研究者詳細 - 竹内　和人

論文 - 竹内　和人

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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 Open Access

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 Open Access

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 Open Access

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

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

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 Open Access

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 Open Access

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