研究者詳細 - 永田　雄一

論文 - 永田　雄一

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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

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

Endoscopic Cystoventricular Stenting in Awake Patients with Electrical Stimulation Mapping for Convexity Cysts: Three Case Reports and a Systematic Review 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

記述言語：英語出版者・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

Isolation of ependymal cilia from mouse brain( vol 409, 110198, 2024) 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 2024年12月

記述言語：英語出版者・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 Mizunoa,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

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

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

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

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

ESTABLISHMENT OF PITUITARY NEUROENDOCRINE TUMOR (PITNET) ORGANOID MODELS

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

Isolation of ependymal cilia from mouse brain 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 2024年9月

記述言語：英語出版者・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

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 Open Access

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

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

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

記述言語：英語出版者・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

Obstructive Hydrocephalus Due to Aggressive Posterior Fossa Tumor Exhibiting Histological Characteristics of Pilocytic Astrocytoma in Two Adult Neurofibromatosis Type 1 (NF1) Cases 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

Pediatric-type high-grade gliomas with <i>PDGFRA</i> amplification in adult patients with Li-Fraumeni syndrome: clinical and molecular characterization of three cases 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 2024年4月

記述言語：英語出版者・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

Safety and efficacy of the endoscopic transsphenoidal transclival approach performed using direct cortical stimulation for pontine cavernous malformations.

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

記述言語：英語出版者・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

Extended Endoscopic Endonasal Transplanum and Transdorsum Sellar Approach for the Resection of Retroinfundibular Craniopharyngioma With Two-Piece Dural Opening: A Technical Case Report

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

A Case of Papillary Craniopharyngioma Mimicking Rathke's Cleft Cyst. 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

Endoscopic debulking canalization for optic pathway glioma with obstructive hydrocephalus

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

記述言語：英語出版者・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

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

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

記述言語：英語出版者・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

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

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

Higher abundance of Campylobacter in the oral microbiome of Japanese patients with moyamoya disease

Takayanagi, K; Kanamori, F; Ishii, K; Yokoyama, K; Araki, Y; Sumitomo, M; Maeda, S; Goto, S; Ota, S; Nagata, Y; Nishihori, M; Maesawa, S; Izumi, T; Takasu, S; Saito, R

SCIENTIFIC REPORTS 13 巻 ( 1 ) 頁： 18545 2023年10月

記述言語：英語出版者・発行元：Scientific Reports

Genetic factors alone cannot explain the pathophysiology of moyamoya disease (MMD), and environmental factors such as an immune response are thought to be involved. Oral and gut microbiomes have attracted attention as environmental factors in the pathophysiology of some vascular and autoimmune diseases. However, the relationship between MMD and these microbiomes is yet to be thoroughly investigated. This prospective case–control study aimed to compare the microbiomes of Japanese patients with MMD with those of healthy individuals to identify the specific bacteria involved in MMD. Saliva and fecal samples were collected from 16 patients with MMD who had not undergone revascularization surgery. Fifteen healthy individuals were matched for age, sex, and body mass index. The microbiomes were determined using 16S rRNA sequencing and analyzed using QIIME2. Differentially abundant microbes were identified using LEfSE and ANCOM-BC. In the oral microbiome, the two analytical methods showed that Campylobacter was more abundant in patients with MMD than in healthy individuals. Differences in the gut microbiome were smaller than those in the oral microbiome. In conclusion, the oral microbiome profiles of patients with MMD significantly differ from those of healthy individuals. Campylobacter spp. could be a substantial environmental factor in the pathophysiology of MMD.

DOI： 10.1038/s41598-023-45755-3

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

Machine learning models predict delayed hyponatremia post-transsphenoidal surgery using clinically available features

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

記述言語：英語出版者・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

Rapid detection of the MYD88 L265P mutation for pre- and intra-operative diagnosis of primary central nervous system lymphoma

Yamaguchi Junya, Ohka Fumiharu, Kitano Yotaro, Maeda Sachi, Motomura Kazuya, Aoki Kosuke, Takeuchi Kazuhito, Nagata Yuichi, Hattori Hikaru, Tsujiuchi Takashi, Motomura Ayako, Nishikawa Tomohide, Kibe Yuji, Shinjo Keiko, Kondo Yutaka, Saito Ryuta

CANCER SCIENCE 2023年3月

記述言語：英語出版者・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

Subcutaneous transplantation of human embryonic stem cells-derived pituitary organoids.

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

記述言語：英語出版者・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

Case of a Pregnant Woman with Capillary Hemangioma of the Parasellar Region

ISHIKAWA Takayuki, TAKEUCHI Kazuhito, NAGATA Yuichi, ITO Keishi, YAMAMOTO Taiki, KABEYA Ryusuke

NMC Case Report Journal 9 巻 ( 0 ) 頁： 77 - 82 2022年12月

CD79B Y196 mutation is a potent predictive marker for favorable response to R-MPV in primary central nervous system lymphoma

Yamaguchi Junya, Ohka Fumiharu, Lushun Chalise, Motomura Kazuya, Aoki Kosuke, Takeuchi Kazuhito, Nagata Yuichi, Ito Satoshi, Mizutani Nobuhiko, Ohno Masasuke, Suzaki Noriyuki, Takasu Syuntaro, Seki Yukio, Kano Takahisa, Wakabayashi Kenichi, Oyama Hirofumi, Kurahashi Shingo, Tanahashi Kuniaki, Hirano Masaki, Shimizu Hiroyuki, Kitano Yotaro, Maeda Sachi, Yamazaki Shintaro, Wakabayashi Toshihiko, Kondo Yutaka, Natsume Atsushi, Saito Ryuta

CANCER MEDICINE 2022年12月

記述言語：英語出版者・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

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

Sasaki Hiroo, Takeuchi Kazuhito, Nagata Yuichi, Tanahashi Kuniaki, Mizuno Akihiro, Harada Hideyuki, Kishida Yugo, Watanabe Tadashi, Nagatani Tetsuya, Saito Ryuta

ACTA NEUROCHIRURGICA 165 巻 ( 3 ) 頁： 667 - 675 2022年11月

記述言語：英語出版者・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

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 Junya, Ohka Fumiharu, Lushun Chalise, Motomura Kazuya, Aoki Kosuke, Takeuchi Kazuhito, Nagata Yuichi, Ito Satoshi, Mizutani Nobuhiko, Ohno Masasuke, Suzaki Noriyuki, Takasu Syuntaro, Seki Yukio, Tanahashi Kuniaki, Hirano Masaki, Shimizu Hiroyuki, Kitano Yotaro, Maeda Sachi, Yamazaki Shintaro, Wakabayashi Toshihiko, Kondo Yutaka, Saito Ryuta

NEURO-ONCOLOGY 24 巻頁： 18 - 18 2022年11月

Endoscopic Trans-Mini-Cylinder Biopsy for Intraparenchymal Brain Lesions

Takeuchi Kazuhito, Ohka Fumiharu, Nagata Yuichi, Maeda Sachi, Tanahashi Kuniaki, Araki Yoshio, Yamamoto Taiki, Sasaki Hiroo, Mizuno Akihiro, Harada Hideyuki, Saito Ryuta

WORLD NEUROSURGERY 167 巻頁： E1147 - E1153 2022年11月

記述言語：英語出版者・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

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

Takeuchi Kazuhito, Nagata Yuichi, Tanahashi Kuniaki, Araki Yoshio, Mizuno Akihiro, Sasaki Hiroo, Harada Hideyuki, Ito Keishi, Saito Ryuta

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

記述言語：英語出版者・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

経鼻頭蓋底術後髄液漏の検討

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 ( S.HPT ) 頁： 25 - 27 2022年8月

ラトケ嚢胞に類似した所見を示した頭蓋咽頭腫の一例

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 ( S.HPT ) 頁： 72 - 73 2022年8月

Effect of cilia-induced surface velocity on cerebrospinal fluid exchange in the lateral ventricles

Yoshida Haruki, Ishida Shunichi, Yamamoto Taiki, Ishikawa Takayuki, Nagata Yuichi, Takeuchi Kazuhito, Ueno Hironori, Imai Yohsuke

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

記述言語：英語出版者・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

Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review

Kibe Yuji, Tanahashi Kuniaki, Ohtakara Kazuhiro, Okumura Yuka, Ohka Fumiharu, Takeuchi Kazuhito, Nagata Yuichi, Motomura Kazuya, Akahori Sho, Mizuno Akihiro, Sasaki Hiroo, Shimizu Hiroyuki, Yamaguchi Junya, Nishikawa Tomohide, Yokota Kenji, Saito Ryuta

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

記述言語：英語出版者・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

Changes in cerebral blood flow in the postoperative chronic phase after combined cerebral revascularization for moyamoya disease with ischaemic onset

Araki Yoshio, Mamiya Takashi, Fujita Naotoshi, Uda Kenji, Yokoyama Kinya, Kanamori Fumiaki, Takayanagi Kai, Ishii Kazuki, Nishihori Masahiro, Takeuch Kazuhito, Tanahashi Kuniaki, Nagata Yuichi, Nishimura Yusuke, Tanei Takafumi, Sumitomo Masaki, Okamoto Sho, Izumi Takashi, Kato Katsuhiko, Saito Ryuta

NEUROSURGICAL REVIEW 45 巻 ( 3 ) 頁： 2471 - 2480 2022年6月

記述言語：英語出版者・発行元：Neurosurgical Review

The purpose of this study was to examine the effects of combined revascularization for ischaemic-onset moyamoya disease (MMD) on cerebral haemodynamics by comparing cerebral blood flow (CBF) during the postoperative chronic phase with preoperative CBF. A retrospective cohort of 24 MMD patients (representing 31 surgeries) who received single photon emission computed tomography (SPECT) before and more than 6 months after surgery was investigated. The CBF value of each vascular territory was extracted from SPECT data, and the value relative to the ipsilateral cerebellar value (relative CBF, or RCBF) was calculated. The correlation between the revascularization effect and the proportional change in RCBF before and after surgery (calculated as post-RCBF/pre-RCBF (“post/pre-RCBF”)) was analysed. Furthermore, the relationships between changes in neurological symptoms and post/pre-RCBF were investigated. Preoperative and postoperative mean RCBF values were 0.92 ± 0.15 and 0.96 ± 0.13 (p = 0.619) in the anterior cerebral artery territory, 0.99 ± 0.17 and 1.01 ± 0.17 (p = 0.598) in the middle cerebral artery territory and 1.15 ± 0.22 and 1.14 ± 0.19 (p = 0.062) in the posterior cerebral artery territory, respectively. No significant correlation was found between the revascularization score and post/pre-RCBF. The revascularization score and post/pre-RCBF were not significant predictors of worsening neurological symptoms postoperatively. No significant change in RCBF was observed in any vascular territory in the chronic phase after revascularization. Combined revascularization may assist in the redirection of blood flow from the internal to the external carotid system and contribute to CBF maintenance.

DOI： 10.1007/s10143-022-01774-8

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

Takeuchi Kazuhito, Nagata Yuichi, Tanahashi Kuniaki, Saito Ryuta

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

記述言語：英語出版者・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

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

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

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

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

Araki Yoshio, Uda Kenji, Yokoyama Kinya, Kanamori Fumiaki, Kurimoto Michihiro, Shiba Yoshiki, Mamiya Takashi, Nishihori Masahiro, Takeuchi Kazuhito, Tanahashi Kuniaki, Nagata Yuichi, Nishimura Yusuke, Okamoto Sho, Sumitomo Masaki, Izumi Takashi, Saito Ryuta

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

記述言語：日本語出版者・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

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

Yamamoto Taiki, Takeuchi Kazuhito, Nagata Yuichi, Mizuno Akihiro, Harada Hideyuki, Saito Ryuta

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

記述言語：日本語出版者・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

Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal

Nagata Yuichi, Takeuchi Kazuhito, Sasaki Hiroo, Mizuno Akihiro, Harada Hideyuki, Tanahashi Kuniaki, Araki Yoshio, Saito Ryuta

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

記述言語：英語出版者・発行元：Neurologia Medico-Chirurgica

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

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

Araki Yoshio, Uda Kenji, Yokoyama Kinya, Kanamori Fumiaki, Kurimoto Michihiro, Shiba Yoshiki, Mamiya Takashi, Nishihori Masahiro, Takeuchi Kazuhito, Tanahashi Kuniaki, Nagata Yuichi, Nishimura Yusuke, Okamoto Sho, Sumitomo Masaki, Izumi Takashi, Saito Ryuta

WORLD NEUROSURGERY 160 巻頁： E220 - E226 2022年4月

記述言語：英語出版者・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

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.

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

Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case.

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

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease.

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 2022年

記述言語：英語出版者・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

Sellar arachnoid cystに対する経鼻内視鏡手術

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 ( S.HPT ) 頁： 49 - 51 2021年9月

内視鏡下経鼻頭蓋底手術後の再建戦略

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 ( S.HPT ) 頁： 16 - 18 2021年9月

A new primate model of hypophyseal dysfunction

Kawabata Teppei, Suga Hidetaka, Takeuchi Kazuhito, Nagata Yuichi, Sakakibara Mayu, Ushida Kaori, Ozone Chikafumi, Enomoto Atsushi, Kawamoto Ikuo, Itagaki Iori, Tsuchiya Hideaki, Arima Hiroshi, Wakabayashi Toshihiko

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 10729 2021年5月

記述言語：日本語出版者・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

Importance of Hydrostatic Pressure and Irrigation Hemostasis in Neuroendoscopic Surgery

Ishikawa Takayuki, Takeuchi Kazuhito, Yamamoto Taiki, Nagata Yuichi, Natsume Atsushi

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 2 ) 頁： 117 - 123 2021年2月

記述言語：英語出版者・発行元：Neurologia Medico-Chirurgica

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 cmH2 O, 10 cmH2 O, 15 H2 O, and 20 cmH2 O without persistent irrigation to bleeding point and 10 cmH2 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 cmH2 O: 138.6 sec, 10 cmH2 O: 104.6 sec (P <0.001), 20 cmH2 O: 56 sec (P <0.001), and 10 cmH2 O with persistent irrigation: 72.8 sec (P <0.01 compared to 10 cmH2 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

Novel Endoscopic Technique for Inserting a Sheath into a Slit Ventricle: The Water-Slide Technique

Yamamoto Taiki, Takeuchi Kazuhito, Nagata Yuichi, Mizuno Akihiro, Wakabayashi Toshihiko

WORLD NEUROSURGERY 145 巻頁： 1 - 4 2021年1月

記述言語：日本語出版者・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

Fully Endoscopic Transcylinder Trans-Magendie Foraminal Approach for Fourth Ventricular Cavernoma: A Technical Case Report

Nagata Yuichi, Takeuchi Kazuhito, Yamamoto Taiki, Mizuno Akihiro, Wakabayashi Toshihiko

WORLD NEUROSURGERY 142 巻頁： 104 - 107 2020年10月

記述言語：日本語出版者・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

Endoscopic Treatment Strategy for a Disproportionately Large Communicating Fourth Ventricle: Case Series and Literature Review

Kawabata Teppei, Takeuchi Kazuhito, Nagata Yuichi, Ishikawa Takayuki, Choo Jungsu, Wakabayashi Toshihiko

NEUROLOGIA MEDICO-CHIRURGICA 60 巻 ( 7 ) 頁： 351 - 359 2020年7月

記述言語：英語出版者・発行元：Neurologia Medico-Chirurgica

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

Preservation of Olfactory Function Following Endoscopic Single-Nostril Transseptal Transsphenoidal Surgery

Kawabata Teppei, Takeuchi Kazuhito, Nagata Yuichi, Ishikawa Takayuki, Choo Jungsu, Sato Yusuke, Tambara Masao, Teranishi Masaaki, Wakabayashi Toshihiko

WORLD NEUROSURGERY 132 巻頁： E665 - E669 2019年12月

記述言語：日本語出版者・発行元：World Neurosurgery

Objective: Olfactory dysfunction is a significant postoperative complication related to endoscopic transsphenoidal surgery (TSS). This study aimed to determine the impact of endoscopic TSS on olfactory function. Methods: We conducted a prospective study of 32 patients with sellar or parasellar tumors who were treated with endoscopic TSS between December 2013 and October 2016. TSS was performed via a right transseptal approach. We performed the Toyota and Takagi olfactometer test and the venous olfaction test for the evaluation of olfactory function preoperatively and at 1 and 3 months postoperatively. Results: The results of the Toyota and Takagi test showed that olfactory function deteriorated in 4 of 32 (12.5%) patients 1 month postoperatively and improved to preoperative baseline levels in all patients 3 months after the procedure. Olfactory function deteriorated in 1 of 31 (3.2%) patients 3 months after the procedure. The venous olfaction test revealed no response in 1 of 31 (3.2%) patients 1 month postoperatively, with no improvement 3 months after the procedure. Conclusions: Endoscopic single-nostril transseptal TSS for sellar or parasellar tumor resection has minimal impact on olfactory function.

DOI： 10.1016/j.wneu.2019.08.051

Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery

Ishikawa Takayuki, Takeuchi Kazuhito, Nagata Yuichi, Choo Jungsu, Kawabata Teppei, Ishizaki Tomotaka, Wakabayashi Toshihiko

JOURNAL OF NEUROSURGERY 131 巻 ( 5 ) 頁： 1625 - 1631 2019年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery

OBJECTIVE Transsphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results. METHODS All patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect. RESULTS There were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito's grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively. CONCLUSIONS Dural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.

DOI： 10.3171/2018.4.JNS18366

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

Nagata Yuichi, Takeuchi Kazuhito, Yamamoto Taiki, Ishikawa Takayuki, Kawabata Teppei, Shimoyama Yoshie, Inoshita Naoko, Wakabayashi Toshihiko

PITUITARY 22 巻 ( 5 ) 頁： 507 - 513 2019年10月

記述言語：日本語出版者・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

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

Nagata Yuichi, Takeuchi Kazuhito, Yamamoto Taiki, Ishikawa Takayuki, Kawabata Teppei, Shimoyama Yoshie, Wakabayashi Toshihiko

WORLD NEUROSURGERY 126 巻頁： 53 - 58 2019年6月

記述言語：日本語出版者・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

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

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

World neurosurgery 122 巻頁： e1202 - e1210 2019年2月

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

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

DOI： 10.1016/j.wneu.2018.11.017

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

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

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

Choo Jungsu, Takeuchi Kazuhito, Nagata Yuichi, Ohka Fumiharu, Kishida Yugo, Watanabe Tadashi, Satoh Yusuke, Nagatani Tetsuya, Kato Kyozo, Wakabayashi Toshihiko, Natsume Atsushi

WORLD NEUROSURGERY 116 巻頁： E35 - E41 2018年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：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

Endoscopic Endonasal Surgery for Subdiaphragmatic Type Craniopharyngiomas.

Nishioka H, Nagata Y, Fukuhara N, Yamaguchi-Okada M, Yamada S

Neurologia medico-chirurgica 58 巻 ( 6 ) 頁： 260-265 2018年6月

Low-Grade Glioma of the Neurohypophysis: Clinical Characteristics and Surgical Outcomes

Nagata Yuichi, Inoshita Naoko, Fukuhara Noriaki, Yamaguchi-Okada Mitsuo, Nishioka Hiroshi, Yamada Shozo

WORLD NEUROSURGERY 114 巻頁： E1225 - E1231 2018年6月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：World Neurosurgery

Background: Low-grade glioma (LGG) of the neurohypophysis is an extremely rare tumor arising from the pituicytes of the posterior pituitary or the infundibulum. The preoperative imaging findings of these tumors mimic those of pituitary adenomas, and radical resection is often challenging in affected patients due to the hypervascularity of the tumor. Here we describe the clinical and radiologic features of this clinical entity. Methods: We identified 8 patients with LGG of the neurohypophysis who underwent surgery at Toranomon Hospital between January 2007 and March 2017. We retrospectively reviewed the clinical and radiologic data for these patients. Results: The patient cohort comprised 5 men and 3 women, with a mean age of 57 years. The presenting symptoms included visual disturbance in 7 patients and anterior pituitary dysfunction in 7 patients. No patient had diabetes insipidus (DI). Preoperative magnetic resonance imaging (MRI) showed a thick anterior pituitary gland located anterior to the tumor in 3 patients and flow voids on T2-weighted images in 6 patients. All patients underwent transsphenoidal surgery, and gross total resection was achieved in 4 patients. Postoperative morbidities included deterioration of anterior pituitary function in 4 patients and permanent DI in 3 patients. Conclusions: Anterior displacement of a thick anterior pituitary by a tumor combined with evidence of flow voids on preoperative MRI is helpful in the preoperative diagnosis of LGG of the neurohypophysis. Radical resection should be attempted in these tumors, especially during primary surgery, even though it is associated with postoperative pituitary dysfunction.

DOI： 10.1016/j.wneu.2018.03.180

Fully endoscopic combined transsphenoidal and supraorbital keyhole approach for parasellar lesions

Nagata Yuichi, Watanabe Tadashi, Nagatani Tetsuya, Takeuchi Kazuhito, Chu Jonsu, Wakabayashi Toshihiko

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

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：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

Growth hormone-producing pituitary adenomas in childhood and young adulthood: clinical features and outcomes.

Nagata Y, Inoshita N, Fukuhara N, Yamaguchi-Okada M, Nishioka H, Iwata T, Yoshimoto K, Yamada S

Pituitary 21 巻 ( 1 ) 頁： 1-9 2018年2月

Prognostic relevance of genetic alterations in diffuse lower-grade gliomas

Aoki, K; Nakamura, H; Suzuki, H; Matsuo, K; Kataoka, K; Shimamura, T; Motomura, K; Ohka, F; Shiina, S; Yamamoto, T; Nagata, Y; Yoshizato, T; Mizoguchi, M; Abe, T; Momii, Y; Muragaki, Y; Watanabe, R; Ito, I; Sanada, M; Yajima, H; Morita, N; Takeuchi, I; Miyano, S; Wakabayashi, T; Ogawa, S; Natsume, A

NEURO-ONCOLOGY 20 巻 ( 1 ) 頁： 66 - 77 2018年1月

記述言語：英語出版者・発行元：Neuro-Oncology

Background Diffuse lower-grade gliomas (LGGs) are genetically classified into 3 distinct subtypes based on isocitrate dehydrogenase (IDH) mutation status and codeletion of chromosome 1p and 19q (1p/19q). However, the subtype-specific effects of additional genetic lesions on survival are largely unknown. Methods Using Cox proportional hazards regression modeling, we investigated the subtype-specific effects of genetic alterations and clinicopathological factors on survival in each LGG subtype, in a Japanese cohort of LGG cases fully genotyped for driver mutations and copy number variations associated with LGGs (n = 308). The results were validated using a dataset from 414 LGG cases available from The Cancer Genome Atlas (TCGA). Results In Oligodendroglioma, IDH-mutant and 1p/19q codeleted, NOTCH1 mutations (P = 0.0041) and incomplete resection (P = 0.0019) were significantly associated with shorter survival. In Astrocytoma, IDH-mutant, PIK3R1 mutations (P = 0.0014) and altered retinoblastoma pathway genes (RB1, CDKN2A, and CDK4) (P = 0.013) were independent predictors of poor survival. In IDH-wildtype LGGs, co-occurrence of 7p gain, 10q loss, mutation in the TERT promoter (P = 0.024), and grade III histology (P < 0.0001) independently predicted poor survival. IDH-wildtype LGGs without any of these factors were diagnosed at a younger age (P = 0.042), and were less likely to have genetic lesions characteristic of glioblastoma, in comparison with other IDH-wildtype LGGs, suggesting that they likely represented biologically different subtypes. These results were largely confirmed in the cohort of TCGA. Conclusions Subtype-specific genetic lesions can be used to stratify patients within each LGG subtype. enabling better prognostication and management.

DOI： 10.1093/neuonc/nox132

Inherent Tumor Characteristics That Limit Effective and Safe Resection of Giant Nonfunctioning Pituitary Adenomas.

Nishioka H, Hara T, Nagata Y, Fukuhara N, Yamaguchi-Okada M, Yamada S

World neurosurgery 106 巻頁： 645-652 2017年10月

The Multiscope Technique for Microvascular Decompression

Nagata Yuichi, Watanabe Tadashi, Nagatani Tetsuya, Takeuchi Kazuhito, Chu Jonsu, Wakabayashi Toshihiko

WORLD NEUROSURGERY 103 巻頁： 310 - 314 2017年7月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：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

Upward ballooning of the third ventricle floor in a patient with slit ventricle syndrome: A unique magnetic resonance imaging finding.

Yamaguchi J, Watanabe T, Nagata Y, Nagatani T, Seki Y

The neuroradiology journal 30 巻 ( 1 ) 頁： 62-64 2017年2月

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

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

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

記述言語：日本語掲載種別：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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