也, 若林俊彦

臨床神経学 59 巻 ( 5 ) 頁： 320 - 320 2019年5月

脳幹部に腫瘍性病変をきたしステロイドパルス療法が有効であった脱髄性疾患の1例

光里翔, 天草善信, 中村亮一, 大岡史治, 竹内和人, 川頭祐一, 熱田直樹, 吉田眞理, 勝野雅央

臨床神経学 59 巻 ( 5 ) 頁： 324 - 324 2019年5月

機能性下垂体腺腫に対する内視鏡下経鼻経蝶形骨手術の限界

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 ( 1 ) 頁： 492 - 492 2019年4月

頭蓋咽頭腫摘出術中下垂体茎温存症例における下垂体機能の検討

竹内和人, 永田雄一, 永谷哲也, 渡邉督, 若林俊彦

日本内分泌学会雑誌 95 巻 ( 1 ) 頁： 447 - 447 2019年4月

Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Faros llar Lesions 査読有り

Ishikawa Takayuki, Takeuchi Kazuhito, Nagatani Tetsuya, Aimi Yuri, Tanemura Eriko, Tambara Masao, Nagata Yuichi, Choo Jungsu, Wakabayashi Toshihiko

WORLD NEUROSURGERY 122 巻頁： E1202-E1210 2019年2月

Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Parasellar Lesions. 国際誌

Ishikawa T, Takeuchi K, Nagatani T, Aimi Y, Tanemura E, Tambara M, Nagata Y, Choo J, Wakabayashi T

World neurosurgery 122 巻頁： e1202 - e1210 2019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：World Neurosurgery

Objective: Although reports regarding the relationship between surgical complications and quality of life (QOL) exist, a general consensus regarding this issue is lacking. The aim of this study was to evaluate QOL after endoscopic transsphenoidal approach. Methods: We assessed patients with sellar or parasellar lesions that were removed with endoscopic transsphenoidal approach or extended endoscopic transsphenoidal approach between January 2010 and December 2016. 36-Item Short Form Health Survey and 30-Item General Health Questionnaire QOL scores were obtained preoperatively and 1 month and 6 months postoperatively. Results: We analyzed 89 patients with nonfunctioning pituitary adenoma (NFPA) and 39 patients with acromegaly. Physical QOL decreased 1 month after surgery but recovered after 6 months in both groups. Mental QOL improved postoperatively compared with preoperatively. Patients with acromegaly had a worse Physical Component Summary (PCS) on 36-Item Short Form Health Survey (48.7, 28.9, and 41.0) at 6 months than patients with NFPA. The low preoperative PCS group did not improve until 6 months postoperatively. Multiple regression analysis revealed the following factors were key to postoperative QOL: age (NFPA PCS 6 months postoperatively; correlation coefficient = −0.489), preoperative Mental Component Summary (MCS) (NFPA MCS 6 months postoperatively, correlation coefficient = 0.573), body mass index (acromegaly PCS 6 months postoperatively; correlation coefficient = −0.376), preoperative PCS (acromegaly PCS 6 months postoperatively; correlation coefficient = 0.905), and preoperative MCS (acromegaly MCS 6 months postoperatively; correlation coefficient = 0.726). Conclusions: Endoscopic transsphenoidal approach can improve QOL in patients by 6 months postoperatively. In patients with acromegaly with significant QOL impairments preoperatively, surgery sometimes may be unable to normalize QOL.

DOI： 10.1016/j.wneu.2018.11.017

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高度な壊死所見と髄液細胞数増多を伴ったTumefactive demyelinating lesionの一例

原田祐三子, 坪井崇, 熱田直樹, 勝野雅央, 大岡史治, 竹内和人

臨床神経学 58 巻 ( 11 ) 頁： 709 - 709 2018年11月

傍鞍部腫瘍術後遅発性低Na血症の発症と予防法の検討

竹内和人, 川端哲平, 永田雄一, 秋禎樹, 石川隆之, 高木博史, 有馬寛, 若林俊彦

日本内分泌学会雑誌 94 巻 ( Suppl.HPT ) 頁： 37 - 40 2018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

当院で傍鞍部腫瘍に対しeTSS(内視鏡下経鼻経蝶形骨手術)を施行した98例(男性50例、女性48例、平均年齢55.9歳)を対象に、術後の遅発性低Na血症(DHN)発症について検討した。その結果、DHNは37例(37.8%)に認められた。DHN発症患者ではDHN発症時のAVP分泌が抑制されていないことが確認された。また、術後7日目においてDHN非発症患者では約3%程度の体重低下を認めるのに対し、DHN発症例では体重減少は1%程度と軽微であり、体内への水分貯留が示唆された。術前より尿崩症が認められた患者群ではDHN発症が少なかったものの、DHN発症例では渇感中枢障害を伴っていた。これは術後の脱水を危惧したADH補充による医原性のものと考えられた。以上、傍鞍部腫瘍の術後DHNの発症にはSIADHが強く関与していることが考えられた。尚、術後早期からの水分制限はDHN発症予防に有効と考えられたが、より適切なプロトコールならびに予測法の確立が必要である。

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Neuroendoscopic Cylinder Surgery and 5-Aminolevulinic Acid Photodynamic Diagnosis of Deep-Seated Intracranial Lesions 国際誌

Choo, J; Takeuchi, K; Nagata, Y; Ohka, F; Kishida, Y; Watanabe, T; Satoh, Y; Nagatani, T; Kato, K; Wakabayashi, T; Natsume, A

WORLD NEUROSURGERY 116 巻頁： E35 - E41 2018年8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: Microscopic detection of intracranial brain tumors with 5-aminolevulinic acid (5-ALA) has proven extremely useful, and reports the use of 5-ALA have recently increased. However, few reports have described 5-ALA photodynamic diagnosis (PDD) using a neuroendoscope. We performed neuroendoscopic 5-ALA PDD for various brain lesions and present a procedure using only a neuroendoscope. Methods: We describe the diagnosis of 20 intracranial brain lesion cases with a 5-ALA–guided fluorescence endoscope. A light-emitting diode that emitted either white light or 400- to 410-nm violet light was attached to a neuroendoscope. We performed cylinder surgery with a transparent sheath under observation with a rigid neuroendoscope. Results: Neuroendoscopic biopsies were performed in 11 patients, and resections were performed in 9 patients. All lesions were observed with a neuroendoscope under sequential white light and violet light. We confirmed the presence of a red fluorescent lesion under violet light in 15 patients, including 4 of 5 glioblastoma cases (80%); 1 of 2 anaplastic astrocytoma cases (50%); 4 of 5 diffuse large B cell lymphoma cases (80%); 2 of 2 metastatic brain tumors; 1 of 1 case each of diffuse astrocytoma, pilocytic astrocytoma, inflammatory change, and germinoma (100%); and no cases of anaplastic ependymoma or cysticercosis. Pretargeted lesions were accurately harvested from all biopsy specimens. Gross total resection was achieved in 5 of 9 patients using a resection procedure. Conclusions: Our described method offers a promising technique for achieving precise brain tumor biopsies and safe resection.

DOI： 10.1016/j.wneu.2018.03.112

残存・コントロール不良成長ホルモン産生腫瘍に対する内視鏡手術の有効性

竹内和人, 永田雄一, 秋禎樹, 川端哲平, 石川隆之, 石崎友崇, 若林俊彦

日本内分泌学会雑誌 94 巻 ( 1 ) 頁： 417 - 417 2018年4月

Fully endoscopic combined transsphenoidal and supraorbital keyhole approach for parasellar lesions 国際誌

Nagata, Y; Watanabe, T; Nagatani, T; Takeuchi, K; Chu, J; Wakabayashi, T

JOURNAL OF NEUROSURGERY 128 巻 ( 3 ) 頁： 685 - 694 2018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

OBJECTIVE: Parasellar tumors that extend far laterally beyond the internal carotid artery or that are fibrous and adhere firmly to critical structures are difficult to remove totally via the endoscopic transsphenoidal approach alone. In such cases, a combined transsphenoidal-transcranial approach is effective to achieve maximal resection in a single stage. In this paper, a new minimally invasive surgical technique for complicated parasellar lesions, a fully endoscopic combined transsphenoidal-supraorbital keyhole approach, is presented. METHODS: A retrospective review of patients who had been treated via a fully endoscopic combined transsphenoidal-supraorbital keyhole approach for complicated parasellar lesions was performed. The data for resection rate, perioperative mortality and morbidity, and postoperative outcomes were analyzed. RESULTS: A total of 12 fully endoscopic combined transsphenoidal-supraorbital keyhole approaches were performed from March 2013 to February 2016; 10 were for pituitary adenomas and 2 were for craniopharyngiomas. Gross-total resection or near-total resection was achieved in 7 of 12 cases. Among the 11 patients who had presented with preoperative visual disturbances, 7 had visual improvement. However, 1 patient showed deterioration in visual function. No patient experienced postoperative hemorrhage, needed additional surgical treatment, or had postoperative CSF leakage. CONCLUSIONS: In the combined transsphenoidal and transcranial approach, safe and effective cooperative manipulation with 2 surgical corridors can be performed for complicated parasellar lesions. The goal of this procedure is not to achieve gross-total resection, but to achieve safe resection. Moreover, this new surgical approach offers neurosurgeons a simpler operative field with less invasiveness than the conventional microscopic combined approach. The fully endoscopic combined endonasal-supraorbital keyhole approach is an efficacious procedure for complicated parasellar lesions with acceptable results.

DOI： 10.3171/2016.11.JNS161833

Long-standing overt ventriculomegaly without aqueductal stenosis: A case report

Ikumi Kazuhiro, Tsuboi Takashi, Atsuta Naoki, Takeuchi Kazuhito, Koike Haruki, Katsuno Masahisa

NEUROLOGY AND CLINICAL NEUROSCIENCE 6 巻 ( 2 ) 頁： 42-44 - 44 2018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：Neurology and Clinical Neuroscience

We report a case of long-standing overt ventriculomegaly without aqueductal stenosis. A 66-year-old woman developed progressive gait disturbance. Her gait was wide-based, with a difficulty in turning. Prominent macrocephaly was present, which suggests the presence of long-standing hydrocephalus since childhood. Cognitive impairments were detected on neuropsychological tests. Cerebral magnetic resonance imaging revealed marked enlargement of the third and lateral ventricles. Aqueductal stenosis was not apparent; however, endoscopic third ventriculostomy partly ameliorated gait disturbance. Endoscopic third ventriculostomy can be a therapeutic option for long-standing overt ventriculomegaly even if the aqueduct is patent.

DOI： 10.1111/ncn3.12176

竹内和人, 加藤美穂子, 波多野寿, 大澤弘勝, 近藤五郎, 栗本路弘, 秋禎樹, 若林俊彦

小児の脳神経 43 巻 ( 1 ) 頁： 20 - 24 2018年3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)日本小児神経外科学会

内視鏡技術の進歩により、のう胞性疾患に対して内視鏡を使用する報告が増えている。内視鏡手術を適応することで症例によっては髄液短絡術を回避でき、回避できない症例においてもシャントシステムをよりシンプルにすることで続発するシャントトラブルを軽減することにつながると考えられる。しかし、標準的手術法がなく個々の症例で治療方針の検討が必要である。また光学機器についても、軟性鏡、硬性鏡のどちらを使用するのか、あるいは併用するのか検討する必要がある。それぞれの光学機器の特徴を踏まえ、その治療成績について報告する。(著者抄録)

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A Novel Dissection Method Using a Flexible Neuroendoscope for Resection of Tumors Around the Aqueduct of Sylvius 国際誌

Ishikawa, T; Takeuchi, K; Tsukamoto, N; Kawabata, T; Wakabayashi, T

WORLD NEUROSURGERY 110 巻頁： 391 - 396 2018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：World Neurosurgery

Background Flexible endoscopes have both a wide range of movement and a wide field of view and are therefore widely used for endoscopic third ventriculostomy and biopsy. However, tumor resection around the aqueduct of Sylvius using flexible endoscopes has scarcely been reported. Case Description We report 2 cases of tumor resection around the aqueduct of Sylvius. The first case is a 38-year-old man presenting with progressive headache, nausea, and diplopia. Magnetic resonance imaging (MRI) revealed a 1.4 cm nonenhancing mass at the entry of the aqueduct of Sylvius and occlusive hydrocephalus. We performed tumor resection and endoscopic third ventriculostomy (ETV) simultaneously. His symptoms disappeared after the operation. Final pathologic diagnosis was ancient schwannoma. The second case is a 78-year-old woman presenting with progressive disturbance of consciousness (coma). MRI showed 0.7 cm nonenhancing mass at the entry of the aqueduct of Sylvius and occlusive hydrocephalus. We performed tumor resection and ETV similarly. Her consciousness improved after the operation. Final tumor diagnosis was cavernous malformation. In both cases there was no additional neurologic deficit after the surgery. Conclusions By using a flexible endoscope for tumor dissection, resection of a tumor without a neck, which cannot be removed through aspiration alone, becomes possible. To our knowledge, the presented cases are the first to describe the effectiveness of complete resection of a tumor in the third ventricle using flexible endoscopy.

DOI： 10.1016/j.wneu.2017.11.044

骨髄移植後に左後頭葉および胸髄に脱髄性病変を来した1例

村上あゆ香, 中村亮一, 川頭祐一, 熱田直樹, 小池春樹, 竹内和人, 寺倉精太郎, 吉田眞理, 勝野雅央

臨床神経学 57 巻 ( 12 ) 頁： 808 - 808 2017年12月

中脳水道狭窄を伴わなかったlong-standing overt ventriculomegaly in adults(LOVA)様水頭症の1例

井汲一尋, 坪井崇, 田中康博, 川端哲平, 秋禎樹, 永田雄一, 竹内和人, 若林俊彦, 伊藤瑞規, 勝野雅央

臨床神経学 57 巻 ( 10 ) 頁： 613 - 613 2017年10月

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