研究者詳細 - 竹内　和人

論文 - 竹内　和人

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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

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

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

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

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 Open Access

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

経蝶形骨術中髄液漏における硬膜下血腫

竹内和人, 永谷哲也, 渡邉督, 岸田悠吾, 永田雄一, 秋禎樹, 川端哲平, 石川隆之, 若林俊彦

日本内分泌学会雑誌 93 巻 ( Suppl.HPT ) 頁： 87 - 89 2017年10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

経蝶形骨手術または拡大経蝶形骨法が施行され、術中に髄液漏を認めた61例を対象とし、術後に硬膜下血腫を認めた10例(A群)と認めなかった51例(B群)に分け検討した。年齢、性別、腫瘍の病理・最大径、術前内分泌機能等の患者背景に加えて、脳室拡大の程度を術前MRIでのEvans' indexを用いて評価した。また、術中髄液漏れの程度についてEsposito分類を用いて評価し、硬膜下血腫の発生について術翌日、1週間後、1ヵ月後、3ヵ月後に撮影されたCTまたはMRIを用いて評価した。その結果、A群はB群に比べ年齢、術前下垂体前葉機能低下の合併頻度、Evans' indexが有意に高かった。その他の項目に両群間で有意差は認めなかった。多変量解析を行ったところ、65歳以上、術前下垂体前葉機能低下、Evans' index≧0.28が術後硬膜下血腫発生の有意なリスク因子であった。

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The Multiscope Technique for Microvascular Decompression 国際誌

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

WORLD NEUROSURGERY 103 巻頁： 310 - 314 2017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：World Neurosurgery

Background Endoscopic surgery has rapidly become widespread in neurosurgery in recent years. Endoscopy can offer close and panoramic surgical views with fine illumination, even in the deep intracranial area. However, it also has the following serious drawback: an intracranial blind area between the field lens of the endoscope and the site of the dural opening. This blind area cannot be viewed on the endoscopic monitor, and several surgical complications, including accidental intracranial neurovascular structural injury, can occur in this area. In this article, we report a new multiscope surgical technique that can compensate for this serious disadvantage of endoscopic surgery. Methods In the multiscope technique, endoscopic and exoscopic systems are used simultaneously with 2 monitors. Microvascular decompression (MVD) is performed fully endoscopically using an exoscope that compensates for the intracranial blind area of the endoscopic view. Two high-definition monitors for the endoscope and exoscope are placed side-by-side in front of the primary surgeon. Results Two patients with hemifacial spasm were treated by endoscopic MVD with the multiscope technique. In these procedures, fine surgical views were obtained by both the endoscope and exoscope. Two monitors were placed side-by-side in front of the surgeon; as a result, the physician could easily view them simultaneously during the operation. No surgery-related complications occurred. Conclusions The multiscope technique can facilitate the performance of safer neuroendoscopic surgery than conventional endoscopic surgery. This technique can also be adopted in other skull base surgeries, in which the importance of endoscopy is growing.

DOI： 10.1016/j.wneu.2017.04.059

小児悪性脳腫瘍の集学的治療総論サバイバーたちの苦悩悪性脳腫瘍治療後には複雑な頭蓋奇形が生じる二次性縫合縫合癒合のリスク因子と診断マーカー

近藤五郎, 栗本路弘, 竹内和人, 川端哲平, 秋禎樹, 荒木芳生, 夏目敦至, 若林俊彦

小児の脳神経 42 巻 ( 2 ) 頁： 124 - 124 2017年4月

術後に糖代謝の改善を認めたGH・TSH産生下垂体腫瘍の一例

川口頌平, 竹内和人, 半田克成, 片岡祐子, 山川文子, 林正幸

糖尿病 60 巻 ( Suppl.1 ) 頁： S - 247 2017年4月

脳幹部海綿状血管腫に対する内視鏡手術 Open Access

秋禎樹, 竹内和人, 渡邊督, 永田雄一, 若林俊彦

脳神経外科ジャーナル 26 巻 ( 3 ) 頁： 216 - 224 2017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)日本脳神経外科コングレス

脳幹部海綿状血管腫(BSCM)は、高い出血率を有する血管奇形の1つとして知られている。出血や増大傾向を示すBSCMは神経学的予後に影響するため外科的治療が必要となるが、脳幹部への外科的治療は少しの正常組織への侵襲も術後の神経予後を大きく悪化させる可能性がある。今回筆者らは2例(橋腹側1例、中小脳脚1例)の症候性BSCMに対して内視鏡的に摘出を行った。どちらの症例もMR diffusion tensor image(DTI)を用いて病変部や錐体路の位置を把握した。術中は内視鏡下にwet field methodを用いて摘出および摘出腔内の止血を行い、術後、神経学的な改善が得られた。これらの技術により、今後、脳幹部病変に対しての内視鏡を用いた治療が正確かつ安全に行われるようになると考える。(著者抄録)

DOI： 10.7887/jcns.26.216

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Endoscopic resection of Brain stem cavernous malformations (BSCMs): Two illustrative cases and surgical methods employed

Chu J., Takeuchi K., Watanabe T., Nagata Y., Wakabayashi T.

Japanese Journal of Neurosurgery 26 巻 ( 3 ) 頁： 216 - 226 2017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：Japanese Journal of Neurosurgery

Brain stem cavernous malformations (BSCMs) are associated with a high rate of hemorrhagic events. Though BSCMs that bleed or grow in size are indicated for resection, the surgical procedure usually involves a high risk of damage to the normal brain. We successfully achieved total resection, in two cases of symptomatic BSCMs, using a neuroendoscope. The BSCM was localized in the ventral part of the pons in the first case and in the middle cerebellar peduncle in the second case. In both cases, diffusion tensor images (DTI) were taken with an MRI to confirm the localization of the BSCM in relation to the pyramidal tracts. We resected the BSCMs using a Vet field method' which renders the surgical fields clear without using suction tubes. The wet field provides the operator with an increased range of manipulation even in a tight space. With our technique, the indications of endoscopic surgery have widened. We have shown that neuro-endoscopic surgery can safely and effectively replace conventional craniotomy for certain brain stem lesions.

DOI： 10.7887/jcns.26.216

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