論文 - 竹内　和人

Intra-aneurysmal Thrombectomy Using Exo-endoscopic 2-step Approach for Thrombosed Vertebral Artery Aneurysm: A Technical Case Report Open Access

KENCANA I Gusti Ketut Agung Surya, IWAMI Kenichiro, NISHIHORI Masahiro, TAKEUCHI Kazuhito, NAGATA Yuichi, OKUMURA Eriko, SATO Yoshiki, NIRYANA I Wayan, MAHADEWA Tjokorda Gde Bagus, SAITO Ryuta

NMC Case Report Journal   13 巻 ( 0 ) 頁： 91 - 96   2026年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japan Neurosurgical Society  

<p>Although rare, thrombosed vertebral artery aneurysms can lead to severe symptoms and are challenging to treat due to their proximity to vital structures. The location of a thrombosed aneurysm on the anterior aspect of the brainstem poses a significant challenge to conventional microscopic approaches. We herein report a 78-year-old man with a thrombosed right vertebral artery aneurysm who developed progressive quadriparesis, dysphagia, and respiratory failure despite prior interventions, including flow diverter stent placement, parent artery occlusion, and microscopic thrombectomy. Given worsening medullary compression and poor clinical status, intra-aneurysmal thrombectomy was performed using an exo-endoscopic 2-step approach. The procedure involved reopening the previous suboccipital craniotomy, partial condylectomy, and C1 hemilaminectomy. Exoscopic thrombus de-bulking was followed by endoscopic evacuation of the residual thrombus compressing the ventral brainstem. Postoperatively, no complication was observed, and the patient demonstrated gradual neurological improvement, including recovery of spontaneous respiration and the ability to wean from mechanical ventilation within 3 weeks. Follow-up imaging confirmed resolution of medullary compression without thrombus recurrence. The exo-endoscopic 2-step approach is a viable option for surgical decompression of thrombosed vertebral artery aneurysms that cause brainstem compression. This enhances surgical access and visualization, particularly in the ventral brainstem, while potentially minimizing brainstem manipulation. Further investigation is warranted to better define the indications, efficacy, and safety of the management of complex thrombosed aneurysms.</p>

DOI： 10.2176/jns-nmc.2025-0316

Open Access

CiNii Research

Rapid intraoperative boundary diagnosis of somatotroph pituitary neuroendocrine tumors using real-time PCR. Open Access

Sato Y, Takeuchi K, Ohka F, Nagata Y, Maeda S, Matsuyama T, Hirose T, Deguchi S, Okumura E, Iwami K, Saito R

Acta neuropathologica communications     2026年2月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40478-026-02255-5

Open Access

PubMed

Organoid-Based Evaluation of Therapeutic Responses in Atypical Choroid Plexus Papilloma

Maeda, S; Ohka, F; Takeuchi, K; Nagata, Y; Aoki, K; Saito, R

CANCER SCIENCE   117 巻   頁： 846 - 846   2026年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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Two-stage surgery for cystic craniopharyngiomas: a purely endoscopic strategy and outcomes 国際誌

Sato, Y; Takeuchi, K; Nagata, Y; Matsuyama, T; Hirose, T; Okumura, E; Iwami, K; Saito, R

PITUITARY   29 巻 ( 1 ) 頁： 21 - 21   2025年12月

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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: This study aimed to evaluate the effectiveness and safety of two-stage endoscopic surgery for the complete resection of cystic craniopharyngiomas. Methods: We retrospectively evaluated 11 patients who underwent two-stage endoscopic surgery between March 2020 and July 2025. The lesions showed suprasellar and lateral extension toward the optic chiasm or the foramen of Monro, resulting in visual impairment or obstructive hydrocephalus. Cyst fenestration (CF) was initially performed using a transventricular approach with a flexible endoscope. One to two months later, endoscopic transsphenoidal surgery (eTSS) was performed to achieve complete resection. Tumor size (vertical diameter, horizontal diameter, and volume) was measured at three time points: pre-CF, post-CF (≤ 4 days), and pre-eTSS. Extent of resection, recurrence, and pituitary and hypothalamic function were assessed post-eTSS. Results: Complete resection was achieved in 10 of 11 patients, with no recurrence during a median follow-up of 22.8 months (range, 3.6–65.3). At a median interval of 54 days (range, 27–86) between CF and eTSS, the mean linear reduction was 45.3% superiorly and 39.3% laterally; mean tumor volume decreased by 68.0%. In some cases, areas typically difficult to access via eTSS alone decreased in size. All preoperative symptoms, except for hypopituitarism and diabetes insipidus, improved immediately after CF. No hypothalamic dysfunction was observed. Conclusion: Two-stage endoscopic surgery for cystic craniopharyngiomas is effective and safe, enabling complete resection with low recurrence during short- to mid-term follow-up.

DOI： 10.1007/s11102-025-01618-w

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Rapid intraoperative genetic analysis of adult-type diffuse gliomas using a microfluidic real-time polymerase chain reaction device 査読有り 国際誌 Open Access

Maeda, S; Kitano, Y; Ohka, F; Motomura, K; Aoki, K; Deguchi, S; Shiba, Y; Seki, M; Ikeda, Y; Shimizu, H; Iwami, K; Takeuchi, K; Nagata, Y; Yamaguchi, J; Kimura, K; Takido, Y; Yamamoto, R; Nakamura, A; Ito, S; Shinjo, K; Kondo, Y; Miyagi, S; Karube, K; Saito, R

NEURO-ONCOLOGY   27 巻 ( 12 ) 頁： 3161 - 3173   2025年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neuro Oncology  

Background. The 5th edition of the World Health Organization Classification of Tumors of the CNS introduced a subclassification of tumors based on key molecular markers. In adult-type diffuse gliomas, isocitrate dehydrogenase (IDH) and telomerase reverse transcriptase (TERT) promoter mutations play pivotal roles in the molecular classification. This study developed a rapid genotyping system using GeneSoC, a real-time PCR platform with microfluidic thermal cycling capable of completing 50 cycles of PCR within 20 min. Methods. To establish optimal analytical conditions, frozen tumor tissues from 67 patients and artificial DNA vectors were analyzed using this system. This system demonstrated a detection limit of at least 5% variant allele frequency for the IDH1 R132H and TERT promoter C228T/C250T mutations. Subsequently, intraoperative testing was performed in 120 cases using this system. Results. The sensitivity and specificity of IDH1 R132H mutation were 0.985 and 0.982, respectively, whereas those of TERT promoter C228T/C250T mutation were 1.000 and 1.000, respectively. These mutations were detected intraoperatively within approximately 25 min after tumor tissue collection. Furthermore, this assay identified tumor boundaries in an IDH-mutated glioma case, where IDH1 R132H mutations could not be detected. Conclusions. The GeneSoC^®︎-based rapid genotyping system may be effective not only for intraoperative diagnosis of diffuse glioma but also for detecting tumor boundaries.

DOI： 10.1093/neuonc/noaf188

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[Endoscopic Treatment of Pediatric Brain Tumors]. 査読有り

Takeuchi K

No shinkei geka. Neurological surgery   53 巻 ( 6 ) 頁： 1100 - 1111   2025年11月

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担当区分：筆頭著者   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：株式会社医学書院  

DOI： 10.11477/mf.030126030530061100

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Surgical Strategies for Giant Pituitary Adenomas to Minimize Postoperative Hematoma Formation 査読有り Open Access

Nagata, Y; Takeuchi, K; Iwami, K; Okumura, E; Sato, Y; Hirose, T; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA   65 巻 ( 11 ) 頁： 532 - 539   2025年11月

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担当区分：責任著者   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  

Postoperative hematoma formation is one of the most life-threatening complications associated with giant pituitary adenomas, and various surgical methods have been proposed to mitigate this risk. This study aims to report our surgical outcomes in patients with giant pituitary adenomas and to identify risk factors associated with postoperative hematoma formation. We retrospectively reviewed 45 patients with giant pituitary adenomas who underwent surgical treatment. The surgical approaches included conventional transsphenoidal surgery in 24 patients, extended transsphenoidal surgery in 9, and simultaneous combined transsphenoidal surgery and transcranial surgery in 12. Intracapsular resection was performed in 28 patients, while extracapsular resection was carried out in 17 patients. Postoperative hematoma formation was observed in 17 patients; among them, 2 experienced neurological deterioration and subsequently required reoperation for hematoma evacuation. The mean maximum tumor diameter was significantly larger in patients with postoperative hematoma (54 mm) compared to those without (45.3 mm) (p = 0.008). Other tumor characteristics were not significantly associated with postoperative hematoma formation. Combined transsphenoidal surgery and transcranial surgery were more frequently performed in patients who developed postoperative hematoma (p = 0.007), whereas extracapsular resection was more common in those without hematoma (p = 0.001). However, these differences in postoperative hemorrhage incidence among surgical techniques may have been substantially influenced by selection bias. Giant pituitary adenomas with extensive intracranial extension and involvement of critical neurovascular structures remain challenging to manage regardless of the surgical approach. Nevertheless, it is essential to tailor surgical strategies to individual cases to minimize postoperative complications.

DOI： 10.2176/jns-nmc.2025-0106

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膠芽腫に対する交流電場腫瘍療法における再発様式の検討

大岡 史治, 滝戸 悠平, 出口 彰一, 本村 和也, 三矢 幸一, 芝 良樹, 竹内 和人, 永田 雄一, 齋藤 竜太

日本癌治療学会学術集会抄録集   63回 巻   頁： O24 - 4   2025年10月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本癌治療学会  

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Intravenous perampanel in clinical practice: A multicenter prospective registry study 査読有り 国際誌

Sato, Y; Iwami, K; Okumura, E; Ohka, F; Takeuchi, K; Deguchi, S; Nagata, Y; Muraoka, S; Ishizaki, T; Nagashima, Y; Shiba, Y; Kato, T; Tanbara, M; Kano, T; Nishizawa, T; Yamamoto, Y; Saito, R

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY   131 巻   頁： 334 - 339   2025年9月

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

Purpose: This study aimed to evaluate the efficacy and safety of intravenous perampanel (IV-PER) in routine clinical practice. Methods: Patients who received IV-PER at Nagoya University Hospital or one of the 21 affiliated institutions between June 2024 and March 2025 were included. Indications for IV-PER included treatment for epileptic seizures, particularly acute symptomatic seizures, and prophylactic use before or after surgery. The primary endpoint was the seizure suppression rate within 7 days of treatment initiation, and the secondary endpoint was the incidence of adverse events (AEs). Clinical data were recorded daily, and blood tests were conducted within 2 weeks of administration. Enrolled patients were categorized into three groups based on the underlying etiology: cerebrovascular disease (CD), brain tumor (BT), and traumatic brain injury (TBI). Treatment efficacy and safety were assessed across these groups. Results: Of the 237 patients, 74, 116, and 47 were classified into the CD, BT, and TBI groups, respectively. The overall seizure suppression rate within 7 days was 89.0 %. Rates by group were 87.8 % (CD), 96.6 % (BT), and 72.3 % (TBI). When stratified by indication, the rates were 99.3 % for prophylactic use, 69.4 % for focal seizures, and 74.4 % for generalized seizures. Regarding AEs, somnolence was reported in 3 patients and irritability in one. Laboratory abnormalities included anemia, elevated liver enzymes, elevated creatine kinase, and hyponatremia. A total of 71 patients experienced one of these. Conclusions: This large multicenter prospective registry demonstrates that IV-PER can be safely used for seizure management during the 7-day acute phase in real-world clinical settings.

DOI： 10.1016/j.seizure.2025.07.023

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嚢胞性頭蓋咽頭腫に対する内視鏡での二期的手術 Open Access

佐藤 佳輝, 竹内 和人, 永田 雄一, 岩味 健一郎, 奥村 衣里子, 近藤 辰磨, 廣瀬 俊明, 齋藤 竜太

日本内分泌学会雑誌   101 巻 ( S.HPT ) 頁： 11 - 12   2025年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_11

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CiNii Research

Giant pituitary neuroendocrine tumorに対する治療戦略 Open Access

永田 雄一, 竹内 和人, 岩味 健一郎, 近藤 辰磨, 佐藤 佳輝, 廣瀬 俊明, 齋藤 竜太

日本内分泌学会雑誌   101 巻 ( S.HPT ) 頁： 46 - 47   2025年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_46

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CiNii Research

機能性下垂体腫瘍に対するreal-time PCR法での遺伝子解析を用いた正確な境界領域診断 Open Access

佐藤 佳輝, 竹内 和人, 大岡 史治, 永田 雄一, 岩味 健一郎, 奥村 衣里子, 近藤 辰磨, 廣瀬 俊明, 齋藤 竜太

日本内分泌学会雑誌   101 巻 ( S.HPT ) 頁： 75 - 77   2025年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_75

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CiNii Research

Metastatic PitNET 3例の検討 Open Access

竹内 和人, 永田 雄一, 岩味 健一郎, 佐藤 佳輝, 廣瀬 俊明, 齋藤 竜太

日本内分泌学会雑誌   101 巻 ( S.HPT ) 頁： 39 - 42   2025年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.101.s.hpt_39

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CiNii Research

Exo- and endoscopic two-step approach for recurrent vestibular schwannomas following surgical resection and radiosurgery: How I do it 国際誌 Open Access

Iwami, K; Takeuchi, K; Nagata, Y; Saito, R

ACTA NEUROCHIRURGICA   167 巻 ( 1 ) 頁： 211 - 211   2025年8月

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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 Neurochirurgica  

Intracanalicular residual vestibular schwannoma (VS) after surgical resection is known to cause recurrence. Lesions demonstrating progression despite adjuvant stereotactic radiosurgery necessitate salvage surgery with meticulous tumour resection to prevent recurrence. We describe our exo- and endoscopic two-step approach (EETA), employing an exoscope to remove the extracanalicular component and an endoscope to remove the intracanalicular component under direct visualisation of the fundus. EETA is a viable option for treating recurrent VS, as it enables enhanced visualisation of both extra- and intracanalicular lesions, including the fundus.

DOI： 10.1007/s00701-025-06625-1

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機能性下垂体腫瘍に対するreal-time PCR法での遺伝子解析を用いた正確な境界領域診断 Open Access

佐藤 佳輝, 竹内 和人, 大岡 史治, 永田 雄一, 岩味 健一郎, 奥村 衣里子, 近藤 辰磨, 廣瀬 俊明, 齋藤 竜太

日本内分泌学会雑誌   101 巻 ( Suppl.HPT ) 頁： 75 - 77   2025年8月

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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  

DOI： 10.1507/endocrine.101.S.HPT_75

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2025&ichushi_jid=J01160&link_issn=&doc_id=20250903390023&doc_link_id=10.1507%2Fendocrine.101.S.HPT_75&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.101.S.HPT_75&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Dpcd Induces Hydrocephalus Because of Partial Defects in the Inner Dynein Arms, With Abnormal Ciliary Motility 査読有り 国際誌

Yamamoto, T; Takeuchi, K; Nagata, Y; Mizuno, A; Harada, H; Ishikawa, T; Maeda, S; Ohka, F; Yanase, R; Shiba, K; Ueno, H; Inaba, K; Saito, R

CYTOSKELETON     2025年7月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cytoskeleton  

Primary ciliary dyskinesia (PCD) is a congenital disease caused by gene mutations linked to ciliary dysfunction. PCD causes different symptoms, including chronic sinusitis, infertility, situs inversus and hydrocephalus. Motile cilia on ventricular ependymal cells are a crucial factor in cerebrospinal fluid circulation, and dysfunction of these cells causes hydrocephalus. Deleted in primary ciliary dyskinesia (Dpcd) is one genetic abnormality known to cause PCD, and its knockout leads to hydrocephalus in mice. PCD occurs in Dpcd^−/− mice because of the lack of an inner dynein arm (IDA) in the motile cilia. However, how this deficiency is associated with the motility of ventricular ependymal motile cilia in Dpcd^−/− mice has not been demonstrated. Herein, we show that Dpcd induces partial defects in dyneins and aberrant motility in ventricular ependymal cilia. In Dpcd^−/− mice, the ependymal cilia demonstrated decreased amplitude, abnormal waveforms and low cerebrospinal fluid flow velocity. In addition, the amount of dynein axonemal heavy chains in some IDAs decreased in the ependymal cilia. In wild-type mice, Dpcd was localised in the cytoplasm and cilia of ependymal cells. Thus, abnormal ciliary movement in Dpcd^−/− mice is likely attributed to a defect in IDA assembly in the ependymal cilia.

DOI： 10.1002/cm.70012

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Distant parenchymal recurrence during long-term use of TTFields treatment for glioblastoma 査読有り Open Access

Takido, Y; Ohka, F; Deguchi, S; Motomura, K; Mitsuya, K; Aoki, K; Shiba, Y; Takeuchi, K; Nagata, Y; Yamaguchi, J; Kibe, Y; Fuse, Y; Maeda, S; Shimizu, H; Saito, R

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY   30 巻 ( 7 ) 頁： 1309 - 1318   2025年7月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Clinical Oncology  

Background: Tumor treating fields (TTFields) treatment has been an important option for the treatment of glioblastoma. The introduction of novel treatment options may lead to distinct recurrence patterns compared to those observed with conventional therapies; however, the specific recurrence pattern during TTFields treatment has not been elucidated. Methods and results: Here, we analyzed 39 cases of glioblastoma treated with TTFields. Although a usage rate of more than 75% is recommended, among 39 cases, 18 discontinued TTFields treatment owing to requests by patients with lower usage rates. In these discontinued cases, patients exhibiting sensory aphasia were more frequently included compared to those who continued TTFields (44.4%, p < 0.001). Among 21 cases involving patients who continued TTFields, tumor recurrence was observed in 15 of those cases. Five out of 15 cases (33.3%) exhibited recurrence in distant parenchyma from the primary lesion. A higher usage rate and relatively longer use of TTFields were observed in these five cases, along with more favorable progression-free survival than those in the other 10 cases (p = 0.019, p = 0.040, and p = 0.024, respectively). In one case, recurrent tumors with lower grade glioma histology but molecular markers characteristic for glioblastoma, IDH-wildtype were indentified. This tumor arose in an area that received a lower local minimum power density of TTFields compared to the primary lesion, following long-term TTFields therapy. Conclusions: Long-term use of TTFields might be correlated with a high frequency of distant parenchymal recurrence in cases with favorable response.

DOI： 10.1007/s10147-025-02775-5

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新規治療標的の同定に有用な頭蓋咽頭腫オルガノイドモデルの樹立

大岡 史治, 山本 諒, 前田 紗知, 竹内 和人, 永田 雄一, 青木 恒介, 出口 彰一, 芝 良樹, 滝戸 悠平, 齋藤 竜太

小児の脳神経   50 巻 ( 2 ) 頁： 138 - 138   2025年6月

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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  

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良性脳腫瘍オルガノイドモデルの樹立

前田 紗知, 大岡 史治, 加留部 謙之輔, 山本 諒, 竹内 和人, 永田 雄一, 青木 恒介, 出口 彰一, 芝 良樹, 齋藤 竜太

Brain Tumor Pathology   42 巻 ( Suppl. ) 頁： 135 - 135   2025年5月

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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：日本脳腫瘍病理学会  

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Benchmark for Setting ACTH Cell Dosage in Clinical Regenerative Medicine for Post-Operative Hypopituitarism 査読有り 国際誌 Open Access

Kondo, T; Suga, H; Takeuchi, K; Fuse, Y; Sato, Y; Hirose, T; Hideyuki, H; Nagata, Y; Saito, R

DISEASES   13 巻 ( 4 )   2025年4月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Diseases  

Background/Objectives: Our objective is to develop hormone-producing pituitary cells that can function in the same manner as the human body and provide more effective treatments than current hormone replacement therapy. We have already established a technique for generating hypothalamic–pituitary organoids using feeder-free human pluripotent stem cells (hPSCs) and demonstrated their effectiveness in vivo through transplantation into hypopituitary mouse models. To prospectively determine the upper limit of transplanting adenohypophyseal cells into humans, we investigated the human maximum secretion capacity of adrenocorticotropic hormone (ACTH) and growth hormone (GH). Methods: We analyzed data from 28 patients with pituitary adenomas, among whom 16 evinced no abnormality of ACTH secretion and 12 showed no GH secretion on corticotropin-releasing hormone (CRH) and growth hormone-releasing hormone-2 (GHRP-2) stimulation testing. Results: The average ACTH peak value after CRH stimulation tests was 97.2 pg/mL, and the average GH peak value after GHRP-2 stimulation tests was 25.1 ng/mL. Conclusions: These data will likely serve as benchmarks of ACTH and GH secretion when transplanting cultured cells into humans.

DOI： 10.3390/diseases13040112

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Imaging features and consideration of progression pattern of diffuse hemispheric gliomas, H3 G34-mutant 国際誌 Open Access

Kibe, Y; Chalise, L; Ohka, F; Motomura, K; Nakahara, N; Aoki, K; Deguchi, S; Shiba, Y; Takeuchi, K; Iwami, K; Yamaguchi, J; Shimizu, H; Maeda, S; Takido, Y; Yamamoto, R; Okuno, Y; Sakai, A; Karube, K; Saito, R

ACTA NEUROPATHOLOGICA COMMUNICATIONS   13 巻 ( 1 ) 頁： 43 - 43   2025年2月

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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 hemispheric glioma H3 G34-mutant (DHG) has been identified as a distinct pediatric-type high-grade glioma, according to the World Health Organization (WHO) classification of central nervous system tumors. Widely accepted treatment options include surgery, radiation, and conventional chemotherapy. However, the efficacy of the surgical resection remains unclear. Although there are some reports, a comprehensive understanding of the clinical characteristics, pathogenesis, and outcomes of DHG is insufficient to evaluate the efficacy of maximal tumor resection. We retrospectively analyzed nine cases of DHG, focusing on imaging features and progression patterns. Initial Magnetic Resonance Imaging (MRI) revealed T2/FLAIR high lesions with minimal or no contrast enhancement in all cases. The lesions exhibited T2/FLAIR hyperintensities and focal diffusion restriction in the deep white matter, with most showing high methionine accumulation, suggesting deep white matter infiltration at the time of diagnosis. The extent of white matter infiltration in tumor resection cases was significantly negatively correlated with the extent of resection (EOR). In addition, cases with EOR of 90% or more had significantly longer progression-free survival (PFS) and overall survival (OS). However, achieving an EOR of 90% or more was possible in fewer than half of the cases, primarily in those with relatively limited white matter involvement. Histopathological findings of the tumor obtained by initial resection and autopsy revealed extensive deep white matter infiltration, with one patient demonstrating tumor invasion into the brainstem at death. Our study highlights early deep white matter infiltration of DHGs, complicating surgical resection, and potentially contributing to a poor prognosis. While EOR may influence survival to some extent, residual lesions extensively infiltrate the white matter and eventually invade the brainstem and contralateral brain, thereby contributing to mortality. These findings underscore the challenges of managing DHGs and emphasize the need for further research on effective therapeutic strategies, particularly to understand and target their unique progression patterns.

DOI： 10.1186/s40478-025-01945-w

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Endoscope-assisted brain tumor removal overcomes the restriction of using intraoperative open magnetic resonance imaging in the suboccipital approach Open Access

Sasaki, K; Ohka, F; Motomura, K; Nagata, Y; Takeuchi, K; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE   87 巻 ( 1 ) 頁： 168 - 172   2025年2月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Intraoperative magnetic resonance imaging (iMRI) plays a crucial role in improving the precision of brain tumor surgeries. However, the use of iMRI can impose certain limitations on intraoperative head positioning. In regular microscopic surgery, head positioning is of utmost importance because an appropriate surgical field is important for the efficacy and safety of surgery. Therefore, in cases where adequate head positioning is difficult, usually, iMRI will not be utilized. Herein, we report an adult case of cerebellar astrocytoma whose tumor extended to the culmen of the cerebellum. Upon surgery via the suboccipital approach, the positional limitations imposed by iMRI led to an insufficient vertex-down position and limited surgical field, which hampered the removal of the upper portion of the tumor. However, this concern could be overcome when used in combination with an endoscope. The potential of iMRI applications is anticipated to be enhanced by overcoming positional limitations through combined endoscopic surgery. The use of multimodality in surgery is an optimal example of how surgical support equipment can also improve surgical outcomes. Here, we report on the new possibilities offered by multimodality.

DOI： 10.18999/nagjms.87.1.168

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Endoscopic Cystoventricular Stenting in Awake Patients with Electrical Stimulation Mapping for Convexity Cysts: Three Case Reports and a Systematic Review 査読有り 国際誌 Open Access

Okumura, E; Takeuchi, K; Nagata, Y; Iwami, K; Motomura, K; Ohka, F; Sato, Y; Hirose, T; Saito, R

WORLD NEUROSURGERY   193 巻   頁： 108 - 118   2025年1月

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担当区分：責任著者   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  

Surgical interventions for arachnoid cysts and glioependymal cysts primarily focus on cyst decompression and establishing communication with cerebrospinal fluid spaces. However, a standardized surgical strategy for symptomatic convexity cysts lacking surrounding cerebrospinal fluid space is still lacking due to the limited number of cases. This systematic review aims to evaluate surgical interventions for symptomatic convexity cysts and proposes a safe and effective treatment approach we have developed. A systematic review of the literature was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Surgical techniques were categorized into cystoperitoneal shunt, cyst excision, cyst fenestration, cyst ventriculostomy, and several uniquely modified methods. Using a method different from these previous reports, we performed endoscopic cystoventricular stenting via burr hole in 3 cases of convexity cysts. While traditional methods have proven effective, cystoperitoneal shunt may lead to malfunction, infection, and subdural hematoma; wall excision is invasive and increases morbidity risks. Fenestration and cystoventriculostomy have also reported cases of recurrence. Other methods also pose issues, including off-label use of instruments and inadequate consideration for removal. The method we performed for placing the stent catheter with multiple side holes demonstrated long-term effectiveness. Furthermore, the surgery was conducted with the patient fully awake, and the use of electrical stimulation mapping enabled preservation of higher neurocognitive functions, including language, working memory, and spatial cognition, at the puncture site. This novel approach offers advantages such as minimally invasive procedure, preservation of safe brain function, and long-term patency. Further studies are warranted to validate these findings and improve surgical strategies for convexity cysts.

DOI： 10.1016/j.wneu.2024.10.031

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脳幹部海綿状血管奇形に対する内視鏡手術 Open Access

竹内 和人, 永田 雄一, 伊藤 英治, 奥村 衣里子, 原田 英幸, 齋藤 竜太

脳卒中の外科   53 巻 ( 2 ) 頁： 108 - 113   2025年

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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：一般社団法人 日本脳卒中の外科学会  

<p>脳幹部海綿状血管奇形（BCM）治療における内視鏡利用の報告は，少数の症例報告に留まっている．内視鏡は，深部でも広く明るい視野が得られることから，深部病変であるBCMに対しても有効と考え，積極的に利用してきた．</p><p>内視鏡治療を応用したBCM症例 32例（中脳 7例，橋 22例，延髄 3例）を後方視的に検討した．脳幹内部への進入ルートは，2 point methodを基本として主に近傍のsafe entry zoneを利用した．5例で経鼻術，27例で開頭術による摘出が行われた．そのうち25例で，手術corridorの確保目的に細径シリンダーが用いられた．30例（93.8％）でGTRが得られた．術後合併症は5例で認められた．術前平均KPS 62.2に対し，手術3カ月後は84.4であり，改善 26例，不変 5例，悪化 1例であった．また，1例で手術半年後に遅発性パーキンソン症候群を合併し，KPSの低下が認められた．</p><p>一般的に，BCMに対する外科治療は，顕微鏡下に行われている．本研究における内視鏡下手術の治療成績は，既報と比較して良好な神経予後を示している．内視鏡を用いることで，手術経路の最小化と水中下手術が可能となり，これにより従来にないアプローチ方法を確立することができた．内視鏡の特徴的な手術法である水中での内部観察は，残存病変や止血の確認に非常に有効であった．内視鏡の利用には欠点も存在するため，さまざまな機器の開発，機器操作法の改良を行っている．内視鏡利用は，いまだ発展途上ではあるが，BCMに対する有用性・安全性が支持された．</p>

DOI： 10.2335/scs.53.108

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Myxoid Glioneuronal Tumours with PDGFRA p.K385 Mutations Causing Hydrocephalus and Successfully Treated with Neuroendoscopic Surgery: A Case Report and Literature Review. Open Access

Wakisaka S, Nagata Y, Fukuoka T, Ohka F, Satake Y, Takeuchi K, Saito R

NMC case report journal   12 巻 ( 0 ) 頁： 361 - 367   2025年

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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  

DOI： 10.2176/jns-nmc.2025-0028

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Registry-Based Assessment of Shunt Operation Methods and Outcomes in Idiopathic Normal Pressure Hydrocephalus (RASHOMON Study): Protocol for a Multicenter Prospective Observational Cohort Study 査読有り 国際誌 Open Access

Okumura, E; Takeuchi, K; Momota, H; Nagatani, T; Taoka, T; Aimi, Y; Hashizume, A; Okazaki, M; Saito, R

JMIR RESEARCH PROTOCOLS   14 巻   頁： e80678   2025年

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2196/80678

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Isolation of ependymal cilia from mouse brain( vol 409, 110198, 2024) 国際誌 Open Access

Mizuno, A; Takeuchi, K; Nagata, Y; Harada, H; Yamamoto, T; Ishikawa, T; Maeda, S; Ohka, F; Ueno, H; Saito, R

JOURNAL OF NEUROSCIENCE METHODS   412 巻   頁： 110293 - 110293   2024年12月

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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 Neuroscience Methods  

The authors regret that the affiliation information was incomplete in the original article. The correct and complete affiliation information should be as follows: Akihiro Mizuno^{a,b a} Department of Neurosurgery, Komaki City Hospital, Aichi, Japan ^b Department of Neurosurgery, Nagoya University, Nagoya, Japan This research was conducted while the author was affiliated with Nagoya University. The addition of this affiliation is important for accurately reflecting the research context. The authors would like to apologize for any inconvenience caused.

DOI： 10.1016/j.jneumeth.2024.110293

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DISTANT PARENCHYMAL RECURRENCE DURING LONG-TERM USE OF TTFIELDS TREATMENT FOR GLIOBLASTOMA Open Access

Takido, Y; Ohka, F; Deguchi, S; Motomura, K; Mitsuya, K; Shiba, Y; Takeuchi, K; Nagata, Y; Yamaguchi, J; Kibe, Y; Fuse, Y; Maeda, S; Shimizu, H; Nohira, S; Yamamoto, R; Ito, S; Nakamura, A; Saito, R

NEURO-ONCOLOGY   26 巻   2024年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/neuonc/noae165.0672

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ESTABLISHMENT OF PITUITARY NEUROENDOCRINE TUMOR (PITNET) ORGANOID MODELS Open Access

Maeda, S; Ohka, F; Kanamori, F; Okumura, Y; Takeuchi, K; Nagata, Y; Yamaguchi, J; Harada, H; Shimizu, H; Takido, Y; Saito, R

NEURO-ONCOLOGY   26 巻   2024年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/neuonc/noae165.1270

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INTRA-OPERATIVE GENETIC ANALYSES FOR DECISION-MAKING DURING TUMOR REMOVAL OF ADULT-TYPE DIFFUSE GLIOMA USING RAPID QUANTITATIVE PCR DEVICE Open Access

Ohka, F; Maeda, S; Shimizu, H; Motomura, K; Takeuchi, K; Nagata, Y; Deguchi, S; Shiba, Y; Yamaguchi, J; Takido, Y; Nakamura, A; Ito, S; Saito, R

NEURO-ONCOLOGY   26 巻   2024年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/neuonc/noae165.0748

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Exo- and endoscopic two-step approach for meningeal tumours invading the lateral wall of large dural venous sinuses: how I do it 国際誌 Open Access

Iwami, K; Watanabe, T; Takeuchi, K; Saito, R

ACTA NEUROCHIRURGICA   166 巻 ( 1 ) 頁： 397 - 397   2024年10月

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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 Neurochirurgica  

Background: Treating meningeal tumours invading the large dural venous sinuses is a subject of debate regarding the approach for removing the intra-sinus components. Additionally, directly observing the invasion site of tumours invading the lateral wall of the sinus is difficult. Method: We describe our exo- and endoscopic two-step approach (EETA): an exoscope is used to remove the extra-sinus component, while an endoscope is used to observe the invaded lateral wall and remove the intra-sinus component. Conclusion: EETA can be a viable option for treating meningeal tumours invading the venous sinus owing to its high resection rate and low invasiveness.

DOI： 10.1007/s00701-024-06298-2

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Cylinder tumor surgery in pediatric low-grade gliomas 査読有り 国際誌

Jaimovich, SG; Takeuchi, K; Testa, VT; Okumura, E; Jaimovich, R; Cinalli, G

CHILDS NERVOUS SYSTEM   40 巻 ( 10 ) 頁： 3051 - 3063   2024年10月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Child S Nervous System  

Background: Periventricular pediatric low-grade gliomas (pLGG) present a surgical challenge due to their deep-seated location, accessibility, and relationship with the subcortical network connections. Minimally invasive parafascicular approaches with tubular brain retractors (port brain surgery) have emerged, in recent years, as an alternative to conventional microsurgical and endoscopic approaches for removal of periventricular tumors. Objectives: To describe the minimally invasive approach with tubular brain retractors for periventricular pLGG, its technique, applications, safety, and efficacy. Methods: In this article, we describe the port brain surgery techniques for periventricular pLGG as performed in different centers, with different commercialized tubular retractor systems. Illustrative cases followed by a literature review are analyzed, with a detailed description of different approaches or techniques, comparing their advantages and disadvantages with contemporary microsurgical and endoscopic approaches. Conclusions: The port brain surgery with micro-exoscopic vision and endoscopic assistance, for the treatment of deep-seated lesions such as periventricular pLGG, is an alternative for achieving a functionally safe—gross total or subtotal—tumor resection, obtaining adequate tissue for pathological examination. This technique could offer a new dimension for a less-invasive, safe, and effective access to deep-seated tumors, offering the possibility to lower morbidity in experienced hands.

DOI： 10.1007/s00381-024-06417-5

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脳腫瘍の術中迅速遺伝子解析法の樹立

大岡 史治, 前田 紗知, 山口 純矢, 清水 大輝, 本村 和也, 出口 彰一, 芝 良樹, 竹内 和人, 永田 雄一, 滝戸 悠平, 齋藤 竜太

日本癌治療学会学術集会抄録集   62回 巻   頁： O88 - 2   2024年10月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本癌治療学会  

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Isolation of ependymal cilia from mouse brain 査読有り 国際誌 Open Access

Mizuno, A; Takeuchi, K; Nagata, Y; Harada, H; Yamamoto, T; Ishikawa, T; Maeda, S; Ohka, F; Ueno, H; Saito, R

JOURNAL OF NEUROSCIENCE METHODS   409 巻   頁： 110198 - 110198   2024年9月

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担当区分：責任著者   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 Neuroscience Methods  

Background: Ependymal cilia play a major role in the circulation of cerebrospinal fluid. Although isolation of cilia is an essential technique for investigating ciliary structure, to the best of our knowledge, no report on the isolation and structural analysis of ependymal cilia from mouse brain is available. New method: We developed a novel method for isolating ependymal cilia from mouse brain ventricles. We isolated ependymal cilia by partially opening the lateral ventricles and gently applying shear stress, followed by pipetting and ultracentrifugation. Results: Using this new method, we were able to observe cilia separately. The results demonstrated that our method successfully isolated intact ependymal cilia with preserved morphology and ultrastructure. In this procedure, the ventricular ependymal cell layer was partially detached. Comparison with existing methods: Compared to existing methods for isolating cilia from other tissues, our method is meticulously tailored for extracting ependymal cilia from the mouse brain. Designed with a keen understanding of the fragility of the ventricular ependyma, our method prioritizes minimizing tissue damage during the isolation procedure. Conclusions: We isolated ependymal cilia from mouse brain by applying shear stress selectively to the ventricles. Our method can be used to conduct more detailed studies on the structure of ependymal cilia.

DOI： 10.1016/j.jneumeth.2024.110198

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神経内視鏡画像における機能性下垂体腫瘍を含めた手術支援AIシステムの構築

布施 佑太郎, 竹内 和人, 橋本 典明, 永田 雄一, 永谷 哲也, 竹内 一郎, 齋藤 竜太

日本内分泌学会雑誌   100 巻 ( S.HPT ) 頁： 19 - 21   2024年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.100.s.hpt_19

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The Potential Role of Preoperative Posterior Cerebral Artery Involvement in Predicting Postoperative Transient Neurological Deficits and Ischemic Stroke After Indirect Revascularization in Patients With Moyamoya Disease 査読有り 国際誌

Araki, Y; Yokoyama, K; Uda, K; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Goto, S; Tsukada, T; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Tanei, T; Nagashima, Y; Muraoka, S; Izumi, T; Seki, Y; Saito, R

WORLD NEUROSURGERY   187 巻   頁： E610 - E619   2024年7月

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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: Transient neurological deficits (TNDs) are known to develop after direct bypass for Moyamoya disease and may be risk factors for subsequent stroke. However, the factors involved in the development of TNDs and stroke after indirect revascularization alone, including their association with subsequent stroke, remain unclear. The purpose of this study was to investigate this issue. Methods: The subjects of the study were 30 patients with Moyamoya disease who underwent a total of 40 indirect revascularization procedures at our institution. Clinical and radiological data were collected retrospectively. To examine factors associated with the development of postoperative TND/stroke/asymptomatic disease, the clinical characteristics of each group were statistically compared. Results: The mean age at surgery was 7 years (range 1–63). TNDs developed after surgery in 9 out of 40 patients (22.5%). Stroke in the acute postoperative period occurred in 3 patients (7.5%), all of whom experienced cerebral infarctions. Demographic data and preoperative clinical information were not different between the groups. However, posterior cerebral artery involvement on preoperative imaging was significantly associated with the development of TNDs and stroke (P = 0.006). Furthermore, postoperative stroke was associated with unfavorable outcomes (P = 0.025). Conclusions: Posterior cerebral artery involvement is significantly associated with the occurrence of TNDs. In contrast, TNDs after indirect revascularization have little relationship with the subsequent development of stroke. TNDs usually resolve without new strokes, and a better understanding of this particular pathology could help establish an optimal treatment regimen.

DOI： 10.1016/j.wneu.2024.04.135

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Case report: Endoscopic endonasal transposterior clinoid approach for resection of posterior clinoid process meningioma: technical notes and literature review 査読有り 国際誌 Open Access

Awyono, S; Takeuchi, K; Ito, E; Nagata, Y; Golden, N; Mahadewa, TGB; Saito, R

FRONTIERS IN ONCOLOGY   14 巻   頁： 1368277 - 1368277   2024年6月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers in Oncology  

Background: Posterior clinoid process (PCP) meningioma is an exceedingly rare entity. It remains the most challenging skull base lesion for neurosurgeons due to its treacherous location that insinuates amongst critical neurovascular structures. This article will describe the technical notes using the endoscopic endonasal approach that provide the earliest devascularization and detachment of the tumor PCP meningioma. Methods: We are introducing the surgical implementation of an endoscopic endonasal approach to removing PCP meningioma. Furthermore, we perform a literature review of posterior clinoid process meningioma that undergoes surgical intervention, then summarize the benefits and limitations of each approach. Results: We present a case of right PCP meningioma that was removed using an endoscopic endonasal approach through the transposterior clinoid corridor in a 52-year-old-woman. We describe the technical notes in performing this approach to have the earliest devascularization and detachment of the tumor by performing posterior clinoidectomy. Safe tumor removal is performed with a wide and clear view of the surrounding neurovascular structure. Based on our database search, we found nine articles reported on the surgical management of PCP meningiomas, with a total number of 15 cases. All of the reported cases performed the tumor removal using the transcranial approach. Conclusion: The endoscopic endonasal transposterior clinoid approach circumvents all disadvantages faced by the traditional transcranial approach, providing the earliest approach to devascularized and detaching the tumor from its attachment at PCP. This approach demonstrates safety and efficacy, making it an acceptable alternative for PCP meningioma resections.

DOI： 10.3389/fonc.2024.1368277

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症例 機能性ゴナドトロピン産生下垂体腫瘍が原因で生じた卵巣囊胞に対しくり返し卵巣腫瘍摘出術が行われた1例

太田 肇, 三宅 菜月, 太田 幸希, 村岡 彩子, 竹内 和人, 大須賀 智子

産科と婦人科   91 巻 ( 5 ) 頁： 593 - 597   2024年5月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：診断と治療社  

DOI： 10.34433/og.0000000711

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機能性ゴナドトロピン産生下垂体腫瘍が原因で生じた卵巣嚢胞に対しくり返し卵巣腫瘍摘出術が行われた1例

太田 肇, 三宅 菜月, 太田 幸希, 村岡 彩子, 竹内 和人, 大須賀 智子

産科と婦人科   91 巻 ( 5 ) 頁： 593 - 597   2024年5月

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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：(株)診断と治療社  

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Obstructive Hydrocephalus Due to Aggressive Posterior Fossa Tumor Exhibiting Histological Characteristics of Pilocytic Astrocytoma in Two Adult Neurofibromatosis Type 1 (NF1) Cases 査読有り 国際誌 Open Access

Nawa, S; Ohka, F; Motomura, K; Takeuchi, K; Nagata, Y; Yamaguchi, J; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE   16 巻 ( 4 ) 頁： e58697   2024年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7759/cureus.58697

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Pediatric-type high-grade gliomas with <i>PDGFRA</i> amplification in adult patients with Li-Fraumeni syndrome: clinical and molecular characterization of three cases 査読有り 国際誌 Open Access

Kibe, Y; Ohka, F; Aoki, K; Yamaguchi, J; Motomura, K; Ito, E; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Shiba, Y; Maeda, S; Nishikawa, T; Shimizu, H; Saito, R

ACTA NEUROPATHOLOGICA COMMUNICATIONS   12 巻 ( 1 ) 頁： 57 - 57   2024年4月

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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  

Li-Fraumeni syndrome (LFS) is an autosomal dominant tumor predisposition syndrome caused by heterozygous germline mutations or deletions in the TP53 tumor suppressor gene. Central nervous system tumors, such as choroid plexus tumors, medulloblastomas, and diffuse gliomas, are frequently found in patients with LFS. Although molecular profiles of diffuse gliomas that develop in pediatric patients with LFS have been elucidated, those in adults are limited. Recently, diffuse gliomas have been divided into pediatric- and adult-type gliomas, based on their distinct molecular profiles. In the present study, we investigated the molecular profiles of high-grade gliomas in three adults with LFS. These tumors revealed characteristic histopathological findings of high-grade glioma or glioblastoma and harbored wild-type IDH1/2 according to whole exome sequencing (WES). However, these tumors did not exhibit the key molecular alterations of glioblastoma, IDH-wildtype such as TERT promoter mutation, EGFR amplification, or chromosome 7 gain and 10 loss. Although WES revealed no other characteristic gene mutations or copy number alterations in high-grade gliomas, such as those in histone H3 genes, PDGFRA amplification was found in all three cases together with uniparental disomy of chromosome 17p, where the TP53 gene is located. DNA methylation analyses revealed that all tumors exhibited DNA methylation profiles similar to those of pediatric-type high-grade glioma H3-wildtype and IDH-wildtype (pHGG H3-/IDH-wt), RTK1 subtype. These data suggest that high-grade gliomas developed in adult patients with LFS may be involved in pHGG H3-/IDH-wt. PDGFRA and homozygous alterations in TP53 may play pivotal roles in the development of this type of glioma in adult patients with LFS.

DOI： 10.1186/s40478-024-01762-7

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Safety and efficacy of the endoscopic transsphenoidal transclival approach performed using direct cortical stimulation for pontine cavernous malformations 査読有り 国際誌

Takeuchi, K; Nagata, Y; Sasagawa, Y; Ito, E; Yamamoto, T; Mizuno, A; Sasaki, H; Kondo, T; Araki, Y; Nakada, M; Saito, R

JOURNAL OF NEUROSURGERY   140 巻 ( 2 ) 頁： 469 - 477   2024年2月

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担当区分：筆頭著者,　責任著者   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 Surgical treatment of brainstem cavernous malformations (CMs) is challenging. Surgery using the endoscopic transsphenoidal transclival approach (eTSTCA) is reported as a useful alternative for ventral brainstem CMs. However, CMs located in the ventral midline of the brainstem are rare, and only a small number of case reports on these CMs treated with the eTSTCA exist. The efficacy and safety of the eTSTCA have not yet been fully examined. METHODS A retrospective analysis was performed for 5 consecutive patients who underwent surgery via the eTSTCA for treating ventral pontine CMs. RESULTS The average maximum CM diameter was 26.0 mm (18–38 mm). All patients underwent MR–diffusion tensor imaging, which confirmed that the corticospinal tract (CST) deviated posteriorly or laterally to the CM. Direct brainstem cortical stimulation was performed to localize the CST before making the cortical incision. After the excision of the CM, the cavity was filled with artificial CSF to make an aqueous surgical field (wet-field technique) for observing the tumor cavity and confirming complete hemostasis and resection. Total removal was achieved in all patients. The preoperative modified Rankin Scale score was 3 in 3 patients and 4 in 2 patients, whereas it was 1 in 2 patients and 0 in 3 patients 3 months after surgery. Postoperative CSF leakage was observed in 1 patient, and transient abducens nerve palsy was observed in 1 patient. No other intra- or postoperative complications were observed. CONCLUSIONS MR–diffusion tensor imaging and direct brainstem cortical stimulation were useful to ascertain the proximity of the CST to the CM. The endoscope provides a clear view even underwater, and it was safe and effective to observe the entire CM cavity and confirm complete hemostasis without additional retraction of the brainstem parenchyma, including the CST. The eTSTCA provides a direct access point to the lesion and may be a safer alternative treatment for patients whose CST deviates laterally or posteriorly to the CM.

DOI： 10.3171/2023.6.JNS23324

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Extended Endoscopic Endonasal Transplanum and Transdorsum Sellar Approach for the Resection of Retroinfundibular Craniopharyngioma With Two-Piece Dural Opening: A Technical Case Report 査読有り 国際誌 Open Access

Matmusayev, M; Kariev, GM; Asadullaev, U; Takeuchi, K; Nagata, Y; Harada, H; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE   16 巻 ( 1 ) 頁： e51850   2024年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7759/cureus.51850

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A Case of Papillary Craniopharyngioma Mimicking Rathke's Cleft Cyst. 査読有り Open Access

Harada H, Takeuchi K, Nagata Y, Inoshita N, Ito E, Okumura E, Kondo T, Sato Y, Saito R

NMC case report journal   11 巻 ( 0 ) 頁： 191 - 194   2024年

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担当区分：責任著者   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  

DOI： 10.2176/jns-nmc.2024-0057

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Endoscopic Cylinder Surgery for Ventricular Lesions.

Takeuchi K

Advances and technical standards in neurosurgery   52 巻   頁： 91 - 104   2024年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Advances and Technical Standards in Neurosurgery  

Cylinder retractors have been developed to reduce the risk of brain retraction injury during surgery by dispersing retraction pressure on the brain. In recent years, various types of cylinder retractors have been developed and widely used in neurosurgery. The ventricles, being deep structures within the brain, present an effective area for cylinder retractor utilization. Endoscopy provides a bright, wide field of view in the deep surgical field, even through narrow corridors.This chapter introduces surgical techniques using an endoscope through a cylinder. Given the deep and complex shapes of the ventricles, preoperative planning is paramount. Two main surgical techniques are employed in endoscopic cylinder surgery. The wet-field technique involves the continuous irrigation of artificial cerebrospinal fluid (CSF) during the procedure, maintaining ventricle shape with natural water pressure, facilitating tumor border identification, and achieving spontaneous hemostasis. Conversely, the dry-field technique involves CSF drainage, providing a clear visual field even during hemorrhage encounters. In intraventricular surgery, both techniques are used and switched as needed.Specific approaches for lateral, third, and fourth ventricular tumors are discussed, considering their locations and surrounding anatomical structures. Detailed intraoperative findings and strategies for tumor removal and hemostasis are presented.Endoscopic cylinder surgery offers a versatile and minimally invasive option for intraventricular tumors, leading to improved surgical outcomes. Overall, this technique enhances surgical precision and patient outcomes in intraventricular tumor cases.

DOI： 10.1007/978-3-031-61925-0_7

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Endoscopic debulking canalization for optic pathway glioma with obstructive hydrocephalus 招待有り 査読有り 国際誌

Takeuchi, K; Ohka, F; Nagata, Y; Ito, E; Harada, H; Saito, R

CHILDS NERVOUS SYSTEM   39 巻 ( 12 ) 頁： 3421 - 3425   2023年12月

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Child S Nervous System  

Optic pathway gliomas (OPGs) are benign tumors that can stop growing or even shrink. In recent years, surgical resection has not been considered the first-line treatment because of its high risk of complications. Chemotherapy is the mainstay of treatment for growing OPGs. Surgical treatment for OPGs with obstructive hydrocephalus is required. Ventriculoperitoneal shunting is effective for all types of hydrocephalus. However, long-term management is required, especially in pediatric cases, and there is a risk of shunt-related complications over a long lifespan. Debulking surgery for OPGs allows us to avoid shunt placement by creating a waterway and releasing the hydrocephalus. To reduce the surgical risk and invasiveness, we used an endoscopic canalization technique with a small-diameter cylinder. In this article, we present a case of endoscopic canalization of an obstructive hydrocephalus caused by OPGs in a 14-year-old female to illustrate our surgical technique. (Trial registration Registry name and number: Efficacy and safety of the neuro-endoscopic treatment for brain tumors (2019–0254)).

DOI： 10.1007/s00381-023-06053-5

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Deep learning based identification of pituitary adenoma on surgical endoscopic images: a pilot study 査読有り

Fuse, Y; Takeuchi, K; Hashimoto, N; Nagata, Y; Takagi, Y; Nagatani, T; Takeuchi, I; Saito, R

NEUROSURGICAL REVIEW   46 巻 ( 1 ) 頁： 291   2023年11月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgical Review  

Accurate tumor identification during surgical excision is necessary for neurosurgeons to determine the extent of resection without damaging the surrounding tissues. No conventional technologies have achieved reliable performance for pituitary adenomas. This study proposes a deep learning approach using intraoperative endoscopic images to discriminate pituitary adenomas from non-tumorous tissue inside the sella turcica. Static images were extracted from 50 intraoperative videos of patients with pituitary adenomas. All patients underwent endoscopic transsphenoidal surgery with a 4 K ultrahigh-definition endoscope. The tumor and non-tumorous tissue within the sella turcica were delineated on static images. Using intraoperative images, we developed and validated deep learning models to identify tumorous tissue. Model performance was evaluated using a fivefold per-patient methodology. As a proof-of-concept, the model’s predictions were pathologically cross-referenced with a medical professional’s diagnosis using the intraoperative images of a prospectively enrolled patient. In total, 605 static images were obtained. Among the cropped 117,223 patches, 58,088 were labeled as tumors, while the remaining 59,135 were labeled as non-tumorous tissues. The evaluation of the image dataset revealed that the wide-ResNet model had the highest accuracy of 0.768, with an F1 score of 0.766. A preliminary evaluation on one patient indicated alignment between the ground truth set by neurosurgeons, the model’s predictions, and histopathological findings. Our deep learning algorithm has a positive tumor discrimination performance in intraoperative 4-K endoscopic images in patients with pituitary adenomas.

DOI： 10.1007/s10143-023-02196-w

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その他リンク： https://link.springer.com/article/10.1007/s10143-023-02196-w/fulltext.html

ESTABLISHMENT OF ORGANOID MODELS OF PATIENT-DERIVED GH-PRODUCING PITUITARY ADENOMA

Maeda, S; Ohka, F; Kanamori, F; Okumura, Y; Takeuchi, K; Nagata, Y; Motomura, K; Yamaguchi, J; Kibe, Y; Harada, H; Shimizu, H; Takido, Y; Saito, R

NEURO-ONCOLOGY   25 巻   2023年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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INTRA-OPERATIVE ANALYSES OF GENETIC ALTERATIONS IN THE CENTRAL NERVOUS SYSTEM TUMORS USING RAPID QUANTITATIVE PCR DEVICE

Ohka, F; Maeda, S; Yamaguchi, J; Shimizu, H; Motomura, K; Takeuchi, K; Nagata, Y; Nishikawa, T; Kibe, Y; Takido, Y; Saito, R

NEURO-ONCOLOGY   25 巻   2023年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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Glossopharyngeal neurinoma of incidental finding in a 65-year-old female patient: case report 査読有り Open Access

Kabulo, KDM; Takeuchi, K; Yamada, Y; Sharafundeen, A; Kalangu, KKN; Kato, Y

EGYPTIAN JOURNAL OF NEUROSURGERY   38 巻 ( 1 )   2023年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s41984-023-00226-9

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再生医療実現に向けたヒト多能性幹細胞由来下垂体細胞の皮下移植

佐々木 博勇, 須賀 英隆, 竹内 和人, 永田 雄一, 原田 英幸, 近藤 辰磨, 伊藤 英治, 有馬 寛, 齋藤 竜太

日本内分泌学会雑誌   99 巻 ( S.HPT ) 頁： 4 - 6   2023年8月

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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：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.99.s.hpt_4

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[Prevention of Cerebrospinal Fluid Leakage and Endocrinological Management after Transsphenoidal Surgery].

Takeuchi K

No shinkei geka. Neurological surgery   51 巻 ( 4 ) 頁： 697 - 705   2023年7月

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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：株式会社医学書院  

DOI： 10.11477/mf.1436204803

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Rapid detection of the <i>MYD88</i> L265P mutation for pre- and intra-operative diagnosis of primary central nervous system lymphoma 国際誌 Open Access

Yamaguchi, J; Ohka, F; Kitano, Y; Maeda, S; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Hattori, H; Tsujiuchi, T; Motomura, A; Nishikawa, T; Kibe, Y; Shinjo, K; Kondo, Y; Saito, R

CANCER SCIENCE   114 巻 ( 6 ) 頁： 2544 - 2551   2023年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer Science  

The myeloid differentiation primary response gene 88 (MYD88) L265P mutation is a disease-specific mutation of primary central nervous system lymphoma (PCNSL) among the central nervous system tumors. Accordingly, this mutation is considered a reliable diagnostic molecular marker of PCNSL. As the intra-operative diagnosis of PCNSL is sometimes difficult to achieve using histological examinations alone, intra-operative detection of the MYD88 L265P mutation could be effective for the accurate diagnosis of PCNSL. Herein, we aimed to develop a novel rapid genotyping system (GeneSoC) using real-time polymerase chain reaction (PCR) based on microfluidic thermal cycling technology. This real-time PCR system shortened the analysis time, which enabled the detection of the MYD88 L265P mutation within 15 min. Rapid detection of the MYD88 L265P mutation was performed intra-operatively using GeneSoC in 24 consecutive cases with suspected malignant brain tumors, including 10 cases with suspected PCNSL before surgery. The MYD88 L265P mutation was detected in eight cases in which tumors were pathologically diagnosed as PCNSL after the operation, while wild-type MYD88 was detected in 16 cases. Although two of the 16 cases with wild-type MYD88 were pathologically diagnosed as PCNSL after the operation, MYD88 L265P could be detected in all eight PCNSL cases harboring MYD88 L265P. The MYD88 L265P mutation could also be detected using cell-free DNA derived from the cerebrospinal fluid of two PCNSL cases. Detection of the MYD88 L265P mutation using GeneSoC might not only improve the accuracy of intra-operative diagnosis of PCNSL but also help the future pre-operative diagnosis through liquid biopsy of cerebrospinal fluid.

DOI： 10.1111/cas.15762

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Machine learning models predict delayed hyponatremia post-transsphenoidal surgery using clinically available features 査読有り 国際誌

Fuse, Y; Takeuchi, K; Nishiwaki, H; Imaizumi, T; Nagata, Y; Ohno, K; Saito, R

PITUITARY   26 巻 ( 2 ) 頁： 237 - 249   2023年4月

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担当区分：責任著者   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: Delayed hyponatremia (DHN), a unique complication, is the leading cause of unexpected readmission after pituitary surgery. Therefore, this study aimed to develop tools for predicting postoperative DHN in patients undergoing endoscopic transsphenoidal surgery (eTSS) for pituitary neuroendocrine tumors (PitNETs). Methods: This was a single-center, retrospective study involving 193 patients with PitNETs who underwent eTSS. The objective variable was DHN, defined as serum sodium levels < 135 mmol/L at ≥ 1 time between post operative days 3 and 9. We trained four machine learning models to predict this objective variable using the clinical variables available preoperatively and on the first postoperative day. The clinical variables included patient characteristics, pituitary-related hormone levels, blood test results, radiological findings, and postoperative complications. Results: The random forest (RF) model demonstrated the highest (0.759 ± 0.039) area under the curve of the receiver operating characteristic curve (ROC-AUC), followed by the support vector machine (0.747 ± 0.034), the light gradient boosting machine (LGBM: 0.738 ± 0.026), and the logistic regression (0.710 ± 0.028). The highest accuracy (0.746 ± 0.029) was observed in the LGBM model. The best-performing RF model was based on 24 features, nine of which were clinically available preoperatively. Conclusions: The proposed machine learning models with pre- and post-resection features predicted DHN after the resection of PitNETs.

DOI： 10.1007/s11102-023-01311-w

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Subcutaneous transplantation of human embryonic stem cells-derived pituitary organoids 査読有り Open Access

Sasaki, H; Suga, H; Takeuchi, K; Nagata, Y; Harada, H; Kondo, T; Ito, E; Maeda, S; Sakakibara, M; Soen, M; Miwata, T; Asano, T; Ozaki, H; Taga, S; Kuwahara, A; Nakano, T; Arima, H; Saito, R

FRONTIERS IN ENDOCRINOLOGY   14 巻   頁： 1130465   2023年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers in Endocrinology  

Introduction: The pituitary gland, regulating various hormones, is central in the endocrine system. As spontaneous recovery from hypopituitarism is rare, and exogenous-hormone substitution is clumsy, pituitary replacement via regenerative medicine, using pluripotent stem cells, is desirable. We have developed a differentiation method that in mice yields pituitary organoids (POs) derived from human embryonic stem cells (hESC). Efficacy of these POs, transplanted subcutaneously into hypopituitary mice, in reversing hypopituitarism was studied. Methods: hESC-derived POs were transplanted into inguinal subcutaneous white adipose tissue (ISWAT) and beneath dorsal skin, a relatively avascular region (AR), of hypophysectomized severe combined immunodeficient (SCID) mice. Pituitary function was evaluated thereafter for ¾ 6mo, assaying basal plasma ACTH and ACTH response to corticotropin-releasing hormone (CRH) stimulation. Histopathologic examination of organoids 150d after transplantation assessed engraftment. Some mice received an inhibitor of vascular endothelial growth factor (VEGF) to permit assessment of how angiogenesis contributed to subcutaneous engraftment. Results: During follow-up, both basal and CRH-stimulated plasma ACTH levels were significantly higher in the ISWAT group (p < 0.001 – 0.05 and 0.001 – 0.005, respectively) than in a sham-operated group. ACTH secretion also was higher in the ISWAT group than in the AR group. Histopathologic study found ACTH-producing human pituitary-cell clusters in both groups of allografts, which had acquired a microvasculature. POs qPCR showed expression of angiogenetic factors. Plasma ACTH levels decreased with VEGF-inhibitor administration. Conclusions: Subcutaneous transplantation of hESC-derived POs into hypopituitary SCID mice efficaciously renders recipients ACTH-sufficient.

DOI： 10.3389/fendo.2023.1130465

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The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery 国際誌

Sasaki, H; Takeuchi, K; Nagata, Y; Tanahashi, K; Mizuno, A; Harada, H; Kishida, Y; Watanabe, T; Nagatani, T; Saito, R

ACTA NEUROCHIRURGICA   165 巻 ( 3 ) 頁： 667 - 675   2023年3月

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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 Neurochirurgica  

Purpose: Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence. Methods: We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. Results: Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI. Conclusions: Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.

DOI： 10.1007/s00701-022-05415-3

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<i>CD79B</i> Y196 mutation is a potent predictive marker for favorable response to R-MPV in primary central nervous system lymphoma 国際誌 Open Access

Yamaguchi, J; Ohka, F; Lushun, C; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Ohno, M; Suzaki, N; Takasu, S; Seki, Y; Kano, T; Wakabayashi, K; Oyama, H; Kurahashi, S; Tanahashi, K; Hirano, M; Shimizu, H; Kitano, Y; Maeda, S; Yamazaki, S; Wakabayashi, T; Kondo, Y; Natsume, A; Saito, R

CANCER MEDICINE   12 巻 ( 6 ) 頁： 7116 - 7126   2023年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cancer Medicine  

Background: Rituximab, high-dose methotrexate (HD-MTX), procarbazine and vincristine (R-MPV), has significantly prolonged the survival of patients with primary central nervous system lymphoma (PCNSL), but predictive factors for response to R-MPV have not yet been investigated. Herein, we investigated the correlation of MYD88 L265P and CD79B Y196 mutations, which are the most frequently found molecular alterations in PCNSL, with prognosis of patients with PCNSL treated with R-MPV. Methods: We investigated the long-term clinical course and status of MYD88 and CD79B genes in 85 patients with PCNSL treated with R-MPV or HD-MTX treatment, and the correlation of these genetic mutations with prognosis. Results: R-MPV achieved an excellent tumor control rate (61.6% and 69.9% of 5-year progression-free and overall survival rates, respectively). While MYD88 L265P mutation had no significant effect on survival, patients with CD79B Y196 mutations exhibited prolonged survival (p < 0.05). However, the association of CD79B Y196 mutation with a better prognosis was not observed in the HD-MTX cohort, which indicated that CD79B Y196 mutation was a predictive marker for a favorable response to R-MPV. Furthermore, we established an all-in-one rapid genotyping system for these genetic mutations. Conclusions: In conclusion, CD79B Y196 mutation is a potent predictive marker for favorable response to R-MPV in PCNSL. The rapid identification of MYD88 L265P and CD79B Y196 mutations can be helpful not only for the accurate molecular diagnosis of PCNSL but also for the prediction of response to R-MPV.

DOI： 10.1002/cam4.5512

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放射線治療とパシレオチドの併用が奏功したクッシング病の1例

村瀬 萌絵, 安田 康紀, 杉山 摩利子, 永田 雄一, 竹内 和人, 井下 尚子, 有馬 寛

日本内分泌学会雑誌   98 巻 ( 5 ) 頁： 1401 - 1401   2023年3月

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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  

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Simultaneous Aneurysmal Subarachnoid Hemorrhage and Epistaxis in an Untreated Prolactinoma: A Case Report and Literature Review. 査読有り Open Access

Nishihori M, Izumi T, Takeuchi K, Goto S, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R

NMC case report journal   10 巻 ( 0 ) 頁： 163 - 168   2023年

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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  

DOI： 10.2176/jns-nmc.2022-0355

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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12月

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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)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.36.296

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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12月

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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)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.36.296

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02943&link_issn=&doc_id=20230112220009&doc_link_id=10.2531%2Fspinalsurg.36.296&url=https%3A%2F%2Fdoi.org%2F10.2531%2Fspinalsurg.36.296&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Endoscopic Trans-Mini-Cylinder Biopsy for Intraparenchymal Brain Lesions 国際誌 Open Access

Takeuchi, K; Ohka, F; Nagata, Y; Maeda, S; Tanahashi, K; Araki, Y; Yamamoto, T; Sasaki, H; Mizuno, A; Harada, H; Saito, R

WORLD NEUROSURGERY   167 巻   頁： E1147 - E1153   2022年11月

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担当区分：筆頭著者,　責任著者   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: The biopsy procedure is intended to obtain an adequate specimen volume from the targeted area while ensuring minimal damage to the normal brain. We performed navigation-guided endoscopic biopsy using a small-diameter cylinder to reduce the invasiveness of the biopsy procedure and ensure a sufficient amount of tissue is collected. We examined whether it is possible to reduce brain tissue injury by using a small-diameter cylinder and improve safety and effectiveness by using an endoscope to directly observe the lesion and achieve hemostasis. Methods: Patients who underwent endoscopic biopsy surgery using a 6-mm-diameter cylinder for intraparenchymal lesions were enrolled in this study. Postoperative hematoma formation and the extent of trajectory scarring were assessed. Results: Fifty-two procedures performed on 51 patients were analyzed in this study. Postoperative neurological deterioration was not observed in any patient. A pathological diagnosis was made for all patients. Postoperative computed tomography revealed no hematoma after 49 procedures and a small hematoma after 3 procedures, and no patients required additional treatment. A postoperative trajectory scar less than 5 mm in diameter was observed after 30 procedures, a scar of 5–10 mm was observed after 19 procedures, a scar larger than 10 mm was observed after 3 procedures at 1 week after surgery, and 40, 6 and 0 scars were observed at 3 months after surgery. Conclusions: Endoscopic biopsy using a small-diameter cylinder is a possible alternative biopsy technique for intraparenchymal lesions. This surgical technique is useful, especially in patients at risk of hemorrhagic complications.

DOI： 10.1016/j.wneu.2022.08.147

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ROLE OF CD79B Y196 MUTATION IN PCNSL AS A POTENT PREDICTIVE MARKER FOR FAVORABLE RESPONSE TO R-MPV TREATMENT AND DEVELOPMENT OF RAPID ALL-IN-ONE GENOTYPING SYSTEM FOR MOLECULAR MARKERS OF PCNSL

Yamaguchi, J; Ohka, F; Lushun, C; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Ohno, M; Suzaki, N; Takasu, S; Seki, Y; Tanahashi, K; Hirano, M; Shimizu, H; Kitano, Y; Maeda, S; Yamazaki, S; Wakabayashi, T; Kondo, Y; Saito, R

NEURO-ONCOLOGY   24 巻   頁： 18 - 18   2022年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations 国際誌

Takeuchi, K; Nagata, Y; Tanahashi, K; Araki, Y; Mizuno, A; Sasaki, H; Harada, H; Ito, K; Saito, R

ACTA NEUROCHIRURGICA   164 巻 ( 10 ) 頁： 2587 - 2594   2022年10月

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担当区分：筆頭著者,　責任著者   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 Neurochirurgica  

Objective: Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique. Methods: We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the “wet-field technique.” Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records. Results: The average maximum CM diameter was 35.3 mm (range: 10–65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed. Conclusions: The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.

DOI： 10.1007/s00701-022-05273-z

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Effect of cilia-induced surface velocity on cerebrospinal fluid exchange in the lateral ventricles 国際誌 Open Access

Yoshida, H; Ishida, S; Yamamoto, T; Ishikawa, T; Nagata, Y; Takeuchi, K; Ueno, H; Imai, Y

JOURNAL OF THE ROYAL SOCIETY INTERFACE   19 巻 ( 193 ) 頁： 20220321 - 20220321   2022年8月

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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 the Royal Society Interface  

Ciliary motility disorders are known to cause hydrocephalus. The instantaneous velocity of cerebrospinal fluid (CSF) flow is dominated by artery pulsation, and it remains unclear why ciliary dysfunction results in hydrocephalus. In this study, we investigated the effects of cilia-induced surface velocity on CSF flow using computational fluid dynamics. A geometric model of the human ventricles was constructed using medical imaging data. The CSF produced by the choroid plexus and cilia-induced surface velocity were given as the velocity boundary conditions at the ventricular walls. We developed healthy and reduced cilia motility models based on experimental data of cilia-induced velocity in healthy wild-type and Dpcd-knockout mice. The results indicate that there is almost no difference in intraventricular pressure between healthy and reduced cilia motility models. Additionally, it was found that newly produced CSF from the choroid plexus did not spread to the anterior and inferior horns of the lateral ventricles in the reduced cilia motility model. These findings suggest that a ciliary motility disorder could delay CSF exchange in the anterior and inferior horns of the lateral ventricles.

DOI： 10.1098/rsif.2022.0321

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ラトケ嚢胞に類似した所見を示した頭蓋咽頭腫の一例 Open Access

原田 英幸, 竹内 和人, 永田 雄一, 棚橋 邦明, 佐々木 博勇, 水野 晃宏, 井下 尚子, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( Suppl.HPT ) 頁： 72 - 73   2022年8月

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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  

DOI： 10.1507/endocrine.98.s.hpt_72

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経鼻頭蓋底術後髄液漏の検討 失敗を活かすために Open Access

竹内 和人, 永田 雄一, 佐々木 博勇, 水野 晃宏, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( Suppl.HPT ) 頁： 25 - 27   2022年8月

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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  

経鼻的内視鏡下頭蓋底手術は下垂体腫瘍をはじめとする傍鞍部腫瘍に対する第一選択の外科的治療法であるが、合併症として術後髄液鼻漏の危険性が伴う。今回、当院と関連施設で2016～2021年に本手術が施行された506例を対象とし、原疾患、手術方法、再建方法、原疾患、術後髄液漏の発生頻度などについて調査し、術後髄液漏発生例について詳細な検討を行った。原疾患は下垂体腺腫294例、頭蓋咽頭腫59例、鞍結節髄膜腫48例、ラトケ嚢胞33例、くも膜嚢胞12例、脊索腫11例などであった。再建方法は通常閉鎖法(鞍内に補綴物を充填し硬膜の縫合を行う)が349例、靴紐閉鎖法(硬膜切開部に補綴物を挟み込むように連続縫合を行う)が116例、パッチ閉鎖法(硬膜欠損部を補綴物でパッチ状に縫合閉鎖する)が41例であった。術後髄液漏は11例(2.2%)に発生し、原疾患の内訳は下垂体腺腫3例、頭蓋咽頭腫3例、鞍結節髄膜腫2例、脊索腫1例、くも膜嚢胞1例、リンパ腫1例であった。再建方法は通常閉鎖法4例、靴紐閉鎖法5例、パッチ閉鎖法2例であった。髄液漏の発生要因について検討した結果、術者側の要因としてグラフトの量や種類・位置に関するものが多く、患者側の要因として多動や放射線治療、脳室腹腔シャント挿入などが考えられた。

DOI： 10.1507/endocrine.98.s.hpt_25

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頭蓋底腫瘍に対する開頭手術と経鼻内視鏡手術の使いわけについて 正中部頭蓋底腫瘍でも硬膜内腫瘍の内頸動脈・脳神経の外側進展例では開頭手術を推奨

阿久津 博義, 竹内 和人

日本医事新報   ( 5127 ) 頁： 53 - 53   2022年7月

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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：(株)日本医事新報社  

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Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review 国際誌 Open Access

Kibe, Y; Tanahashi, K; Ohtakara, K; Okumura, Y; Ohka, F; Takeuchi, K; Nagata, Y; Motomura, K; Akahori, S; Mizuno, A; Sasaki, H; Shimizu, H; Yamaguchi, J; Nishikawa, T; Yokota, K; Saito, R

BMC NEUROLOGY   22 巻 ( 1 ) 頁： 223 - 223   2022年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Neurology  

Background: Eccrine spiradenocarcinoma (SC), also known as malignant eccrine spiradenoma, is a rare malignant cutaneous adnexal neoplasm arising from long-standing benign eccrine spiradenoma. Malignant skin tumors rarely show direct intracranial invasion. However, once the intracranial structure is infiltrated, curative excision with sufficient margins can become extremely difficult, particularly when the venous sinuses are involved. No effective adjuvant therapies have yet been established. Here, we report an extremely rare case of scalp eccrine SC with direct intracranial invasion, which does not appear to have been reported previously. Case presentation: An 81-year-old woman presented with a large swelling on the parietal scalp 12 years after resection of spiradenoma from the same site. The tumor showed intracranial invasion with involvement of the superior sagittal sinus and repeated recurrences after four surgeries with preservation of the sinus. The histopathological diagnosis was eccrine SC. Adjuvant high-precision external beam radiotherapy (EBRT) proved effective after the third surgery, achieving remission of the residual tumor. The patient died 7 years after the first surgery for SC. Conclusions: Scalp SC with direct intracranial invasion is extremely rare. Radical resection with tumor-free margins is the mainstay of treatment, but the involvement of venous sinuses makes this unfeasible. High-precision EBRT in combination with maximal resection preserving the venous sinuses could be a treatment option for local tumor control.

DOI： 10.1186/s12883-022-02749-4

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Quick and simple dural threading technique for transsphenoidal surgery - dural tenting, haemostasis and skull base reconstruction 国際誌

Takeuchi, K; Nagata, Y; Tanahashi, K; Saito, R

ACTA NEUROCHIRURGICA   164 巻 ( 6 ) 頁： 1619 - 1622   2022年6月

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担当区分：筆頭著者,　責任著者   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 Neurochirurgica  

Background: Dural suturing is one of the most robust reconstruction methods in transsphenoidal surgery; however, the technique is considered difficult, primarily due to the restricted range of needle movement. Method: We performed dural threading during transsphenoidal surgery by holding the needle with forceps as a hook and moving the needle in a distal to proximal direction. Conclusion: Our dural suturing technique is simple and quick. It can be used not only for dural closure but also for other procedures, such as controlling haemostasis from the intercavernous sinus and dural tenting.

DOI： 10.1007/s00701-022-05227-5

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脳内病変に対する内視鏡手術の有用性とは?【内視鏡では周辺の正常脳の損傷を抑えた手術治療が可能である】

竹内 和人, 西田 南海子

日本医事新報   ( 5120 ) 頁： 51 - 51   2022年6月

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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：(株)日本医事新報社  

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Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series Open Access

Araki, Y; Mamiya, T; Fujita, N; Yokoyama, K; Uda, K; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Tanei, T; Muraoka, S; Izumi, T; Kato, K; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS   3 巻 ( 19 )   2022年5月

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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 Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (DRCBF) (to ipsilateral cerebellar ratio (denoted DRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the DRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke.

DOI： 10.3171/CASE2274

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術中所見はラトケ嚢胞、されど病理は頭蓋咽頭腫

永田 雄一, 竹内 和人, 棚橋 邦明, 佐々木 博勇, 原田 英幸, 井下 尚子, 齋藤 竜太

Brain Tumor Pathology   39 巻 ( Suppl. ) 頁： 110 - 110   2022年5月

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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：日本脳腫瘍病理学会  

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A novel endoscopic ventriculocisternostomy and stenting technique with a transparent acryl puncture needle for a trapped temporal horn: a technical report and literature review 国際誌

Yamamoto, T; Takeuchi, K; Nagata, Y; Mizuno, A; Harada, H; Saito, R

NEUROSURGICAL REVIEW   45 巻 ( 2 ) 頁： 1783 - 1789   2022年4月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgical Review  

Trapped temporal horn is a rare type of noncommunicating focal hydrocephalus, and no standard treatment has been established yet for trapped temporal horn. Recent studies have shown the efficacy of endoscopic ventriculocisternostomy by opening the choroidal fissure; however, some surgical complications were reported during the procedure. Thus, we aimed to report a novel endoscopic ventriculocisternostomy and stenting technique for trapped temporal horn. In this technique, a 5.8-mm transparent acryl puncture needle with a 2.7-mm 0° rigid endoscope was used to open the choroidal fissure. It can fenestrate the choroidal fissure under real-time endoscopic observation of the critical neurovascular structures over the choroidal fissure. Moreover, the dull tip of the needle is less likely to injure the critical neurovascular structures, resulting in safer ventriculocisternostomy than the previously reported technique. Then, a stent is placed along the tract to prevent future obstruction of the stoma. Six trapped temporal horns in four patients were treated using the technique. All the patients showed improved symptoms with no surgical complications. None of the patients showed recurrence of trapped temporal horn during the mean follow-up period of 39.3 months. The combination of endoscopic ventriculocisternostomy and stenting with a transparent acryl puncture needle is a safe and effective treatment option for trapped temporal horn.

DOI： 10.1007/s10143-021-01634-x

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Challenging direct bypass surgery for very young children with moyamoya disease: technical notes 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

NEUROSURGICAL REVIEW   45 巻 ( 2 ) 頁： 1799 - 1807   2022年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgical Review  

Cerebral revascularization for moyamoya disease (MMD) is an effective treatment for improving cerebral ischaemia and preventing rebleeding. Although direct bypass surgery is commonly performed on older children and adults, it is challenging in very young children due to the high difficulty level of the procedure. The subjects were MMD patients under 3 years of age on whom surgery was performed by a single surgeon (Y.A.). Preoperative clinical findings, information related to direct bypass surgery, bypass patency, and the incidence of postoperative stroke were investigated. Combined revascularization, including direct bypass surgery, was performed on 3 MMD patients (3 sides) under 3 years of age. The average diameter of the grafts used in direct bypass was 0.8 mm. The average recipient diameter was 0.8 ± 0.17 (range 0.6–1) mm. In all cases, the anastomotic procedure was completed using 11–0 monofilament nylon thread, and patency was confirmed. Direct bypass for MMD patients under 3 years old is technically challenging. However, despite the anatomical differences between very young children and elderly individuals, direct bypass surgery could certainly be completed. In addition, a rapid recovery from cerebral blood flow insufficiency could yield a promising neurological outcome.

DOI： 10.1007/s10143-021-01685-0

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Risk Factors for Cerebral Infarction Early After Revascularization in Children Younger than 5 Years with Moyamoya Disease 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

WORLD NEUROSURGERY   160 巻   頁： E220 - E226   2022年4月

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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: Cerebral revascularization is necessary for pediatric patients younger than 5 years with moyamoya disease (MMD). However, they have a high risk of developing cerebral infarction early after surgery. This study aimed to analyze the risk factors for developing cerebral infarction among these patients. Methods: The charts of 21 consecutive patients with MMD (39 surgeries) younger than 5 years who had undergone revascularization at our hospital were retrospectively analyzed. Because cerebral infarction occurring within 1 month after surgery was the primary end point, other clinical information was evaluated, including each surgical procedure. Multivariate analysis of the risk factors for postoperative cerebral infarction was performed. Results: Cerebral infarction occurred after 7 of 39 surgeries (17.9%). Of the 39 surgeries, 23 (59%) included direct and indirect combined revascularization. The incidence of cerebral infarction did not differ significantly between the combined (21.7%) and indirect (12.5%) groups (P = 0.46). Logistic regression showed no association between the revascularization procedure and the occurrence of cerebral infarction after surgery (P = 0.3). However, younger age at surgery was correlated with a higher risk of developing cerebral infarction in the early postoperative period (P = 0.05). Conclusions: No differences were found in the risk of developing cerebral infarction early after surgery as a result of surgical procedures. However, younger patients had higher postoperative risk. Further multicenter research should examine this issue for young pediatric patients with moyamoya at high risk of developing cerebral infarction.

DOI： 10.1016/j.wneu.2021.12.115

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Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Open Access

Nagata, Y; Takeuchi, K; Sasaki, H; Mizuno, A; Harada, H; Tanahashi, K; Araki, Y; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA   62 巻 ( 4 ) 頁： 203 - 208   2022年4月

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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  

Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, se-cure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent colla-gen matrix. The collagen matrix harvested from this area was pathologically examined; neovasculari-zation and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, ne-ovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.

DOI： 10.2176/jns-nmc.2021-0355

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3D培養法を用いた新規下垂体腺腫オルガノイドモデルの作成

佐々木 博勇, 竹内 和人, 棚橋 邦明, 永田 雄一, 水野 晃宏, 原田 英幸, 須賀 英隆, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( 1 ) 頁： 329 - 329   2022年4月

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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  

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小児頭蓋咽頭腫の長期成績からみた課題と展望 小児頭蓋咽頭腫に対する神経内視鏡治療の実際と展望

竹内 和人, 永田 雄一, 加藤 美穂子, 佐々木 博勇, 齋藤 竜太

小児の脳神経   47 巻 ( 2 ) 頁： 201 - 201   2022年4月

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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  

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頭蓋咽頭腫術後下垂体機能温存に上下垂体動脈血流が重要である

竹内 和人, 永田 雄一, 水野 晃宏, 佐々木 博勇, 原田 英幸, 齋藤 竜太

日本内分泌学会雑誌   98 巻 ( 1 ) 頁： 309 - 309   2022年4月

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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  

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機能性下垂体腺腫に対する外科治療 術前評価から根治切除に向けて

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

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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  

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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

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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

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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

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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

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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

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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

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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  

DOI： 10.2176/jns-nmc.2021-0326

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(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

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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 ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and ¹¹C-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

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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

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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：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.36.296

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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

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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

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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

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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

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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

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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

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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  

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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

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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  

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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  

DOI： 10.2176/nmccrj.cr.2020-0215

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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

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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

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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

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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  

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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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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)日本神経学会  

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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

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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  

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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

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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

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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  

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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

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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

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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

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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

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinical Neurology and Neurosurgery  

DOI： 10.1016/j.clineuro.2020.105764

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<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

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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

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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

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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  

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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

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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  

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.25259/SNI_354_2020

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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

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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

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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

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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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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

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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

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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

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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

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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

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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

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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

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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

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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)日本神経学会  

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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

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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)日本神経学会  

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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

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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  

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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

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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  

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7076/j.wneu.2018.71.017

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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

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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

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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)日本神経学会  

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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

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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

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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

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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

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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  

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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

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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

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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

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小児のう胞性疾患に対する内視鏡治療

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

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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

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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

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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

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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)日本神経学会  

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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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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)日本神経学会  

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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

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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

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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

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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

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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  

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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

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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)日本糖尿病学会  

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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

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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

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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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