Updated on 2024/04/18

写真a

 
SAITO Ryuta
 
Organization
Graduate School of Medicine Program in Integrated Medicine Clinical Neurosciences Professor
Graduate School
Graduate School of Medicine
Undergraduate School
School of Medicine Department of Medicine
Title
Professor
External link

Degree 1

  1. 博士(医学) ( 2004.3   東北大学 ) 

Research Interests 6

  1. 集学的治療

  2. Pediatric Brain Tumor

  3. 脳腫瘍治療に向けたトランスレーショナルリサーチ

  4. 脳腫瘍免疫治療の開発

  5. surgical treatment for brain tumor

  6. convection enhanced delivery

Research Areas 2

  1. Life Science / Neurosurgery

  2. Life Science / Neurosurgery  / brain tumor

Research History 14

  1. 名古屋大学脳神経外科

    2020.12

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    Country:Japan

  2. Nagoya University Graduate School of Medicine   Neurisurgery   Professor

    2020.12

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    Country:Japan

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  3. Tohoku University Graduate School of Medicine   Neurosurgery   Asscociate Professor

    2019.12 - 2020.11

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  4. Tohoku University   Graduate School of Medicine   Lecturer

    2018 - 2019.11

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  5. 東北大学脳神経外科

    2008.9 - 2020.12

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    Country:Japan

  6. Tohoku University   Graduate School of Medicine   Assistant Professor

    2008 - 2017

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  7. さいたま赤十字病院脳神経外科

    2007.6 - 2008.8

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    Country:Japan

  8. 仙台医療センター脳神経外科

    2007.4 - 2007.5

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    Country:Japan

  9. 岩手県立中央病院脳神経外科

    2006.10 - 2007.3

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    Country:Japan

  10. 広南病院脳神経外科

    2006.1 - 2006.9

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    Country:Japan

  11. 東北大学脳神経外科

    2005.4 - 2005.12

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    Country:Japan

  12. 宮城県立がんセンター

    2004.10 - 2005.3

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    Country:Japan

  13. Department of Neurological Surgery, University of California San Francisco

    2002.9 - 2004.9

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    Country:United States

  14. Department of Neurosurgery, Tohoku University

    1998.5 - 2000.4

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    Country:Japan

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Education 3

  1. Tohoku University   Department of Neurosurgery

    2000.4 - 2004.3

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    Country: Japan

  2. Tohoku University   Faculty of Medicine

    - 1998.3

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    Country: Japan

  3. Tohoku University   Faculty of Medicine

    - 1998.3

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    Country: Japan

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Professional Memberships 30

  1. 日本脳神経外科コングレス   理事・運営委員

    2000

  2. 日本脳神経外科コングレス

    2000

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  3. 日本脳神経外科学会   理事・中部支部長

    1998

  4. 日本脳神経外科学会

    1998

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  5. American Society of Clinical Oncology

    2022.4

  6. American Society of Clinical Oncology

    2022.4

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  7. 愛知県脳卒中対策推進委員会

    2022.4

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  8. 愛知県脳卒中対策推進委員会   委員長

    2022.4

  9. 愛知県脳卒中協会   副会長

    2021

  10. 愛知県脳卒中協会

    2021

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  11. 脳神経外科手術と機器学会   理事

    2000.12

  12. 脳神経外科手術と機器学会

    2000.12

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  13. 日本脳腫瘍学会   理事

  14. 日本脳腫瘍の外科学会

  15. Society for Neurooncology

  16. 日本脳卒中の外科学会   評議員

  17. 日本脳卒中学会

  18. 日本小児脳神経外科学会

  19. 日本神経内視鏡学会

  20. 日本癌学会

  21. 日本がん治療学会

  22. 日本脳腫瘍病理学会

  23. The Japan Neurosurgical Society

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  24. 日本脳腫瘍学会

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  25. THE JAPAN SOCIETY OF BRAIN TUMOR PATHOLOGY

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  26. 日本脳腫瘍の外科学会

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  27. THE JAPAN STROKE SOCIETY

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  28. THE JAPANESE SOCIETY ON SURGERY FOR CEREBRAL STROKE

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  29. 日本小児脳神経外科学会

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  30. 日本脳腫瘍病理学会   理事・事務局長

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Committee Memberships 14

  1. 名古屋大学てんかんセンター   センター長  

    2023.4   

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  2. 名古屋大学てんかんセンター   センター長  

    2023.4   

  3. 日本癌治療学会   日本癌治療学会思春期・若年(AYA)がん診療検討委員会専門委員  

    2022.12   

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    Committee type:Academic society

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  4. 日本癌治療学会   日本癌治療学会思春期・若年(AYA)がん診療検討委員会専門委員  

    2022.12   

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    Committee type:Academic society

  5. 名古屋大学脳とこころの研究センター   副センター長  

    2022.4   

  6. 名古屋大学脳とこころの研究センター   副センター長  

    2022.4   

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  7. 脳腫瘍リファレンスセンター   理事  

    2021.8   

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  8. JCCG   脳腫瘍委員会委員  

    2021.8   

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  9. 脳腫瘍リファレンスセンター   理事  

    2021.8   

  10. JCCG   脳腫瘍委員会委員  

    2021.8   

  11. 愛知県脳卒中協会   副協会長  

    2021.1   

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  12. 愛知県脳卒中協会   副協会長  

    2021.1   

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    Committee type:Academic society

  13. 愛知県脳卒中対策推進委員会   委員長  

    2020.12   

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    Committee type:Academic society

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  14. 愛知県脳卒中対策推進委員会   委員長  

    2020.12   

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    Committee type:Academic society

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Papers 267

  1. Pediatric-type high-grade gliomas with <i>PDGFRA</i> amplification in adult patients with Li-Fraumeni syndrome: clinical and molecular characterization of three cases Reviewed

    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   Vol. 12 ( 1 ) page: 57   2024.4

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher: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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  2. Development and validation of machine learning models to predict postoperative infarction in moyamoya disease. Reviewed International journal

    Yutaro Fuse, Kazuki Ishii, Fumiaki Kanamori, Shintaro Oyama, Takahiro Imaizumi, Yoshio Araki, Kinya Yokoyama, Syuntaro Takasu, Yukio Seki, Ryuta Saito

    Journal of neurosurgery     page: 1 - 9   2024.4

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    OBJECTIVE: Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ability to predict its occurrence based on these limited predictors remains inadequately explored. This study aimed to assess the feasibility of machine learning algorithms for predicting cerebral infarction after revascularization surgery in patients with MMD. METHODS: This retrospective study was conducted across two centers and harnessed data from 512 patients with MMD who had undergone revascularization surgery. The patient cohort was partitioned into internal and external datasets. Using perioperative clinical data from the internal cohort, three distinct machine learning algorithms-namely the support vector machine, random forest, and light gradient-boosting machine models-were trained and cross-validated to predict the occurrence of postoperative cerebral infarction. Predictive performance validity was subsequently assessed using an external dataset. Shapley additive explanations (SHAP) analysis was conducted to augment the prediction model's transparency and to quantify the impact of each input variable on shaping both the aggregate and individual patient predictions. RESULTS: In the cohort of 512 patients, 33 (6.4%) experienced postrevascularization cerebral infarction. The cross-validation outcomes revealed that, among the three models, the support vector machine model achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at mean ± SD 0.785 ± 0.052. Notably, during external validation, the light gradient-boosting machine model exhibited the highest accuracy at 0.903 and the largest ROC-AUC at 0.710. The top-performing prediction model utilized five input variables: postoperative serum gamma-glutamyl transpeptidase value, positive posterior cerebral artery (PCA) involvement on preoperative MRA, infarction as the rationale for surgery, presence of an infarction scar on preoperative MRI, and preoperative modified Rankin Scale score. Furthermore, the SHAP analysis identified presence of PCA involvement, infarction as the rationale for surgery, and presence of an infarction scar on preoperative MRI as positive influences on postoperative cerebral infarction. CONCLUSIONS: This study indicates the usefulness of employing machine learning techniques with routine perioperative data to predict the occurrence of cerebral infarction after revascularization procedures in patients with MMD.

    DOI: 10.3171/2024.1.JNS232173

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  3. Cerebellar and thalamic connector hubs facilitate the involvement of visual and cognitive networks in essential tremor Reviewed International coauthorship

    Bagarinao, E; Maesawa, S; Kato, S; Mutoh, M; Ito, Y; Ishizaki, T; Tanei, T; Tsuboi, T; Suzuki, M; Watanabe, H; Hoshiyama, M; Isoda, H; Katsuno, M; Sobue, G; Saito, R

    PARKINSONISM & RELATED DISORDERS   Vol. 121   page: 106034   2024.4

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Parkinsonism and Related Disorders  

    Introduction: Connector hubs are specialized brain regions that connect multiple brain networks and therefore have the potential to affect the functions of multiple systems. This study aims to examine the involvement of connector hub regions in essential tremor. Methods: We examined whole-brain functional connectivity alterations across multiple brain networks in 27 patients with essential tremor and 27 age- and sex-matched healthy controls to identify affected hub regions using a network metric called functional connectivity overlap ratio estimated from resting-state functional MRI. We also evaluated the relationships of affected hubs with cognitive and tremor scores in all patients and with motor function improvement scores in 15 patients who underwent postoperative follow-up evaluations after focused ultrasound thalamotomy. Results: We have identified affected connector hubs in the cerebellum and thalamus. Specifically, the dentate nucleus in the cerebellum and the dorsomedial thalamus exhibited more extensive connections with the sensorimotor network in patients. Moreover, the connections of the thalamic pulvinar with the visual network were also significantly widespread in the patient group. The connections of these connector hub regions with cognitive networks were negatively associated (FDR q < 0.05) with cognitive, tremor, and motor function improvement scores. Conclusion: In patients with essential tremor, connector hub regions within the cerebellum and thalamus exhibited widespread functional connections with sensorimotor and visual networks, leading to alternative pathways outside the classical tremor axis. Their connections with cognitive networks also affect patients’ cognitive function.

    DOI: 10.1016/j.parkreldis.2024.106034

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  4. Characteristics of deceased subjects transported to a postmortem imaging center due to unusual death related to epilepsy Reviewed

    Ito, Y; Hata, N; Maesawa, S; Tanei, T; Ishizaki, T; Mutoh, M; Hashida, M; Kobayashi, Y; Saito, R

    EPILEPSIA OPEN   Vol. 9 ( 2 ) page: 592 - 601   2024.4

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Epilepsia Open  

    Objective: Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy and identify factors that may contribute to these deaths and may also include sudden unexpected death in epilepsy (SUDEP). Methods: We analyzed 5291 cases in which a postmortem imaging (PMI) study was performed using plane CT, because of an unexplained death. A rapid troponin T assay was performed using peripheral blood samples. Clinical information including the cause of death suspected by the attending physician, body position, place of death, medical history, and antiseizure medications was evaluated. Results: A total of 132 (2.6%) patients had an obvious history of epilepsy, while 5159 individuals had no history of epilepsy (97.4%). Cerebrovascular disease was the cause of death in 1.6% of patients in the group with epilepsy, and this was significantly lower than that in the non-epilepsy group. However, drowning was significantly higher (9.1% vs. 4.4%). Unspecified cause of death was significantly more frequent in the epilepsy group (78.0% vs. 57.8%). Furthermore, the proportion of patients who demonstrated elevation of troponin T levels without prior cardiac disease was significantly higher in the epilepsy group (37.9% vs. 31.1%). At discovery of death, prone position was dominant (30.3%), with deaths occurring most commonly in the bedroom (49.2%). No antiseizure medication had been prescribed in 12% of cases, while 29.5% of patients were taking multiple antiseizure medications. Significance: The prevalence of epilepsy in individuals experiencing unusual death was higher than in the general population. Despite PMI studies, no definitive cause of death was identified in a significant proportion of cases. The high troponin T levels may be explained by long intervals between death and examination or by higher incidence of myocardial damage at the time of death. Plain Language Summary: This study investigated unusual deaths in epilepsy patients, analyzing 5291 postmortem imaging cases. The results showed that 132 cases (2.6%) had a clear history of epilepsy. In these cases, only 22% cases were explained after postmortem examination, which is less than in non-epilepsy group (42.2%). Cerebrovascular disease was less common in the epilepsy group, while drowning was more common. Elevated troponin T levels, which suggest possibility of myocardial damage or long intervals between death and examination, were also more frequent in the epilepsy group compared to non-epilepsy group.

    DOI: 10.1002/epi4.12891

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  5. Molecular insights and the role of 18F-FDG-PET/CT in the diagnosis of spinal gliomas Reviewed

    Nagashima, Y; Nishimura, Y; Eguchi, K; Yamaguchi, J; Haimoto, S; Ohka, F; Motomura, K; Abe, T; Matsuo, M; Tsukamoto, E; Hara, M; Saito, R

    ACTA NEUROCHIRURGICA   Vol. 166 ( 1 ) page: 154   2024.3

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    Authorship:Last author   Language:English   Publisher:Acta Neurochirurgica  

    Background: In recent years, molecular findings on spinal gliomas have become increasingly important. This study aimed to investigate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in the diagnosis of spinal glioma. Methods: This study included patients diagnosed with spinal cord glioma who underwent 18F-FDG-PET examination at the Department of Neurosurgery, Nagoya University Hospital between January 2016 and November 2023. The gliomas were divided into two groups, high-grade and low-grade, based on pathological and molecular studies. The maximum standardized uptake values (SUVmax) of the tumors were quantified and subsequently represented using receiver operating characteristic (ROC) curves. Results: Eighteen participants were included in this study. Of the participants, seven had high-grade glioma with an SUVmax of 6.76 ± 0.72, and eleven had low-grade glioma with an SUVmax of 4.02 ± 1.78, and a statistically significant difference between the two groups. The ROC curve delineated an SUVmax cutoff value of 5.650, with an area under the curve (AUC) of approximately 0.909. Based on the cutoff value, the results of the diagnostic performance rendered a sensitivity and negative predictive value of 1.0, whereas the specificity and positive predictive value were 0.909 and 0.875, respectively. Conclusions: The present study shows that 18F-FDG-PET exhibits a markedly sensitive and negative predictive value in the assessment of spinal gliomas. Additionally, these findings have potential implications for the qualitative assessment of spinal gliomas using 18F-FDG-PET/CT. This imaging modality may be useful for making timely treatment decisions in situations where a detailed diagnosis by molecular analysis is not possible.

    DOI: 10.1007/s00701-024-06039-5

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  6. Delayed leukoencephalopathy following non-coil embolization flow diverter stent deployment for an intracranial aneurysm Reviewed

    Muraoka, S; Asai, T; Hamasaki, H; Fukui, T; Suzuki, N; Nishizawa, T; Araki, Y; Saito, R

    NEURORADIOLOGY   Vol. 66 ( 3 ) page: 427 - 429   2024.3

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Neuroradiology  

    This report examines delayed leukoencephalopathy as a postoperative complication after the use of flow diverter (FD) devices for endovascular cerebral aneurysm treatment. A case involving a 78-year-old female treated with a pipeline embolization device for a left internal carotid artery aneurysm is presented. Despite adherence to dual anti-platelet therapy, the patient developed intermittent headaches and memory issues 3 months post-operation. MRI revealed T1-enhancing foci and T2 hyperintense signal abnormalities in the left cerebral hemisphere, without new ischemic lesions, indicating potential embolic events or foreign body reactions. Following aphasia, a change from clopidogrel to prasugrel and the initiation of steroid pulse therapy led to the resolution of symptoms and MRI abnormalities over 6 months. This case underscores the reversibility of delayed leukoencephalopathy with appropriate intervention.

    DOI: 10.1007/s00234-024-03281-7

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  7. Neonatal Ventricular Reservoir Implantation for Hydrocephalus Management in Chiari III Malformations: A Case Report. International journal

    Risa Ito, Yutaro Fuse, Keishi Ito, Hisashi Hatano, Ryuta Saito

    Cureus   Vol. 16 ( 3 ) page: e55896   2024.3

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    Chiari III malformation, a rare and severe subtype of Chiari malformations, is frequently associated with hydrocephalus. The conventional treatment approaches for hydrocephalus in Chiari III malformations have mainly focused on ventriculoperitoneal (VP) shunting, but optimal methods and timing remain uncertain. We report a case of a newborn girl with Chiari III malformation who underwent surgical closure of an occipitocervical encephalocele and ventricular reservoir implantation on her third day of life. This procedure successfully managed her hydrocephalus without significant short-term complications. Three months post-surgery, she developed secondary external hydrocephalus, which was managed through subdural-peritoneal shunting, allowing her to thrive until at least five years of age. This case demonstrates the potential of ventricular reservoir implantation in treating hydrocephalus associated with Chiari III malformation and brings to light secondary external hydrocephalus, subsequently managed by VP shunting.

    DOI: 10.7759/cureus.55896

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  8. Awake Craniotomy for Gliomas in the Non-Dominant Right Hemisphere: A Comprehensive Review Reviewed International coauthorship

    Mamadaliev, DM; Saito, R; Motomura, K; Ohka, F; Scalia, G; Umana, GE; Conti, A; Chaurasia, B

    CANCERS   Vol. 16 ( 6 )   2024.3

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    Awake surgery has become a standard practice for managing diffuse low-grade gliomas (LGGs), particularly in eloquent brain areas, and is established as a gold standard technique for left-dominant-hemisphere tumors. However, the intraoperative monitoring of functions in the right non-dominant hemisphere (RndH) is often neglected, highlighting the need for a better understanding of neurocognitive testing for complex functions in the right hemisphere. This article aims to comprehensively review the current literature on the benefits of awake craniotomy in gliomas of the non-dominant right hemisphere. A systematic review was conducted using the PubMed and ScienceDirect databases with keywords such as “right hemisphere”, “awake surgery”, “direct electrical brain stimulation and mapping”, and “glioma”. The search focused on anatomical and surgical aspects, including indications, tools, and techniques of awake surgery in right cerebral hemisphere gliomas. The literature search identified 74 sources, including original articles, books, monographs, and review articles. Two papers reported large series of language assessment cases in 246 patients undergoing awake surgery with detailed neurological semiology and mapping techniques, while the remaining studies were predominantly neuroradiological and neuroimaging in nature. Awake craniotomy for non-dominant-hemisphere gliomas is an essential tool. The term “non-dominant” should be revised, as this hemisphere contributes significantly to essential cognitive functions in the human brain.

    DOI: 10.3390/cancers16061161

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  9. Cerebral venous sinus thrombosis detected using diffusion-weighted magnetic resonance imaging during maintenance temozolomide chemotherapy in a patient with glioblastoma: illustrative case. Reviewed International journal

    Youhei Takeuchi, Ryuta Saito, Masayuki Kanamori, Kuniyasu Niizuma, Shunji Mugikura, Hidenori Endo

    Journal of neurosurgery. Case lessons   Vol. 7 ( 9 )   2024.2

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    Authorship:Corresponding author   Language:English   Publishing type:Research paper (scientific journal)  

    BACKGROUND: Cerebral venous sinus thrombosis (CVST) sometimes occurs in the background of hypercoagulopathic disorders, including malignancy, chemotherapy, etc. Glioblastoma (GBM) is a malignancy found in the central nervous system, and reports on cases of GBM complicated by CVST are sparse. The authors herein report a case of GBM complicated by CVST during maintenance temozolomide (TMZ) chemotherapy and describe the utility of diffusion-weighted magnetic resonance imaging (MRI) for the detection of CVST. OBSERVATIONS: A 65-year-old male was treated for left temporal GBM. After surgical removal of the lesion, the patient was treated with chemoradiation therapy, which included 60 Gy local radiation with concomitant TMZ chemotherapy. He was subsequently received TMZ maintenance therapy. Routine MRI performed 7 months after surgery revealed no evidence of tumor recurrence. However, diffusion-weighted imaging (DWI) revealed a high-intensity signal at the posterior portion of the superior sagittal sinus, indicating the presence of a thrombus. In addition to the preexisting symptoms, the patient experienced some disorientation. Angiography revealed an obstruction in the superior sagittal sinus, right transverse sinus, right sigmoid sinus, and straight sinus. His symptoms improved with endovascular and anticoagulant therapy. LESSONS: Performing DWI during routine follow-up can help in the early diagnosis of CVST in patients with malignant gliomas.

    DOI: 10.3171/CASE23762

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  10. Hormone Concentration Measurement in Intracranial Dural Arteriovenous Fistulae. Reviewed

    Kropp AE, Nishihori M, Izumi T, Goto S, Yokoyama K, Saito R

    World neurosurgery     2024.2

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    Authorship:Last author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:World Neurosurgery  

    Objective: Intracranial dural arteriovenous fistulae (DAVFs) represent a subset of cerebral vascular malformations associated with significant morbidity and mortality. In Japan, DAVF exhibits sex-based differences in anatomical distribution, with female predominance in the cavernous sinus (CS) and male predominance in the transverse sinus (TS). Nevertheless, the pathophysiology of DAVF is not fully understood, and hormonal influences are hypothesized to play a role in its development. This study aimed to investigate changes in the concentrations of sex steroid hormones between intracranial and peripheral sampling sites in patients with CS- and TS-DAVF. Methods: We recruited 19 patients with CS-DAVF (n = 12) and TS-DAVF (n = 7) in this study. Blood hormone measurements were obtained from peripheral and jugular bulb samples during endovascular intervention. Hormone concentrations were analyzed using enzyme-linked immunosorbent assay kits, and statistical analyses were performed. Results: Our study revealed a higher prevalence of CS-DAVF in females and TS-DAVF in males, which is consistent with previous studies. Estradiol concentration was significantly lower in the jugular bulb compared with in the periphery in both patients with CS- and TS-DAVF. This decrease in estradiol was observed irrespective of the patient's sex and independent of follicle-stimulating hormone levels. Conclusions: These findings indicate a local decrease in estradiol levels within the intracranial vasculature of patients with DAVF. This suggests a potential multifactorial role of estradiol in the pathomechanism of DAVFs, warranting further investigation to understand its influence on DAVF formation and potential targeted therapies, thereby enhancing patient outcomes.

    DOI: 10.1016/j.wneu.2024.02.052

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  11. Outcomes and Prognostic Factors of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor at 2-year Follow-up Reviewed

    HASHIDA Miki, MAESAWA Satoshi, KATO Sachiko, NAKATSUBO Daisuke, TSUGAWA Takahiko, TORII Jun, TANEI Takafumi, ISHIZAKI Tomotaka, MUTOH Manabu, ITO Yoshiki, TSUBOI Takashi, MIZUNO Satomi, SUZUKI Masashi, WAKABAYASHI Toshihiko, KATSUNO Masahisa, SAITO Ryuta

    Neurologia medico-chirurgica   Vol. 64 ( 4 ) page: 137 - 146   2024.2

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    <p>Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Furthermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤ 25, T-max ≥ 52.5°C, anterior-posterior size of lesion ≥ 3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysarthria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.</p>

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  12. Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases. International journal

    Masayuki Kanamori, Yohei Morishita, Yoshiteru Shimoda, Eiko Yamamori, Shiho Sato, Yoshinari Osada, Shin-Ichiro Osawa, Ichiyo Shibahara, Ryuta Saito, Yukihiko Sonoda, Toshihiro Kumabe, Hidenori Endo

    Acta neurochirurgica   Vol. 166 ( 1 ) page: 83 - 83   2024.2

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    BACKGROUND: Distant recurrence can occur by infiltration along white matter tracts or dissemination through the cerebrospinal fluid (CSF). This study aimed to clarify the clinical features and mechanisms of recurrence in the dentate nucleus (DN) in patients with supratentorial gliomas. Based on the review of our patients, we verified the hypothesis that distant DN recurrence from a supratentorial lesion occurs through the dentato-rubro-thalamo-cortical (DRTC) pathway. METHODS: A total of 380 patients with supratentorial astrocytoma, isocitrate dehydrogenase (IDH)-mutant (astrocytoma), oligodendroglioma, IDH mutant and 1p/19q-codeleted (oligodendroglioma), glioblastoma, IDH-wild type (GB), and thalamic diffuse midline glioma, H3 K27-altered (DMG), who underwent tumor resection at our department from 2009 to 2022 were included in this study. Recurrence patterns were reviewed. Additionally, clinical features and magnetic resonance imaging findings before treatment, at the appearance of an abnormal signal, and at further progression due to delayed diagnosis or after salvage treatment of cases with recurrence in the DN were reviewed. RESULTS: Of the 380 patients, 8 (2.1%) had first recurrence in the DN, 3 were asymptomatic when abnormal signals appeared, and 5 were diagnosed within one month after the onset of symptoms. Recurrence in the DN developed in 8 (7.4%) of 108 cases of astrocytoma, GB, or DMG at the frontal lobe or thalamus, whereas no other histological types or sites showed recurrence in the DN. At the time of the appearance of abnormal signals, a diffuse lesion developed at the hilus of the DN. The patterns of further progression showed that the lesions extended to the superior cerebellar peduncle, tectum, tegmentum, red nucleus, thalamus, and internal capsule along the DRTC pathway. CONCLUSION: Distant recurrence along the DRTC pathway is not rare in astrocytomas, GB, or DMG at the frontal lobe or thalamus. Recurrence in the DN developed as a result of the infiltration of tumor cells through the DRTC pathway, not dissemination through the CSF.

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  13. Development of a rapid and comprehensive genomic profiling test supporting diagnosis and research for gliomas.

    Takuma Nakashima, Ryo Yamamoto, Makoto Ohno, Hirokazu Sugino, Masamichi Takahashi, Yusuke Funakoshi, Shohei Nambu, Atsuhito Uneda, Shunsuke Yanagisawa, Takeo Uzuka, Yoshiki Arakawa, Ryosuke Hanaya, Joji Ishida, Koji Yoshimoto, Ryuta Saito, Yoshitaka Narita, Hiromichi Suzuki

    Brain tumor pathology     2024.2

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    A prompt and reliable molecular diagnosis for brain tumors has become crucial in precision medicine. While Comprehensive Genomic Profiling (CGP) has become feasible, there remains room for enhancement in brain tumor diagnosis due to the partial lack of essential genes and limitations in broad copy number analysis. In addition, the long turnaround time of commercially available CGPs poses an additional obstacle to the timely implementation of results in clinics. To address these challenges, we developed a CGP encompassing 113 genes, genome-wide copy number changes, and MGMT promoter methylation. Our CGP incorporates not only diagnostic genes but also supplementary genes valuable for research. Our CGP enables us to simultaneous identification of mutations, gene fusions, focal and broad copy number alterations, and MGMT promoter methylation status, with results delivered within a minimum of 4 days. Validation of our CGP, through comparisons with whole-genome sequencing, RNA sequencing, and pyrosequencing, has certified its accuracy and reliability. We applied our CGP for 23 consecutive cases of intracranial mass lesions, which demonstrated its efficacy in aiding diagnosis and prognostication. Our CGP offers a comprehensive and rapid molecular profiling for gliomas, which could potentially apply to clinical practices and research primarily in the field of brain tumors.

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

    Kazuhito Takeuchi, Yuichi Nagata, Yasuo Sasagawa, Eiji Ito, Taiki Yamamoto, Akihiro Mizuno, Hiroo Sasaki, Tatsuma Kondo, Yoshio Araki, Mitsutoshi Nakada, Ryuta Saito

    Journal of neurosurgery   Vol. 140 ( 2 ) page: 469 - 477   2024.2

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    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.

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  15. Safety of antiplatelet therapy during the perioperative period of revascularization surgery for moyamoya disease patients with ischemic onset Reviewed

    Nakamura, A; Takasu, S; Seki, Y; Saito, R

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 86 ( 1 ) page: 82 - 90   2024.2

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    For patients with moyamoya disease, antiplatelet agents are often used during the perioperative periods of revascularization surgeries to prevent ischemic events. However, antiplatelet therapy is associated with the risk of hemorrhagic complications. Further, the influence of antiplatelet therapy on perioperative ischemic or hemorrhagic complications has not been investigated. This study aimed to determine the impact of antiplatelet agents on adult moyamoya disease patients with ischemic onset during the perioperative period. From January 2016 to December 2020, 183 consecutive combined (direct and indirect) revascularization surgeries for moyamoya disease patients were performed. Among these surgeries, 96 consecutive combined revascularization surgeries for adult moyamoya disease patients with ischemic onset were analyzed and perioperative ischemic and hemorrhagic complications were reviewed. Antiplatelet agents were continued during the perioperative period including on the day of surgery and the day after the surgery. Among 96 surgeries, no hemorrhagic complications occurred postoperatively. Infarction occurred in five cases (5.2%). Among the five cases, neurological deficits persisted in two cases and improved in three. The median value of bleeding volume was 112.5 mL (interquartile range, 80.0–200.0). Twenty-five cases (26.0%) needed blood transfusion. The modified Rankin Scale score deteriorated in two cases due to cerebral infarction. The incidence of hemorrhagic and ischemic complications after combined revascularization surgery in patients with ischemic moyamoya disease under antiplatelet therapy was low, indicating the safety of continued antiplatelet therapy.

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  16. Protective Mechanism of Stem Cells from Human Exfoliated Deciduous Teeth in Treating Spinal Cord Injury Reviewed

    Nishii, T; Osuka, K; Nishimura, Y; Ohmichi, Y; Ohmichi, M; Suzuki, C; Nagashima, Y; Oyama, T; Abe, T; Kato, H; Saito, R

    JOURNAL OF NEUROTRAUMA     2024.1

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    Spinal cord injury (SCI) induces devastating permanent deficits. Recently, cell transplantation therapy has become a notable treatment for SCI. Although stem cells from human exfoliated deciduous teeth (SHED) are an attractive therapy, their precise mechanism of action remains to be elucidated. In this study, we explored one of the neuroprotective mechanisms of SHED treatment at the subacute stage after SCI. We used a rat clip compression SCI model. The animals were randomly divided into three groups: SCI, SCI + phosphate-buffered saline (PBS), and SCI + SHED. The SHED or PBS intramedullary injection was administered immediately after SCI. After SCI, we explored the effects of SHED on motor function, as assessed by the Basso-Beattie-Bresnahan score and the inclined plane method, the signal transduction pathway, especially the Janus kinase (JAK) and the signal transducer and activator of transcription 3 (STAT3) pathway, the apoptotic pathway, and the expression of neurocan, one of the chondroitin sulfate proteoglycans. SHED treatment significantly improved functional recovery from Day 14 relative to the controls. Western blot analysis showed that SHED significantly reduced the expression of glial fibrillary acidic protein (GFAP) and phosphorylated STAT3 (p-STAT3) at Tyr705 on Day 10 but not on Day 5. However, SHED had no effect on the expression levels of Iba-1 on Days 5 or 10. Immunohistochemistry revealed that p-STAT3 at Tyr705 was mainly expressed in GFAP-positive astrocytes on Day 10 after SCI, and its expression was reduced by administration of SHED. Moreover, SHED treatment significantly induced expression of cleaved caspase 3 in GFAP-positive astrocytes only in the epicenter lesions on Day 10 after SCI but not on Day 5. The expression of neurocan was also significantly reduced by SHED injection on Day 10 after SCI. Our results show that SHED plays an important role in reducing astrogliosis and glial scar formation between Days 5 and 10 after SCI, possibly via apoptosis of astrocytes, ultimately resulting in improvement in neurological functions thereafter. Our data revealed one of the neuroprotective mechanisms of SHED at the subacute stage after SCI, which improved functional recovery after SCI, a serious condition.

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  17. Primary Bone Lymphoma of the Spine: A Case Report Highlighting Diagnostic Complexities and Treatment Reviewed

    Tsukamoto, E; Nagashima, Y; Nishimura, Y; Kuwabara, K; Saito, R

    CUREUS JOURNAL OF MEDICAL SCIENCE   Vol. 16 ( 1 ) page: e52524   2024.1

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  18. Boltless nylon-suture technique for stereotactic electroencephalography as a safe, effective alternative when the anchor bolt is inappropriate Reviewed

    Mutoh, M; Maesawa, S; Nakatsubo, D; Ishizaki, T; Tanei, T; Torii, J; Ito, Y; Hashida, M; Saito, R

    ACTA NEUROCHIRURGICA   Vol. 166 ( 1 ) page: 18   2024.1

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    Background: The use of anchor bolts to secure electrodes to the skull can be difficult in some clinical situations. Herein, we present the boltless technique to secure electrodes to the scalp using nylon sutures to overcome the problems associated with anchor bolts. We investigated the safety, accuracy errors, and patient-related and operative factors affecting errors in the boltless technique. Methods: This single-institution retrospective series analyzed 103 electrodes placed in 12 patients. The target-point localization error (TPLE), entry-point localization error (EPLE), radial error (RE), and depth error (DE) of the electrodes were calculated. Results: The median of the mean operative time per electrode was 9.3 min. The median TPLE, EPLE, RE, and absolute DE value were 4.1 mm, 1.6 mm, 2.7 mm, and 1.9 mm, respectively. Positive correlations were observed between the preoperative scalp thickness, mean operative time per electrode, EPLE, RE, and the absolute value of DE versus TPLE (r =.228, p =.02; r =.678, p =.015; r =.228, p =.02; r =.445, p <.01; r =.630, p <.01, respectively), and electrode approach angle versus EPLE (r =.213, p =.031). Multivariate analysis revealed that the absolute value of DE had the strongest influence on the TPLE, followed by RE and preoperative scalp thickness, respectively (β =.938,.544,.060, respectively, p <.001). No complications related to SEEG insertion and monitoring were encountered. Conclusion: The boltless technique using our unique planning and technical method is a safe, effective, and low-cost alternative in cases where anchor bolts are contraindicated.

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  19. Hemodynamic and electrophysiological responses of the human amygdala during face imitation-a study using functional MRI and intracranial EEG Reviewed

    Iidaka, T; Maesawa, S; Kanayama, N; Miyakoshi, M; Ishizaki, T; Saito, R

    CEREBRAL CORTEX   Vol. 34 ( 1 )   2024.1

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    The involvement of the human amygdala in facial mimicry remains a matter of debate. We investigated neural activity in the human amygdala during a task in which an imitation task was separated in time from an observation task involving facial expressions. Neural activity in the amygdala was measured using functional magnetic resonance imaging in 18 healthy individuals and using intracranial electroencephalogram in six medically refractory patients with epilepsy. The results of functional magnetic resonance imaging experiment showed that mimicry of negative and positive expressions activated the amygdala more than mimicry of non-emotional facial movements. In intracranial electroencephalogram experiment and time-frequency analysis, emotion-related activity of the amygdala during mimicry was observed as a significant neural oscillation in the high gamma band range. Furthermore, spectral event analysis of individual trial intracranial electroencephalogram data revealed that sustained oscillation of gamma band activity originated from an increased number and longer duration of neural events in the amygdala. Based on these findings, we conclude that during facial mimicry, visual information of expressions and feedback from facial movements are combined in the amygdalar nuclei. Considering the time difference of information approaching the amygdala, responses to facial movements are likely to modulate rather than initiate affective processing in human participants.

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

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

    CUREUS JOURNAL OF MEDICAL SCIENCE   Vol. 16 ( 1 ) page: e51850   2024.1

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  21. Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial. Reviewed International journal

    Yoshitaka Nagashima, Yoshio Araki, Kazuki Nishida, Shunichiro Kuramitsu, Kenichi Wakabayashi, Shinji Shimato, Takeshi Kinkori, Toshihisa Nishizawa, Takahisa Kano, Toshinori Hasegawa, Atsushi Noda, Kenko Maeda, Yu Yamamoto, Osamu Suzuki, Naoki Koketsu, Takeshi Okada, Masashige Iwasaki, Kiyo Nakabayashi, Shigeru Fujitani, Hideki Maki, Yachiyo Kuwatsuka, Masahiro Nishihori, Takafumi Tanei, Tomohide Nishikawa, Yusuke Nishimura, Ryuta Saito

    Trials   Vol. 25 ( 1 ) page: 6 - 6   2024.1

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    BACKGROUND: The surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH. METHODS: The study will be conducted across 19 neurosurgical departments in Japan. The 1186 eligible patients will be randomly allocated to two groups: irrigation using ACF or not. In either group, a subdural drain is to be placed for at least 12 h postoperatively. Similar to what was done in previous studies, we set the proportion of patients that meet the criteria for ipsilateral reoperation at 7% in the irrigation group and 12% in the non-irrigation group. The primary endpoint is the proportion of patients who meet the criteria for ipsilateral reoperation within 6 months of surgery (clinical worsening of symptoms and increased hematoma on imaging compared with the postoperative state). The secondary endpoints are the proportion of reoperations within 6 months, the proportion being stratified by preoperative hematoma architecture by computed tomography (CT) scan, neurological symptoms, patient condition, mortality at 6 months, complications associated with surgery, length of hospital stay from surgery to discharge, and time of the surgical procedure. DISCUSSION: We present the study protocol for a multicenter randomized controlled trial to investigate our hypothesis that intraoperative irrigation with ACF reduces the recurrence proportion after the removal of chronic subdural hematomas compared with no irrigation. TRIAL REGISTRATION: ClinicalTrials.gov jRCT1041220124. Registered on January 13, 2023.

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  22. Effect of thin-split encephalomyosynangiosis on transient neurological events in revascularization surgery for pediatric patients with moyamoya disease. Reviewed International journal

    Kazuki Ishii, Fumiaki Kanamori, Yoshio Araki, Kenji Uda, Kinya Yokoyama, Takashi Mamiya, Kai Takayanagi, Shunsaku Goto, Masahiro Nishihori, Takashi Izumi, Ryuta Saito

    Journal of neurosurgery. Pediatrics   Vol. 33 ( 1 ) page: 29 - 34   2024.1

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    OBJECTIVE: Transient neurological events (TNEs) are among the most important events after revascularization surgery in pediatric patients with moyamoya disease (MMD). Although hemodynamic changes and crying are representative factors of TNEs, brain compression by encephalomyosynangiosis (EMS) is another important cause of TNEs. Therefore, the authors assumed that making the EMS as thin as possible reduces the frequency of TNEs. However, thin-split EMS can lead to insufficient development of collateral vessels. This study aimed to evaluate the effects of thin-split EMS in combined revascularization surgery on postoperative outcomes in pediatric patients with MMD. METHODS: The authors retrospectively included 56 consecutive combined revascularization surgeries in the anterior cerebral circulation in pediatric patients with MMD. These surgeries were classified into the former group and thin-split EMS group. The temporal muscle was halved in the former EMS group and split as thinly as possible in the thin-split EMS group. The authors performed between-group comparisons of postoperative stroke events and TNEs during the acute period and the development of collateral flow and stroke events during the chronic period. RESULTS: Former and thin-split EMS procedures were performed in 37 and 19 patients, respectively. TNEs without crying or hemodynamic changes were observed significantly less frequently in the thin-split EMS group than in the former EMS group (0 [0.0%] in the thin-split EMS group vs 9 [24.3%] in the former EMS group, p = 0.021). There were no significant between-group differences in the development of indirect bypass during the chronic period (good: 34 [91.9%] and poor: 3 [8.1%] in the former EMS group vs good: 16 [84.2%] and poor: 3 [15.8%] in the thin-split EMS group; p = 0.397). Additionally, there were no significant between-group differences in the incidence of chronic clinical events, including death or stroke. CONCLUSIONS: Thin-split EMS can reduce TNEs that do not accompany crying or hemodynamic changes. Furthermore, the procedure has sufficient prevention effects against stroke events during the chronic postoperative period in pediatric patients with MMD.

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  23. Characteristics of donor vessels and cerebral blood flow in the chronic phase after combined revascularization surgery for moyamoya disease. Reviewed International journal

    Takashi Mamiya, Yoshio Araki, Toshiaki Taoka, Naotoshi Fujita, Kinya Yokoyama, Kenji Uda, Shinsuke Muraoka, Fumiaki Kanamori, Kai Takayanagi, Kazuki Ishii, Masahiro Nishihori, Takashi Izumi, Katsuhiko Kato, Ryuta Saito

    Clinical neurology and neurosurgery   Vol. 236   page: 108110 - 108110   2024.1

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    OBJECTIVE: This study aimed to analyze whether the development of donor vessels after combined revascularization surgery for moyamoya disease (MMD) is related to cerebral blood flow (CBF) changes. METHODS: We retrospectively reviewed the charts of 11 adult (12 hemispheres) and 13 pediatric (19 hemispheres) patients who underwent combined revascularization in our department. The total vessel cross-sectional area (TVA) was the sum of the cross-sectional areas of the superficial temporal, middle meningeal, and deep temporal arteries imaged using time-of-flight magnetic resonance angiography. The ipsilateral relative CBF (RCBF) on the brain surface in the craniotomy area was calculated by single-photon emission computed tomography. ΔTVA and ΔRCBF were defined as the preoperative and postoperative ratios of TVA and RCBF, and their correlations were analyzed in adult and pediatric patients. RESULTS: The TVA and RCBF showed a significant increase after surgery, regardless of the age group. However, there was no significant correlation between ΔTVA and ΔRCBF in either the adult or pediatric groups. While the adult group exhibited significantly higher ΔRCBF values compared to the pediatric group (p < 0.01, r = -0.44), the ΔTVA values were higher in the pediatric group compared to the adult group (p = 0.06). CONCLUSIONS: In the chronic phase after combined revascularization surgery for MMD, the development of measurable TVA of donor vessels does not necessarily correlate with an increase in CBF around the craniotomy area.

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  24. T cell exhaustion and challenges of CAR-T cell therapy for solid tumors Invited

    Kuramitsu Shunichiro, Yamaguchi Junya, Nohira Shota, Ohno Masasuke, Fujita Mitsugu, Saito Ryuta

    Japanese Journal of Transplantation and Cellular Therapy   Vol. 13 ( 1 ) page: 33 - 41   2024

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    <p> CD19-redirected chimeric antigen receptor (CAR) T cell therapy has achieved remarkable success in hematological malignancies. However, targeting solid tumor is still challenging. T cell exhaustion is one of the major barriers in tumor microenvironment of solid tumors. In this review, we summarize the multifaceted mechanisms of T cell exhaustion and describe a new insight of CAR T cell exhaustion characterized by a T to NK like transition. Furthermore, the strategies to overcome T cell exhaustion to improve the efficacy of CAR T cell therapy will be addressed.</p>

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  25. Hemifacial spasm caused by multiple vascular attachments due to remote compression effects of a dermoid cyst in the cerebellar hemisphere: illustrative case. Reviewed International journal

    Kento Hirayama, Takafumi Tanei, Takenori Kato, Toshinori Hasegawa, Eiji Ito, Yusuke Nishimura, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 6 ( 23 )   2023.12

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    BACKGROUND: Dermoid cysts located laterally in the posterior fossa are rare. The authors report the case of a dermoid cyst in the cerebellar hemisphere presenting with hemifacial spasm (HFS) caused by multiple vascular attachments due to remote compression effects. OBSERVATIONS: A 48-year-old man presented with left HFS. Computed tomography showed a mass lesion in the left cerebellar hemisphere with calcification and erosion of skull bone. Magnetic resonance imaging showed no contrast enhancement of the lesion and a dural defect. The lesion compressed the brainstem and cerebellopontine cistern, but no vascular attachments to the facial nerve were seen. Tumor removal and microvascular decompression were performed. The lesion was composed of soft tissue containing oil-like liquid and hairs, and the border of the cerebellar arachnoid was clear. There were multiple vascular attachments to the root exit zone, facial nerve, and brainstem. After displacing these arteries, the intraoperative abnormal muscle response disappeared. Histopathological findings showed stratified squamous epithelium, keratin flakes, calcifications, and hairs. The HFS disappeared completely and has remained absent for 27 months. LESSONS: The dermoid cyst originating from occipital bone compressed the cerebellar hemisphere, displacing multiple vessels and leading to HFS. Tumor removal and the removal of all vascular factors can completely resolve HFS.

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  26. Clinical Efficiency of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Aneurysm: Comparison with the Conventional Method. Reviewed International journal

    Kojiro Ishikawa, Takashi Izumi, Masahiro Nishihori, Takahiro Imaizumi, Shunsaku Goto, Keita Suzuki, Kinya Yokoyama, Fumiaki Kanamori, Kenji Uda, Yoshio Araki, Ryuta Saito

    Clinical neuroradiology   Vol. 33 ( 4 ) page: 1143 - 1150   2023.12

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    PURPOSE: Artificial intelligence (AI)-based three-dimensional angiography (3D-A) was reported to demonstrate visualization of cerebral vasculature equivalent to that of three-dimensional digital subtraction angiography (3D-DSA). However, the applicability and efficacy of the AI-based 3D‑A algorithm have not yet been investigated for 3D-DSA micro imaging. In this study, we evaluated the usefulness of the AI-based 3D‑A in 3D-DSA micro imaging. MATERIALS AND METHODS: The 3D-DSA micro datasets of 20 consecutive patients with cerebral aneurysm (CA) were reconstructed with 3D-DSA and 3D‑A. Three reviewers compared 3D-DSA and 3D‑A in terms of qualitative parameters (degrees of visualization of CA and the anterior choroidal artery [AChA]) and quantitative parameters (aneurysm diameter, neck diameter, parent vessel diameter, and visible length of AChA). RESULTS: Qualitative evaluation of diagnostic potential revealed that visualization of CA and the proximal to middle parts of the AChA with 3D‑A was equal to that with conventional 3D-DSA; in contrast, visualization of the distal part of the AChA was lower with 3D‑A than with 3D-DSA. Further, regarding quantitative evaluation, the aneurysm diameter, neck diameter, and parent vessel diameter were comparable between 3D‑A and 3D-DSA; in contrast, the visible length of the AChA was lower with 3D‑A than with 3D-DSA. CONCLUSIONS: The AI-based 3D‑A technique is feasible and evaluable visualization of cerebral vasculature with respect to quantitative and qualitative parameters in 3D-DSA micro imaging. However, the 3D‑A technique offers lower visualization of such as the distal portion of the AChA than 3D-DSA.

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  27. Lateral Lumbar Interbody Fusion within Three-level for Patients with Neurological Symptoms due to Vertebral Fragility Fractures in the Lumbar Spine Reviewed

    Nagashima, Y, Nishimura, Y, Kanemura, T, Hata, N, Satake, K, Akahori, S, Ishii, M, Tanei, T, Takayasu, M, Saito, R

    Neurologia Medico-Chirurgica   Vol. 63 ( 12 ) page: 548 - 554   2023.12

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    <p>There is a lack of agreement on whether minimally invasive lateral lumbar intervertebral fusion (LLIF) is a suitable treatment option for vertebral fragility fractures (VFFs). Hence, we sought to evaluate the efficacy and safety of LLIF in the management of VFF with neurological deficits in the lumbar spine. Between April 2015 and March 2020, we conducted a retrospective observational study of patients with VFF treated with three-level or less LLIF. The participants had previously received conservative treatment but had not been able to control their neurological symptoms. To assess the outcomes of the LLIF procedures, the patients were followed up for a minimum of 1 year. Clinical and radiological results, which include the timing and location of the bony fusion, were analyzed. The study involved 19 patients with 23 vertebral fracture levels. The residual height of the fractured vertebra was found to be 57.0 ± 12.3% of the height of the adjacent level. The mean Japanese Orthopedic Association score significantly improved postoperatively. Postoperative radiological parameters were significantly maintained at 1 year, and lumbar lordosis was maintained at the last follow-up (45.0 ± 26.7). In total 31 LLIF levels, bone fusion was observed in four levels at 6 months postoperatively, in 16 levels at 1 year, and in 23 levels at the last follow-up. The facet joint had the highest bony fusion location. LLIF within three levels can be safely performed in certain VFF cases with sufficient residual vertebral height.</p>

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  28. Endoscopic debulking canalization for optic pathway glioma with obstructive hydrocephalus. Reviewed International journal

    Kazuhito Takeuchi, Fumiharu Ohka, Yuichi Nagata, Eiji Ito, Hideyuki Harada, Ryuta Saito

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery   Vol. 39 ( 12 ) page: 3421 - 3425   2023.12

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    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)).

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

    Yutaro Fuse, Kazuhito Takeuchi, Noriaki Hashimoto, Yuichi Nagata, Yusuke Takagi, Tetsuya Nagatani, Ichiro Takeuchi, Ryuta Saito

    Neurosurgical Review   Vol. 46 ( 1 ) page: 291   2023.11

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  30. Difference of coil distribution made by finishing coils in large size aneurysm model with radiolucent coils. Reviewed

    Hiroki Matsuno, Takashi Izumi, Masahiro Nishihori, Shunsaku Goto, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Ryuta Saito

    Nagoya journal of medical science   Vol. 85 ( 4 ) page: 725 - 732   2023.11

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    We conducted a study to understand the characteristics of the finishing coils to select the appropriate coil for the final stage of embolization. Consequently, experimental embolization was performed on a 10 mm spherical silicone aneurysm filled with radiolucent coils, which simulated a volume embolization ratio of 20%. Nine different coils (i-ED complex ∞ SilkySoft, SilkySoft, ExtraSoft, V-Trak HyperSoft helical, Barricade 10 complex finishing, Optima complex 10 soft, Target 360 Ultra, Galaxy G3 mini, and Axium prime 3D ExtraSoft) were analyzed six times at random. After each coil insertion, indices that include area, Feret diameter, circularity, and centroid center of mass were calculated using biplane x-ray images. Furthermore, these data were analyzed using the spring constant k, which represents the stiffness of the coil. In multiple comparisons, a significant difference was observed in the area analysis. The i-ED complex ∞ SilkySoft was more widespread than Target 360 Ultra (p < 0.05). However, no significant differences were observed in the other indices. The spring constant k value of Target 360 Ultra was 2.5 times larger than that of the i-ED complex ∞ SilkySoft, and it negatively correlated with the area index rather than with the other indices. Notably, it was suggested that the smaller the spring constant k, the wider the distribution of the finishing coils. Although there was little difference between the coils, some coils had characteristics suggesting that good embolization could be expected using appropriate finishing coils.

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  31. DISSECTING THE INTRA- AND INTER-TUMORAL HETEROGENEITY UNDERLYING GLIOBLASTOMA PATHOGENESIS UTILIZING MULTI-OMICS ANALYSIS

    Nakashima, T; Funakoshi, Y; Yajima, H; Yamamoto, R; Sugihara, Y; Nambu, S; Arakawa, Y; Tanaka, S; Ishida, J; Saito, R; Hanaya, R; Yoshimoto, K; Narita, Y; Suzuki, H

    NEURO-ONCOLOGY   Vol. 25   2023.11

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  32. 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

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  33. DISSECTING THE INTRA- AND INTER-TUMORAL HETEROGENEITY UNDERLYING GLIOBLASTOMA PATHOGENESIS UTILIZING MULTI-OMICS ANALYSIS

    Nakashima, T, Funakoshi, Y, Yajima, H, Yamamoto, R, Sugihara, Y, Nambu, S, Arakawa, Y, Tanaka, S, Ishida, J, Saito, R, Hanaya, R, Yoshimoto, K, Narita, Y, Suzuki, H

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  34. 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

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  35. GLIOBLASTOMA, IDH-WILDTYPE WITHOUT KEY MOLECULAR FEATURES

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

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  36. IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMAS, H3 G34-MUTANT

    Kibe, Y, Ohka, F, Motomura, K, Aoki, K, Maeda, S, Yamaguchi, J, Shimizu, H, Saito, R

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  37. Epileptogenic zone in Broca's area is resectable under awake surgery in accordance with the hodotopic framework: A case report Reviewed

    Suzuki, T, Ishizaki, T, Maesawa, S, Hashida, M, Mutoh, M, Ito, Y, Tanei, T, Saito, R

    Seizure   Vol. 112   page: 84 - 87   2023.11

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  38. Minor Suture Fusion is Associated With Chiari Malformation in Nonsyndromic Craniosynostosis. Reviewed International journal

    Kosuke Mizutani, Michihiro Kurimoto, Masamune Nagakura, Tomoki Nawashiro, Toshiya Nagai, Kosuke Aoki, Mihoko Kato, Ryuta Saito

    The Journal of craniofacial surgery   Vol. 34 ( 8 ) page: 2308 - 2312   2023.11

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    Here, we focused on the association between minor suture fusion and Chiari malformation (CM) occurrence in nonsyndromic craniosynostosis (NSC), and evaluated how the minor suture affects the posterior cranial fossa by measuring the posterior fossa deflection angle (PFA). In this retrospective study, the clinical records of 137 patients who underwent surgery for NSC at Aichi Children's Health and Medical Center between April 2010 and May 2022 were analyzed. Clinical data from Aichi Developmental Disability Center Central Hospital was collected for 23 patients as the external validation set. Among the 137 patients, 123 were diagnosed with NSC and the remaining 14 with syndromic craniosynostosis. Of the 123 NSC patients, 23 patients presented with CM. Multivariate analysis showed that occipito-mastoid fusion was the only significant risk factor for CM (P=0.0218). Within the NSC group, CM patients had a significantly increased PFA (6.33±8.10 deg) compared with those without CM (2.76±3.29 deg, P=0.0487). Nonsyndromic craniosynostosis patients with occipito-mastoid suture fusion had a significantly increased PFA (6.50±7.60 deg) compared with those without occipito-mastoid fusion (2.60±3.23 deg, P=0.0164). In the validation cohort, occipito-mastoid suture fusion was validated as an independent risk factor for CM in univariate analysis. Minor suture fusion may cause CM associated with NSC. Chiari malformation could develop due to an increased PFA due to minor suture fusion, which causes growth disturbance in the affected side and compensatory dilation in the contralateral side within the posterior cranial fossa.

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  39. Local Delivery of Nimustine Hydrochloride against Brain Tumors: Basic Characterization Study Reviewed

    Xiaodong Shao, Ryuta Saito, Aya Sato, Saori Okuno, Daisuke Saigusa, Ritsumi Saito, Akira Uruno, Yoshinari Osada, Masayuki Kanamori, Teiji Tominaga

    The Tohoku Journal of Experimental Medicine   Vol. 261 ( 3 ) page: 187 - 194   2023.11

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    <p>Convection-enhanced delivery (CED) delivers agents directly into tumors and the surrounding parenchyma. Although a promising concept, clinical applications are often hampered by insufficient treatment efficacy. Toward developing an effective CED-based strategy for delivering drugs with proven clinical efficacy, we performed a basic characterization study to explore the locally delivered characteristics of the water soluble nitrosourea nimustine hydrochloride (ACNU). First, ACNU distribution after CED in rodent brain was studied using mass spectrometry imaging. Clearance of <sup>14</sup>C-labeled ACNU after CED in striatum was also studied. ACNU was robustly distributed in rodent brain similar to the distribution of the hydrophilic dye Evans blue after CED, and locally delivered ACNU was observed for over 24 h at the delivery site. Subsequently, to investigate the potential of ACNU to induce an immunostimulative microenvironment, Fas and transforming growth factor-<i>β</i>1 (TGF-<i>β</i>1) was assessed <i>in vitro</i>. We found that ACNU significantly inhibited TGF-<i>β</i>1 secretion and reduced Fas expression. Further, after CED of ACNU in 9L-derived intracranial tumors, the infiltration of CD4/CD8 lymphocytes in tumors was evaluated by immunofluorescence.CED of ACNU in xenografted intracranial tumors induced tumor infiltration of CD4/CD8 lymphocytes. ACNU has a robust distribution in rodent brain by CED, and delayed clearance of the drug was observed at the local infusion site. Further, local delivery of ACNU affects the tumor microenvironment and induces immune cell migration in tumor. These characteristics make ACNU a promising agent for CED.</p>

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  40. 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

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  41. IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMAS, H3 G34-MUTANT

    Kibe, Y; Ohka, F; Motomura, K; Aoki, K; Maeda, S; Yamaguchi, J; Shimizu, H; Saito, R

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  42. GLIOBLASTOMA, IDH-WILDTYPE WITHOUT KEY MOLECULAR FEATURES

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

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  43. 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

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

    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   Vol. 13 ( 1 ) page: 18545   2023.10

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    DOI: 10.1038/s41598-023-45755-3

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  45. Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas Reviewed

    Fuse, Y; Nagashima, Y; Nishiwaki, H; Ohka, F; Muramatsu, Y; Araki, Y; Nishimura, Y; Ienaga, J; Nagatani, T; Seki, Y; Watanabe, K; Ohno, K; Saito, R

    SCIENTIFIC REPORTS   Vol. 13 ( 1 ) page: 16997   2023.10

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    Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. Data were retrospectively collected from patients who underwent CSDH surgery at two institutions: one for internal validation and the other for external validation. The poor functional outcome was defined as a modified Rankin scale score of 3–6 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n = 188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. The prediction performance of these models was also validated in an external cohort (n = 99). The area under the curve of the receiver operating characteristic curve (ROC-AUC) of each machine learning-based model was found to be high in both validations (internal: 0.906–0.925, external: 0.833–0.860). In external validation, the SVM model demonstrated the highest ROC-AUC of 0.860 and accuracy of 0.919. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery.

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  46. Comparative Study of Surgical Outcomes of Occipitocervical and Atlantoaxial Fusion for Retro-Odontoid Pseudotumor Reviewed

    Nishii, T, Nishimura, Y, Nagashima, Y, Tanei, T, Hara, M, Takayasu, M, Kanemura, T, Saito, R

    World Neurosurgery   Vol. 178   page: E230 - E238   2023.10

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    DOI: 10.1016/j.wneu.2023.07.038

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  47. Focus disconnection of the SEEG-identified epileptic network by radiofrequency thermal coagulation Reviewed

    Ishizaki, T, Maesawa, S, Yamamoto, H, Hashida, M, Mutoh, M, Ito, Y, Tanei, T, Natsume, J, Saito, R

    Seizure   Vol. 111   page: 17 - 20   2023.10

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  48. Paroxysmal Sympathetic Hyperactivity in Stroke Reviewed

    Muraoka, S., Kumagai, Y., Koketsu, N., Araki, Y., Saito, R.

    World Neurosurgery   Vol. 178   page: 28 - 36   2023.10

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  49. Simulation of the occipital transtentorial approach incorporating visualization of the cerebellar tentorium using three-dimensional computed tomography angiography and gadolinium-enhanced T1-weighted magnetic resonance imaging: technical note. International journal

    Yuto Shingai, Masayuki Kanamori, Yoshiteru Shimoda, Shingo Kayano, Hitoshi Nemoto, Shunji Mugikura, Ryuta Saito, Teiji Tominaga

    Neurosurgical review   Vol. 46 ( 1 ) page: 259 - 259   2023.9

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    The occipital transtentorial approach (OTA) is one of the useful approaches to the lesions of the pineal region, dorsal brainstem, and supracerebellar region. However, a wide operative field is sometimes difficult to obtain due to the tentorial sinus and bridging veins. This study evaluated the usefulness of preoperative simulation of OTA, specifically including the cerebellar tentorium in 9 patients. All patients underwent computed tomography angiography and venography and gadolinium-enhanced three-dimensional T1-weighted magnetic resonance images (Gd-3D-T1WI). The images were fused, and the cerebellar tentorium, vessels, and tumor were manually extracted from Gd-3D-T1WI to obtain the simulation images. Visualization of the cerebellar tentorium could discriminate between bridging veins from the occipital lobe and cerebellum, and recognize the site of bridging to the tentorial sinus and variants which may interfere with the tentorial incision. Simulation of the tentorial incision was also possible based on the relationships between the tumor, tentorial sinus, bridging vein, and cerebellar tentorium. The simulation suggested that safe tentorial incision was difficult in two sides because of the crossed tentorial sinus draining the left basal vein and draining veins from the glioblastoma. The OTA was performed in eight cases, and no difficulty was experienced in the tentorial incision in all cases. The simulation findings of the bridging vein and tentorial sinus were consistent with the intraoperative findings. Preoperative simulation including the cerebellar tentorium is useful for determining the optimum and safe side and required extent of the tentorial incision necessary for tumor resection with the OTA.

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  50. Efficacy of the latest new stimulation patterns of spinal cord stimulation for intractable neuropathic pain compared to conventional stimulation: study protocol for a clinical trial. Reviewed International journal

    Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Yoshitaka Nagashima, Tomotaka Ishizaki, Masahiko Ando, Yachiyo Kuwatsuka, Atsushi Hashizume, Shimon Kurasawa, Ryuta Saito

    Trials   Vol. 24 ( 1 ) page: 604 - 604   2023.9

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    BACKGROUND: Spinal cord stimulation (SCS) is one of the neuromodulation therapies for chronic neuropathic pain. The conventional paresthesia-based SCS involves the application of tonic stimulation that induces a sense of paresthesia. Recently, new SCS stimulation patterns without paresthesia have been developed. Differential target multiplexed (DTM) stimulation and fast-acting subperception therapy (FAST) stimulation are the latest paresthesia-free SCS patterns. METHODS: A single-center, open-label, crossover, randomized clinical trial to investigate the superiority of SCS using the latest new stimulation patterns over conventional tonic stimulation for neuropathic pain is planned. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). In the SCS trial, participants will be randomly assigned to 4 groups receiving stimulation, including tonic, DTM, and FAST. Each stimulation will then be performed for 2 days, and a visual analog scale (VAS) for pain will be evaluated before and after each stimulation pattern. A stimulation-off period for 1 day is set between each stimulation pattern to wash out the residual previous stimulation effects. Pain improvement is defined as more than 33% reduction in the pain VAS. The primary analysis will compare pain improvement between the new stimulation patterns and the conventional tonic stimulation pattern in the SCS trial. The secondary outcomes will be evaluated as follows: (1) the relationships between causative disease and improvement rate by each stimulation pattern; (2) comparison of pain improvement between the DTM and FAST stimulation patterns in all cases and by causative disease; (3) changes in assessment items preoperatively to 24 months after the implantation; (4) preoperative factors associated with long-term effects defined as continuing for more than 12 months; and (5) adverse events related to this study 3 months after the implantation. DISCUSSION: This study aims to clarify the effectiveness of the latest new stimulation patterns compared to the conventional tonic stimulation. In addition, which stimulation pattern is most effective for which kind of causative disease will be clarified. TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT) 1,042,220,094. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is an approved member of the Primary Registry Network of WHO ICTRP.

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  51. Predictive factors of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping Reviewed

    Motomura, K, Kawamura, A, Ohka, F, Aoki, K, Nishikawa, T, Yamaguchi, J, Kibe, Y, Shimizu, H, Maeda, S, Saito, R

    Journal of Neuropsychology   Vol. 18 Suppl 1 ( S1 ) page: 73 - 84   2023.9

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  52. [Ependymoma in WHO Classification of Tumours 5th Edition]. Invited Reviewed

    Saito R

    No shinkei geka. Neurological surgery   Vol. 51 ( 5 ) page: 867 - 875   2023.9

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  53. 本態性振戦およびジストニア性振戦の9軸モーションセンサを用いた特徴抽出

    坪井 崇, 澤田 桂都, 星野 聖奈, 樋口 萌花, 武藤 学, 伊藤 芳記, 石崎 友崇, 種井 隆文, 中坪 大輔, 前澤 聡, 鈴木 将史, 佐藤 茉紀, 玉腰 大悟, 平賀 経太, 佐竹 勇紀, 齋藤 竜太, 勝野 雅央

    臨床神経学   Vol. 63 ( Suppl. ) page: S246 - S246   2023.9

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  54. 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   Vol. 99 ( S.HPT ) page: 4 - 6   2023.8

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  55. 特集 覚醒下手術の最前線--臨床的意義と神経科学 言語機能温存を目指したlower grade gliomaに対する覚醒下手術

    本村 和也, 齋藤 竜太

    医学のあゆみ   Vol. 286 ( 9 ) page: 707 - 713   2023.8

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  56. TUG1-mediated R-loop resolution at microsatellite loci as a prerequisite for cancer cell proliferation. Reviewed International journal

    Miho M Suzuki, Kenta Iijima, Koichi Ogami, Keiko Shinjo, Yoshiteru Murofushi, Jingqi Xie, Xuebing Wang, Yotaro Kitano, Akira Mamiya, Yuji Kibe, Tatsunori Nishimura, Fumiharu Ohka, Ryuta Saito, Shinya Sato, Junya Kobayashi, Ryoji Yao, Kanjiro Miyata, Kazunori Kataoka, Hiroshi I Suzuki, Yutaka Kondo

    Nature communications   Vol. 14 ( 1 ) page: 4521 - 4521   2023.8

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    Oncogene-induced DNA replication stress (RS) and consequent pathogenic R-loop formation are known to impede S phase progression. Nonetheless, cancer cells continuously proliferate under such high-stressed conditions through incompletely understood mechanisms. Here, we report taurine upregulated gene 1 (TUG1) long noncoding RNA (lncRNA), which is highly expressed in many types of cancers, as an important regulator of intrinsic R-loop in cancer cells. Under RS conditions, TUG1 is rapidly upregulated via activation of the ATR-CHK1 signaling pathway, interacts with RPA and DHX9, and engages in resolving R-loops at certain loci, particularly at the CA repeat microsatellite loci. Depletion of TUG1 leads to overabundant R-loops and enhanced RS, leading to substantial inhibition of tumor growth. Our data reveal a role of TUG1 as molecule important for resolving R-loop accumulation in cancer cells and suggest targeting TUG1 as a potent therapeutic approach for cancer treatment.

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  57. Transarterial embolization and transvenous embolization for transverse-sigmoid sinus dural arteriovenous fistulas with cortical venous reflux: A comparative study. Reviewed International journal

    Tetsuya Tsukada, Takashi Izumi, Masahiro Nishihori, Yoshio Araki, Kenji Uda, Kinya Yokoyama, Ryuta Saito

    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences     page: 15910199231195135 - 15910199231195135   2023.8

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    BACKGROUND: Dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) carry a high risk for neurological sequelae or death. Recently, transverse-sigmoid sinus DAVFs were shown as good indications for transarterial embolization (TAE) with ONYX. Here, we compared the effectiveness and safety of conventional transvenous embolization (TVE) with those of TAE with ONYX for transverse-sigmoid sinus DAVFs with CVR. METHODS: Sixty-one patients with transverse-sigmoid sinus DAVFs were treated from April 2013 to May 2020. Among them, 37 patients with CVR were included. Transarterial embolization and TVE were compared in terms of complete occlusion and residual CVR immediately after treatment, complications with worsening modified Rankin Scale (mRS) ≥ 1, amount of contrast media used during treatment, radiation exposure, and surgical procedure time. RESULTS: Ten patients were treated with 10 TAEs using ONYX and 27 patients with 29 TVEs. Transarterial embolization and TVE showed no differences in the overall complete occlusion rate (80% [8/10 patients] vs. 80% [23/27], respectively), whereas the residual rate of existing CVR was 10% (1/10 patient) vs. 3.4% (1/27) in the TAE and TVE groups, respectively. No complications with worsening mRS ≥1 occurred in either group. Among the parameters of amount of contrast media, radiation dose, and operative time, only radiation dose in the TAE group was lower than that in the TVE group (median: 2239 mGy vs. 3268 mGy, respectively; p = 0.07). CONCLUSION: For transverse-sigmoid sinus DAVFs with CVR, TAE treatment reduced radiation exposure. However, both TAE and TVE achieved high complete occlusion rates and low complication rates.

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  58. Real-world data of clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. Reviewed International journal

    Shinsuke Muraoka, Takumi Asai, Takahiko Fukui, Shinji Ota, Shinji Shimato, Naoki Koketsu, Toshihisa Nishizawa, Yoshio Araki, Ryuta Saito

    Neurosurgical review   Vol. 46 ( 1 ) page: 195 - 195   2023.8

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    Aneurysmal subarachnoid hemorrhage (aSAH) may lead to cerebral vasospasm, significantly associated with morbidity and mortality. In double-blind, placebo-controlled phase 3 studies, clazosentan reduces cerebral vasospasm-related morbidity and all-cause mortality in patients with aSAH. There are no reports about the clinical efficacy of clazosentan combination therapy with some other drugs. Initially, we explored the efficacy of clazosentan combination therapy with cilostazol, statin, and antiepileptic drugs. Subsequently, we assessed the add-on effect of fasudil to clazosentan combination therapy for aSAH patients. This multicenter, retrospective, observational cohort study included Japanese patients with aSAH between June 2022 and March 2023. The primary outcome was the ordinal score on the modified Rankin Scale (mRS; range, 0-6, with elevated scores indicating greater disability) at discharge. Among the 47 cases (women 74.5%; age 64.4 ± 15.0 years) undergoing clazosentan combination therapy, 29 (61.7%) resulted in favorable outcomes. Overall, vasospasm occurred in 16 cases (34.0%), with four cases (8.5%) developing vasospasm-related delayed cerebral ischemia (DCI). Both hypotension and vasospasm-related DCI were related to unfavorable outcome at discharge. Fasudil were added in 18 (38.3%) cases. Despite adding fasudil to clazosentan combination therapy, the incidence of aSAH-related vasospasm did not decrease. Added-on fasudil to combination therapy related to pulmonary edema, vasospasm, and vasospasm-related DCI, and unfavorable outcomes. Clazosentan combination therapy could potentially result in favorable outcomes for aSAH patients to prevent post-aSAH vasospasm-related DCI. The add-on effect of fasudil to combination therapy did not demonstrate a significant impact in reducing aSAH-related vasospasm or improving outcomes at discharge.

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  59. Moyamoya disease-specific extracellular vesicle-derived microRNAs in the cerebrospinal fluid revealed by comprehensive expression analysis through microRNA sequencing. Reviewed International journal

    Shinji Ota, Kinya Yokoyama, Fumiaki Kanamori, Takashi Mamiya, Kenji Uda, Yoshio Araki, Toshihiko Wakabayashi, Kazuhiro Yoshikawa, Ryuta Saito

    Acta neurochirurgica   Vol. 165 ( 8 ) page: 2045 - 2055   2023.8

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    PURPOSE: To examine the specific changes that occur in the expression levels of extracellular vesicle-derived microRNAs (miRNAs) in intracranial cerebrospinal fluid (CSF) in moyamoya disease. METHODS: Patients with arteriosclerotic cerebral ischemia were used as controls to eliminate the effects of cerebral ischemia. Intracranial CSF was collected from moyamoya disease and control patients during bypass surgery. Extracellular vesicles (EVs) were extracted from the CSF. Comprehensive expression analysis of miRNAs extracted from EVs by next-generation sequencing (NGS) and validation by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed. RESULTS: Experiments were conducted on eight cases of moyamoya disease and four control cases. In the comprehensive miRNA expression analysis, 153 miRNAs were upregulated, and 98 miRNAs were downregulated in moyamoya disease compared to the control cases (q-value < 0.05 and |log2 fold change|> 1). qRT-PCR performed on the four most variable miRNAs (hsa-miR-421, hsa-miR-361-5p, hsa-miR-320a, and hsa-miR-29b-3p) associated with vascular lesions among the differentially expressed miRNAs gave the same results as miRNA sequencing. On gene ontology (GO) analysis for the target genes, cytoplasmic stress granule was the most significant GO term. CONCLUSIONS: This study is the first comprehensive expression analysis of EV-derived miRNAs in the CSF of moyamoya disease patients using NGS. The miRNAs identified here may be related to the etiology and pathophysiology of moyamoya disease.

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  60. Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy. Reviewed

    Motonori Ishii, Yusuke Nishimura, Masahito Hara, Yu Yamamoto, Yoshitaka Nagashima, Takafumi Tanei, Masakazu Takayasu, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 63 ( 8 ) page: 350 - 355   2023.8

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    Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

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  61. Latest classification of ependymoma in the molecular era and advances in its treatment: a review. Invited Reviewed International journal

    Junya Yamaguchi, Fumiharu Ohka, Kazuya Motomura, Ryuta Saito

    Japanese journal of clinical oncology   Vol. 53 ( 8 ) page: 653 - 663   2023.7

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    Ependymoma is a rare central nervous system (CNS) tumour occurring in all age groups and is one of the most common paediatric malignant brain tumours. Unlike other malignant brain tumours, ependymomas have few identified point mutations and genetic and epigenetic features. With advances in molecular understanding, the latest 2021 World Health Organization (WHO) classification of CNS tumours divided ependymomas into 10 diagnostic categories based on the histology, molecular information and location; this accurately reflected the prognosis and biology of this tumour. Although maximal surgical resection followed by radiotherapy is considered the standard treatment method, and chemotherapy is considered ineffective, the validation of the role of these treatment modalities continues. Although the rarity and long-term clinical course of ependymoma make designing and conducting prospective clinical trials challenging, knowledge is steadily accumulating and progress is being made. Much of the clinical knowledge obtained from clinical trials to date was based on the previous histology-based WHO classifications, and the addition of new molecular information may lead to more complex treatment strategies. Therefore, this review presents the latest findings on the molecular classification of ependymomas and advances in its treatment.

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  62. Direct Screw Osteosynthesis for an Elderly Osteoporotic Patient With C2 Complex Fracture Reviewed

    Nagashima, Y; Nishimura, Y; Matsuo, M; Tanei, T; Saito, R

    CUREUS JOURNAL OF MEDICAL SCIENCE   Vol. 15 ( 7 ) page: e42510   2023.7

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  63. Brain metastasis and intracranial leptomeningeal metastasis from malignant peripheral nerve sheath tumors: illustrative cases. Reviewed International journal

    Masasuke Ohno, Shoichi Haimoto, Satoshi Tsukushi, Waki Hosoda, Fumiharu Ohka, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 6 ( 3 )   2023.7

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    BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft-tissue tumors. Intracranial metastasis from MPNSTs is quite rare. OBSERVATIONS: The authors report on a 73-year-old male whose MPNST metastasized to the brain and a 32-year-old male with leptomeningeal metastasis from MPNST and review 41 cases of MPNST that developed intracranial metastasis, as reported in the literature. LESSONS: Brain metastasis and leptomeningeal metastasis of MPNSTs show different clinical courses and require pathology-specific treatment.

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  64. The Significance of Photodynamic Diagnosis Using 5-aminolevulinic Acid in The Resection of Glioblastoma

    Kanamori Masayuki, Saito Ryuta, Shimoda Yoshiteru, Tominaga Teiji

    The Journal of Japan Society for Laser Surgery and Medicine   Vol. 44 ( 2 ) page: 164 - 170   2023.7

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    <p>This study elucidated the relationship between the findings of photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) and tumor control in 41 patients undergoing resection of newly diagnosed glioblastoma. All patients underwent maximal resection of contrast-enhanced lesions by PDD using 5-ALA. Intraoperative PDD findings, postoperative lesions with contrast-enhanced residuals, and recurrence sites were analyzed. Residual fluorescent lesion was correlated with the total resection of contrast-enhanced lesion seen in magnetic resonance images. In addition, recurrent disease tended to develop within the lesions with residual fluorescence after resection under white light or blue light. These findings suggested that tumor evaluation using PDD with 5-ALA may aid in the determination of the extent of resection in enhanced lesion and in the prediction of sites for intensification of local treatment.</p>

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  65. Surgical reconstruction for spheno-orbital meningioma extending into the sphenoid sinus with hyperostosis. Reviewed International journal

    Toshihito Maki, Eiji Ito, Kiyoshi Saito, Ryuta Saito

    Clinical case reports   Vol. 11 ( 7 ) page: e7705   2023.7

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    Spheno-orbital meningiomas (SOMs) are complex tumors that grow and extend into nearby structures. SOM tumor growth is often associated with hyperostosis caused by tumor cell infiltration and bone alteration. We describe the case of a 64-year-old man with SOM that extended into the sphenoid sinus without a direct connection between the intracranial and extracranial lesions. This report emphasizes the importance of identifying the growth patterns of SOMs and assessing the paranasal sinuses adjacent to the hyperostotic orbit walls from preoperative images.

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  66. Two-Piece Craniotomy Is Associated With Improved Postoperative Outcomes of Combined Revascularization in Patients With Moyamoya Disease Reviewed

    Kanamori, F; Takasu, S; Hatano, N; Araki, Y; Seki, Y; Saito, R

    STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY   Vol. 3 ( 4 )   2023.7

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  67. 振戦優位型パーキンソン病(TD-PD)におけるMRガイド下集束超音波治療(MRgFUS)の適応判断と治療効果

    中坪 大輔, 津川 隆彦, 加藤 祥子, 前澤 聡, 坪井 崇, 鈴木 将史, 鳥居 潤, 武藤 学, 伊藤 芳記, 若林 俊彦, 勝野 雅央, 齋藤 竜太

    パーキンソン病・運動障害疾患コングレスプログラム・抄録集   Vol. 17回   page: 101 - 101   2023.7

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  68. Connectivity alteration in thalamic nuclei and default mode network-related area in memory processes in mesial temporal lobe epilepsy using magnetoencephalography. Reviewed International journal

    Tomotaka Ishizaki, Satoshi Maesawa, Daisuke Nakatsubo, Hiroyuki Yamamoto, Jun Torii, Manabu Mutoh, Jun Natsume, Minoru Hoshiyama, Ryuta Saito

    Scientific reports   Vol. 13 ( 1 ) page: 10632 - 10632   2023.6

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    This work aimed to investigate the involvement of the thalamic nuclei in mesial temporal lobe epilepsy (MTLE) and identify the influence of interictal epileptic discharges on the neural basis of memory processing by evaluating the functional connectivity (FC) between the thalamic nuclei and default mode network-related area (DMNRA) using magnetoencephalography. Preoperative datasets of nine patients with MTLE with seizure-free status after surgery and those of nine healthy controls were analyzed. The FC between the thalamic nuclei (anterior nucleus [ANT], mediodorsal nucleus [MD], intralaminar nuclei [IL]), hippocampus, and DMNRA was examined for each of the resting, pre-spike, spike, and post-spike periods in the delta to ripple bands using magnetoencephalography. The FC between the ANT, MD, hippocampus, and medial prefrontal cortex increased in the gamma to ripple bands, whereas the FC between the ANT, IL, and DMNRA decreased in the delta to beta bands, compared with that of the healthy controls at rest. Compared with the rest period, the pre-spike period had significantly decreased FC between the ANT, MD, and DMNRA in the ripple band. Different FC changes between the thalamic nuclei, hippocampus, and DMNRA of specific connections in a particular band may reflect impairment or compensation in the memory processes.

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  69. Differential target multiplexed spinal cord stimulation using a paddle-type lead placed at the appropriate site for neuropathic pain after spinal cord injury in patients with past spinal surgical histories: study protocol for an exploratory clinical trial. Reviewed International journal

    Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Yoshitaka Nagashima, Tomotaka Ishizaki, Masahiko Ando, Yachiyo Kuwatsuka, Atsushi Hashizume, Shimon Kurasawa, Ryuta Saito

    Trials   Vol. 24 ( 1 ) page: 395 - 395   2023.6

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    BACKGROUND: Neuropathic pain after spinal cord injury (SCI), both traumatic and non-traumatic, is refractory to various treatments. Spinal cord stimulation (SCS) is one of the neuromodulation therapies for neuropathic pain, although SCS has insufficient efficacy for neuropathic pain after SCI. The reasons are presumed to be inappropriate locations of SCS leads and conventional tonic stimulation itself does not have a sufficient analgesic effect for the pain. In patients with past spinal surgical histories, the cylinder-type leads are likely to be placed on the caudal side of the SCI because of surgical adhesions. Differential target multiplexed (DTM) stimulation is one of the latest new stimulation patterns that is superior to conventional stimulation. METHODS: A single-center, open-label, randomized, two-way crossover trial is planned to investigate the efficacy of SCS using DTM stimulation placing a paddle lead at the appropriate site for neuropathic pain after SCI in patients with spinal surgical histories. The paddle-type lead delivers energy more efficiently than a cylinder-type lead. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). The primary outcome is rates of achieving pain improvement with more than 33% reduction 3 months after SCS system implantation. The secondary outcomes are to be evaluated as follows: (1) effectiveness of DTM and tonic stimulations during the SCS trial; (2) changes of assessment items from 1 to 24 months; (3) relationships between the result of the SCS trial and the effects 3 months after SCS system implantation; (4) preoperative factors associated with a long-term effect, defined as continuing for more than 12 months; and (5) whether gait function improves from 1 to 24 months. DISCUSSION: A paddle-type lead placed on the rostral side of SCI and using DTM stimulation may provide significant pain relief for patients with intractable neuropathic pain after SCI in patients with past spinal surgical histories. TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT) jRCT 1042220093. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.

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  70. Rapid detection of the MYD88 L265P mutation for pre- and intra-operative diagnosis of primary central nervous system lymphoma. Reviewed International journal

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

    Cancer science   Vol. 114 ( 6 ) page: 2544 - 2551   2023.6

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    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.

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  71. Efficacy and safety of bevacizumab, irinotecan, and temozolomide combination for relapsed or refractory pediatric central nervous system embryonal tumor: a single-institution study. Reviewed International journal

    Yoshiki Shiba, Kazuya Motomura, Rieko Taniguchi, Michihiro Kurimoto, Kosuke Mizutani, Fumiharu Ohka, Kosuke Aoki, Eiji Ito, Tomohide Nishikawa, Junya Yamaguchi, Yuji Kibe, Hiroki Shimizu, Sachi Maeda, Takuma Nakashima, Hiromichi Suzuki, Hideki Muramatsu, Yoshiyuki Takahashi, Ryuta Saito

    Journal of neurosurgery. Pediatrics   Vol. 31 ( 6 ) page: 624 - 632   2023.6

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    OBJECTIVE: This study aimed to evaluate the efficacy and safety of combination therapy with bevacizumab (Bev), irinotecan (CPT-11), and temozolomide (TMZ) in children with central nervous system (CNS) embryonal tumor relapse. METHODS: The authors retrospectively examined 13 consecutive pediatric patients with relapsed or refractory CNS embryonal tumors who received combination therapy comprising Bev, CPT-11, and TMZ. Specifically, 9 patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumor (AT/RT), and 1 had CNS embryonal tumor with rhabdoid features. Of the 9 medulloblastoma cases, 2 were categorized in the Sonic hedgehog subgroup and 6 in molecular subgroup 3 for medulloblastoma. RESULTS: The complete and partial objective response rates were 66.6% in patients with medulloblastoma and 75.0% in patients with AT/RT or CNS embryonal tumors with rhabdoid features. Furthermore, the 12- and 24-month progression-free survival rates were 69.2% and 51.9% for all patients with recurrent or refractory CNS embryonal tumors, respectively. In contrast, the 12- and 24-month overall survival rates were 67.1% and 58.7%, respectively, for all patients with relapsed or refractory CNS embryonal tumors. The authors observed grade 3 neutropenia, thrombocytopenia, proteinuria, hypertension, diarrhea, and constipation in 23.1%, 7.7%, 23.1%, 7.7%, 7.7%, and 7.7% of patients, respectively. Furthermore, grade 4 neutropenia was observed in 7.1% of patients. Nonhematological adverse effects, such as nausea and constipation, were mild and controlled with standard antiemetics. CONCLUSIONS: This study demonstrated favorable survival outcomes in patients with relapsed or refractory pediatric CNS embryonal tumors and thus helped to investigate the efficacy of combination therapy comprising Bev, CPT-11, and TMZ. Moreover, combination chemotherapy had high objective response rates, and all adverse events were tolerable. To date, data supporting the efficacy and safety of this regimen in the relapsed or refractory AT/RT population are limited. These findings suggest the potential efficacy and safety of combination chemotherapy in patients with relapsed or refractory pediatric CNS embryonal tumors.

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  72. Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study. Reviewed

    Yoshitaka Nagashima, Yusuke Nishimura, Takayuki Awaya, Nobuhiro Hata, Takafumi Tanei, Motonori Ishii, Takahiro Oyama, Tomoya Nishii, Nobuhisa Fukaya, Takashi Abe, Hiroyuki Kato, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 63 ( 5 ) page: 200 - 205   2023.5

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    The Occipito (O) -C2 angle reflects the correct craniocervical spine alignment; however, the poor image quality of standard intraoperative fluoroscopy at times lead to inaccurate measurements. Herein, we preliminarily investigated the relationship between the O-C2 angle and the Gonion-C2 distance, which is based on the positioning of the mandible and the cervical spine. We enrolled patients who underwent cervical spine radiography in neutral, flexion, and extension positions from January 2020 to October 2020. The difference by posture changes for each parameter was defined as the Δ value, and the Spearman's rank correlation coefficient was determined. Furthermore, we determined the cutoff value of the ΔGonion-C2 distance to predict a decrease of > 10° in the ΔO-C2 angle, which is reported to be related to dysphagia and dyspnea. Seventy-four patients were included. Spearman's rank correlations for the neutral, flexion, and extension positions were 0.630 (P < 0.001), 0.471 (P < 0.001), and 0.625 (P < 0.001), respectively, while the cutoff values of the ΔGonion-C2 distance for predicting > 10° in the ΔO-C2 angle were 9.3 mm for the neutral flexion change (sensitivity: 0.435, specificity: 0.882) and 8.3 mm for the extension-neutral change (sensitivity: 0.712, specificity: 0.909). The O-C2 angle and Gonion-C2 distances correlated; however, this correlation was weaker in the flexed position. Nevertheless, the ΔGonion-C2 distance can be used as a warning sign for postoperative complications after posterior occipital bone fusion surgery, because a decrease of > 10° in the ΔO-C2 angle can be predicted with high specificity.

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  73. Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan. Reviewed

    Satoshi Maesawa, Tomotaka Ishizaki, Manabu Mutoh, Yoshiki Ito, Jun Torii, Takafumi Tanei, Daisuke Nakatsubo, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 63 ( 5 ) page: 179 - 190   2023.5

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    Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.

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  74. [Intraoperative Functional Monitoring in Brain Tumor Surgery]. Invited Reviewed

    Kazuya Motomura, Ryuta Saito

    No shinkei geka. Neurological surgery   Vol. 51 ( 3 ) page: 481 - 489   2023.5

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    Invasive brain tumors, especially gliomas, often arise in the eloquent areas of the brain that are involved in language and motor function. The most important goal of brain tumor removal is to safely remove the maximum amount of tumor while preserving neurological function. Maximizing the amount of removed tumor is thought to improve prognosis by prolonging both the progression-free and overall survival periods of patients. In the present study, we review the intraoperative monitoring techniques for motor function-sparing surgery for gliomas arising near the eloquent areas of the brain and electrophysiological monitoring techniques for motor function-sparing surgery for brain tumors arising deep within the brain. In brain tumor surgery, monitoring of direct cortical motor evoked potentials(MEPs), transcranial MEPs, and subcortical MEPs is integral for preserving motor function.

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  75. Erratum to: Evaluation of Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlation Analysis of CT and MRI Findings (Neurol Med Chir (Tokyo) 63, 158-164, 2023)

    Yoshikawa, S, Nishimura, Y, Nagashima, Y, Ito, H, Oyama, T, Nishii, T, Gonda, T.M, Ryu, H, Nomura, K, Hara, M, Takayasu, M, Ginsberg, H.J, Kanemura, T, Saito, R

    Neurologia Medico-Chirurgica   Vol. 63 ( 5 ) page: 220 - 220   2023.5

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  76. Secondary aneurysmal bone cyst of the frontal bone with fibrous dysplasia showing rapid expansion: a case report. Reviewed

    Yuta Koketsu, Takafumi Tanei, Kyoko Kuwabara, Toshinori Hasegawa, Takenori Kato, Satoshi Maesawa, Yusuke Nishimura, Yoshio Araki, Ryuta Saito

    Nagoya journal of medical science   Vol. 85 ( 2 ) page: 395 - 401   2023.5

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    A 19-year-old woman presented with swelling of the left forehead without pain. She did not have any relevant past or family history. Computed tomography showed destruction of the outer cortex of the frontal bone. A solitary mass lesion with a fluid collection was detected with magnetic resonance imaging. Because the swelling of the left forehead had enlarged rapidly with osteolytic changes, surgical removal of the lesion was performed. The lesion appeared to be enveloped in a fibrous capsule. The soft lesion was removed from the frontal bone. The outer frontal bone was absent, although the inner frontal bone was preserved. Then, the frontal bone was resected with margins from the edge of the erosion. The dura mater under the lesion was intact. A cranioplasty was performed using titanium mesh. On histological examination, the trabecular bones revealed irregular shapes and arrangements, indicating fibrous dysplasia. There was a continuous high-cell-concentration pathological lesion outside the fibrous dysplasia. There were numerous cells, such as mononuclear cells, osteoclast-like multinucleated giant cells, foam cells, and red blood cells. The osteoclast-like multinucleated giant cells and other cells did not show significant nuclear atypia. Immunostaining with H3.3G34W was negative, and the ubiquitin-specific peptidase 6/Tre-2 gene showed no rearrangements. The histopathological diagnosis was secondary aneurysmal bone cyst with fibrous dysplasia. Additional postsurgical therapy was not performed. There has been no evidence of recurrence of the lesion for two years.

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  77. Effects of superficial temporal artery to middle cerebral artery bypass on postoperative infarction rates among young children (≤ 5 years old) with moyamoya disease. Reviewed International journal

    Syuntaro Takasu, Fumiaki Kanamori, Norikazu Hatano, Yukio Seki, Ryuta Saito

    Neurosurgical review   Vol. 46 ( 1 ) page: 87 - 87   2023.4

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    Revascularization surgery for young children with moyamoya disease (MMD) is challenging. Although indirect revascularization is preferred because of the technical difficulty in direct anastomosis, higher risks of postoperative infarction remain a problem. We aimed to investigate the effect of superficial temporal artery to middle cerebral artery (STA-MCA) bypass on postoperative outcomes during the acute postoperative period in young children ≤ 5 years old with MMD. This retrospective study included consecutive young children with MMD who underwent surgical revascularization of the anterior cerebral circulation. Groups were determined according to the procedures performed, namely, the combined (STA-MCA bypass with indirect revascularization) and the indirect revascularization groups. The incidences of radiological or symptomatic infarction, transient neurological events, and new neurological deficits that remained at discharge were compared between groups. Of 38 surgical procedures, there were 23 combined and 15 indirect revascularizations. The median age of the patients was 3.0 years, which was significantly different between groups (P < .01). When comparing the postoperative outcomes between groups, the incidences of radiological and symptomatic infarction and new neurological deficits that remained at discharge were significantly lower in the combined revascularization group (P < .05). Logistic regression analysis adjusted for potential confounders found that surgical modality was a statistically significant independent risk factor associated with radiological and symptomatic infarctions (indirect/combined, odds ratio: 10.2; 95% confidence interval: 1.30-79.7; P < .05). STA-MCA bypass combined with indirect revascularization can reduce the incidence of postoperative infarction in young children with MMD and might lead to better neurological outcomes.

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  78. Machine learning models predict delayed hyponatremia post-transsphenoidal surgery using clinically available features. Reviewed International journal

    Yutaro Fuse, Kazuhito Takeuchi, Hiroshi Nishiwaki, Takahiro Imaizumi, Yuichi Nagata, Kinji Ohno, Ryuta Saito

    Pituitary   Vol. 26 ( 2 ) page: 237 - 249   2023.4

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    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.

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  79. Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy. Reviewed International journal

    Shun Yamamoto, Yoshitaka Nagashima, Hideki Maki, Yusuke Nishimura, Yoshio Araki, Masahiro Nishihori, Tomoyuki Noda, Tasuku Imai, Teppei Kawabata, Masahiro Ueno, Yasumasa Nishida, Ryuta Saito

    Acta neurochirurgica   Vol. 165 ( 4 ) page: 841 - 848   2023.4

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    BACKGROUND: In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle. METHODS: This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications. RESULTS: Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon's decision or patient requests. Among the 55 punctures, 43.0 ± 16.0 ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4 ml in the BTS-alone group and 49.4 ± 12.9 ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein. CONCLUSIONS: The BTS technique is an effective alternative to reoperation with BHC.

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  80. Clinical characteristics and radiological features of glioblastoma, IDH-wildtype, grade 4 with histologically lower-grade gliomas. Reviewed

    Kazuya Motomura, Yuji Kibe, Fumiharu Ohka, Kosuke Aoki, Junya Yamaguchi, Ryuta Saito

    Brain tumor pathology   Vol. 40 ( 2 ) page: 48 - 55   2023.4

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    The 2021 World Health Organization (WHO) classification of central nervous system tumors applied molecular criteria and further integrated histological and molecular diagnosis of gliomas. This classification allows for the diagnosis of isocitrate dehydrogenase wild-type (IDHwt) glioblastoma (GBM), and WHO grade 4 with histologically lower-grade gliomas (LrGGs), even in the absence of high-grade histopathologic features, such as necrosis and/or microvascular proliferation. They contain at least one of the following molecular features: epidermal growth factor receptor amplification, chromosome 7 gain/10 loss, or telomerase reverse transcriptase promoter mutation. In the imaging features at the time of histological diagnosis, a gliomatosis cerebri growth pattern was frequently observed in these tumors. Furthermore, this growth pattern was significantly higher in IDHwt GBM, WHO grade 4, with histological grade II gliomas. Although the exact prognosis of IDHwt GBM, WHO grade 4, with histologically LGGs remains unknown, its OS was approximately 1-2 years similar to that of histologically IDHwt GBM, WHO grade 4, despite histopathological features similar to IDHmut LrGGs. These findings reinforce the need for the analysis of molecular features, regardless of presenting similar clinical characteristics and imaging features to IDHmut LrGGs.

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  81. Easy-to-use machine learning system for the prediction of IDH mutation and 1p/19q codeletion using MRI images of adult-type diffuse gliomas. Reviewed

    Tomohide Nishikawa, Fumiharu Ohka, Kosuke Aoki, Hiromichi Suzuki, Kazuya Motomura, Junya Yamaguchi, Sachi Maeda, Yuji Kibe, Hiroki Shimizu, Atsushi Natsume, Hideki Innan, Ryuta Saito

    Brain tumor pathology   Vol. 40 ( 2 ) page: 85 - 92   2023.4

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    Adult-type diffuse gliomas are divided into Astrocytoma, IDH-mutant, Oligodendroglioma, IDH-mutant and 1p/19q-codeleted and Glioblastoma, IDH-wildtype based on the IDH mutation, and 1p/19q codeletion status. To determine the treatment strategy for these tumors, pre-operative prediction of IDH mutation and 1p/19q codeletion status might be effective. Computer-aided diagnosis (CADx) systems using machine learning have been noted as innovative diagnostic methods. However, it is difficult to promote the clinical application of machine learning systems at each institute because the support of various specialists is essential. In this study, we established an easy-to-use computer-aided diagnosis system using Microsoft Azure Machine Learning Studio (MAMLS) to predict these statuses. We constructed an analysis model using 258 adult-type diffuse glioma cases from The Cancer Genome Atlas (TCGA) cohort. Using MRI T2-weighted images, the overall accuracy, sensitivity, and specificity for the prediction of IDH mutation and 1p/19q codeletion were 86.9%, 80.9%, and 92.0%, and 94.7%, 94.1%, and 95.1%, respectively. We also constructed an reliable analysis model for the prediction of IDH mutation and 1p/19q codeletion using an independent Nagoya cohort including 202 cases. These analysis models were established within 30 min. This easy-to-use CADx system might be useful for the clinical application of CADx in various institutes.

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  82. Evaluation of Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlation Analysis of CT and MRI Findings. Reviewed

    Satoshi Yoshikawa, Yusuke Nishimura, Yoshitaka Nagashima, Hiroshi Ito, Takahiro Oyama, Tomoya Nishii, Tomomi Gonda, Hiroshi Ryu, Kei Nomura, Masahito Hara, Masakazu Takayasu, Howard J Ginsberg, Tokumi Kanemura, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 63 ( 4 ) page: 158 - 164   2023.4

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    The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morphological traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgically repaired TL burst fractures between January 2013 and December 2020 were retrospectively analyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic morphological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were considerably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (local kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multivariate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities.

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  83. Increased cerebrospinal fluid S100B protein levels in patients with trigeminal neuralgia and hemifacial spasm. Reviewed International journal

    Eiji Ito, Yukio Seki, Kiyoshi Saito, Ryuta Saito

    Acta neurochirurgica   Vol. 165 ( 4 ) page: 959 - 965   2023.4

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    BACKGROUND: The pathophysiology of neurovascular compression syndrome has not been fully elucidated, and cerebrospinal fluid levels of nerve tissue-related markers involved in this disorder have not yet been reported. METHODS: We measured cerebrospinal fluid levels of S100B protein, neuron-specific enolase, and myelin basic protein in 21 patients with trigeminal neuralgia, 9 patients with hemifacial spasms, and 10 patients with non-ruptured intracranial aneurysms (control). Cerebrospinal fluid levels of these markers were determined using commercially available assay kits. RESULTS: Both trigeminal neuralgia and hemifacial spasm groups showed significantly increased cerebrospinal fluid levels of S100B compared with the control group (1120 [IQR 391-1420], 766 [IQR 583-1500], and 255 [IQR 190-285] pg/mL, respectively; p = 0.001). There were no statistically significant differences in cerebrospinal fluid levels of neuron-specific enolase or myelin basic protein among the groups. CONCLUSION: Cerebrospinal fluid S100B levels were significantly higher in patients with trigeminal neuralgia and hemifacial spasm than in controls, which suggests the involvement of S100B in the underlying pathophysiology of neurovascular compression syndrome.

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  84. Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis Reviewed International journal

    Masayuki Kanamori, Yoshiteru Shimoda, Rei Umezawa, Osamu Iizuka, Shunji Mugikura, Kyoko Suzuki, Hisanori Ariga, Keiichi Jingu, Ryuta Saito, Yukihiko Sonoda, Toshihiro Kumabe, Teiji Tominaga

    Journal of Radiation Research   Vol. 64 ( 2 ) page: 428 - 437   2023.3

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    This study investigated the effectiveness and safety of low-dose salvage craniospinal irradiation (CSI) for recurrent germinoma. We retrospectively reviewed long-term tumor control and late adverse effects in 15 recurrent germinoma patients treated at our hospital between 1983 and 2019. Following the first recurrence of germinoma, seven were treated with 24–30 Gy of salvage CSI, three underwent non-CSI, and five were treated with only chemotherapy. CSI achieved a significantly better recurrence-free survival rate after the first recurrence compared to other strategies (100% vs 33%, p &amp;lt; 0.001: log-rank test). To evaluate the safety of salvage CSI, we assessed the outcomes at the final follow-up of seven patients who received salvage CSI at first recurrence and three patients who received salvage CSI at second recurrence. The median follow-up period was 220 months after initial treatment. Five patients who received 40–50 Gy of radiation therapy or underwent multiple radiation therapy before salvage CSI were classified into Group A, whereas five patients treated with platinum-based chemotherapy and 24–32 Gy of radiation therapy to the primary site, whole ventricle, or whole brain were classified into Group B. In Group A, one had endocrine dysfunction and the other had visual dysfunction. None were socially independent. Meanwhile, in Group B, no endocrine or visual dysfunction was found, and three patients were socially independent. Salvage CSI achieved excellent tumor control in recurrent germinoma and was safe in patients initially treated with low-dose radiation therapy and chemotherapy.

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  85. Mesencephalic developmental venous anomaly causing obstructive hydrocephalus: illustrative case. Reviewed International journal

    Kota Hiraga, Shigemasa Hayashi, Ryosuke Oshima, Tatsuma Kondo, Fumiaki Kanamori, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 5 ( 12 )   2023.3

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    BACKGROUND: Developmental venous anomalies (DVAs) are congenital anatomical variants of the normal deep parenchymal veins. DVAs are occasionally found incidentally on brain imaging, and most cases are asymptomatic. However, they rarely cause central nervous disorders. Herein, a case of mesencephalic DVA that caused aqueduct stenosis and hydrocephalus and discuss its diagnosis and treatment is reported. OBSERVATIONS: The patient was a 48-year-old female who presented with depression. Computed tomography and magnetic resonance imaging (MRI) of the head revealed obstructive hydrocephalus. Contrast-enhanced MRI revealed an abnormally distended linear region with enhancement on the top of the cerebral aqueduct, which was confirmed as a DVA by digital subtraction angiography. An endoscopic third ventriculostomy (ETV) was performed to improve the patient's symptoms. Intraoperative endoscopic imaging showed obstruction of the cerebral aqueduct by the DVA. LESSONS: This report describes a rare case of obstructive hydrocephalus caused by DVA. It highlights the usefulness of contrast-enhanced MRI for diagnosing cerebral aqueduct obstructions due to DVAs and the effectiveness of ETV as a treatment option.

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  86. Subcutaneous transplantation of human embryonic stem cells-derived pituitary organoids. Reviewed International journal

    Hiroo Sasaki, Hidetaka Suga, Kazuhito Takeuchi, Yuichi Nagata, Hideyuki Harada, Tatsuma Kondo, Eiji Ito, Sachi Maeda, Mayu Sakakibara, Mika Soen, Tsutomu Miwata, Tomoyoshi Asano, Hajime Ozaki, Shiori Taga, Atsushi Kuwahara, Tokushige Nakano, Hiroshi Arima, Ryuta Saito

    Frontiers in endocrinology   Vol. 14   page: 1130465 - 1130465   2023.3

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    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.

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  87. Long noncoding RNA profile of the intracranial artery in patients with moyamoya disease. Reviewed International journal

    Takashi Mamiya, Fumiaki Kanamori, Kinya Yokoyama, Akinobu Ota, Sivasundaram Karnan, Kenji Uda, Yoshio Araki, Satoshi Maesawa, Kazuhiro Yoshikawa, Ryuta Saito

    Journal of neurosurgery   Vol. 138 ( 3 ) page: 709 - 716   2023.3

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    OBJECTIVE: Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the internal carotid artery (ICA) and secondary formation of collateral vessels. Revascularization surgery is performed in patients with MMD to prevent stroke; however, the pathogenesis of MMD remains unknown. Recently, long noncoding RNAs (lncRNAs) have been found to play a key role in gene regulation and are implicated in various vascular diseases. However, the lncRNA expression profile in MMD lesions has not been investigated. In this study the authors aimed to determine the characteristics of lncRNA expression in MMD lesions. METHODS: The authors collected microsamples of the middle cerebral artery (MCA) from patients with MMD (n = 21) and patients with control conditions (n = 11) who underwent neurosurgical treatment. Using microarray experiments, the authors compared the profiles of lncRNA expression in the MCAs of the MMD and control patient groups and identified differentially expressed lncRNAs (fold change > 2, q < 0.05). In addition, the neighboring coding genes, whose transcription can be regulated in cis by the identified differentially expressed lncRNAs, were investigated and Gene Ontology (GO) analysis was applied to predict associated biological functions. RESULTS: The authors detected 308 differentially expressed lncRNAs (fold change > 2, q < 0.05), including 306 upregulated and 2 downregulated lncRNAs in the MCA from patients with MMD. Regarding the prediction of biological function, GO analyses with possible coding genes whose transcription was regulated in cis by the identified differentially expressed lncRNAs suggested involvement in the antibacterial humoral response, T-cell receptor signaling pathway, positive regulation of cytokine production, and branching involved in blood vessel morphogenesis. CONCLUSIONS: The profile of lncRNA expression in MMD lesions was different from that in the normal cerebral artery, and differentially expressed lncRNAs were identified. This study provides new insights into the pathophysiology of MMD.

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  88. Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a single-center, long-term, retrospective, observational study. Reviewed International journal

    Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Tasuku Imai, Yoshio Araki, Fumiaki Kanamori, Kenji Uda, Kinya Yokoyama, Ryuta Saito

    Journal of neurosurgery   Vol. 138 ( 3 ) page: 724 - 731   2023.3

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    OBJECTIVE: The protocol for antiplatelet therapy after stent-assisted coil embolization (SACE) for intracranial aneurysms is not well established. In particular, the indications for single antiplatelet therapy (SAPT) discontinuation remain controversial. The authors investigated the long-term outcomes of SAPT discontinuation after SACE among patients at a single institution. METHODS: Patients who underwent SACE during the period from 2010 to 2020 and who were followed up for > 1 year were included in this study. The delayed ischemic and hemorrhagic complication rates were examined during follow-up. Moreover, the risk factors of antiplatelet therapy reduction or discontinuation and the outcomes of SAPT discontinuation were examined. RESULTS: In total, 240 patients were included in the analysis. The average patient age was 60.3 years, and the average follow-up period was 46.7 months. Nine (3.8%) patients presented with symptomatic delayed ischemic complication, and 3 (1.3%) patients experienced a decline in modified Rankin Scale score. The stent configuration (T- or Y-stent) was the only risk factor associated with delayed ischemic complication (p < 0.001). SAPT was discontinued in 147 (71.7%) of 205 patients who were followed up for > 2 years, and no ischemic complications were observed. CONCLUSIONS: It is safe to discontinue SAPT in patients without ischemic complications and with stable intraaneurysmal signals on MRA 2 years after SACE. The T- or Y-stent is a high-risk factor for delayed ischemic complications, and antiplatelet therapy reduction or discontinuation should be cautiously considered.

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  89. The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery. Reviewed International journal

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

    Acta neurochirurgica   Vol. 165 ( 3 ) page: 667 - 675   2023.3

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    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.

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

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

    Cancer medicine   Vol. 12 ( 6 ) page: 7116 - 7126   2023.3

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    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.

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  91. Comparative Study of Anterior Transvertebral Foraminotomy and Anterior Cervical Discectomy and Fusion for Unilateral Cervical Spondylotic Radiculopathy. Reviewed International journal

    Sho Akahori, Yusuke Nishimura, Kaoru Eguchi, Yoshitaka Nagashima, Ryo Ando, Takayuki Awaya, Takafumi Tanei, Masahito Hara, Tokumi Kanemura, Masakazu Takayasu, Ryuta Saito

    World neurosurgery   Vol. 171   page: E516 - E523   2023.3

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    OBJECTIVE: To study the compared surgical and radiographic outcomes of Transvertebral foraminotomy (TVF) with anterior cervical discectomy and fusion (ACDF) in patients with unilateral cervical spondylotic radiculopathy (CSR). METHODS: We performed a retrospective comparative study of 72 consecutive patients with 1- or 2-level CSR treated with ACDF or TVF. 27 patients who underwent TVF (group T) and 45 patients who underwent ACDF (group A) with a minimum 2-year follow-up were enrolled. We evaluated clinical outcomes and radiological assessment. Clinical outcome included Visual analog scale (VAS) scores for axial, arm pain at preoperatively and final follow-up. VAS score for painful swallowing was also evaluated 1 week after surgery. Radiological assessment included C2-7 sagittal Cobb angle (C2-7 CA), range of motion (ROM) of C2-7 CA, the height, angle and ROM of the functional spinal unit (FSU), and tip of the spinous process of the operated segment. We also evaluated the disc height, FSU angle, and ROM of the FSU at the cranial adjacent segment. RESULTS: Both groups had good clinical outcomes. Soft tissue swelling was significantly less prominent in group T than that for group A. VAS scores for painful swallowing is lower in group T without significant difference. The ROM of C2-7 CA, FSU, and spinous processes demonstrated a significant reduction in group A compared with group T.(P < 0.05). Disc height at the cranial adjacent segment was maintained in group T. CONCLUSIONS: TVF is as effective as ACDF for unilateral CSR and preserves whole cervical spine and segmental alignment.

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  92. Eyelid myokymia caused by a trigeminal schwannoma as determined by the trigeminal-evoked blink reflex. Reviewed International journal

    Eiji Ito, Ryotaro Sugita, Ryuta Saito

    Clinical case reports   Vol. 11 ( 3 ) page: e7086   2023.3

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    A 57-year-old man had trigeminal schwannoma in Meckel's cave with eyelid myokymia only. The evaluation of the trigeminal-evoked blink reflex was useful for confirming eyelid myokymia and contributed to surgical decision-making. In patients with persistent eyelid myokymia, neurophysiological and imaging evaluations may be useful for determining the underlying pathophysiology.

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  93. 運動合併症の改善に淡蒼球DBSが有効であったPARK14の1例

    近藤 初, 坪井 崇, 古川 宗磨, 小池 春樹, 中坪 大輔, 前澤 聡, 齋藤 竜太, 勝野 雅央

    臨床神経学   Vol. 63 ( 3 ) page: 182 - 182   2023.3

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  94. 運動合併症の改善に淡蒼球DBSが有効であったPARK14の1例

    近藤 初, 坪井 崇, 古川 宗磨, 小池 春樹, 中坪 大輔, 前澤 聡, 齋藤 竜太, 勝野 雅央

    臨床神経学   Vol. 63 ( 3 ) page: 182 - 182   2023.3

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  95. The first-in-human phase I study of a brain penetrant mutant IDH1 inhibitor DS-1001 in patients with recurrent or progressive IDH1-mutant gliomas. Reviewed International journal

    Atsushi Natsume, Yoshiki Arakawa, Yoshitaka Narita, Kazuhiko Sugiyama, Nobuhiro Hata, Yoshihiro Muragaki, Naoki Shinojima, Toshihiro Kumabe, Ryuta Saito, Kazuya Motomura, Yohei Mineharu, Yasuji Miyakita, Fumiyuki Yamasaki, Yuko Matsushita, Koichi Ichimura, Kazumi Ito, Masaya Tachibana, Yasuyuki Kakurai, Naoko Okamoto, Takashi Asahi, Soichiro Nishijima, Tomoyuki Yamaguchi, Hiroshi Tsubouchi, Hideo Nakamura, Ryo Nishikawa

    Neuro-oncology   Vol. 25 ( 2 ) page: 326 - 336   2023.2

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    BACKGROUND: Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in accumulation of oncometabolite D-2-hydroxyglutarate (D-2-HG); this leads to epigenetic dysregulation, oncogenesis, and subsequent clonal expansion. DS-1001 is an oral brain-penetrant mutant IDH1 selective inhibitor. This first-in-human study investigated the safety, pharmacokinetics, pharmacodynamics, and efficacy of DS-1001. METHODS: This was a multicenter, open-label, dose-escalation, phase I study of DS-1001 for recurrent/progressive IDH1-mutant (R132) glioma (N = 47) (NCT03030066). DS-1001 was administered orally at 125-1400 mg twice daily. Dose escalation used a modified continual reassessment method. RESULTS: The maximum tolerated dose was not reached. Eight patients were continuing treatment at the data cut-off. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least one grade 3 AE. No grade 4 or 5 AEs or serious drug-related AEs were reported. Common AEs (>20%) were skin hyperpigmentation, diarrhea, pruritus, alopecia, arthralgia, nausea, headache, rash, and dry skin. The objective response rates were 17.1% for enhancing tumors and 33.3% for non-enhancing tumors. Median progression-free survival was 10.4 months (95% confidence interval [CI], 6.1 to 17.7 months) and not reached (95% CI, 24.1 to not reached) for the enhancing and non-enhancing glioma cohorts, respectively. Seven on-treatment brain tumor samples showed a significantly lower amount of D-2-HG compared with pre-study archived samples. CONCLUSIONS: DS-1001 was well-tolerated with a favorable brain distribution. Recurrent/progressive IDH1-mutant glioma patients responded to treatment. A study of DS-1001 in patients with chemotherapy- and radiotherapy-naïve IDH1-mutated WHO grade 2 glioma is ongoing (NCT04458272).

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  96. Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case. Reviewed International journal

    Hiroyuki Kato, Takafumi Tanei, Yusuke Nishimura, Yoshitaka Nagashima, Motonori Ishii, Tomoya Nishii, Nobuhisa Fukaya, Takashi Abe, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 5 ( 7 )   2023.2

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    BACKGROUND: Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare in the pineal gland. A case of PPTID that disseminated to the lumbosacral spine 13 years after the total resection of a primary intracranial tumor has been reported. OBSERVATIONS: A 14-year-old female presented with headache and diplopia. Magnetic resonance imaging revealed a pineal tumor that induced obstructive hydrocephalus. A biopsy and endoscopic third ventriculostomy were performed. Histological diagnosis revealed a grade II PPTID. Two months later, the tumor was removed via craniotomy because the postoperative Gamma Knife surgery was ineffective. Histological diagnosis confirmed PPTID, although the grade was revised from II to III. Postoperative adjuvant therapy was not performed, because the lesion had been irradiated and gross total tumor removal was achieved. She has had no recurrence in 13 years. However, pain around the anus newly appeared. Magnetic resonance imaging of the spine revealed a solid lesion in the lumbosacral spine. The lesion was subtotally resected, and histological diagnosis revealed grade III PPTID. Postoperative radiotherapy was performed, and she had no recurrence 1 year after radiotherapy. LESSONS: Remote dissemination of PPTID can occur several years after the initial resection. Regular follow-up imaging, including the spinal region, should be encouraged.

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  97. A Case of Haemorrhagic-Onset Glioblastoma With Delayed Diagnosis. Reviewed International journal

    Mayuko Otomo, Masayuki Kanamori, Shiho Sato, Yoshiteru Shimoda, Mika Watanabe, Tomohiro Kawaguchi, Ryuta Saito, Teiji Tominaga

    Cureus   Vol. 15 ( 2 ) page: e34672   2023.2

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    Glioblastoma sometimes develops with acute onset due to intracerebral hemorrhage. Although it is sometimes difficult to diagnose patients with hemorrhagic-onset glioblastoma at the acute phase of intracerebral hemorrhage (ICH), the progressive enlargement of perifocal edema or the development of contrast-enhanced lesion triggers the diagnosis of glioblastoma within six months. Herein, we present a rare case of glioblastoma in which the diagnosis was delayed as long as 17 months after ICH. A 62-year-old man presented with a headache and aphasia. Computed tomography revealed ICH in the left temporal lobe. Magnetic resonance (MR) images revealed that the hematoma had a mix of isointense and surrounding hypointense lesions on T1-weighted MR images and gadolinium-enhanced lesions at the wall and the septum of the hematoma. An endoscopic evacuation of the hematoma was performed. No causative lesions were found during intraoperative and histological examinations. After seven months, abnormal signals were completely resolved on MR images, except for the small and stable enhanced lesion on three-dimensional gadolinium-enhanced T1-weighted MR imaging (3D Gd-T1WI) at the base of the hematoma, which did not change in size for seven months. However, a large gadolinium-enhanced lesion at the left temporal lobe developed 17 months after ICH. He underwent total resection of the lesion and was diagnosed with glioblastoma. He received radiation therapy and temozolomide but died of disseminated recurrence 31 months after ICH. In conclusion, this report presents a didactic case of glioblastoma in which the diagnosis of glioblastoma was delayed 17 months after ICH whereas hemorrhagic-onset glioblastoma was previously considered ruled out in cases in which six months or more have passed after ICH. In order not to overlook these cases, follow-up with 3D Gd-T1WI is essential in the case of suspected tumor-related ICH and close follow-up is recommended when the enhanced lesion does not resolve after a long period even if it does not grow.

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  98. Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling

    Nakashima, T; Funakoshi, Y; Nambu, S; Uneda, A; Katayama, K; Hanaya, R; Imoto, S; Tanaka, S; Saito, R; Yoshimoto, K; Narita, Y; Yoshimoto, K; Narita, Y; Suzuki, H

    CANCER SCIENCE   Vol. 114   page: 205 - 205   2023.2

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  99. Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant

    Funakoshi, Y, Nakashima, T, Nambu, S, Uneda, A, Katayama, K, Imoto, S, Hanaya, R, Tanaka, S, Saito, R, Yoshimoto, K, Narita, Y, Suzuki, H

    CANCER SCIENCE   Vol. 114   page: 203 - 203   2023.2

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  100. Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted

    Funakoshi, Y, Nambu, S, Nakashima, T, Uneda, A, Katayama, K, Imoto, S, Hanaya, R, Tanaka, S, Saito, R, Yoshimoto, K, Narita, Y, Suzuki, H

    CANCER SCIENCE   Vol. 114   page: 206 - 206   2023.2

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  101. The usefulness of three-dimensional fusion imaging of spinal arteriovenous malformation by a workstation connected to angiography systems. Reviewed

    Yoshitaka Nagashima, Takashi Izumi, Yusuke Nishimura, Masahiro Nishihori, Takahiro Oyama, Mamoru Matsuo, Hiroshi Ito, Tomoya Nishii, Ryuta Saito

    Nagoya journal of medical science   Vol. 85 ( 1 ) page: 127 - 133   2023.2

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    Digital subtraction angiography (DSA) is the most useful technique for diagnosing spinal arteriovenous malformations (AVM). In recent years, with the improvement of imaging capabilities, the usefulness of three-dimensional (3D) imaging by fusing various modalities has been recognized. The use of 3D fusion imaging with a workstation connected to an angiography system has been reported in many cases of intracranial disease, but less frequently for spinal AVM. In this article, we describe two illustrative cases of spinal AVM in which 3D fusion imaging was useful for treatment. Although 3D fusion images using the system have the disadvantage that only a maximum of two images can be fused, it provides spinal surgeons with useful information for preoperative evaluation in a small amount of time.

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  102. Characteristic image on cerebral angiography in ruptured blood blister-like aneurysms. Reviewed International journal

    Naoki Kato, Takashi Izumi, Masahiro Nishihori, Shunsaku Goto, Yoshio Araki, Kinya Yokoyama, Ryuta Saito

    Clinical neurology and neurosurgery   Vol. 225   page: 107583 - 107583   2023.2

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    OBJECTIVE: To evaluate the static and dynamic features of blood blister-like aneurysms (BBAs) using cerebral angiography to identify characteristic features to improve the diagnosis of these uncommon aneurysms. METHODS: Digital subtraction angiography (DSA) images were compared between patients with BBAs (n = 12, group A) and patients with unruptured paraclinoid aneurysms ≤ 5 mm in size treated by endovascular procedures (n = 12, group B). DSA images were assessed for irregularities in the diameter of the parent artery and delayed inflow and outflow of contrast medium in the aneurysm. Enlargement of the aneurysm and morphological changes from the first assessment were also evaluated in patients with BBAs. RESULTS: Compared to the group B, group A had a higher proportion of irregular vessel diameter (p = 0.013) and the delayed contrast medium outflow (p = 0.014). As well, stagnation of contrast medium along the aneurysm wall was a characteristic finding of BBAs, even for small aneurysms. CONCLUSION: Irregular morphological features of the parent artery and delayed contrast medium outflow as characteristic findings of ruptured BBAs may improve the diagnosis of these uncommon aneurysms, which remains challenging in practice.

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  103. Differences in gaze behaviors between trainees and experts during endovascular therapy for cerebral aneurysms: a preliminary study using a cerebral aneurysm model. Reviewed

    Takafumi Otsuka, Takashi Izumi, Masaya Yamamoto, Yusuke Seshita, Takeshi Kohama, Masahiro Nishihori, Tetsuya Tsukada, Ryuta Saito

    Nagoya journal of medical science   Vol. 85 ( 1 ) page: 50 - 58   2023.2

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    In the neuroendovascular field, the training of operators has become an important issue. Recently, eye-tracking technology has been introduced into various fields of medical education. This study aimed to apply eye-tracking technology to the training of neuroendovascular therapy. Six neurosurgeons, including three neuroendovascular specialists and three trainees, at our institution and related facilities participated in the study. Eye movement was recorded by the eye-tracking device during the microcatheter navigation and coil placement into the silastic aneurysm model under biplane X-ray fluoroscopy. Eye-tracking analysis during neuroendovascular therapy was feasible in all six subjects. In microcatheter navigation, specialists tended to more frequently switch their attention between frontal and lateral images than trainees. In coil embolization, the overall gaze frequency tended to increase, and the average fixation duration tended to decrease as the number of experienced cases increased. Inexperienced operators tend to fix their gaze when they are operators than when they are assistants. More experienced operators tended to look at the microcatheter longer in the coil insertion task. The eye-tracking analysis may be useful for operator training in neuroendovascular therapy. Experts may have moved their eyes more frequently than trainees to gaze at the right place. In the future, it will be necessary to collect gaze data for more operators in various tasks.

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  104. Intra-operative analysis of genetic alterations in brain tumor using rapid quantitative PCR device

    Ohka, F, Maeda, S, Yamaguchi, J, Motomura, K, Saito, R

    CANCER SCIENCE   Vol. 114   page: 1818 - 1818   2023.2

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  105. Identification of therapeutic targets exhibiting synthetic lethality with IDH1 inhibitor using the CRISPR/Cas9 system

    Maeda, S, Aoki, K, Hinohara, K, Yamaguchi, J, Ohka, F, Natsume, A, Saito, R

    CANCER SCIENCE   Vol. 114   page: 1460 - 1460   2023.2

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  106. Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling

    Nakashima, T, Funakoshi, Y, Nambu, S, Uneda, A, Katayama, K, Hanaya, R, Imoto, S, Tanaka, S, Saito, R, Yoshimoto, K, Narita, Y, Yoshimoto, K, Narita, Y, Suzuki, H

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  107. Identification of therapeutic targets exhibiting synthetic lethality with IDH1 inhibitor using the CRISPR/Cas9 system

    Maeda, S; Aoki, K; Hinohara, K; Yamaguchi, J; Ohka, F; Natsume, A; Saito, R

    CANCER SCIENCE   Vol. 114   page: 1460 - 1460   2023.2

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  108. Intra-operative analysis of genetic alterations in brain tumor using rapid quantitative PCR device

    Ohka, F; Maeda, S; Yamaguchi, J; Motomura, K; Saito, R

    CANCER SCIENCE   Vol. 114   page: 1818 - 1818   2023.2

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  109. Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted

    Funakoshi, Y; Nambu, S; Nakashima, T; Uneda, A; Katayama, K; Imoto, S; Hanaya, R; Tanaka, S; Saito, R; Yoshimoto, K; Narita, Y; Suzuki, H

    CANCER SCIENCE   Vol. 114   page: 206 - 206   2023.2

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  110. Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant

    Funakoshi, Y; Nakashima, T; Nambu, S; Uneda, A; Katayama, K; Imoto, S; Hanaya, R; Tanaka, S; Saito, R; Yoshimoto, K; Narita, Y; Suzuki, H

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  111. Spontaneous Shrinkage of isocitrate dehydrogenase (IDH)-mutant astrocytoma caused by intra-tumoural cyst rupture: a case report. Reviewed International journal

    Ryutaro Suzuki, Masayuki Kanamori, Ryuta Saito, Yoshiteru Shimoda, Mika Watanabe, Teiji Tominaga

    British journal of neurosurgery     page: 1 - 5   2023.1

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    BACKGROUND: T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign is a specific imaging finding of isocitrate dehydrogenase (IDH)-mutant astrocytomas. Histologically, a hypointense area on FLAIR images indicates the presence of microcysts. Here we report a case of IDH-mutant astrocytoma that shrunk spontaneously. CASE DESCRIPTION: A 26-year-old woman presented with a complaint of headache. Her magnetic resonance (MR) images revealed a lesion mass with a T2-FLAIR mismatch sign in the left frontal lobe. Subsequently, after 1 month, she was referred to our department, and we found that the lesion had unexpectedly shrunk; however, no further shrinkage was observed in the next 3 months. Furthermore, a biopsy was performed, and the results indicated a diagnosis of astrocytoma, IDH-mutant CNS WHO grade 3. Thus, she underwent subtotal resection. We found no neurological deficits in the patient, and she received 60 Gy of radiotherapy at the local site and chemotherapy with nimustine hydrochloride (ACNU), followed by the administration of ACNU every 8 weeks for 2 years. Overall, after 36 months of tumour resection, she was in good health and exhibited no recurrence. Notably, her histological and MR image findings suggested that the macroscopic cyst was formed by the fusion of microcysts, which is a characteristic feature of IDH-mutant astrocytoma with a T2-FLAIR mismatch sign, and that the tumour shrunk because of the rupture of the cyst in the Sylvian cistern. CONCLUSION: The present case report suggests that IDH-mutant astrocytoma cannot be ruled out even when the lesion shrinks spontaneously.

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  112. A multicenter, randomized, placebo-controlled phase IIb trial of an autologous formalin-fixed tumor vaccine for newly diagnosed glioblastomas. Reviewed International journal

    Yoshihiro Muragaki, Eiichi Ishikawa, Takashi Maruyama, Masayuki Nitta, Taiichi Saito, Soko Ikuta, Takashi Komori, Takakazu Kawamata, Tetsuya Yamamoto, Koji Tsuboi, Akira Matsumura, Hideo Nakamura, Junichiro Kuroda, Tatsuya Abe, Yasutomo Momii, Ryuta Saito, Teiji Tominaga, Yusuke Tabei, Ichiro Suzuki, Yoshiki Arakawa, Susumu Miyamoto, Masao Matsutani, Katsuyuki Karasawa, Yoichi Nakazato, Katsuya Maebayashi, Koichi Hashimoto, Tadao Ohno

    Journal of neurosurgery     page: 1 - 11   2023.1

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    OBJECTIVE: An autologous formalin-fixed tumor vaccine (AFTV) derived from resected glioblastoma (GBM) tissue can be used against unidentified tumor antigens. Thus, the authors conducted a multicenter double-blind phase IIb trial to investigate the efficacy of an AFTV. METHODS: Eligible patients were adults with supratentorial GBMs, 16-75 years of age, with Karnofsky Performance Scale (KPS) scores ≥ 60%, and no long-term steroid administration. An AFTV comprising fixed paraffin-embedded tumor tissue with immune adjuvants or an identical placebo without fixed tumor tissue was injected intradermally over three courses before and after chemoradiotherapy. The primary and secondary end points were overall survival (OS), progression-free survival (PFS), and 3-year survival rate. RESULTS: Sixty-three patients were enrolled. The average patient age was 61 years. The median KPS score was 80%, and the median resection rate was 95%. The full analysis set of 57 patients indicated no significant difference in OS (p = 0.64) for the AFTV group (median OS 25.6 months, 3-year OS rate 38%) compared with the placebo group (31.5 months and 41%, respectively) and no difference in PFS (median PFS 13.3 months in both groups, p = 0.98). For patients with imaging-based total tumor removal, the 3-year PFS rate was 81% in the AFTV group versus 46% in the placebo group (p = 0.067), whereas the 3-year OS rate was 80% versus 54% (p = 0.16), respectively. Similar results were obtained in the p53-negative subgroups. Severe adverse effects were not observed. CONCLUSIONS: The AFTV may have potential effects in certain patient subgroups. A phase III study for patients with total tumor removal remains warranted to confirm these findings. Clinical trial registration no.: UMIN000010602 (UMIN Clinical Trials Registry).

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  113. Imaging features of localized IDH wild-type histologically diffuse astrocytomas: a single-institution case series. Reviewed International journal

    Yuji Kibe, Kazuya Motomura, Fumiharu Ohka, Kosuke Aoki, Hiroyuki Shimizu, Junya Yamaguchi, Tomohide Nishikawa, Ryuta Saito

    Scientific reports   Vol. 13 ( 1 ) page: 23 - 23   2023.1

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    Isocitrate dehydrogenase wild-type (IDHwt) diffuse astrocytomas feature highly infiltrative patterns, such as a gliomatosis cerebri growth pattern with widespread involvement. Among these tumors, localized IDHwt histologically diffuse astrocytomas are rarer than the infiltrative type. The aim of this study was to assess and describe the clinical, radiographic, histopathological, and molecular characteristics of this rare type of IDHwt histologically diffuse astrocytomas and thereby provide more information on how its features affect clinical prognoses and outcomes. We retrospectively analyzed the records of five patients with localized IDHwt histologically diffuse astrocytomas between July 2017 and January 2020. All patients were female, and their mean age at the time of the initial treatment was 55.0 years. All patients had focal disease that did not include gliomatosis cerebri or multifocal disease. All patients received a histopathological diagnosis of diffuse astrocytomas at the time of the initial treatment. For recurrent tumors, second surgeries were performed at a mean of 12.4 months after the initial surgery. A histopathological diagnosis of glioblastoma was made in four patients and one of gliosarcoma in one patient. The initial status of IDH1, IDH2, H3F3A, HIST1H3B, and BRAF was "wild-type" in all patients. TERT promoter mutations (C250T or C228T) were detected in four patients. No tumors harbored a 1p/19q codeletion, EGFR amplification, or chromosome 7 gain/10 loss (+ 7/ - 10). We assessed clinical cases of localized IDHwt histologically diffuse astrocytomas that resulted in malignant recurrence and a poor clinical prognosis similar to that of glioblastomas. Our case series suggests that even in patients with histologically diffuse astrocytomas and those who present with radiographic imaging findings suggestive of a localized tumor mass, physicians should consider the possibility of IDHwt histologically diffuse astrocytomas.

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  114. Concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated with miliary tuberculosis. Reviewed International journal

    Shinsuke Muraoka, Takuya Oguri, Risa Kimura, Keita Sakurai, Yasuhiko Suzuki, Hiroyuki Shimizu, Satoshi Shinoda, Naoki Koketsu, Yoshio Araki, Ryuta Saito

    Acta neurochirurgica   Vol. 165 ( 3 ) page: 647 - 650   2023.1

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    Cerebrovascular complications of central nervous system tuberculosis (TB) are predictors of poor prognosis and adverse outcomes. These complications are mainly intracranial arterial involvement, with occasional venous involvement. Here, we present a 67-year-old woman with concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated by miliary tuberculosis. Mycobacterium tuberculosis was observed on the luminal side of the carotid plaques in pathological specimens. Treatment with anti-TB drugs alone would likely not cure the patient, as M. tuberculosis would continue to disseminate. Endarterectomy could directly remove the embolic source, and a complete cure was achieved.

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  115. Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor. Reviewed International journal

    Jun Torii, Satoshi Maesawa, Daisuke Nakatsubo, Takahiko Tsugawa, Sachiko Kato, Tomotaka Ishizaki, Sou Takai, Masashi Shibata, Toshihiko Wakabayashi, Takashi Tsuboi, Masashi Suzuki, Ryuta Saito

    Journal of neurosurgery   Vol. 138 ( 1 ) page: 38 - 49   2023.1

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    OBJECTIVE: The efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) ablation for essential tremor (ET) is well known; however, no prognostic factors have been established. The authors aimed to retrospectively investigate MRgFUS ablation outcomes and associated factors and to define the cutoff values for each prognostic factor. METHODS: Sixty-four Japanese patients who underwent unilateral ventral intermediate nucleus thalamotomy with MRgFUS for ET were included. Follow-up evaluations were performed at 1 week and 1, 3, 6, 12, and 24 months postoperatively. Tremor suppression was evaluated using the Clinical Rating Scale for Tremor (CRST), and adverse effects were recorded postoperatively. Outcome-associated factors were examined preoperatively, intraoperatively, and postoperatively using multivariate analyses. The cutoff values for the prognostic factors were calculated using receiver operating characteristics. RESULTS: Percentage improvements in the CRST scores of the affected upper limb were 82.4%, 72.2%, 68.6%, and 65.9% at 1, 3, 6, and 12 months, respectively. Preoperatively, a high skull density ratio (SDR) (p ≤ 0.047), low CRST part B score (used to assess tremors during several tasks) (cutoff value 25, p ≤ 0.041), and nonoccurrence of resting tremors (p = 0.027) were significantly associated with improved tremor control. An intraoperatively high maximum mean temperature (cutoff value 52.5°C, p ≤ 0.047), postoperatively large lesion (cutoff value 3.9 mm in the anterior-posterior direction, p ≤ 0.002; cutoff value 5.0-5.55 mm in the superior-inferior direction, p ≤ 0.026), and small transducer focus correction (p ≤ 0.015) were also associated with improved tremor control. No valid cutoff value was found for SDR. Adverse effects (limb weakness, sensory disturbance, ataxia/walking disturbance, dysgeusia, dysarthria, and facial swelling) occurred transiently and were associated with high SDR, high temperature, high number of sonication sessions, large lesion, and occurrence of resting tremor. Patients who developed leg weakness experienced greater percentage improvement in tremors at 3 months postoperatively than those who did not. CONCLUSIONS: MRgFUS ablation could be used to achieve good tremor control with acceptable adverse effects in Japanese patients with ET. The relatively low SDR in Asian ethnic groups as compared with that of Western populations makes treatment difficult; however, the cutoff values obtained in this study may be useful for achieving good treatment outcomes even in such patients. Clinical trial registration no.: UMIN000026952 (University Hospital Medical Information Network). ABBREVIATIONS: ACPC = anterior commissure-posterior commissure; AP = anterior to posterior; CRST = Clinical Rating Scale for Tremor; ET = essential tremor; MRgFUS = magnetic resonance-guided focused ultrasound; PC = posterior commissure; PSA = posterior subthalamic area; RL = right to left; ROC = receiver operating characteristic; SDR = skull density ratio; SI = superior to inferior; T2WI = T2-weighted imaging; VIM = ventral intermediate nucleus.

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  116. [Seizure Semiology and Functional Anatomy in the Cerebral Cortex].

    Satoshi Maesawa, Tomotaka Ishizaki, Ryuta Saito

    No shinkei geka. Neurological surgery   Vol. 51 ( 1 ) page: 17 - 28   2023.1

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    Understanding the semiology and underlying anatomy of each seizure is essential for epilepsy surgeons. According to the International League Against Epilepsy(ILAE)classification in 2017, seizure types are classified as focal, generalized, or unknown onset, all of which are further classified as motor or non-motor onset. Impairment of awareness is involved in consciousness systems(consisting of subcortical structures such as the thalamus and upper brain stem)and cortical structures(including the frontoparietal association cortices). Seizures with motor features are divided into elementary symptoms for which myoclonic, clonic, and tonic expressions reflect the somatotopy of the primary motor cortex; and integrated or gestural motor expression representing activation of the motor association cortex. A rostrocaudal gradient is demonstrated in hyperkinetic movements in frontal lobe epilepsy. Non-motor epileptic features should be understood together with auras, which correspond to focal aware seizures and hold crucial localizing semiologic values. The correlation between functional anatomy and seizure semiology is justified by invasive recordings such as stereotactic electroencephalography and subdural recordings, and also confirmed by seizure outcomes after resection of supposed epileptogenic zones. In addition to the conventional localization theory, it is necessary to consider the neural network theory for further recognition of the functionally anatomical basis in an incomprehensible demonstration of seizures.

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  117. 振戦優位型パーキンソン病(TD-PD)におけるMRガイド下集束超音波治療(MRgFUS)の適応判断と治療効果の検討

    中坪 大輔, 前澤 聡, 津川 隆彦, 加藤 祥子, 鳥居 潤, 武藤 学, 伊藤 芳記, 坪井 崇, 鈴木 将史, 若林 俊彦, 勝野 雅央, 齊藤 竜太

    日本定位・機能神経外科学会プログラム・抄録集   Vol. 62回   page: 133 - 133   2023.1

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  118. Surgical treatment for recurrent pediatric malignant brain tumors

    Sonoda Yukihiko, Matsuda Ken-ichiro, Ito Miiko, Saito Ryuta, Kanamori Masayuki, Kanemura Yonehiro, Tominaga Teiji

    Nervous System in Children   Vol. 48 ( 1 ) page: 33 - 38   2023

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    <p>The effect of surgical resection on recurrent pediatric malignant brain tumors is still controversial. We analyzed cases of seven patients who underwent surgical resection of recurrent lesions.</p><p>In all patients, the Karnofsky performance status was not aggravated after multiple surgeries. The progression free survival periods in four patients with posterior infratentorial ependymomas were 10, 18, 24, and 35 months. Three of the four patients survived about 100 months following multiple repeat surgeries and re-radiation. However, one patient died because of disseminated lesions 21 months after the initial therapy. These results suggested that repeat surgeries for recurrent ependymomas were effective unless disseminated lesions were detected. However, the effects of repeat surgeries were modest in our patients with glioblastoma. Based on the World Health Organization’s Classification of Central Nervous System tumors, 5<sup>th</sup> Edition, these tumors were diagnosed as diffuse astrocytoma, <i>IDH</i>-mutant, grade 4, and diffuse hemispheric tumor, <i>H3 G34</i>-mutant. Although these tumors did not recur as leptomeningeal dissemination, local tumor control was very poor by repeat surgeries. Finally, one infant case with <i>SHH</i>, <i>TP53</i>-wild type medulloblastoma survived more than 100 months following repeat surgeries and chemotherapy alone. The indication of repeat surgeries for medulloblastoma might be limited; thus, precise molecular and histological information was useful to determine therapy.</p>

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  119. Investigation of cystine as differential diagnostic biomarker between astrocytomas and oligodendrogliomas based on global- and targeted analysis using liquid chromatography/tandem mass spectrometric analysis Reviewed

    Masahiro Watanabe, Masamitsu Maekawa, Masayuki Kanamori, Minami Yamauchi, Ai Abe, Yoshiteru Shimoda, Ryuta Saito, Hidenori Endo, Nariyasu Mano

    Advances in Biomarker Sciences and Technology   Vol. 5   page: 76 - 85   2023

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  120. Usefulness of Stanch Belt Plus in Postoperative Management after Endovascular Neurosurgery

    Nishihori Masahiro, Kawase Ryo, Izumi Takashi, Nakase Hiroe, Onishi Erina, Saito Ryuta

    Journal of Neuroendovascular Therapy   Vol. 17 ( 12 ) page: 281 - 285   2023

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    <p><b>Objective</b>: We verified the usefulness of patient management using a balloon-pressurized belt (Stanch Belt Plus) to prevent puncture site hematomas, which can occur at a specific rate even with hemostatic devices after endovascular neurosurgery.</p><p><b>Methods</b>: A total of 113 patients who underwent endovascular surgery with a femoral puncture from April 2019 to September 2020 were divided into two groups: 31 cases using a traditional compression belt and 82 cases using a newly introduced balloon-pressurized belt during this period. The clinical data were analyzed retrospectively. The chi-square test and Mann–Whitney U test were used to test for significant differences.</p><p><b>Results</b>: There were no significant differences in treatment procedures or frequency of hemostatic device use, but the balloon-pressurized belt group had a significantly lower incidence of hematomas (2.4% vs 12.9%, p <0.05) and a significantly lower incidence of moderate or higher lumbago (22.0% vs 41.9%, p <0.05). The incidence of epidermal detachment tended to be low; however, no significant difference was observed (3.7% vs. 12.9%, n.s.).</p><p><b>Conclusion</b>: Patient management with the newly introduced balloon-pressurized belt may decrease the occurrence of groin hematoma and lumbago among complications after endovascular neurosurgery.</p>

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  121. Latest Treatments and Expectations for Precision Medicine against Malignant Glioma Invited Reviewed

    Saito Ryuta

    Japanese Journal of Neurosurgery   Vol. 32 ( 3 ) page: 148 - 153   2023

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    <p>  Malignant glioma is one of the most intractable malignant neoplasms. Standard treatment consists of surgery, radiotherapy, and chemotherapy, although substantial therapeutic effects cannot be expected. In particular, the blood-brain barrier (BBB) protects the central nervous system, reducing the effectiveness of chemotherapy. Temozolomide is the standard treatment, but it only prolongs the median survival time by about two months compared to surgery and radiation. Molecular-targeted therapies, which have revolutionized the treatment of many cancer types, have all failed to treat malignant gliomas, and the focus is now on the spatial and temporal diversity of tumors. In addition, the problem of drug penetration across the BBB has been refocused. Precision medicine is also attracting great expectations, but panel testing can only be done once. Even if an expert panel recommends a treatment, there is a problem in that most treatments have to rely on investigational therapies. It is also known that even if there is a draggable genetic abnormality in tumors, drugs targeting those abnormalities are often ineffective against brain tumors. Therefore, it is necessary that all novel therapeutic approaches, such as virus therapy, neutron capture therapy, and drug delivery techniques like convection-enhanced delivery, be employed to improve treatment outcomes in malignant glioma.</p>

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  122. Dural Arteriovenous Fistula Mimicking a Brain Tumor on Methionine-positron Emission Tomography: A Case Report Reviewed

    HANYU Taketo, NISHIHORI Masahiro, IZUMI Takashi, MOTOMURA Kazuya, OHKA Fumiharu, GOTO Shunsaku, ARAKI Yoshio, YOKOYAMA Kinya, UDA Kenji, SAITO Ryuta

    NMC Case Report Journal   Vol. 9 ( 0 ) page: 289 - 294   2022.12

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    <p>In this article, we report a case wherein a brain tumor was suspected based on computed tomography and magnetic resonance imaging findings. We made an initial diagnosis of malignant brain tumor based on methionine-positron emission tomography (PET) findings, but the correct diagnosis was dural arteriovenous fistula (DAVF). The patient was a 45-year-old man with DAVF who developed headache. Methionine-PET imaging showed high methionine uptake in the lesion. Although the tumor was strongly suspected from the findings of methionine-PET, the diagnosis of DAVF could be made correctly only by interpreting digital subtraction angiography and computed tomographic angiography. The findings of methionine-PET, which is considered useful in the diagnosis and denial of brain tumors, made the diagnosis of DAVF more difficult. The increased uptake of methionine-PET in DAVF is an important finding because, to our knowledge, this study is the first to report such finding. The results of this study might be useful for differential diagnoses when the diagnosis is uncertain.</p>

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  123. Delayed Recurrence of Choroid Plexus Carcinoma in the Sacral Spinal Cord 17 Years after Its Initial Presentation

    NAGAI Arata, KANAMORI Masayuki, SHIMODA Yoshiteru, WATANABE Mika, SAITO Ryuta, KUMABE Toshihiro, AIZAWA Toshimi, TOMINAGA Teiji

    NMC Case Report Journal   Vol. 9 ( 0 ) page: 301 - 306   2022.12

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    <p>Choroid plexus carcinomas (CPCs) are rare malignant tumors of neuro-ectodermal origin, accounting for less than 1% of all intracranial tumors. The recurrence rates of CPCs are very high and typically occur in the short-term following surgery, even after gross total removal. Here we present a rare case of CPC with spinal metastasis, which occurred long after its initial presentation. A 25-year-old woman with a history of increased intracranial pressure underwent resection for a tumor of the fourth ventricle, with a histopathological diagnosis of CPC. After tumor resection, she received 30 Gy of radiation therapy to the craniospinal axis and 20 Gy to the primary site, followed by nimustine hydrochloride chemotherapy. The residual lesion completely responded to these treatments. She suffered sensory loss in the sacral region 13 years later, followed by refractory skin ulcer in the sacral region 17 years after the initial treatments. Magnetic resonance imaging at 17 years after the initial treatments showed tumor in the sacral region, which was enlarged upon follow-up after 18 months, causing incontinence and loss of urinary intention. She underwent tumor resection, with a histological diagnosis of recurrent CPC. She received salvage re-irradiation. This case shows that CPC can spread via the cerebrospinal fluid pathways and cause spinal metastasis, with relatively slow clinical course. The present case suggests that patients with CPCs may need long-term follow-up imaging of the total neural axis to identify late recurrence at both the primary site and spinal metastasis.</p>

    DOI: 10.2176/jns-nmc.2022-0056

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  124. Diagnosis and Treatment Strategies for Arachnoiditis Ossificans Following Subarachnoid Hemorrhage: A Case Report

    NAGASHIMA Yoshitaka, NISHIMURA Yusuke, ITO Hiroshi, NISHII Tomoya, OYAMA Takahiro, SAITO Ryuta

    NMC Case Report Journal   Vol. 9 ( 0 ) page: 295 - 299   2022.12

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    <p>Arachnoiditis ossificans (AO) is a rare disease, wherein ossified lesions in the subarachnoid space obstruct the flow of spinal fluid or compress the spinal cord, thereby causing myelopathy. Here we describe a rare case of AO and discuss the diagnosis and treatment strategies for this disease. A 66-year-old man with a history of subarachnoid hemorrhage presented with gait disturbance and dysuria for 7 months. Spinal magnetic resonance imaging and computed tomography (CT) myelography showed syringomyelia at the T5-T8 level and dorsally tethered spinal cord at the T8-T10 level. Preoperative noncontrast CT was not performed. The patient was diagnosed with adhesive arachnoiditis and underwent arachnoidolysis. However, intraoperative findings showed the presence of ossification lesions on the dorsal surface of the spinal cord, and intraoperative ultrasound (IOU) showed a hyperintense lesion with acoustic shadowing on the dorsal surface of the spinal cord, with limited visibility of the spinal cord. After removal of the lesions, IOU showed untethered and well-decompressed spinal cord and restoration of cerebrospinal fluid pulsation. Based on these findings, the patient was finally diagnosed with AO, which is an extremely rare disease, with an unknown frequency of occurrence. Therefore, all patients with adhesive spinal arachnoiditis require a preoperative noncontrast CT scan to evaluate for ossification lesions. In this case, we were fortunate to be able to treat AO with IOU, which demonstrated specific findings.</p>

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  125. Four-dimensional digital subtraction angiography for the vascular anatomical diagnosis of dural arteriovenous malformation: Comparison with the conventional method. International journal

    Kojiro Ishikawa, Masahiro Nishihori, Takashi Izumi, Ryosuke Oshima, Takeshi Uemura, Fumiaki Kanamori, Kenji Uda, Kinya Yokoyama, Yoshio Araki, Ryuta Saito

    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences     page: 15910199221145526 - 15910199221145526   2022.12

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    BACKGROUND: Two-dimensional digital subtraction angiography (2D-DSA) and conventional three-dimensional digital subtraction angiography (3D-DSA) are used for the detailed analysis of dural arteriovenous fistula (DAVF). Recently, four-dimensional digital subtraction angiography (4D-DSA), a novel technology, has been attracting attention. The current study aimed to evaluate the capability of 4D-DSA in assessing anatomical angioarchitecture in DAVF. METHODS: In total, 10 consecutive patients with DAVF who underwent 3D-DSA and 4D-DSA at a single institution were included in the analysis. Initially, one-slice multiplanar reconstruction (MPR) images obtained via 4D-DSA and 3D-DSA were compared to investigate the visibility of the feeding artery, fistulous point, and draining vein. Next, 4D-DSA images alone were compared and evaluated with and the MPR images of conventional 3D-DSA in terms of diagnosis of the angioarchitecture. RESULTS: In total, six men and four women (with a mean age of 65.6 ± 10.0 years) were included in the study. The MPR image obtained via 3D-DSA had a significantly better visibility of the feeding artery and fistulous point than that acquired via 4D-DSA (p < 0.05). As for the draining vein, the score was equivalent and not significant. The diagnosis of the vascular architecture of only 4D-DSA images was nearly equivalent to that of MPR images of 3D-DSA. There were no inter-rater differences. CONCLUSION: The MPR images obtained via 4D-DSA may be slightly inferior to those acquired via 3D-DSA in identifying fine angioarchitecture in DAVF. However, they were comparable in terms of diagnostic accuracy.

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  126. A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy. International journal

    Satoshi Maesawa, Jun Torii, Daisuke Nakatsubo, Hiroshi Noda, Manabu Mutoh, Yoshiki Ito, Tomotaka Ishizaki, Takashi Tsuboi, Masashi Suzuki, Takafumi Tanei, Masahisa Katsuno, Ryuta Saito

    Frontiers in human neuroscience   Vol. 16   page: 1065459 - 1065459   2022.12

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    Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.

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  127. Human herpesvirus 6 DNA was not detected in a brain specimen from a patient with mesial temporal sclerosis after status epilepticus due to human herpesvirus 6 infection. International journal

    Yoshiki Kawamura, Satoshi Maesawa, Shingo Numoto, Ryuta Saito, Tetsushi Yoshikawa, Akihisa Okumura

    Epilepsia open   Vol. 7 ( 4 ) page: 817 - 821   2022.12

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    We performed virological analysis of resected brain tissues from a patient with temporal lobe epilepsy associated with mesial temporal sclerosis after febrile status epilepticus caused by human herpesvirus 6 infection. The patient had febrile status epilepticus at 9 months of age associated with human herpesvirus 6 infection. Magnetic resonance imaging revealed reduced water diffusion in the right temporal lobe and hippocampus. Polymerase chain reaction analysis detected 1.6 × 105 copies/μg of human herpesvirus 6 DNA in whole blood, but none in the cerebrospinal fluid. The patient developed temporal lobe epilepsy associated with mesial temporal sclerosis at 67 months of age, necessitating surgical treatment. Anterior temporal lobectomy was performed at 171 months of age. Real-time polymerase chain reaction analysis of resected brain tissues revealed no viral DNA. In our patient, human herpesvirus 6 infection triggered febrile status epilepticus, while direct evidence to prove contribution of HHV-6 to the development of MTS was not obtained.

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  128. 脊椎脊髄疾患における3Dプリンター活用の実際と現状

    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   Vol. 36 ( 3 ) page: 296 - 301   2022.12

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  129. 脊椎脊髄疾患における3Dプリンター活用の実際と現状

    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   Vol. 36 ( 3 ) page: 296 - 301   2022.12

  130. Magnetic Resonance Imaging Scans of Cervical Spinal Cord Ependymoma with Changing Radiological Features over a Short Period of Time. International journal

    Yoshitaka Nagashima, Yusuke Nishimura, Ryuta Saito

    World neurosurgery   Vol. 167   page: 95 - 97   2022.11

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    In a 30-year-old woman with cervical ependymoma, magnetic resonance imaging (MRI) features changed over a short period of time. A T2-weighted MRI scan obtained 1 month before surgery showed an intramedullary tumor with mixed intensity suggesting solid and cystic components at the C4-7 level. Gadolinium-enhanced MRI showed ring enhancement, including a cystic component at the C4-7 level. However, fluorodeoxyglucose positron emission tomography revealed uptake at the C5 level, and another gadolinium-enhanced MRI scan performed 24 days after the previous scan showed only enhanced lesions corresponding to the solid component at the C5-6 level. These images changed over a short time because the spontaneous hematoma, which was enhanced on the first MRI scan, had disappeared later. Fluorodeoxyglucose positron emission tomography or repeated gadolinium-enhanced MRI may be useful if the initial MRI scan suggests the presence of a hematoma in spinal ependymoma.

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  131. Endoscopic Trans-Mini-Cylinder Biopsy for Intraparenchymal Brain Lesions. International journal

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

    World neurosurgery   Vol. 167   page: E1147 - E1153   2022.11

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    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.

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  132. 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   Vol. 24   page: 18 - 18   2022.11

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  133. 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   Vol. 24   page: 18 - 18   2022.11

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  134. Abnormal foreshortening of a Flow Re-Direction Endoluminal Device caused by in-stent thrombosis immediately after deployment.

    Takafumi Otsuka, Takashi Izumi, Masahiro Nishihori, Tetsuya Tsukada, Shunsaku Goto, Mizuka Ikezawa, Naoki Kato, Mizuki Nakano, Kenji Uda, Kinya Yokoyama, Yoshio Araki, Ryuta Saito

    Nagoya journal of medical science   Vol. 84 ( 4 ) page: 884 - 889   2022.11

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    Thromboembolic complications are a concern in the treatment of cerebral aneurysms using a flow diverter. In this study, we report a case of abnormal foreshortening of a Flow Re-Direction Endoluminal Device (FRED) caused by in-stent thrombosis immediately after its deployment. A 72-year-old woman had a large cavernous carotid aneurysm, which caused ptosis and diplopia. FRED deployment was planned, and dual antiplatelet therapy was initiated 2 weeks before the procedure. Under systemic heparinization, FRED was deployed with local compaction over the aneurysm orifice. Cone-beam computed tomography subsequently revealed slightly poor wall apposition at the proximal side. While the balloon catheter was prepared for angioplasty, the stent became abnormally foreshortened, the proximal side slipped into the aneurysm, and the internal carotid artery became occluded. FRED was removed using a snare wire, and recanalization was obtained. The lumen of the removed FRED was filled with thrombus. The antiplatelet therapy was changed to triple regimen, and a Pipeline Flex embolization device was placed 1 month later. At that time, no thromboembolic complications were noted. It was considered that thrombotic occlusion was followed by foreshortening of FRED on the distal side because of antegrade blood flow. Multiple factors, such as increased mesh density by locally compacted stent deployment, slightly poor wall apposition, clopidogrel resistance, and the dual-layer structure of FRED, may have been involved in thrombus formation.

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  135. CLINICAL AND MOLECULAR FEATURES OF GLIOBLASTOMA, IDH-WILDTYPE ARISING IN THE SETTING OF LI FRAUMENI SYNDROME

    Kibe, Y; Ohka, F; Motomura, K; Aoki, K; Maeda, S; Yamaguchi, J; Nishikawa, T; Mizutani, K; Shimizu, H; Hiramatsu, T; Suzuki, K; Saito, R

    NEURO-ONCOLOGY   Vol. 24   page: 154 - 154   2022.11

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  136. Efficacy of comparing coil behavior and distribution using the silicone aneurysm model: difference of coil distribution in the early filling stage.

    Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Ryuta Saito

    Nagoya journal of medical science   Vol. 84 ( 4 ) page: 762 - 771   2022.11

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    This study sought to establish an experimental aneurysm model of visualizing coil insertion using radiolucent nylon coils. Moreover, this study aimed to clarify the characteristics and differences of each coil and use them clinically as indices of coil selection. The coil insertion test was performed on the 10 mm spherical silicone aneurysm model filled to a nylon coil volume embolization ratio of 11.8%. Five types of coil were randomly tested six times, and the distribution of the coils was analyzed by fluoroscopy imaging. Indices of "Area (mm2)," "Feret's diameter (mm)," and "Circularity" were calculated from the fluoroscopic images. Among the indices, only "Area" showed a significant difference between coils (p = 0.002). On multivariate analysis, "Area" of the ED Infini was larger than those of Target XL soft and Galaxy G3 (p = 0.018 and 0.026, respectively). Furthermore, the area of the 360 soft was larger than that of G3 (p = 0.049). Analysis of the correlation between these values and the coil configuration showed that "Area" was negatively correlated with the stock-wire diameter (r = -0.50; p = 0.004) and primary coil configuration (r = -0.65; p < 0.001). When inserting the coils in the early stage, although the difference between each coil is relatively difficult to obtain, knowledge on the proper use of the coils with differences in characteristics can help in selecting the coil most appropriate for the conditions.

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  137. IDENTIFICATION OF A NOVEL THERAPEUTIC TARGET THAT IS SYNTHETICALLY LETHAL WITH MUTANT IDH INHIBITOR IN GLIOMA USING THE CRISPR/CAS9 GENOME EDITING TECHNOLOGY

    Maeda, S; Aoki, K; Hinohara, K; Yamaguchi, J; Ohka, F; Motomura, K; Kibe, Y; Natsume, A; Saito, R

    NEURO-ONCOLOGY   Vol. 24   page: 107 - 107   2022.11

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  138. IDENTIFICATION OF A NOVEL THERAPEUTIC TARGET THAT IS SYNTHETICALLY LETHAL WITH MUTANT IDH INHIBITOR IN GLIOMA USING THE CRISPR/CAS9 GENOME EDITING TECHNOLOGY

    Maeda, S, Aoki, K, Hinohara, K, Yamaguchi, J, Ohka, F, Motomura, K, Kibe, Y, Natsume, A, Saito, R

    NEURO-ONCOLOGY   Vol. 24   page: 107 - 107   2022.11

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  139. CLINICAL AND MOLECULAR FEATURES OF GLIOBLASTOMA, IDH-WILDTYPE ARISING IN THE SETTING OF LI FRAUMENI SYNDROME

    Kibe, Y, Ohka, F, Motomura, K, Aoki, K, Maeda, S, Yamaguchi, J, Nishikawa, T, Mizutani, K, Shimizu, H, Hiramatsu, T, Suzuki, K, Saito, R

    NEURO-ONCOLOGY   Vol. 24   page: 154 - 154   2022.11

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  140. Persistence of tolvaptan medication for autosomal dominant polycystic kidney disease: A retrospective cohort study using Shizuoka Kokuho Database. International journal

    Ryuta Saito, Hiroyuki Yamamoto, Nao Ichihara, Hiraku Kumamaru, Shiori Nishimura, Koki Shimada, Kiyoshi Mori, Yoshiki Miyachi, Hiroaki Miyata

    Medicine   Vol. 101 ( 40 ) page: e30923   2022.10

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    Autosomal dominant polycystic kidney disease (ADPKD) is a rare hereditary disease leading to end-stage renal failure in approximately half of patients by seventy years of age. It is important to continuously take tolvaptan to control disease progression. However, adherence to tolvaptan in a real-world setting, rather than randomized controlled trials (RCTs), has not been sufficiently reported. We aimed to investigate tolvaptan persistence among patients with ADPKD using a large claims database. Using the Shizuoka Kokuho Database, we identified patients diagnosed with ADPKD who were prescribed tolvaptan from March 2014-September 2018 in Japan. The persistence rate of tolvaptan medication was estimated by Kaplan-Meier analysis, and patient background factors associated with treatment discontinuation were exploratively evaluated with log-rank tests. We identified 1714 eligible patients with ADPKD, and among them, 25 patients used tolvaptan medication. We followed up these patients, whose median treatment duration was 21 months. The persistence rates at 12, 24, and 36 months were estimated to be 70.8% (95% confidence interval: 48.2-93.4), 46.5% (23.2-66.9), and 38.7% (16.4-60.8), respectively. In the exploratory analysis, there were no factors that were obviously associated with tolvaptan discontinuation. The persistence rate of tolvaptan in patients with ADPKD in a real-world setting may be lower than that in previous RCTs. Our innovative method, particularly in Japan, to analyze adherence using large claims data should change the way clinical epidemiological research and health policies of rare diseases are designed in the future.

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  141. The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor. Reviewed International journal

    Satoshi Shinoda, Shinsuke Muraoka, Hiroyuki Shimizu, Naoki Koketsu, Yoshio Araki, Ryuta Saito

    Neurosurgical review   Vol. 45 ( 5 ) page: 2995 - 3002   2022.10

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    Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5-6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.

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  142. Wearable sensor device-based detection of decreased heart rate variability in Parkinson's disease. International journal

    Masashi Suzuki, Tomohiko Nakamura, Masaaki Hirayama, Masamichi Ueda, Mai Hatanaka, Yumiko Harada, Masahiro Nakatochi, Daisuke Nakatsubo, Satoshi Maesawa, Ryuta Saito, Koichi Fujiwara, Masahisa Katsuno

    Journal of neural transmission (Vienna, Austria : 1996)   Vol. 129 ( 10 ) page: 1299 - 1306   2022.10

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    The evidence that heart rate variability (HRV) decreases during early Parkinson's disease (PD) largely depends on electrocardiogram data. In this study, we examined HRV in PD using wearable sensors and assessed various evaluation methods for detecting disease-related alterations. We evaluated 27 patients with PD and 23 disease controls. The wearable sensors POLAR V800 HR and POLAR H10 were used for the HRV measurements. The participants wore the two sensors for approximately 24 h, and long-term HRV data were acquired. We analyzed the standard deviation of normal R-R intervals (SDNN) and coefficient of variation of R-R intervals (CVRR) for every 100 consecutive beats. Focusing on the fluctuation of SDNN and CVRR, we extracted the minimum, first decile, first quartile, and median values of SDNN and CVRR. The area under the receiver operating characteristic curve (AUC) for each HRV parameter was calculated to differentiate PD from the disease controls. The minimum values of SDNN and CVRR had the highest AUC (SDNN: AUC 0.90, 95% confidence interval [CI] 0.78-0.96; CVRR: AUC 0.90, CI 0.76-0.96) among the evaluation methods tested. The minimum values of SDNN and CVRR were significantly decreased in PD (SDNN: 9.5 ± 4.0 ms vs. 4.4 ± 2.0 ms, p < 0.0001; CVRR: 1.15 ± 0.33% vs. 0.65 ± 0.24%, p < 0.0001). We detected decreased HRV in PD using wearable sensors. Analyzing the minimum values of the HRV parameter in long-term recordings appears to be appropriate for detecting the decrease in HRV in PD.

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

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

    Acta neurochirurgica   Vol. 164 ( 10 ) page: 2587 - 2594   2022.10

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    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.

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  144. Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study. Reviewed International journal

    Y Maki, J Natsume, Y Ito, Y Okai, E Bagarinao, H Yamamoto, S Ogaya, T Takeuchi, T Fukasawa, F Sawamura, T Mitsumatsu, S Maesawa, R Saito, Y Takahashi, H Kidokoro

    AJNR. American journal of neuroradiology   Vol. 43 ( 10 ) page: 1502 - 1507   2022.10

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    BACKGROUND AND PURPOSE: West syndrome is a developmental and epileptic encephalopathy characterized by epileptic spasms, neurodevelopmental regression, and a specific EEG pattern called hypsarrhythmia. Our aim was to investigate the brain activities related to hypsarrhythmia at onset and focal epileptiform discharges in the remote period in children with West syndrome using simultaneous electroencephalography and fMRI recordings. MATERIALS AND METHODS: Fourteen children with West syndrome underwent simultaneous electroencephalography and fMRI at the onset of West syndrome. Statistically significant blood oxygen level-dependent responses related to hypsarrhythmia were analyzed using an event-related design of 4 hemodynamic response functions with peaks at 3, 5, 7, and 9 seconds after the onset of each event. Six of 14 children had focal epileptiform discharges after treatment and underwent simultaneous electroencephalography and fMRI from 12 to 25 months of age. RESULTS: At onset, positive blood oxygen level-dependent responses were seen in the brainstem (14/14 patients), thalami (13/14), basal ganglia (13/14), and hippocampi (13/14), in addition to multiple cerebral cortices. Group analysis using hemodynamic response functions with peaks at 3, 5, and 7 seconds showed positive blood oxygen level-dependent responses in the brainstem, thalamus, and hippocampus, while positive blood oxygen level-dependent responses in multiple cerebral cortices were seen using hemodynamic response functions with peaks at 5 and 7 seconds. In the remote period, 3 of 6 children had focal epileptiform discharge-related positive blood oxygen level-dependent responses in the thalamus, hippocampus, and brainstem. CONCLUSIONS: Positive blood oxygen level-dependent responses with hypsarrhythmia appeared in the brainstem, thalamus, and hippocampus on earlier hemodynamic response functions than the cerebral cortices, suggesting the propagation of epileptogenic activities from the deep brain structures to the neocortices. Activation of the hippocampus, thalamus, and brainstem was still seen in half of the patients with focal epileptiform discharges after adrenocorticotropic hormone therapy.

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  145. 小児脳幹部神経膠腫に対する脳内広範囲薬剤送達技術を用いた塩酸ニムスチン局所投与 多施設共同第II相医師主導治験

    齋藤 竜太, 金森 政之, 峰晴 陽平, 荒川 芳輝, 千葉 謙太郎, 藍原 康雄, 柴原 一陽, 隈部 俊宏, 松田 憲一朗, 園田 順彦, 高橋 史朗, 冨永 悌二

    日本癌治療学会学術集会抄録集   Vol. 60回   page: EN6 - 4   2022.10

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  146. 小児脳幹部神経膠腫に対する脳内広範囲薬剤送達技術を用いた塩酸ニムスチン局所投与 多施設共同第II相医師主導治験

    齋藤 竜太, 金森 政之, 峰晴 陽平, 荒川 芳輝, 千葉 謙太郎, 藍原 康雄, 柴原 一陽, 隈部 俊宏, 松田 憲一朗, 園田 順彦, 高橋 史朗, 冨永 悌二

    日本癌治療学会学術集会抄録集   Vol. 60回   page: EN6 - 4   2022.10

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  147. 機能的脳神経外科治療が検討された振戦性疾患の診断と治療方針

    坪井 崇, 鈴木 将史, 佐藤 茉紀, 平賀 経太, 佐竹 勇紀, 服部 誠, 原 一洋, 鳥居 潤, 中坪 大輔, 前澤 聡, 斎藤 竜太, 勝野 雅央

    臨床神経学   Vol. 62 ( Suppl. ) page: S256 - S256   2022.10

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  148. 機能的脳神経外科治療が検討された振戦性疾患の診断と治療方針

    坪井 崇, 鈴木 将史, 佐藤 茉紀, 平賀 経太, 佐竹 勇紀, 服部 誠, 原 一洋, 鳥居 潤, 中坪 大輔, 前澤 聡, 斎藤 竜太, 勝野 雅央

    臨床神経学   Vol. 62 ( Suppl. ) page: S256 - S256   2022.10

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  149. The usefulness and safety of dexmedetomidine for postoperative sedation in pediatric patients with moyamoya disease. International journal

    Fumiaki Kanamori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Michihiro Kurimoto, Yoshiki Shiba, Takashi Mamiya, Kai Takayanagi, Kazuki Ishii, Masahiro Nishihori, Takashi Izumi, Sho Okamoto, Ryuta Saito

    Journal of neurosurgery. Pediatrics   Vol. 30 ( 3 ) page: 301 - 307   2022.9

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    OBJECTIVE: After revascularization surgery in pediatric patients with moyamoya disease (MMD), resting and avoiding crying is important. However, this inaction is often difficult because of pain or anxiety. Dexmedetomidine (DEX), which has sedative and analgesic properties, may be useful in reducing those uncomfortable conditions; however, its common side effects include bradycardia and hypotension, which have a risk of decreasing the cerebral blood flow. The aim of this study was to investigate the efficacy and safety of using DEX for pediatric patients with MMD in the acute period after revascularization surgery. METHODS: This retrospective study included pediatric patients with MMD who underwent revascularization surgery. Based on whether DEX was used for light sedation during postoperative days (PODs) 0-1 after extubation, the patients were divided into DEX or control groups. For neurological outcomes, the incidence of symptomatic cerebral infarction and transient neurological events (TNEs) during PODs 0-1 and the entire hospitalization were investigated. In addition, the Richmond Agitation-Sedation Scale (RASS) was used to assess the effect of DEX, and bradycardia and hypotension were evaluated as side effects. RESULTS: A total of 84 surgical procedures were included in this study (27 in the DEX group and 57 in the control group). During PODs 0-1, symptomatic infarction was not observed in either group. The incidence of TNEs was almost the same in both groups: 2 (7.4%) of the 27 procedures in the DEX group and 4 (7.0%) of the 57 procedures in the control group (p > 0.99). Moreover, the incidences of symptomatic infarction and TNEs during the entire hospitalization did not differ significantly (symptomatic infarction, p > 0.99; TNEs, p = 0.20). Regarding the DEX effect, the median RASS scores during PODs 0-1 were -1.0 (drowsy) in the DEX group and +1.0 (restless) in the control group, showing a significant difference (p < 0.01). Regarding side effects, bradycardia was observed only in 3 (11.1%) of the 27 procedures in the DEX group (p = 0.03), and hypotension was not observed in any of the cases. CONCLUSIONS: In pediatric patients with MMD who are extubated after revascularization surgery, DEX produced appropriate light sedation and analgesia. The risk for symptomatic infarction is almost the same in cases in which DEX is used and those in which it is not; however, neurosurgeons should be cautious of bradycardia and TNEs as potential side effects.

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  150. 星細胞腫IDH変異型の全ゲノムシークエンスと包括的な分子学的解析(Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant)

    舟越 勇介, 中島 拓真, 南部 翔平, 畝田 篤仁, 片山 琴絵, 井元 清哉, 花谷 亮典, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1038   2022.9

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  151. ゲノムおよびトランスクリプトーム解析による膠芽腫の分子的多様性の解明(Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling)

    中島 拓真, 舟越 勇介, 南部 翔平, 畝田 篤仁, 片山 琴絵, 花谷 亮典, 井元 清哉, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1040   2022.9

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  152. Oligodendroglioma,IDH-mutant and 1p/19q-codeletedのマルチオミクス解析による全ゲノム解析の全貌(Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted)

    舟越 勇介, 南部 翔平, 中島 拓真, 畝田 篤仁, 片山 琴絵, 井元 清哉, 花谷 亮典, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1041   2022.9

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  153. True Angina Pectoris Immediately After Cervical Disc Herniation Surgery for Preoperative Cervical Angina Symptoms: A Case Report. International journal

    Takashi Abe, Takafumi Tanei, Yusuke Nishimura, Ryuta Saito

    Cureus   Vol. 14 ( 8 ) page: e28313   2022.8

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    Cervical angina, originating from cervical spine disorders, is a rare clinical syndrome presenting with chest pain mimicking angina pectoris. A rare case of cervical angina with cervical disc herniation requiring coronary artery stenting because of a true angina pectoris attack immediately after cervical spine surgery is reported. A 77-year-old woman presented with persistent pain around the neck, bilateral chest, left shoulder, and left back. She also complained of numbness and motor weakness in her left upper limb. Cervical spine imaging examinations showed instability at C4-5 and a calcified herniated disc with spinal cord compression at C4-6. She had a history of hypertension, diabetes mellitus not requiring insulin, and atrial fibrillation for which she was on anticoagulant therapy. The preoperative electrocardiogram and transthoracic echocardiography were within normal limits, and thus further cardiac study was considered unnecessary by the cardiologist. The anterior cervical discectomy and fusion were safely performed. However, she suddenly started to complain of left anterior chest pain with a cold sweat one hour after the surgery. An emergency electrocardiogram showed ischemic changes, and coronary angiography showed 99% stenosis at the right main coronary artery. A coronary stent was placed and good dilatation was achieved. Preoperative cervical angina symptoms such as numbness, motor weakness, and pain were improved immediately after surgery. The left chest pain also disappeared completely after coronary artery stent placement. Postoperative cervical imaging assessments showed good spinal decompression. She was discharged home without neurological deficits and no cardiac symptoms.

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  154. 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   Vol. 98 ( S.HPT ) page: 25 - 27   2022.8

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  155. 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   Vol. 98 ( S.HPT ) page: 72 - 73   2022.8

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  156. Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab: illustrative case. International journal

    Masasuke Ohno, Shunichiro Kuramitsu, Akari Iwakoshi, Junya Yamaguchi, Fumiharu Ohka, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 4 ( 6 )   2022.8

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    BACKGROUND: Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab. OBSERVATIONS: A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months. LESSONS: Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary.

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  157. Spontaneous regression of asymptomatic tumefactive perivascular spaces in the anterior temporal lobe.

    Miki Hashida, Yoshitaka Nagashima, Yusuke Nishimura, Kaoru Eguchi, Toshiaki Taoka, Hisashi Kawai, Ryuta Saito

    Nagoya journal of medical science   Vol. 84 ( 3 ) page: 678 - 685   2022.8

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    Perivascular spaces are fluid-filled spaces that surround the perforating vessels of the brain and are normal findings on brain imaging. These are usually asymptomatic and are considered a manifestation of aging. Perivascular spaces occasionally undergo significant enlargement and are referred to as tumefactive perivascular spaces, which are often indistinguishable from neoplastic lesions. Spontaneous regression of tumefactive perivascular spaces during follow-up is rare. We report the imaging findings and clinical course of a patient who showed spontaneous regression of tumefactive perivascular spaces in the anterior temporal lobe, together with a literature review and discussion regarding the characteristics and pathogenesis of spontaneous regression of tumefactive perivascular spaces. Most studies in the available literature report tumefactive perivascular spaces in the anterior temporal lobe; in our view, the characteristics of anterior temporal lobe tumefactive perivascular spaces may differ from those of tumefactive perivascular spaces that occur at other locations.

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  158. Radiological Analysis of Minimally Invasive Microscopic Laminectomy for Lumbar Canal Stenosis with a Focus on Multilevel Stenosis and Spondylolisthesis. International journal

    Takayuki Awaya, Yusuke Nishimura, Kaoru Eguchi, Yoshitaka Nagashima, Ryo Ando, Sho Akahori, Satoshi Yoshikawa, Shoichi Haimoto, Masahito Hara, Masakazu Takayasu, Ryuta Saito

    World neurosurgery   Vol. 164   page: E224 - E234   2022.8

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    OBJECTIVE: We retrospectively compared the radiological and clinical outcomes of two different surgical techniques (lumbar spinous process splitting laminectomy [LSPSL] and unilateral laminotomy for bilateral decompression [ULBD]) to treat lumbar spinal canal stenosis (LCS). METHODS: We performed a retrospective comparative study of 141 consecutive patients with an average age of 70.8 ± 9.4 years who had undergone LSPSL or ULBD for LCS between April 2015 and April 2019. None of the patients had developed remote fractures of the spinous processes using either technique. These cases were divided into 2 groups: group L, 73 patients who had undergone LSPSL from April 2015 to April 2017; and group U, 68 patients who had undergone ULBD from May 2017 to April 2019. The clinical and radiological outcomes and surgical complications at the 1-year postoperative follow-up period were evaluated. RESULTS: We found no significant differences in the operative time between the 2 groups. However, group U had had significantly less blood loss than group L. The facet joints were significantly well preserved in group U. We examined the multilevel and spondylolisthesis cases separately and found that both surgical procedures were equally effective and that the visual analog scale scores for back or leg pain and Japanese Orthopaedic Association scores had significantly improved postoperatively in each group. Group U showed better outcomes in terms of LCS recurrence, with 3 patients in the group L requiring repeat surgery. CONCLUSIONS: We found both ULBD and LSPSL to be safe and effective techniques for LCS, even for patients with spondylolisthesis and multilevel disease. ULBD was superior in terms of recurrence prevention, preservation of the facet joints, and less blood loss.

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  159. Role of the parietooccipital fissure and its implications in the pathophysiology of posterior medial temporal gliomas. International journal

    Ichiyo Shibahara, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Sumito Sato, Takuichiro Hide, Teiji Tominaga, Toshihiro Kumabe

    Journal of neurosurgery   Vol. 137 ( 2 ) page: 505 - 514   2022.8

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    OBJECTIVE: The parietooccipital fissure is an anatomical landmark that divides the temporal, occipital, and parietal lobes. More than 40% of gliomas are located in these three lobes, and the temporal lobe is the most common location. The parietooccipital fissure is located just posterior to the medial temporal lobe, but little is known about the clinical significance of this fissure in gliomas. The authors investigated the anatomical correlations between the parietooccipital fissure and posterior medial temporal gliomas to reveal the radiological features and unique invasion patterns of these gliomas. METHODS: The authors retrospectively reviewed records of all posterior medial temporal glioma patients treated at their institutions and examined the parietooccipital fissure. To clarify how the surrounding structures were invaded in each case, the authors categorized tumor invasion as being toward the parietal lobe, occipital lobe, isthmus of the cingulate gyrus, insula/basal ganglia, or splenium of the corpus callosum. DSI Studio was used to visualize the fiber tractography running through the posterior medial temporal lobe. RESULTS: Twenty-four patients with posterior medial temporal gliomas were identified. All patients presented with a parietooccipital fissure as an uninterrupted straight sulcus and as the posterior border of the tumor. Invasion direction was toward the parietal lobe in 13 patients, the occipital lobe in 4 patients, the isthmus of the cingulate gyrus in 19 patients, the insula/basal ganglia in 3 patients, and the splenium of the corpus callosum in 8 patients. Although the isthmus of the cingulate gyrus and the occipital lobe are located just posterior to the posterior medial temporal lobe, there was a significantly greater preponderance of invasion toward the isthmus of the cingulate gyrus than toward the occipital lobe (p = 0.00030, McNemar test). Based on Schramm's classification for the medial temporal tumors, 4 patients had type A and 20 patients had type D tumors. The parietooccipital fissure determined the posterior border of the tumors, resulting in a unique and identical radiological feature. Diffusion spectrum imaging (DSI) tractography indicated that the fibers running through the posterior medial temporal lobe toward the occipital lobe had to detour laterally around the bottom of the parietooccipital fissure. CONCLUSIONS: Posterior medial temporal gliomas present identical invasion patterns, resulting in unique radiological features that are strongly affected by the parietooccipital fissure. The parietooccipital fissure is a key anatomical landmark for understanding the complex infiltrating architecture of posterior medial temporal gliomas.

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  160. Medical Management of a Mural Thrombus Inducing Repeated Ischemic Strokes in a Patient with Congenital Afibrinogenemia. International journal

    Masahiro Nishihori, Yoshio Araki, Nobuaki Suzuki, Shogo Tamura, Mayo Hattori, Takashi Izumi, Shunsaku Goto, Kinya Yokoyama, Kenji Uda, Tadashi Matsushita, Ryuta Saito

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   Vol. 31 ( 7 ) page: 106526 - 106526   2022.7

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    OBJECTIVES: Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment. CASE DESCRIPTION: A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events. CONCLUSION: This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.

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  161. 特集 癒着性くも膜炎の病態と治療法を学ぼう 術後に生じる癒着性くも膜炎

    西村 由介, 永島 吉孝, 齋藤 竜太

    脊椎脊髄ジャーナル   Vol. 35 ( 2 ) page: 99 - 105   2022.6

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  162. Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review. International journal

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

    BMC neurology   Vol. 22 ( 1 ) page: 223 - 223   2022.6

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    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.

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  163. Phase II single-arm, multi-center, physician-initiated clinical trial of convection-enhanced delivery of nimustine hydrochloride (ACNU) against diffuse intrinsic pontine gliomas

    Ryuta Saito, Masayuki Kanamori, Yohei Mineharu, Yoshiki Arakawa, Kentaro Chiba, Yasuo Aihara, Ichiyo Shibahara, Toshihiro Kumabe, Kenichiro Matsuda, Yukihiko Sonoda, Fumiaki Takahashi, Teiji Tominaga

    JOURNAL OF CLINICAL ONCOLOGY   Vol. 40 ( 16 )   2022.6

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

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

    Neurosurgical review   Vol. 45 ( 3 ) page: 2471 - 2480   2022.6

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    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.

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  165. Evaluation of the differences in pressure applied to the vessel wall by different types of balloon remodeling microcatheters in an experimental model. International journal

    Mizuka Ikezawa, Takashi Izumi, Masahiro Nishihori, Tetsuya Tsukada, Yosuke Tamari, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Shunsaku Goto, Asuka E Kropp, Takafumi Otsuka, Naoki Kato, Mizuki Nakano, Ryuta Saito

    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences   Vol. 28 ( 3 ) page: 323 - 331   2022.6

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    BACKGROUND: We examined compliance differences among balloon remodeling microcatheters, which have not been established previously. METHODS: Straight and 120° angulated vascular models were created in a 3 mm diameter tube with 3 mm hole (vascular model A), a tube with a 4 mm hole (vascular model B), and a 4 mm diameter tube (vascular model C). We compared the pressure exerted when each balloon was herniated 1 or 2 mm between three compliant balloons (SHOURYU SR, TransForm C, and Scepter C) and four super-compliant balloons (HyperForm, SHOURYU HR, TransForm SC, and Scepter XC). RESULTS: In vascular model A, there was a significant difference in the pressure exerted by compliant balloons and super-compliant balloons in both the straight and angulated models. In the straight model (1 and 2 mm), the lowest pressure was exerted by HyperForm (super-compliant balloons group) and SHOURYU SR (compliant balloons group). The lowest pressure was exerted in the angulated model by HyperForm (super-compliant balloons group) and Scepter C (compliant balloons group). The Scepter balloon exerted higher pressure in the straight model than other balloon remodeling microcatheters but less in the angulated model. In vascular model B, the pressure decreased in all balloons compared with model A. In vascular model C, the pressure increased in all balloons compared with model A. CONCLUSIONS: Pressure differed across balloon remodeling microcatheters. In addition, vessel shape and diameter, and hole size, affected the results. Our findings can help select balloon remodeling microcatheters.

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

    Kazuhito Takeuchi, Yuichi Nagata, Kuniaki Tanahashi, Ryuta Saito

    Acta neurochirurgica   Vol. 164 ( 6 ) page: 1619 - 1622   2022.6

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    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.

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  167. Recent Molecular and Genetic Findings in Intramedullary Spinal Cord Tumors. International journal

    Yoshitaka Nagashima, Yusuke Nishimura, Kaoru Eguchi, Junya Yamaguchi, Shoichi Haimoto, Fumiharu Ohka, Masakazu Takayasu, Ryuta Saito

    Neurospine   Vol. 19 ( 2 ) page: 262 - 271   2022.6

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    The study of genetic alterations and molecular biology in central nervous system (CNS) tumors has improved the accuracy of estimations of patient prognosis and tumor categorization. Therefore, the updated 2021 World Health Organization (WHO) classification includes various diagnostic genes, molecules, and pathways for diagnosis, as well as histological findings. These findings are expected both to have diagnostic applications and to facilitate new targeted therapies that target tumor-specific genetic changes and molecular biology. Intramedullary spinal cord tumors (IMSCTs) are rare CNS tumors that are difficult to treat because they occur in eloquent areas. Although the genetic underpinnings of IMSCTs remain unclear compared to their intracranial counterparts, the genetic characteristics of these tumors are gradually being revealed. Here, we describe the major changes in the new 2021 WHO classification and review the major types of IMSCTs, with an emphasis on their clinical features and genetic alterations.

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  168. Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions. International journal

    Kazuya Motomura, Fumiharu Ohka, Kosuke Aoki, Ryuta Saito

    Frontiers in neurology   Vol. 13   page: 874826 - 874826   2022.5

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    Gliomas are a category of infiltrating glial neoplasms that are often located within or near the eloquent areas involved in motor, language, and neurocognitive functions. Surgical resection being the first-line treatment for gliomas, plays a crucial role in patient outcome. The role of the extent of resection (EOR) was evaluated, and we reported significant correlations between a higher EOR and better clinical prognosis of gliomas. However, recurrence is inevitable, even after aggressive tumor removal. Thus, efforts have been made to achieve extended tumor resection beyond contrast-enhanced mass lesions in magnetic resonance imaging (MRI)-defined areas, a process known as supratotal resection. Since it has been reported that tumor cells invade beyond regions visible as abnormal areas on MRI, imaging underestimates the true spatial extent of tumors. Furthermore, tumor cells have the potential to spread 10-20 mm away from the MRI-verified tumor boundary. The primary goal of supratotal resection is to maximize EOR and prolong the progression-free and overall survival of patients with gliomas. The available data, as well as our own work, clearly show that supratotal resection of gliomas is a feasible technique that has improved with the aid of awake functional mapping using intraoperative direct electrical stimulation. Awake brain mapping has enabled neurosurgeons achieve supratotal resection with favorable motor, language, and neurocognitive outcomes, ensuring a better quality of life in patients with gliomas.

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  169. Blood flow stagnation after treatment of a giant internal carotid artery aneurysm: a computed fluid dynamics analysis. International journal

    Shinsuke Muraoka, Reiya Takagi, Yoshio Araki, Kenji Uda, Masaki Sumitomo, Sho Okamoto, Masahiro Nishihori, Takashi Izumi, Masanori Nakamura, Ryuta Saito

    Scientific reports   Vol. 12 ( 1 ) page: 7283 - 7283   2022.5

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    Balloon test occlusion (BTO) is an angiographic test to evaluate ischemic tolerance after permanent occlusion of an internal carotid artery (ICA). BTO can simulate ischemia caused by parent artery occlusion and can be used to select a suitable bypass surgery using specific criteria. On the other hand, a postoperative thrombus can form despite proper case selection, optimal radiological evaluation, and an appropriate surgical strategy. Postoperative ischemic complications related to perforating branches are clinically significant. This simulation study aimed to analyze postoperative flow characteristics and elucidate the cause of ischemic complications related to the perforating branch using computational fluid dynamics (CFD). An unexpected postoperative thrombus formation related to the perforating branch occurred after treating a giant aneurysm in the cavernous portion of the ICA in a patient. Three-dimensional digital subtraction angiography was used to acquire flow data and set up the CFD simulation. The flow simulations were performed at various bypass flow rates. The CFD analysis indicated flow stagnation in the ICA only when surgical treatment using a low-flow bypass graft was performed. Thrombus formation may lead to ischemic complications related to the perforating branch, such as the anterior choroidal artery. BTO did not reflect the influence of bypass blood flow. Therefore, recognizing that blood flow stagnation may occur and comprehensively deciding on the surgical strategy by CFD analysis can be helpful to prevent ischemic complications in patients with giant aneurysms.

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  170. 脳腫瘍研究のcutting edge-先端画像、実験/分子病理、デジタル病理- 神経膠腫の術中迅速遺伝子変異解析を目指した高速リアルタイムPCR法の確立

    前田 紗知, 大岡 史治, 北野 詳太郎, 本村 和也, 青木 恒介, 西川 知秀, 山口 純矢, 木部 祐士, 齋藤 竜太

    Brain Tumor Pathology   Vol. 39 ( Suppl. ) page: 069 - 069   2022.5

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  171. 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   Vol. 39 ( Suppl. ) page: 110 - 110   2022.5

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  172. Angiographic characteristics of improper watershed shift after STA-MCA bypass in a patient with moyamoya disease: illustrative case. International journal

    Fumiaki Kanamori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Takashi Mamiya, Shota Nohira, Kai Takayanagi, Kazuki Ishii, Masahiro Nishihori, Takashi Izumi, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 3 ( 16 )   2022.4

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    BACKGROUND: In patients with moyamoya disease (MMD) who receive superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, hypoperfusion remote from the anastomosis site rarely occurs. Watershed shift due to direct bypass has been proposed as the mechanism; however, no report has confirmed this phenomenon using angiography. OBSERVATIONS: A 48-year-old man presented with transient weakness in his left arm. Angiography revealed severe bilateral stenosis of the MCAs and moyamoya vessels. The right anterior cerebral artery (ACA) had short stenosis at A2 but ample blood supply to the cortical area of the right ACA and MCA regions. The patient was diagnosed with MMD and received a single STA-MCA bypass. The next day, he had difficulty communicating, and a cerebral infarction away from the anastomosis site was identified. Perfusion examination revealed hyperperfusion around the direct bypass and hypoperfusion away from the anastomosis site. Angiography revealed bypass patency; however, the original anterograde flow of the right ACA decreased significantly at the stenosed point, indicating an improper watershed shift. LESSONS: STA-MCA bypass for patients with MMD can cause an improper watershed shift decreasing cerebral flow. Donor flow should be prepared based on each angiographic characteristic, and the risk of the improper watershed shift should be considered.

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  173. Challenging direct bypass surgery for very young children with moyamoya disease: technical notes. International journal

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

    Neurosurgical review   Vol. 45 ( 2 ) page: 1799 - 1807   2022.4

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    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.

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  174. Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads. International journal

    Kenji Uda, Kuniaki Tanahashi, Takashi Mamiya, Fumiaki Kanamori, Kinya Yokoyama, Masahiro Nishihori, Takashi Izumi, Yoshio Araki, Ryuta Saito

    Neurosurgical review   Vol. 45 ( 2 ) page: 1617 - 1624   2022.4

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    Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA-SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO- and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO-, and StA. In all parameters, ApA-ZO- extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO-, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon's anastomosis skill level.

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  175. 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   Vol. 45 ( 2 ) page: 1783 - 1789   2022.4

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    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.

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  176. Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery.

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

    Neurologia medico-chirurgica   Vol. 62 ( 4 ) page: 203 - 208   2022.4

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    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, secure 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 collagen matrix. The collagen matrix harvested from this area was pathologically examined; neovascularization and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, neovascularization 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.

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

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

    World neurosurgery   Vol. 160   page: E220 - E226   2022.4

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    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.

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  178. 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   Vol. 47 ( 2 ) page: 201 - 201   2022.4

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  179. 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   Vol. 98 ( 1 ) page: 329 - 329   2022.4

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  180. 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   Vol. 98 ( 1 ) page: 278 - 278   2022.4

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  181. 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   Vol. 98 ( 1 ) page: 309 - 309   2022.4

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  182. 特集 脊椎脊髄疾患の再手術症例における手術のコツと留意点 頸椎症における再手術

    西村 由介, 永島 吉孝, 齋藤 竜太

    脊椎脊髄ジャーナル   Vol. 34 ( 12 ) page: 896 - 901   2022.3

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    DOI: 10.11477/mf.5002201765

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  183. Increased Risk of Thyroid Dysfunction by PD-1 and CTLA-4 Blockade in Patients Without Thyroid Autoantibodies at Baseline. International journal

    Shintaro Iwama, Tomoko Kobayashi, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Masahiko Ando, Xin Zhou, Ayana Yamagami, Takeshi Onoue, Yohei Kawaguchi, Takashi Miyata, Mariko Sugiyama, Hiroshi Takagi, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tetsunari Hase, Masahiro Morise, Keiko Wakahara, Kenji Yokota, Masashi Kato, Naoki Nishio, Chie Tanaka, Kazushi Miyata, Atsushi Ogura, Takanori Ito, Tsunaki Sawada, Tomoya Shimokata, Kaoru Niimi, Fumiharu Ohka, Masatoshi Ishigami, Momokazu Gotoh, Naozumi Hashimoto, Ryuta Saito, Hitoshi Kiyoi, Hiroaki Kajiyama, Yuichi Ando, Hideharu Hibi, Michihiko Sone, Masashi Akiyama, Yasuhiro Kodera, Hiroshi Arima

    The Journal of clinical endocrinology and metabolism   Vol. 107 ( 4 ) page: E1620 - E1630   2022.3

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    BACKGROUND: Previous studies showed that although the risk of thyroid dysfunction [thyroid immune-related adverse events (irAEs)] induced by anti-programmed cell death-1 antibodies (PD-1-Ab) was as low as 2% to 7% in patients negative for anti-thyroid antibodies (ATAs) at baseline, it was much higher (30%-50%) in patients positive for ATAs. However, whether a similar increase occurs with combination therapy using PD-1-Ab plus anti-cytotoxic T-lymphocyte antigen-4 antibody (CTLA-4-Ab) is unknown. METHODS: A total of 451 patients with malignancies treated with PD-1-Ab, CTLA-4-Ab, or a combination of PD-1-Ab and CTLA-4-Ab (PD-1/CTLA-4-Abs) were evaluated for ATAs at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then observed until the last clinical visit. RESULTS: Of the 451 patients, 51 developed thyroid irAEs after immunotherapy [41 of 416 (9.9%) treated with PD-1-Ab, 0 of 8 (0%) treated with CTLA-4-Ab, and 10 of 27 (37.0%) treated with PD-1/CTLA-4-Abs]. The cumulative incidence of thyroid irAEs was significantly higher in patients who were positive vs negative for ATAs at baseline after both PD-1-Ab [28/87 (32.2%) vs 13/329 (4.0%), P < 0.001] and PD-1/CTLA-4-Abs [6/10 (60.0%) vs 4/17 (23.5%), P < 0.05] treatments. The risk of thyroid irAEs induced by PD-1/CTLA-4Abs, which was significantly higher than that induced by PD-1-Ab, in patients negative for ATAs at baseline was not statistically different from that induced by PD-1-Ab in patients positive for ATAs at baseline. CONCLUSIONS: This study showed that the incidence of thyroid irAEs was high and not negligible after PD-1/CTLA-4-Abs treatment even in patients negative for ATAs at baseline.

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  184. 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. International journal

    Yoshio Araki, Kinya Yokoyama, Kenji Uda, Fumiaki Kanamori, Takashi Mamiya, Kai Takayanagi, Kazuki Ishii, Masahiro Nishihori, Kazuhito Takeuchi, Kuniaki Tanahashi, Yuichi Nagata, Takafumi Tanei, Yusuke Nishimura, Takashi Izumi, Ryuta Saito

    Journal of neurosurgery. Case lessons   Vol. 3 ( 12 )   2022.3

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    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.

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  185. Surgical management of brain metastasis as a part of systematic metastases from adenoid cystic carcinoma of the external auditory canal: illustrative case International journal

    Shunichiro Kuramitsu, Kazuya Motomura, Yasuhiro Nakajima, Takashi Tsujiuchi, Ayako Motomura, Mamoru Matsuo, Nobuhisa Fukaya, Akinori Kageyama, Iori Kojima, Masasuke Ohno, Ryuta Saito

    Journal of Neurosurgery: Case Lessons   Vol. 3 ( 11 )   2022.3

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    BACKGROUND

    Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is a rare tumor that accounts for approximately 5% of all EAC tumors. ACC is generally known as a slow-growing tumor, but patients often experience recurrence or distant metastasis in the long clinical course. While the major pattern of recurrence is pulmonary metastasis, brain metastasis of ACC of the EAC is rare.

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    The authors describe the case of a 72-year-old male who was diagnosed with ACC of the EAC. Approximately 7 years later, brain magnetic resonance imaging revealed an intra-axial homogenously enhancing mass lesion that had no direct connection with the skull base in the left frontal lobe. The patient underwent tumor resection and histopathological examination revealed a mixture of cribriform and tubular patterns. The image and pathological characteristics of the tumor were similar to those of primary ACC or ACC from other sites of origin.

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    While patients with ACC of the EAC often experience recurrence or distant metastasis in the long clinical course, they survive for a relatively long period of time, even though an optimal treatment has not been established. The authors therefore recommend surgical resection for brain metastasis of ACC of the EAC to improve neurological symptoms.

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  186. Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor. International journal

    Sachiko Kato, Satoshi Maesawa, Epifanio Bagarinao, Daisuke Nakatsubo, Takahiko Tsugawa, Satomi Mizuno, Kazuya Kawabata, Takashi Tsuboi, Masashi Suzuki, Masashi Shibata, Sou Takai, Tomotaka Ishizaki, Jun Torii, Manabu Mutoh, Ryuta Saito, Toshihiko Wakabayashi, Masahisa Katsuno, Norio Ozaki, Hirohisa Watanabe, Gen Sobue

    Journal of neurosurgery   Vol. 138 ( 2 ) page: 306 - 317   2022.2

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    OBJECTIVE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs). METHODS: Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined. RESULTS: Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post-MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs. CONCLUSIONS: The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the pathophysiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.

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

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

    Journal of neurosurgery. Case lessons   Vol. 3 ( 3 )   2022.1

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    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.

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  188. [Diffuse midline glioma]. Reviewed

    Ryuta Saito

    No shinkei geka. Neurological surgery   Vol. 50 ( 1 ) page: 29 - 38   2022.1

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    Diffuse midline glioma(DMG), H3 K27M-mutant is an infiltrative midline high-grade glioma with predominantly astrocytic differentiation and a K27M mutation in either H3F3A or HIST1H3B/C. It is commonly located in the brain stem, thalamus, and spinal cord. DMG is predominant in children but can occur in adults. Brain stem disease, known as diffuse intrinsic pontine glioma(DIPG), is the representative: -80% harbor the H3 K27M mutation. Generally, the prognosis of DMG is poor: the 2-year survival rate is < 10%, despite intensive research and therapies. Consequently, radiation is the only treatment and there is no effective chemotherapeutic regimen. The recent findings concerning the genetic profiles of DMG shed light on precision medicine. Until today, approximately 250 clinical trials with molecular targeted therapy as a strategy have been conducted for different biological pathways in DMG. Unfortunately, none of them has shown significant efficacy for DMG. One of the problems in these clinical trials is insufficient knowledge of whether the used molecular targeted agents penetrate the blood-brain barrier. Continuous efforts to develop effective precision medicine against DMG should pave the way for overcoming DMG in the future.

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  189. Multitier Network Analysis Using Resting-state Functional MRI for Epilepsy Surgery.

    Satoshi Maesawa, Epifanio Bagarinao, Daisuke Nakatsubo, Tomotaka Ishizaki, Sou Takai, Jun Torii, Sachiko Kato, Masashi Shibata, Toshihiko Wakabayashi, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 62 ( 1 ) page: 45 - 55   2022.1

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    Resting-state functional MRI (rs-fMRI) has been utilized to visualize large-scale brain networks. We evaluated the usefulness of multitier network analysis using rs-fMRI in patients with focal epilepsy. Structural and rs-fMRI data were retrospectively evaluated in 20 cases with medically refractory focal epilepsy, who subsequently underwent surgery. First, structural changes were examined using voxel-based morphometry analysis. Second, alterations in large-scale networks were evaluated using dual-regression analysis. Third, changes in cortical hubs were analyzed and the relationship between aberrant hubs and the epileptogenic zone (EZ) was evaluated. Finally, the relationship between the hubs and the default mode network (DMN) was examined using spectral dynamic causal modeling (spDCM). Dual-regression analysis revealed significant decrease in functional connectivity in several networks including DMN in patients, although no structural difference was seen between groups. Aberrant cortical hubs were observed in and around the EZ (EZ hubs) in 85% of the patients, and a strong degree of EZ hubs correlated to good seizure outcomes postoperatively. In spDCM analysis, facilitation was often seen from the EZ hub to the contralateral side, while inhibition was seen from the EZ hub to nodes of the DMN. Some cognition-related networks were impaired in patients with focal epilepsy. The EZ hub appeared in the vicinity of EZ facilitating connections to distant regions in the early phase, which may eventually generate secondary focus, while inhibiting connections to the DMN, which may cause cognitive deterioration. Our results demonstrate pathological network alterations in epilepsy and suggest that earlier surgical intervention may be more effective.

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  190. Reliability of IDH1-R132H and ATRX and/or p53 immunohistochemistry for molecular subclassification of Grade 2/3 gliomas.

    Tomohide Nishikawa, Reiko Watanabe, Yotaro Kitano, Akane Yamamichi, Kazuya Motomura, Fumiharu Ohka, Kosuke Aoki, Masaki Hirano, Akira Kato, Junya Yamaguchi, Sachi Maeda, Yuji Kibe, Ryuta Saito, Toshihiko Wakabayashi, Yukinari Kato, Shuta Sato, Tomoyoshi Ogino, Atsushi Natsume, Ichiro Ito

    Brain tumor pathology   Vol. 39 ( 1 ) page: 14 - 24   2022.1

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    Since the World Health Organization 2016 classification (2016 WHO), genetic status has been incorporated into the diagnosis of Grade 2/3 gliomas (lower-grade gliomas). Therefore, immunohistochemistry (IHC) of IDH1-R132H, ATRX, and p53 have been used in place of genetic status. We report the associations between histological findings, IHC, and genetic status. We performed IHC of IDH1-R132H, ATRX, and p53 in 76 lower-grade gliomas and discussed its validity based on the 2016 WHO and the upcoming 2021 WHO classification. The sensitivity and specificity of anti-ATRX, p53, and IDH1-R132H IHC were 40.9%/98.1%, 78.6%/85.4%, and 90.5%/84.6%, respectively. Among 21 IDH1-mutant gliomas without 1p/19q codeletion, two gliomas (9.5%) mimicked the so-called classic for oligodendroglioma (CFO) in their morphology. Of the 42 gliomas with 1p/19q codeletion, four cases were difficult to diagnose as oligodendroglioma through morphological examination. Moreover, there were three confusing cases with ATRX mutations but with retained ATRX-IHC positivity. The lessons learned from this study are as follows: (1) ATRX-IHC and p53-IHC should be supplementary to morphological diagnosis, (2) rare IDH mutations other than IDH1 R132H should be considered, and (3) there is no complete alternative test to detect molecular features of glioblastoma under the 2021 WHO classification.

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  191. A successful case of surgical embolectomy for acute large vessel occlusion after thoracic endovascular aortic repair

    Muramatsu Yusuke, Fuse Yutaro, Ota Shinji, Nakamura Shigekazu, Kurimoto Futoshi, Watanabe Kazuhiko, Saito Ryuta

    Japanese Journal of Stroke   Vol. 44 ( 6 ) page: 664 - 669   2022

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    <p>Here, we report a case of acute MCA occlusion in a patient who underwent thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm 2 years ago. An 83-year-old man presented with sudden right hemiparesis and aphasia. CT with contrast revealed occlusion of the left MCA, and MRI revealed mild hyperintense signals in the left MCA area. The aortic arch stent graft partially overlapped the origin of the left common carotid artery on the contrast CT. Therefore, we decided not to perform mechanical thrombectomy via the transaortic approach. Instead, the patient underwent a surgical embolectomy with frontotemporal craniotomy. His symptoms improved remarkably, and he was discharged with only mild aphasia, dysarthria, and disorientation. In a case where mechanical thrombectomy via the transaortic approach is expected to be difficult, surgical embolectomy can be an alternative choice.</p>

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  192. Atypical Incomplete Detachment Following PulseRider Deployment

    Goto Shunsaku, Izumi Takashi, Nishihori Masahiro, Araki Yoshio, Yokoyama Kinya, Uda Kenji, Saito Ryuta

    Journal of Neuroendovascular Therapy   Vol. 16 ( 8 ) page: 409 - 412   2022

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    <p><b>Objective</b>: Owing to the limited time since the introduction of the PulseRider (PR), inconsequential or rare complications that clinicians should be aware of remain unreported yet. Here, we report a rare complication of incomplete detachment.</p><p><b>Case Presentation</b>: A 50-year-old male underwent PR-assisted coil embolization for a basilar tip aneurysm. Coiling was completed, and the detachment procedure was performed using a detachment machine; the success signal was observed. The delivery microcatheter was subsequently advanced back up to the proximal markers, and no reapproximation of the proximal markers, which indicates successful detachment, was observed. However, only one of the proximal markers returned to the microcatheter, and incomplete detachment of only one leg was detected. Ultimately, electrical detachment was not possible, and physical separation by tension was achieved.</p><p><b>Conclusion</b>: Our case report presents a rare case of a detachment problem in the PR. The PR could not be detached, although the signal revealed successful detachment. Therefore, careful withdrawal of the delivery wire by checking not only the proximal markers but also the behavior of the entire PR and coil complex is important.</p>

    DOI: 10.5797/jnet.cr.2021-0095

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  193. Contrast-Enhanced Magnetic Resonance Imaging Suggested a Possibility of Transvenous Embolization in the Superior Petrosal Sinus Dural Arteriovenous Fistula: A Case Report

    Nishihori Masahiro, Izumi Takashi, Tsukada Tetsuya, Kato Yutaka, Uda Kenji, Yokoyama Kinya, Araki Yoshio, Saito Ryuta

    Journal of Neuroendovascular Therapy   Vol. 16 ( 3 ) page: 163 - 169   2022

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    <p><b>Objective</b>: Superior petrosal sinus dural arteriovenous fistula (SPS-DAVF) is a rare subtype of intracranial DAVF that sometimes leads to hemorrhagic symptoms following deep venous drainage. Here we report the case of SPS-DAVF with retrograde venous reflux to the cerebellar vein. Preoperative contrast-enhanced MRI was a decisive factor in a safe and effective treatment.</p><p><b>Case Presentation</b>: A 37-year-old woman was referred to our hospital with abnormal MRI findings, which was performed when she had a mild headache during her check-up. DSA revealed left-sided SPS-DAVF, which was diagnosed as Cognard type IIb. Both CTA and DSA could not detect the whole SPS but only the shunt pouch. Using contrast-enhanced MRI, we were able to visualize the presence of the SPS and its continuity within the shunt pouch. 3D-T1 turbo spin echo (SPACE) showed a low-intensity area in the SPS, which was not seen in the 3D-T1 fast field echo (FFE). During the procedure, there was a point where it was difficult to advance the microcatheter, which coincided with the low-intensity area. We achieved effective transvenous embolization from the occluded venous access by devising a surgical technique.</p><p><b>Conclusion</b>: In addition to the contrast-enhanced 3D-T1 FFE, 3D-T1 SPACE might provide beneficial information for endovascular therapy in the evaluation of venous sinuses, which could not be detected by standard examinations.</p>

    DOI: 10.5797/jnet.cr.2021-0029

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  194. A Case of Isolated ACTH Deficiency with Suspected Origin from Cervical Spondylotic Myelopathy

    Saito Tsuyoshi, Yoshida Mitsuhiro, Nakabayashi Kiyo, Aimi Yuri, Ishida Mamoru, Hamasaki Hajime, Terao Kazuichi, Nakajima Shoko, Nawashiro Tomoki, Saito Ryuta

    Spinal Surgery   Vol. 36 ( 1 ) page: 88 - 93   2022

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    <p>  The patient was a 46-year-old man who presented with fatigue for 6 months. His activities of daily living (ADL) gradually worsened and he was transported to our hospital’s emergency room because of difficulty in walking due to muscle weakness in the extremities. His weight had decreased by 20 kg in 6 months, and he was almost bedridden. Upon arrival, he presented with emaciation, hypotension, and muscle weakness predominantly in the proximal portions. However, he showed no clumsiness in the hands, pain, sensory disorders, or bladder-rectal disturbances. Only Hoffman’s reflex was positive. Deep tendon reflexes were almost normal in his upper limbs but flaccid in his lower limbs. The Japan Orthopaedic Association (JOA) score was 14/17. Images of the cervical spine showed a developmental narrow canal, cervical spondylotic changes at C4-7 levels, and cervical spinal cord compression with myelomalacia at C4-6 levels. These findings suggested cervical spondylotic myelopathy (CSM). However, laboratory data showed mild hyponatremia (sodium 135 mmol/L) and hypothyroidism (free thyroxine [T4] 1.00 ng/ml, thyroid-stimulating hormone [TSH] 6.62 µIU/ml). Based on radiology, endocrinology, and neurology consultations, the patient was diagnosed with an isolated adrenocorticotropic hormone (ACTH) deficiency. Hydrocortisone (20 mg/day) administration dramatically improved his symptoms and ADL. The JOA score improved to 17/17 over a few months, and the patient returned to his daily life. He has been followed-up without surgery until now.</p><p>  Several differential diagnoses other than CSM involve muscle weakness of the extremities. Even if there is a clear cervical spine lesion on imaging, it is important to consider whether it is a lesion actually responsible for the symptoms. Cooperation with other departments is also necessary. In particular, if a patient has endocrine diseases, such as in this case, it can cause fatal complications during surgery. Therefore, we should pay attention to these patients and initiate prophylactic measures if the patient needs surgery.</p>

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  195. Laminectomy triggers symptomatic growth of spinal schwannoma in a patient with schwannomatosis.

    Oyama T, Nishimura Y, Nagashima Y, Nishii T, Hara M, Takayasu M, Sakakibara A, Saito R

    Surgical neurology international   Vol. 13   page: 261   2022

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

    Yoshio Araki, Kinya Yokoyama, Kenji Uda, Fumiaki Kanamori, Takashi Mamiya, Kai Takayanagi, Kazuki Ishii, Kazunori Shintai, Masahiro Nishihori, Tetsuya Tsukada, Kazuhito Takeuchi, Kuniaki Tanahashi, Yuichi Nagata, Yusuke Nishimura, Takafumi Tanei, Yoshitaka Nagashima, Shinsuke Muraoka, Takashi Izumi, Yukio Seki, Ryuta Saito

    Surg Neurol Int   Vol. 13   page: 511   2022

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    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.

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  197. Downward penetrating endplate screw technique under O-arm navigation posterior fusion in patients with osteoporotic vertebral body fractures associated with diffuse idiopathic skeletal hyperostosis. International journal

    Daimon Shiraishi, Yu Yamamoto, Ishii Motonori, Yusuke Nishimura, Masahito Hara, Ryuta Saito, Masakazu Takayasu

    Surgical neurology international   Vol. 13   page: 436 - 436   2022

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    BACKGROUND: A downward penetrating endplate screw (PES) technique combined with caudal anchor screws inserted in the upward direction under O-arm navigation (i.e., crossing screw technique) avoided screw backout and proximal junctional kyphosis (PJK) in three patients with osteoporotic vertebral body fractures and diffuse idiopathic skeletal hyperostosis (DISH). METHODS: The PES techniques were utilized for patients with T12 (one patient) and L1 (two patients) spontaneous fusion across the targeted vertebrae, with minimal damage to the involved endplates/intervertebral discs. The average number of instrumented vertebrae was 5.3. RESULTS: There were no perioperative complications over the mean follow-up period of 28.7 months; no screw loosening, and no PJK. CONCLUSION: The PES technique prevented screw backout, and PJK in three patients with lumbar osteoporotic vertebral fractures and DISH.

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  198. 覚醒下手術中痙攣発作コントロールにおけるレベチラセタム・ペランパネル併用療法の有効性について

    本村 和也, 齋藤 竜太

    神経治療学   Vol. 39 ( 4 ) page: 655 - 655   2022

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  199. Unilateral laminotomy for bilateral decompression and balloon kyphoplasty to decompress lumber canal stenosis aggravated by osteoporotic vertebral compression fractures: A technical note. International journal

    Yoshitaka Nagashima, Yusuke Nishimura, Motonori Ishii, Tomoya Nishii, Nobuhisa Fukaya, Takahiro Oyama, Takashi Abe, Hiroyuki Kato, Eisuke Tsukamoto, Takafumi Tanei, Ryuta Saito

    Surgical neurology international   Vol. 13   page: 538 - 538   2022

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    BACKGROUND: The optimal treatment of lumbar canal stenosis (LCS) associated with osteoporotic vertebral fractures (OVFs) remains unclear. Here, we have combined a minimally invasive unilateral laminotomy for bilateral decompression (ULBD) alone with balloon kyphoplasty (BKP) for LCS aggravated by OVF. METHODS: ULBD with BKP was performed in three patients who showed LCS associated with OVFs on MR images with progressive lower extremity neurological deficits. Clinical outcomes were assessed using the numerical rating scale (NRS) and the Japanese Orthopaedic Association (JOA) score. Radiological outcomes were evaluated using multiple parameters (i.e., fractured vertebral body height, lumbar lordosis [LL], and focal angle of the fractured vertebral body). RESULTS: Over 6 postoperative months, the NRS and JOA scores were clearly improved while radiological parameters remained maintained (i.e., loss of fractured vertebral body height was only 0.3-1.4 mm in all cases). Two of the three cases showed restoration of LL and focal angle postoperatively. CONCLUSION: The combination of ULBD with BKP is an effective option for LCS aggravated by OVF.

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  200. Scurvy with non-traumatic epidural hematoma: a case report

    Takido Yuhei, Nagakura Masamune, Kato Mihoko, Saito Ryuta

    Nervous System in Children   Vol. 47 ( 3 ) page: 309 - 313   2022

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    <p>Scurvy due to Vit.C deficiency was widely prevalent in the world during the Age of Discovery. It reduces strength of vessel wall and causes bleeding. Nowadays, it is a rare and uncommon disease. We present a case of epidural hematoma associated with scurvy.</p><p> A 4-year-old girl admitted to our hospital with symptoms of difficulty in walking, leg pain, and bleeding from the swelled gums lasting 2.5 months. The blood cell count, hemogram and coagulation factors in laboratory data were normal. She had a headache without obvious trauma. CT scanning revealed an epidural hematoma in the right frontal region. A removal of epidural hematoma with hemostasis was performed. Re-bleeding did not occur after surgery, but the anemia was progressed. Other symptoms had also gotten worse. An interview about her daily meal revealed she was extremely picky eater. As the serum Vit.C concentration was quite low, she was finally diagnosed with scurvy. After starting oral administration of Vit.C, her symptoms quickly improved.</p><p> In modern times, it is extremely rare to experience nutritional disorders in developed country. However, mal-nutrition can be occur due to some reason like this case. Intracranial hemorrhage without history of underlying disease or trauma and accompanied with multi-organ findings may be caused by nutritional disorders.</p>

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  201. Current Clinical Applications of Three-dimensional Printing in Spine Surgery and Education

    Nagashima Yoshitaka, Nishimura Yusuke, Akahori Sho, Takeuchi Kazuhito, Uda Kenji, Ito Hiroshi, Saito Ryuta

    Spinal Surgery   Vol. 36 ( 3 ) page: 296 - 301   2022

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    <p>  The clinical applications of three-dimensional (3D) printing in the field of spine surgery and education have recently begun to progress. Technological advances have made it relatively inexpensive and easy to create 3D models. Herein, we explain how to construct a full-scale model using a 3D printer, and review articles on the current clinical applications and limitations. Creation of a 3D model based on the patient’s radiographic image data facilitates understanding of the complicated anatomy. This model enables improvements in visual understanding, preoperative surgical planning, and gives the surgeon a training opportunity. Furthermore, 3D printer technology can also be useful during surgery, and 3D printed surgical guidance systems have previously been successfully used for spine surgery. 3D printing patient-specific guides and templates are highly useful to facilitate safe screw insertion. In addition, 3D printers can be used to create patient-specific implants.</p>

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  202. 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   Vol. 3 ( 19 )   2022

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  203. Clinical and Radiological Clues of Traumatic Craniocervical Junction Injuries Requiring Occipitocervical Fusion to Early Diagnosis. International journal

    Daimon Shiraishi, Yusuke Nishimura, Isaac Aguirre-Carreno, Masahito Hara, Satoshi Yoshikawa, Kaoru Eguchi, Yoshitaka Nagashima, Hiroshi Ito, Shoichi Haimoto, Yu Yamamoto, Howard J Ginsberg, Masakazu Takayasu, Ryuta Saito

    Neurospine   Vol. 18 ( 4 ) page: 741 - 748   2021.12

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    OBJECTIVE: The purpose of this study is to find the clinical and radiographic characteristics of traumatic craniocervical junction (CCJ) injuries requiring occipitocervical fusion (OC fusion) for early diagnosis and surgical intervention. METHODS: We retrospectively reviewed 12 patients with CCJ injuries presenting to St. Michaels Hospital in Toronto who underwent OC fusion and looked into the following variables; (1) initial trauma data on emergency room arrival, (2) associated injuries, (3) imaging characteristics of computed tomography (CT) scan and magnetic resonance imaging (MRI), (4) surgical procedures, surgical complications, and neurological outcome. RESULTS: All patients were treated as acute spinal injuries and underwent OC fusion on an emergency basis. Patients consisted of 10 males and 2 females with an average age of 47 years (range, 18-82 years). All patients sustained high-energy injuries. Three patients out of 6 patients with normal BAI (basion-axial interval) and BDI (basion-dens interval) values showed visible CCJ injuries on CT scans. However, the remaining 3 patients had no clear evidence of occipitoatlantal instability on CT scans. MRI clearly described several findings indicating occipitoatlantal instability. The 8 patients with normal values of ADI (atlantodens interval interval) demonstrated atlantoaxial instability on CT scan, however, all MRI more clearly and reliably demonstrated C1/2 facet injury and/or cruciate ligament injury. CONCLUSION: We advocate measures to help recognize CCJ injury at an early stage in the present study. Occipitoatlantal instability needs to be carefully investigated on MRI in addition to CT scan with special attention to facet joint and ligament integrity.

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  204. Two cases of solitary fibrous tumor/hemangiopericytoma with different clinical features according to the World Health Organization classification: case report and review of the literature.

    Nishii T, Nagashima Y, Nishimura Y, Ito H, Oyama T, Matsuo M, Sakakibara A, Shimada S, Saito R

    Journal of spine surgery (Hong Kong)   Vol. 7 ( 4 ) page: 532 - 539   2021.12

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  205. Resting State Networks Related to the Maintenance of Good Cognitive Performance During Healthy Aging. International journal

    Satoshi Maesawa, Satomi Mizuno, Epifanio Bagarinao, Hirohisa Watanabe, Kazuya Kawabata, Kazuhiro Hara, Reiko Ohdake, Aya Ogura, Daisuke Mori, Daisuke Nakatsubo, Haruo Isoda, Minoru Hoshiyama, Masahisa Katsuno, Ryuta Saito, Norio Ozaki, Gen Sobue

    Frontiers in human neuroscience   Vol. 15   page: 753836 - 753836   2021.11

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    Purpose: Maintenance of cognitive performance is important for healthy aging. This study aims to elucidate the relationship between brain networks and cognitive function in subjects maintaining relatively good cognitive performance. Methods: A total of 120 subjects, with equal number of participants from each age group between 20 and 70 years, were included in this study. Only participants with Addenbrooke's Cognitive Examination - Revised (ACE-R) total score greater than 83 were included. Anatomical T1-weighted MR images and resting-state functional MR images (rsfMRIs) were taken from all participants using a 3-tesla MRI scanner. After preprocessing, several factors associated with age including the ACE-R total score, scores of five domains, sub-scores of ACE-R, and brain volumes were tested. Morphometric changes associated with age were analyzed using voxel based morphometry (VBM) and changes in resting state networks (RSNs) were examined using dual regression analysis. Results: Significant negative correlations with age were seen in the total gray matter volume (GMV, r = -0.58), and in the memory, attention, and visuospatial domains. Among the different sub-scores, the score of the delayed recall (DR) showed the highest negative correlation with age (r = -0.55, p < 0.001). In VBM analysis, widespread regions demonstrated negative correlation with age, but none with any of the cognitive scores. Quadratic approximations of cognitive scores as functions of age showed relatively delayed decline compared to total GMV loss. In dual regression analysis, some cognitive networks, including the dorsal default mode network, the lateral dorsal attention network, the right / left executive control network, the posterior salience network, and the language network, did not demonstrate negative correlation with age. Some regions in the sensorimotor networks showed positive correlation with the DR, memory, and fluency scores. Conclusion: Some domains of the cognitive test did not correlate with age, and even the highly correlated sub-scores such as the DR score, showed delayed decline compared to the loss of total GMV. Some RSNs, especially involving cognitive control regions, were relatively maintained with age. Furthermore, the scores of memory, fluency, and the DR were correlated with the within-network functional connectivity values of the sensorimotor network, which supported the importance of exercise for maintenance of cognition.

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  206. Aphasic status epilepticus after glioma resection: two case reports. International journal

    Yoshiteru Shimoda, Masayuki Kanamori, Ryuta Saito, Shinichiro Osawa, Shunji Mugikura, Teiji Tominaga

    Acta neurochirurgica   Vol. 163 ( 11 ) page: 3109 - 3113   2021.11

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    Aphasic status epilepticus (ASE) is a subtype of focal nonconvulsive status epilepticus, in which language disturbance is the only objective clinical manifestation. We present two cases of patients who experienced delayed onset of temporal aphasia after the removal of glioma at the language-dominant hemisphere. In both cases, arterial spin labeling was useful for diagnosis and antiepileptic drug was effective. ASE should be considered a cause of persistent aphasia after glioma resection at or near the language area.

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  207. Newly established patient-derived organoid model of intracranial meningioma. International journal

    Shintaro Yamazaki, Fumiharu Ohka, Masaki Hirano, Yukihiro Shiraki, Kazuya Motomura, Kuniaki Tanahashi, Takashi Tsujiuchi, Ayako Motomura, Kosuke Aoki, Keiko Shinjo, Yoshiteru Murofushi, Yotaro Kitano, Sachi Maeda, Akira Kato, Hiroyuki Shimizu, Junya Yamaguchi, Alimu Adilijiang, Toshihiko Wakabayashi, Ryuta Saito, Atsushi Enomoto, Yutaka Kondo, Atsushi Natsume

    Neuro-oncology   Vol. 23 ( 11 ) page: 1936 - 1948   2021.11

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    BACKGROUND: Recent comprehensive studies have revealed several molecular alterations that are frequently found in meningiomas. However, effective treatment reagents targeting specific molecular alterations have not yet been identified because of the limited number of representative research models of meningiomas. METHODS: We performed organoid cultures using meningioma cells and meningioma tumor tissues. Using immunohistochemistry and molecular analyses consisting of whole-exome sequencing, RNA-seq, and DNA methylation analyses, we compared the histological findings and molecular profiling of organoid models with those of parental tumors. Further, using these organoid models together with a public database of meningiomas, we explored molecular alterations, which are a potent treatment target for meningioma. RESULTS: We established 18 organoid models comprising of two malignant meningioma cells (HKBMM and IOMM-Lee), 10 benign meningiomas, four malignant meningiomas, and two solitary fibrous tumors (SFTs). The organoids exhibited consistent histological features and molecular profiles with those of the parental tumors. Using a public database, we identified that upregulated forkhead box M1 (FOXM1) was correlated with increased tumor proliferation. Overexpression of FOXM1 in benign meningioma organoids increased organoid proliferation; depletion of FOXM1 in malignant organoids decreased proliferation. Additionally, thiostrepton, a FOXM1 inhibitor combined with radiation therapy, significantly inhibited the proliferation of malignant meningioma organoid models. CONCLUSIONS: An organoid model for meningioma enabled us to elucidate the tumor biology of meningioma along with potent treatment targets for meningioma.

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  208. Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor.

    Satoshi Maesawa, Daisuke Nakatsubo, Takahiko Tsugawa, Sachiko Kato, Masashi Shibata, Sou Takai, Jun Torii, Tomotaka Ishizaki, Toshihiko Wakabayashi, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 61 ( 11 ) page: 629 - 639   2021.11

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    Magnetic resonance (MR)-guided focused ultrasound surgery (MRgFUS) is the latest minimally invasive stereotactic procedure, and thalamotomy using this novel modality has demonstrated its effectiveness and safety, especially for patients with essential tremor (ET) and Parkinson's disease (PD). In Japan, the application of MRgFUS to treat ET and PD has recently been covered by health insurance. Technically, the transducer with 1024 elements emits ultrasound beams, which are then focused on the target with a phase control, resulting in optimal ablation by thermal coagulation. The technical advantages of MRgFUS are continuous intraoperative monitoring of clinical symptoms and MR images and fine adjustment of the target by the steering function. Postoperative tremor control is compatible with other modalities, although long-term follow-up is necessary. The adverse effects are usually transient and acceptable. Prognostic factors for good tremor control include high temperature and large lesion size. A high skull density ratio is a factor to achieve high temperature and large lesioning, but it may not be necessary and sufficient for clinical outcomes. For patients with advanced symptoms such as bilateral tremor or head/neck tremor, deep brain stimulation may be recommended because of the adjustability of stimulation and the possibility of bilateral treatment. Patients have high expectations of MRgFUS because of its non-invasiveness. To perform this treatment safely and effectively, physicians need to understand the technological aspects, the physiological principles. To choose the appropriate modality, physicians also should recognize the clinical advantages and disadvantages of MRgFUS compared to other modalities.

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  209. Effects of oxytocin on responses to nociceptive and non-nociceptive stimulation in the upper central nervous system. International journal

    Hidehisa Saito, Shizu Hidema, Ayano Otsuka, Jun Suzuki, Michio Kumagai, Akihiro Kanaya, Toru Murakami, Yusuke Takei, Kazutomo Saito, Shigekazu Sugino, Hiroaki Toyama, Ryuta Saito, Teiji Tominaga, Katsuhiko Nishimori, Masanori Yamauchi

    Biochemical and biophysical research communications   Vol. 574   page: 8 - 13   2021.10

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    Oxytocin is known as a social bonding hormone, but it also functions as an anxiolytic or analgesic neurotransmitter. When oxytocin regulates pain or anxiousness centrally as a neurotransmitter, it is secreted by neurons and directly projected to targeted regions. Although the function of oxytocin at the spinal level is well studied, its effects at the supraspinal level are poorly understood. We aimed to investigate the effect of oxytocin at the supraspinal level in vivo using C57BL/6J (wild-type [WT]), oxytocin-deficient (Oxt-/-), oxytocin receptor-deficient (Oxtr-/-), and oxytocin receptor-Venus (OxtrVenus/+) mice lines. Response thresholds in Oxtr-/- mice in Hargreaves and von-Frey tests were significantly lower than those in WT mice, whereas open field and light/dark tests showed no significant differences. Moreover, response thresholds in Oxt-/- mice were raised to those in WT mice after oxytocin administration. Following the Hargreaves test, we observed the co-localisation of c-fos with Venus or the oxytocin receptor in the periaqueductal gray (PAG), medial amygdala (MeA), and nucleus accumbens (NAc) regions in OxtrVenus/+ mice. Furthermore, in the PAG, MeA, and NAc regions, the co-localisation of oxytocin with c-fos and gamma-aminobutyric acid was much stronger in Oxtr-/- mice than in WT mice. However, following von-Frey test, the same findings were observed only in the MeA and NAc regions. Our results suggest that oxytocin exerts its analgesic effect on painful stimulation via the PAG region and a self-protective effect on unpleasant stimulation via the MeA and NAc regions.

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  210. Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device.

    Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Tetsuya Tsukada, Yoshio Araki, Kenji Uda, Kinya Yokoyama, Ryuta Saito

    Neurologia medico-chirurgica   Vol. 61 ( 10 ) page: 583 - 590   2021.10

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    The carotid sinus reflex (CSR) is a rare complication of the Pipeline Embolization Device (PED) deployment. No study has assessed the potential risk factors in a case series. The purpose of this study was to examine CSR triggering during PED deployment. Thirty-seven consecutive patients who underwent PED deployment were included. All procedures were performed under local anesthesia with mild sedation. We retrospectively analyzed patient characteristics, PED deployment time, and vital signs during the procedure. The vital signs included the pulse rate (PR) and systolic blood pressure (SBP) obtained at three timepoints (pre-deployment, during deployment, post-deployment). We examined the triggering of the CSR during PED deployment by comparing the vital signs at the three timepoints. Moreover, risk factors for CSR were analyzed with univariate analysis. The patients' average age was 66.3 years. The average size of the aneurysm was 18.0 mm. Six patients (16.2%) showed a decline in the SBP or PR defined as CSR. One patient had a transient cardiac arrest and two had severe transient bradycardia. Deployment into the ophthalmic segment of the internal carotid artery (C2 segment) aneurysm (p = 0.022), prolonged PED deployment time more than 14.5 minutes (p = 0.005), and an acute angle of the anterior genu less than 51.5 degrees (p = 0.005) were risk factors in triggering CSR. CSR may be triggered during PED deployment under local anesthesia with mild sedation. Deployment to the C2 segment aneurysm, prolonged PED deployment time, and an acute angle of the anterior genu were associated with CSR triggering.

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  211. 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   Vol. 97 ( S.HPT ) page: 49 - 51   2021.9

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  212. 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   Vol. 97 ( S.HPT ) page: 16 - 18   2021.9

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  213. Mathematical Modeling and Mutational Analysis Reveal Optimal Therapy to Prevent Malignant Transformation in Grade II IDH-Mutant Gliomas. International journal

    Kosuke Aoki, Hiromichi Suzuki, Takashi Yamamoto, Kimiyo N Yamamoto, Sachi Maeda, Yusuke Okuno, Melissa Ranjit, Kazuya Motomura, Fumiharu Ohka, Kuniaki Tanahashi, Masaki Hirano, Tomohide Nishikawa, Hiroyuki Shimizu, Yotaro Kitano, Junya Yamaguchi, Shintaro Yamazaki, Hideo Nakamura, Masamichi Takahashi, Yoshitaka Narita, Mitsutoshi Nakada, Shoichi Deguchi, Masahiro Mizoguchi, Yasutomo Momii, Yoshihiro Muragaki, Tatsuya Abe, Jiro Akimoto, Toshihiko Wakabayashi, Ryuta Saito, Seishi Ogawa, Hiroshi Haeno, Atsushi Natsume

    Cancer research   Vol. 81 ( 18 ) page: 4861 - 4873   2021.9

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    Isocitrate dehydrogenase-mutant low-grade gliomas (IDHmut-LGG) grow slowly but frequently undergo malignant transformation, which eventually leads to premature death. Chemotherapy and radiotherapy treatments prolong survival, but can also induce genetic (or epigenetic) alterations involved in transformation. Here, we developed a mathematical model of tumor progression based on serial tumor volume data and treatment history of 276 IDHmut-LGGs classified by chromosome 1p/19q codeletion (IDHmut/1p19qcodel and IDHmut/1p19qnoncodel) and performed genome-wide mutational analyses, including targeted sequencing and longitudinal whole-exome sequencing data. These analyses showed that tumor mutational burden correlated positively with malignant transformation rate, and chemotherapy and radiotherapy significantly suppressed tumor growth but increased malignant transformation rate per cell by 1.8 to 2.8 times compared with before treatment. This model revealed that prompt adjuvant chemoradiotherapy prolonged malignant transformation-free survival in small IDHmut-LGGs (≤ 50 cm3). Furthermore, optimal treatment differed according to genetic alterations for large IDHmut-LGGs (> 50 cm3); adjuvant therapies delayed malignant transformation in IDHmut/1p19qnoncodel but often accelerated it in IDHmut/1p19qcodel. Notably, PI3K mutation was not associated with malignant transformation but increased net postoperative proliferation rate and decreased malignant transformation-free survival, prompting the need for adjuvant therapy in IDHmut/1p19qcodel. Overall, this model uncovered therapeutic strategies that could prevent malignant transformation and, consequently, improve overall survival in patients with IDHmut-LGGs. SIGNIFICANCE: A mathematical model successfully estimates malignant transformation-free survival and reveals a link between genetic alterations and progression, identifying precision medicine approaches for optimal treatment of IDH-mutant low-grade gliomas.

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  214. A Super-selective Wada Test Successfully Detected an Artery That Supplied Broca's Area in a Case of Left Frontal Lobe Glioblastoma: Technical Case Report.

    Shota Yamashita, Ryuta Saito, Shin-Ichiro Osawa, Kuniyasu Niizuma, Kazushi Ukishiro, Masayuki Kanamori, Kazuo Kakinuma, Kyoko Suzuki, Teiji Tominaga

    Neurologia medico-chirurgica   Vol. 61 ( 11 ) page: 661 - 666   2021.8

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    In cases of malignant gliomas located at language eloquent area, it is often difficult to preoperatively detect those area with functional MRI. Awake surgery is often used to spare the language eloquent area during surgery for such tumors; it is not available for a patient whose intracranial pressure is elevated due to the malignant tumor. The Wada test involves infusing anesthetic agents into the internal carotid artery to determine language dominancy before surgery for epilepsy or brain tumor. The super-selective Wada test is a technique to detect more detailed functional localization by infusing anesthetics into far distal middle cerebral artery branches. We present a 37-year-old man suffering from a left frontal lobe glioblastoma, in whom detection of an artery supplying Broca's area was attempted by a super-selective Wada test. The super-selective Wada test successfully detected the branch of middle cerebral artery supplying Broca's area. Total resection of the contrast-enhancing area was achieved without damaging the artery supplying Broca's area without any neurological sequelae. This is the first report describing the usefulness of the super-selective Wada test in glioblastoma treatment. Our findings suggest that the super-selective Wada test is a powerful and useful means to distinguish the artery that supplies the language area from the tumor feeding artery in cases of tumors in the language eloquent area.

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  215. Association between IDH mutational status and tumor-associated epilepsy or venous thromboembolism in patients with grade II and III astrocytoma

    Yoshinari Osada, Ryuta Saito, Satoshi Miyata, Takuhiro Shoji, Ichiyo Shibahara, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    Brain Tumor Pathology   Vol. 38 ( 3 ) page: 218 - 227   2021.7

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    In previous studies, isocitrate dehydrogenase (IDH) mutations were associated with tumor-associated epilepsy (TAE) and venous thromboembolism (VTE). We examined the relationship between IDH mutations in grade II/III astrocytomas and TAE/VTE according to the 2016 World Health Organization classification. The clinical data of patients with newly diagnosed grade II/III gliomas who were treated at Tohoku University Hospital from January 2010 to December 2018 were reviewed. Associations between TAE or VTE and the clinical/biological characteristics, histology, and IDH1/2 mutational status in patients with grade II/III gliomas were evaluated. Of the initial 137 patients (290 hospitalizations), 117 patients (203 hospitalizations) were included in the TAE group and 124 patients (213 hospitalizations) were included in the VTE group. Seventy-eight patients (66.7%) in the TAE group were diagnosed with astrocytoma and 38/78 (48.3%) presented with TAE. According to the multivariable analysis, the IDH mutational status and male sex were associated independently with an increased risk of TAE (p < 0.05). Eighty-five patients (68.5%) in the VTE group were diagnosed with astrocytoma. VTE was observed in 16/161 (9.9%) hospitalizations. According to the multivariable analysis, age, diffuse astrocytoma histology, and resection were associated independently with an increased risk of VTE. The decision tree analysis showed that TAE was more frequent in younger patients while VTE was more frequent in older patients. This study demonstrated that the IDH mutational status was associated with TAE but not with VTE. Therefore, a future large-scale study is needed to provide sufficient evidence. TAE was more common in young patients, while VTE was more common in the elderly.

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  216. [Magnetic Resonance-guided Focused Ultrasound Ablation:Techniques and Neurological Applications].

    Satoshi Maesawa, Daisuke Nakatsubo, Takahiko Tsugawa, Sachiko Kato, Masashi Shibata, Sou Takai, Jun Torii, Toshihiko Wakabayashi, Ryuta Saito

    No shinkei geka. Neurological surgery   Vol. 49 ( 4 ) page: 847 - 856   2021.7

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    Magnetic resonance(MR)-guided focused ultrasound ablation(FUS)is a minimally invasive technique for targeted tissue thermo-ablation and is promising for neuromodulation in various neurological disorders. The effectiveness and safety of this technique have been recognized worldwide. In Japan, the applications of FUS for the treatment of essential tremors and Parkinson's disease have recently been covered under health insurance. The FUS system is composed of a phased-array transducer with 1024 elements, with a beam of ultrasound emerging from each element. The phase and amplitude of the beam are computed and controlled to focus on the target with the calculation of computed tomography(CT)profiles, resulting in optimal thermo-ablation. To utilize FUS safely and effectively, a deep understanding of the physics of this technology is necessary. Furthermore, the technique should be compared with other options including deep brain stimulation(DBS)and radiofrequency thermo-ablation. Although FUS has received attention because of minimally invasive characteristics and a possibility of procedural target refinement, DBS has some advantages on bilateral implantation, a potential of postoperative adjustment, and control of head/leg tremors. In this article, we first reviewed the physics of FUS and demonstrated the typical treatment protocols. Second, we reviewed the outcomes from the existing literature, and revealed the advantages and disadvantages of this procedure, with the evaluation of the optimal condition for FUS.

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  217. 頭蓋内胚腫治療後にてんかんを発症した症例群の検討

    下田 由輝, 金森 政之, 大沢 伸一郎, 齋藤 竜太, 園田 順彦, 隈部 俊宏, 中里 信和, 冨永 悌二

    てんかん研究   Vol. 39 ( 2 ) page: 305 - 305   2021.7

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  218. Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. International journal

    Kazuya Motomura, Lushun Chalise, Fumiharu Ohka, Kosuke Aoki, Kuniaki Tanahashi, Masaki Hirano, Tomohide Nishikawa, Junya Yamaguchi, Hiroyuki Shimizu, Toshihiko Wakabayashi, Ryuta Saito

    Journal of neuro-oncology   Vol. 153 ( 2 ) page: 361 - 372   2021.6

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    PURPOSE: The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping. METHODS: We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. RESULTS: EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of ≥ 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR ≥ 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7-48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR ≥ 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9-51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3-59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. CONCLUSIONS: The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was ≥ 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.

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  219. Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway International journal

    Ichiyo Shibahara, Sumito Sato, Takuichiro Hide, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga, Toshihiro Kumabe

    Acta Neurochirurgica   Vol. 163 ( 5 ) page: 1269 - 1278   2021.5

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    BACKGROUND: Postoperative motor deficits are among the worst morbidities of glioma surgery. We aim to investigate factors associated with postoperative motor deficits in patients with frontoparietal opercular gliomas. METHODS: Thirty-four patients with frontoparietal opercular gliomas were retrospectively investigated. We examined the postoperative ischemic changes and locations obtained from MRI. RESULTS: Twenty-one patients (62%) presented postoperative ischemic changes. Postoperative MRI was featured with ischemic changes, all located at the subcortical area of the resection cavity. Six patients had postoperative motor deficits, whereas 28 patients did not. Compared to those without motor deficits, those with motor deficits were associated with old age, pre- and postcentral gyri resection, and postcentral gyrus resection (P = 0.023, 0,024, and 0.0060, respectively). A merged image of the resected cavity and T1-weighted brain atlas of the Montreal Neurological Institute showed that a critical area for postoperative motor deficits is the origin of the long insular arteries (LIAs) and the postcentral gyrus. Detail anatomical architecture created by the Human Connectome Project database and T2-weighted images showed that the subcortical area of the operculum of the postcentral gyrus is where the medullary arteries supply, and the motor pathways originated from the precentral gyrus run. CONCLUSIONS: We verified that the origin of the LIAs could damage the descending motor pathways during the resection of frontoparietal opercular gliomas. Also, we identified that motor pathways run the subcortical area of the operculum of the postcentral gyrus, indicating that the postcentral gyrus is an unrecognized area of damaging the descending motor pathways.

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  220. [Chemotherapy for Glioma].

    Ryuta Saito

    No shinkei geka. Neurological surgery   Vol. 49 ( 3 ) page: 588 - 596   2021.5

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    Chemotherapeutic treatment of malignant gliomas is extremely challenging. Tumor accumulation of systemically-administrated chemotherapy is always hindered by the blood-brain barrier(BBB). Although temozolomide administered orally or intravenously represents the standard of care for malignant gliomas, its efficacy is unsatisfactory. Local chemotherapy bypasses the BBB and, therefore, achieves a high drug concentration at the site the drug is administered. Carmustine wafers are clinically available local chemotherapeutic agents. However, their efficacy is limited because of limited drug penetration into the tumor. Combined with the highly chemoresistant features of glioma itself, ongoing chemotherapy is far from satisfactory in terms of efficacy. This review covers several important issues regarding temozolomide chemotherapy, including the reactivation of hepatitis B virus, assessment of MGMT promoter methylation, and pseudo-progression. Local chemotherapy for newly diagnosed resectable glioblastoma cases using carmustine wafers is currently under investigation with a randomized phase 3 trial (JCOG 1703), which will also be discussed. In addition, recent progress in convection-enhanced delivery of chemotherapeutics against gliomas has also been reported. Development of an alternative strategy to effectively deliver drugs to the tumor site may improve the efficacy of chemotherapy against gliomas in the near future.

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  221. Effect of endoscope flexibility on tissue dissection profile assessed with pulsed water jet device: ensuring safety, efficacy, and handling of thin devices for neuroendoscopic surgery. International journal

    Tetsuya Kusunoki, Tomohiro Kawaguchi, Atsuhiro Nakagawa, Yuta Noguchi, Shin-Ichiro Osawa, Hidenori Endo, Toshiki Endo, Ryuta Saito, Masayuki Kanamori, Kuniyasu Niizuma, Teiji Tominaga

    BMC research notes   Vol. 14 ( 1 ) page: 64 - 64   2021.2

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    OBJECTIVE: We developed an actuator-driven pulsed water jet device (ADPJ) for flexible neuroendoscopy to achieve effective tissue dissection with vasculature preservation. Although flexibility is a strong advantage for minimally invasiveness, the effect of the ductile curvature on the dissection profiles remains unknown. The purpose of this study was to clarify the impact of the curvature change of the ADPJ connecting tube on the dissection safety and efficacy. RESULTS: Three ADPJ connecting tubes with different inner diameters (1.0, 0.75, 0.5 mm) were used to dissect the brain phantom. They were bent at 3 angles: 0°, 60°, and 120°. The dissection profiles were evaluated using the mean depth and coefficient of variation (CV) for efficacy and safety, respectively.The larger inner diameter connecting tube dissected more deeply. The dissection depth was not changed regardless of the curvature degree in each tube. There was no significant difference in CVs regardless of inner diameter and curvature. The ductile curvature of the flexible neuroendoscope did not affect the efficacy and safety of the ADPJ dissection profile. Among the numerous instruments, tube-formed devices, including suction and injecting devices such as ADPJ, can be used safely and effectively without flexibility-related limitations.

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  222. Hepatitis B virus reactivation during temozolomide administration for malignant glioma.

    Takuhiro Shoji, Masayuki Kanamori, Jun Inoue, Ryuta Saito, Yoshinari Osada, Yoshiteru Shimoda, Masashi Chonan, Hiroshi Uenohara, Atsushi Masamune, Teiji Tominaga

    International journal of clinical oncology   Vol. 26 ( 2 ) page: 305 - 315   2021.2

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    INTRODUCTION: The purpose of this study is to clarify the clinical features of temozolomide (TMZ)-related hepatitis B virus (HBV) reactivation and to identify HBV reactivation predictive factors. METHOD: We retrospectively reviewed the clinical course of 145 patients newly diagnosed or with recurrent malignant glioma treated with TMZ. Before treatment, we screened patients for HB surface antigen (HBsAg) positivity (HBV carrier) and HBsAg negativity. Patients were also screened for antibody for HB core antigen (anti-HBc) positivity and/or for HB surface antigen positivity (resolved HBV infection). The patients were monitored by HBV DNA, alanine, and aspartate aminotransaminase during and after the completion of TMZ. HBV carriers and those with resolved HBV infections with HBV reactivation received preemptive entecavir treatment. In those with resolved HBV infections, we analyzed clinical characters for the predictive factors for HBV reactivation. RESULTS: In one of two HBV carriers, HBV DNA turned positive 8 months after the completion of TMZ and entecavir. In four (16.7%) of 24 resolved HBV infections, HBV DNA turned detectable at completion of concomitant radiation and TMZ or during monthly TMZ. HBV DNA turned negative with entecavir in all patients without liver dysfunction. In resolved HBV infections, those with a high anti-HBc titer had significantly higher incidence of HBV reactivation than those with low anti-HBc titers (60% vs. 5.3%: p = 0.018). CONCLUSION: Screenings, monitoring, and preemptive entecavir were important for preventing TMZ-related HBV reactivations. Anti-HBc titers could be the predictive markers for HBV reactivation in the those with resolved HBV infections.

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  223. H3K27M and TERT promoter mutations are poor prognostic factors in surgical cases of adult thalamic high-grade glioma International journal

    Yoshinari Osada, Ryuta Saito, Ichiyo Shibahara, Keisuke Sasaki, Takuhiro Shoji, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    Neuro-Oncology Advances   Vol. 3 ( 1 ) page: vdab038   2021.1

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    <title>Abstract</title>
    <sec>
    <title>Background</title>
    Thalamic high-grade gliomas (HGGs) are rare tumors with a dismal prognosis. H3K27M and telomerase reverse transcriptase promoter (TERTp) mutations reportedly contribute to poor prognoses in HGG cases. We investigated the outcomes of surgically treated adult thalamic HGGs to evaluate the prognostic significance of H3K27M and TERTp mutations.


    </sec>
    <sec>
    <title>Methods</title>
    We retrospectively analyzed 25 adult patients with thalamic HGG who underwent maximum surgical resection from January 1997 to March 2020. The histological and molecular characteristics, progression-free survival (PFS), and overall survival (OS) of the patients were compared. For molecular characteristics, target sequencing was used to determine the H3F3A, HIST1H3B, and TERTp mutations.


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    <title>Results</title>
    H3K27M mutations were detected in 12/25 (48.0%) patients. TERTp mutations were not detected in H3K27M-mutant gliomas but were detected in 8/13 (61.5%) of H3 wild-type gliomas. Although it was not significant, H3K27M-mutant gliomas tended to have a shorter PFS (6.7 vs 13.1 months; P = .2928) and OS (22.8 vs 24.4 months; P = .2875) than H3 wild-type gliomas. Moreover, the prognosis of TERTp-mutant gliomas was as poor as that of H3K27M-mutant gliomas. Contrary, 5 gliomas harboring both H3 and TERTp wild-type showed a better median PFS (59.2 vs 6.4 months; P = .0456) and OS (71.8 vs 24.4 months; P = .1168) than those harboring H3K27M or TERTp mutations.


    </sec>
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    <title>Conclusions</title>
    TERTp-mutant gliomas included in the H3 wild-type glioma group limited patient survival as they exhibited an aggressive course similar to H3K27M-mutant gliomas. Comprehensive molecular work-up for the H3 wild-type cases may further confirm this finding.


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    DOI: 10.1093/noajnl/vdab038

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  224. Corpus Callosum Swelling after Resection of Intraventricular Central Neurocytoma.

    Daiki Aburakawa, Masayuki Kanamori, Toshiaki Akashi, Shiho Sato, Ryuta Saito, Teiji Tominaga

    NMC case report journal   Vol. 8 ( 1 ) page: 535 - 543   2021

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    Corpus callosum swelling has been reported to occur after ventriculoperitoneal shunting for long-standing hydrocephalus. This report presents a case of corpus callosum swelling after intraventricular tumor resection. A 34-year-old woman presented with a headache that worsened over 1 month. Magnetic resonance (MR) images revealed a mass lesion in the left lateral ventricle and obstructive hydrocephalus. She underwent subtotal resection with a transcallosal approach. After tumor resection, she had long-lasting status epilepticus followed by consciousness disturbance. T2-weighted MR images obtained 8 hr after the operation showed a hyperintense area in the corpus callosum. The patient then presented with bilateral dilated pupils 14 hr after the operation due to acute hydrocephalus and tension pneumocephalus. An emergent re-craniotomy was performed and a ventricular drain was placed. The patient recovered consciousness 3 days after the operation. However, she experienced progressive corpus callosum swelling 25 days after the operation, which improved since then. Approximately 4 months after the operation, she returned to her usual workplace with no neurocognitive functional decline. Two years later, she was doing well with no radiological abnormal findings except corpus callosum thinning. Thus, corpus callosum swelling can develop not only after shunting for chronic hydrocephalus but also after intraventricular tumor resection. It occurred relatively acutely and there was no decline in intelligence after long-term follow-up. This case suggests that corpus callosum swelling after intraventricular tumor resection is a rare but noteworthy complication that can improve without intervention.

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  225. 覚醒下手術中痙攣発作コントロールにおけるレベチラセタム・ペランパネル併用療法の有効性について

    本村 和也, 齋藤 竜太

    神経治療学   Vol. 38 ( 6 ) page: S211 - S211   2021

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  226. An Approach to Superior Petrosal Sinus via Contralateral Superior Petrosal Sinus in a Case of Dural Arteriovenous Fistulas with Difficulty in Access

    SUZUKI Keita, NISHIHORI Masahiro, IZUMI Takashi, SUZUKI Osamu, MUTO Manabu, ARAKI Yoshio, UDA Kenji, YOKOYAMA Kinya, SAITO Ryuta

    No Kekkannai Chiryo   Vol. 6 ( 3 ) page: 161 - 168   2021

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    <p><b>Objective</b>: Herein, we report a case of multiple dural arteriovenous fistulas (DAVFs) in the left superior petrosal sinus (SPS) successfully treated by transvenous embolization via the right SPS.</p><p><b>Case Presentation</b>: A 60-year-old woman was diagnosed with multiple DAVFs with deep venous reflux to evaluate consciousness disturbance. We performed packing of the left transverse sinus, which was chiefly involved in reflux to the straight sinus. However, consciousness continued to be mildly disturbed, and DSA was performed again. A shunt was inserted into the left SPS, and the subsequently occurring deep venous reflux was clearly revealed. Because the ipsilateral transverse sinus and both inferior petrosal sinuses were already occluded and unavailable as access routes, we used the contralateral SPS and both cavernous sinuses to navigate the microcatheter into the shunt. We achieved occlusion of the SPS and stopped the reflux by inserting the intermediate catheter firmly into the bilateral SPS.</p><p><b>Conclusion</b>: An access route through the contralateral SPS might successfully enable transvenous embolization of DAVF cases without an ipsilateral access route.</p>

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  227. TERT promoter mutation confers favorable prognosis regardless of 1p/19q status in adult diffuse gliomas with IDH1/2 mutations International journal

    Hideyuki Arita, Yuko Matsushita, Ryunosuke Machida, Kai Yamasaki, Nobuhiro Hata, Makoto Ohno, Shigeru Yamaguchi, Takashi Sasayama, Shota Tanaka, Fumi Higuchi, Toshihiko Iuchi, Kuniaki Saito, Masayuki Kanamori, Ken ichiro Matsuda, Yohei Miyake, Kaoru Tamura, Sho Tamai, Taishi Nakamura, Takehiro Uda, Yoshiko Okita, Junya Fukai, Daisuke Sakamoto, Yasuhiko Hattori, Eriel Sandika Pareira, Ryusuke Hatae, Yukitomo Ishi, Yasuji Miyakita, Kazuhiro Tanaka, Shunsaku Takayanagi, Ryohei Otani, Tsukasa Sakaida, Keiichi Kobayashi, Ryuta Saito, Kazuhiko Kurozumi, Tomoko Shofuda, Masahiro Nonaka, Hiroyoshi Suzuki, Makoto Shibuya, Takashi Komori, Hikaru Sasaki, Masahiro Mizoguchi, Haruhiko Kishima, Mitsutoshi Nakada, Yukihiko Sonoda, Teiji Tominaga, Motoo Nagane, Ryo Nishikawa, Yonehiro Kanemura, Aya Kuchiba, Yoshitaka Narita, Koichi Ichimura

    Acta Neuropathologica Communications   Vol. 8 ( 1 ) page: 201 - 201   2020.12

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    TERT promoter mutations are commonly associated with 1p/19q codeletion in IDH-mutated gliomas. However, whether these mutations have an impact on patient survival independent of 1p/19q codeletion is unknown. In this study, we investigated the impact of TERT promoter mutations on survival in IDH-mutated glioma cases. Detailed clinical information and molecular status data were collected for a cohort of 560 adult patients with IDH-mutated gliomas. Among these patients, 279 had both TERT promoter mutation and 1p/19q codeletion, while 30 had either TERT promoter mutation (n = 24) or 1p/19q codeletion (n = 6) alone. A univariable Cox proportional hazard analysis for survival using clinical and genetic factors indicated that a Karnofsky performance status score (KPS) of 90 or 100, WHO grade II or III, TERT promoter mutation, 1p/19q codeletion, radiation therapy, and extent of resection (90–100%) were associated with favorable prognosis (p < 0.05). A multivariable Cox regression model revealed that TERT promoter mutation had a significantly favorable prognostic impact (hazard ratio = 0.421, p = 0.049), while 1p/19q codeletion did not have a significant impact (hazard ratio = 0.648, p = 0.349). Analyses incorporating patient clinical and genetic information were further conducted to identify subgroups showing the favorable prognostic impact of TERT promoter mutation. Among the grade II-III glioma patients with a KPS score of 90 or 100, those with IDH-TERT co-mutation and intact 1p/19q (n = 17) showed significantly longer survival than those with IDH mutation, wild-type TERT, and intact 1p/19q (n = 185) (5-year overall survival, 94% and 77%, respectively; p = 0.032). Our results demonstrate that TERT promoter mutation predicts favorable prognosis independent of 1p/19q codeletion in IDH-mutated gliomas. Combined with its adverse effect on survival among IDH-wild glioma cases, the bivalent prognostic impact of TERT promoter mutation may help further refine the molecular diagnosis and prognostication of diffuse gliomas.

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  228. A multinodular and vacuolating neuronal tumor in the right temporal lobe with positive methionine uptake: A case report

    Taketo Nishizawa, Ryuta Saito, Masashi Chonan, Masayuki Kanamori, Kentaro Takanami, Mika Watanabe, Teiji Tominaga

    Interdisciplinary Neurosurgery: Advanced Techniques and Case Management   Vol. 22   2020.12

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    Multinodular and vacuolating neuronal tumor (MVNT) is a recently recognized type of neural tumor that was first documented in 2013. This tumor type is characterized by multiple nodules of neuronal cells with vacuolar degeneration localized in the subcortical white matter. Here, we report a case of MVNT in the right temporal lobe of a 26-year-old female. Magnetic resonance imaging (MRI) revealed a high-intensity lesion on a T2- weighted image of the right temporal lobe without contrast enhancement. Positron emission tomography revealed increased 11C-methionine uptake in the lesion, which was pathologically diagnosed as MVNT.

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  229. がん遺伝子パネル検査でSMARCB1変異を認め、INI-1蛋白陽性のAT/RTと考えられた一例(Clinical sequencing revealed two distinct mutations in SMARCB1, in an INI-1 positive AT/RT)

    Kaino Akira, Niizuma Hidetaka, Moriya Kunihiko, Katayama Saori, Irie Masahiro, Rikiishi Takeshi, Saito Ryuta, Kanamori Masayuki, Sasahara Yoji, Kure Shigeo

    日本小児血液・がん学会雑誌   Vol. 57 ( 4 ) page: 245 - 245   2020.10

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  230. Orengedokuto and shosaikoto for intractable intracranial carmustine implant-induced fever in a patient with brain tumor: A case report. International journal

    Satoko Suzuki, Shin Takayama, Akiko Kikuchi, Ryutaro Arita, Michiaki Abe, Ryuta Saito, Masayuki Kanamori, Teiji Tominaga, Tadashi Ishii

    Explore (New York, N.Y.)   Vol. 17 ( 3 ) page: 236 - 238   2020.8

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    INTRODUCTION: Anaplastic astrocytoma has a dismal prognosis with conventional treatment. Multidisciplinary treatment is needed to control the disease; however, side effects of the treatment reduce a patient's quality of life (QOL). Carmustine-impregnated wafers (Gliadel®, Eisai Co., Ltd., Tokyo, Japan), one of the treatment modalities for anaplastic astrocytoma, has been reported to have drug-induced fever as a side effect. CASE REPORT: A 36-year-old man underwent excision for a recurrent brain tumor. Histopathological examination established a diagnosis of anaplastic astrocytoma and an intracranial carmustine implant was placed for local chemotherapy. Postoperatively, the patient developed high fever, which could not be controlled using antipyretics. The high fever ameliorated dramatically after the administration of Kampo medicines, specifically orengedokuto and shosaikoto, and the patient could continue chemotherapy. CONCLUSION: To the best of our knowledge, this is the first report of successful treatment of intractable carmustine implant-induced fever using Kampo medicine. In this case, Kampo medicine led to an improvement of QOL.

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  231. Frequent Clinical and Radiological Progression of Optic Pathway/Hypothalamic Pilocytic Astrocytoma in Adolescents and Young Adults. Reviewed

    Takuhiro Shoji, Masayuki Kanamori, Ryuta Saito, Yuko Watanabe, Mika Watanabe, Miki Fujimura, Yoshikazu Ogawa, Yukihiko Sonoda, Toshihiro Kumabe, Shigeo Kure, Teiji Tominaga

    Neurologia medico-chirurgica   Vol. 60 ( 6 ) page: 277 - 285   2020.5

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    Most cases of optic hypothalamic pilocytic astrocytoma (OHPA) develop during childhood, so few cases of histologically verified OHPA have been described in adolescents and young adults (AYA). To elucidate the clinical features of OHPA with histological verification in AYA, we reviewed the clinical and radiological finding of OHPA treated at our institute from January 1997 and July 2017. AYA are aged between 15 and 39 years. The clinical courses of 11 AYA patients with optic hypothalamic glioma (OHG) without neurofibromatosis type 1 were retrospectively reviewed. About six patients were diagnosed in childhood and followed up after 15 years of age, and five patients developed OHPA during AYA. Histological diagnosis, verified at initial presentation or recurrence, was pilocytic astrocytoma in 10 and pilomyxoid astrocytoma in one. After initial treatment including debulking surgery and/or chemotherapy, tumor progression occurred 16 times in seven patients as cyst formation, tumor growth, and intratumoral hemorrhage. Five of 10 patients suffered deterioration of visual function during AYA. One of 10 cases had endocrinopathies requiring hormone replacement at last follow-up examination. In conclusion, histological diagnoses of OHG before and in AYA were pilocytic astrocytoma or pilomyxoid astrocytoma. Both pediatric and AYA-onset OHPA demonstrate high incidences of tumor progression and visual dysfunctions in AYA, so that long-term follow up is essential after the completion of treatment for pediatric and AYA-onset OHPA. The optimal timing of debulking surgery and radiation therapy should be established to achieve the long-term tumor control and to preserve the visual function.

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  232. Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review. International journal

    Toshiki Endo, Tomoo Inoue, Shinichiro Sugiyama, Ryuta Saito, Teiji Tominaga

    Operative neurosurgery (Hagerstown, Md.)   Vol. 18 ( 4 ) page: 451 - 459   2020.4

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    BACKGROUND: Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases. OBJECTIVE: To apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control. METHODS: Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS: After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo. CONCLUSION: The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.

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  233. 髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

    戒能 明, 新妻 秀剛, 入江 正寛, 片山 紗乙莉, 森谷 邦彦, 力石 健, 齋藤 竜太, 金森 政之, 笹原 洋二, 呉 繁夫

    日本小児科学会雑誌   Vol. 124 ( 2 ) page: 321 - 321   2020.2

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  234. 髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

    戒能 明, 新妻 秀剛, 入江 正寛, 片山 紗乙莉, 森谷 邦彦, 力石 健, 齋藤 竜太, 金森 政之, 笹原 洋二, 呉 繁夫

    日本小児科学会雑誌   Vol. 124 ( 2 ) page: 321 - 321   2020.2

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  235. Phase I trial of convection-enhanced delivery of nimustine hydrochloride (ACNU) for brainstem recurrent glioma International journal

    Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Yoji Yamashita, Kenichi Nagamatsu, Takaki Murata, Shunji Mugikura, Toshihiro Kumabe, Eva Wembacher-Schröder, Rowena Thomson, Teiji Tominaga

    Neuro-Oncology Advances   Vol. 2 ( 1 ) page: vdaa033   2020.1

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    <title>Abstract</title>
    <sec>
    <title>Background</title>
    Treatment options for patients suffering brainstem gliomas are quite limited as surgery is not an option against intrinsic tumors at brainstem and chemotherapy generally failed to demonstrate its efficacy. Intracerebral convection-enhanced delivery (CED) is a novel approach for administering chemotherapy to patients with brain tumors. We present the results of phase I trial of CED of nimustine hydrochloride (ACNU), designed to determine the maximum tolerable concentration of ACNU, for patients with recurrent brainstem gliomas.


    </sec>
    <sec>
    <title>Methods</title>
    Sixteen patients, aged 3–81 years old, suffering from recurrent brainstem gliomas, including diffuse intrinsic pontine glioma patients as well as patients with recurrent gliomas that originated from non-brainstem sites, were enrolled in this trial between February 2011 and April 2016. The dose/concentration escalation trial included 3 dose/concentration groups (0.25, 0.5, and 0.75 mg/mL, all at 7 mL) to determine the safety and tolerability of CED of ACNU. Real-time monitoring of drug distribution was performed by mixing gadolinium-tetraazacyclododecanetetraacetic acid (Gd-DOTA) in the infusion solution. CED of ACNU was given in combination with oral or intravenous temozolomide chemotherapy.


    </sec>
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    <title>Results</title>
    CED of ACNU demonstrated antitumor activity, as assessed by radiographic changes and prolonged overall survival. The recommended dosage was 0.75 mg/mL. Drug-associated toxicity was minimal.


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    <title>Conclusions</title>
    Intracerebral CED of ACNU under real-time monitoring of drug distribution, in combination with systemic temozolomide, was well tolerated among patients with recurrent brainstem gliomas. The safety and efficacy observed suggest the clinical benefits of this strategy against this devastating disease. Based on this phase I study, further clinical development of ACNU is warranted.


    </sec>

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  236. TERT promoter mutation associated with multifocal phenotype and poor prognosis in patients with IDH wild-type glioblastoma International journal

    Zensho Kikuchi, Ichiyo Shibahara, Tetsu Yamaki, Ema Yoshioka, Tomoko Shofuda, Rintaro Ohe, Ken-ichiro Matsuda, Ryuta Saito, Masayuki Kanamori, Yonehiro Kanemura, Toshihiro Kumabe, Teiji Tominaga, Yukihiko Sonoda

    Neuro-Oncology Advances   Vol. 2 ( 1 ) page: vdaa114   2020.1

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    <title>Abstract</title>
    <sec>
    <title>Background</title>
    Although mutations in the promoter region of the telomerase reverse transcriptase (TERTp) gene are the most common alterations in glioblastoma (GBM), their clinical significance remains unclear. Therefore, we investigated the impact of TERTp status on patient outcome and clinicopathological features in patients with GBM over a long period of follow-up.


    </sec>
    <sec>
    <title>Methods</title>
    We retrospectively analyzed 153 cases of GBM. Six patients with isocitrate dehydrogenase 1 (IDH1) or H3F3A gene mutations were excluded from this study. Among the 147 cases of IDH wild-type GBM, 92 (62.6%) had the TERTp mutation. Clinical, immunohistochemical, and genetic factors (BRAF, TP53 gene mutation, CD133, ATRX expression, O6-methylguanine-DNA methyltransferase [MGMT] promoter methylation) and copy number alterations (CNAs) were investigated.


    </sec>
    <sec>
    <title>Results</title>
    GBM patients with the TERTp mutation were older at first diagnosis versus those with TERTp wild type (66.0 vs. 60.0 years, respectively, P = .034), and had shorter progression-free survival (7 vs. 10 months, respectively, P = .015) and overall survival (16 vs. 24 months, respectively, P = .017). Notably, magnetic resonance imaging performed showed that TERTp-mutant GBM was strongly associated with multifocal/distant lesions (P = .004). According to the CNA analysis, TERTp mutations were positively correlated with EGFR amp/gain, CDKN2A deletion, and PTEN deletion; however, these mutations were negatively correlated with PDGFR amp/gain, CDK4 gain, and TP53 deletion.


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    <title>Conclusions</title>
    TERTp mutations were strongly correlated with multifocal/distant lesions and poor prognosis in patients with IDH wild-type GBM. Less aggressive GBM with TERTp wild type may be a distinct clinical and molecular subtype of IDH wild-type GBM.


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  237. Cystic Glioblastoma Rupturing into the Ventricle.

    Yoshimichi Sato, Ryuta Saito, Masayuki Kanamori, Teiji Tominaga

    NMC case report journal   Vol. 7 ( 1 ) page: 39 - 41   2020.1

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    Cystic tumors, such as craniopharyngiomas and Rathke's cleft cysts, as well as arachnoid cysts have been reported to rupture occasionally. Approximately 8-10% of glioblastomas (GBMs) are known to have a significant cystic component; however, to the best of our knowledge, no studies have reported cystic rupturing of GBMs. Here, we describe a unique case of cystic GBM rupturing and penetrating into the cerebral ventricle. A 77-year-old man with a right frontal lobe lesion suspected as GBM with a large cyst was referred to our hospital. At admission, disorientation and left facial weakness were detected. Consciousness disturbance worsened on the 8th day of hospitalization. Computed tomography (CT) revealed prominent shrinkage of the tumor and intratumoral cyst. Signs of meningeal irritation were observed, and chemical meningitis due to cystic tumor rupture and leakage of necrotic components into the ventricle was highly suspected. Surgical resection of the right frontal lobe tumor was performed on the 10th day of hospitalization. During the surgery, clear and colorless cerebrospinal fluid was obtained upon penetration of the tumoral cyst, suggesting traffic of tumor cysts and cerebral ventricle. Adjuvant chemoradiation therapy was initiated postoperatively. Local recurrence was noted at the corpus callosum 7 months postoperatively and was treated with a gamma knife. Further therapy was performed after this recurrence. However, his condition gradually deteriorated 15 months postoperatively, and he was subjected to terminal care. To the best of our knowledge, this is the first report on a cystic GBM rupture.

    DOI: 10.2176/nmccrj.cr.2019-0043

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  238. Functional outcomes of germ cell tumors

    Kanamori, M, Saito, R, Tominaga, T

    Japanese Journal of Neurosurgery   Vol. 29 ( 4 )   2020

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    DOI: 10.7887/jcns.29.270

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  239. A multicenter randomized phase III study for newly diagnosed maximally resected glioblastoma comparing carmustine wafer implantation followed by chemoradiotherapy with temozolomide with chemoradiotherapy alone; Japan Clinical Oncology Group Study JCOG1703 (MACS study). International journal

    Tomohiro Kadota, Ryuta Saito, Toshihiro Kumabe, Junki Mizusawa, Hiroshi Katayama, Minako Sumi, Hiroshi Igaki, Manabu Kinoshita, Takashi Komori, Koichi Ichimura, Yoshitaka Narita, Ryo Nishikawa

    Japanese journal of clinical oncology   Vol. 49 ( 12 ) page: 1172 - 1175   2019.12

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    A randomized phase III trial in Japan commenced in June 2019. The present standard treatment for newly diagnosed glioblastoma is maximal resection followed by chemoradiotherapy with temozolomide. The purpose of this study is to confirm the superiority of maximal resection with carmustine wafer implantation followed by chemoradiotherapy with temozolomide over the standard maximal resection followed by chemoradiotherapy with temozolomide in terms of overall survival for newly diagnosed glioblastoma. A total of 250 patients will be accrued from 35 Japanese institutions in 5.5 years. Patients with >90% surgical resection will be registered and randomly assigned to each group with 1:1 allocation. The primary endpoint is overall survival and the secondary endpoints are progression-free survival, loco-regional progression-free survival and incidence of adverse events. This trial has been registered in the Japan Registry of Clinical Trial, as jRCT1031190035 [https://jrct.niph.go.jp/en-latest-detail/jRCT1031190035].

    DOI: 10.1093/jjco/hyz169

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  240. Experience of Low Dose Perampanel to Add-on in Glioma Patients with Levetiracetam-uncontrollable Epilepsy. Reviewed

    Chonan M, Saito R, Kanamori M, Osawa SI, Watanabe M, Suzuki H, Nakasato N, Tominaga T

    Neurologia medico-chirurgica   Vol. 60 ( 1 ) page: 37 - 44   2019.11

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    After introduction of levetiracetam (LEV), treatment of seizures in patients with malignant brain tumors has prominently improved. On the other hand, we still experience some cases with LEV-uncontrollable epilepsy. Perampanel (PER) is a noncompetitive a-amino-3-hydroxy-5-methyl-4-isoaxazolepropionate acid receptor antagonist that has recently been approved for treating focal epilepsy as a secondary drug of choice. Available literature reporting PER medication in patients with gliomas is still sparse. Here, we report our initial experience with glioma patients and report efficacy of adding low dose 2–4 mg PER to LEV in patients whose seizure were uncontrollable with LEV monotherapy. Clinical outcome data of 18 consecutive patients were reviewed. This included nine males and nine females aged 24–76 years (median, 48.5 years), treated for glioma between June 2009 to December 2018. We added PER to patients with LEV-uncontrollable epilepsy. Adverse effects, irritability occurred in two patients, but continuous administration was possible in all cases. Though epileptic seizures occurred in four cases receiving 2 mg PER, 17 cases achieved seizure freedom by dose increments; final dose, 2–4 mg PER added to LEV 500–3000 mg. Our study revealed anti-epileptic efficacy of low dose PER 2–4 mg as first add-on therapy to LEV in glioma patients who have failed or intolerable to LEV monotherapy. Low dose PER added on to LEV may have favorable efficacy with tolerable adverse effects in glioma patients with LEV-uncontrollable epilepsy.

    DOI: 10.2176/nmc.oa.2018-0245

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  241. 超選択的Wada testによる血管解剖と機能解剖のハイブリッド評価 Reviewed

    大沢 伸一郎, 鈴木 匡子, 新妻 邦泰, 浮城 一司, 柿沼 一雄, 上利 大, 神 一敬, 斎藤 竜太, 金森 政之, 中里 信和, 冨永 悌二

    脳血管内治療   Vol. 4 ( Suppl. ) page: S383 - S383   2019.11

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  242. Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases. Reviewed International journal

    Osada Y, Shibahara I, Nakagawa A, Sakata H, Niizuma K, Saito R, Kanamori M, Fujimura M, Suzuki S, Tominaga T

    British journal of neurosurgery   Vol. 34 ( 6 ) page: 1 - 6   2019.9

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    Background: Chronic subdural hematoma (CSDH) is a common neurosurgical disease. A subset of patients with CSDH may exhibit underlying spontaneous intracranial hypotension (SIH). Bilateral CSDH has a causal relationship with SIH, but there is no known causal relationship between unilateral CSDH and SIH.Case description: We encountered four cases of unilateral CSDH due to SIH. The patients' age ranged between 44 and 64 years; there were three males and one female. All patients presented with headache as their initial symptom, and then became comatose. Computed tomography demonstrated unilateral CSDH and transtentorial herniation in all patients. Treatments were emergency epidural blood patch (EBP) and evacuation of CSDH. The site of cerebrospinal fluid leak could not be identified in three patients; therefore, EBP was performed at upper and lower spine. All patients recovered from SIH; however, one patient experienced poor outcome due to Duret hemorrhage and ischemic complications of transtentorial herniation. Cranial asymmetry was present in all four patients, and unilateral CSDH was located on the side of the most curved cranial convexity.Conclusions: Unilateral CSDH, asymmetric cranial morphology, and transtentorial herniation in relatively young patients may indicate underlying SIH.

    DOI: 10.1080/02688697.2019.1667482

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  243. Coexistence of Intracranial Germ Cell Tumor with Growing Arteriovenous Fistula.

    Ishida T, Endo H, Saito R, Kanamori M, Sato K, Matsumoto Y, Endo T, Fujimura M, Tominaga T

    World neurosurgery   Vol. 127   page: 126 - 130   2019.7

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    DOI: 10.1016/j.wneu.2019.04.015

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  244. Phase I study of a brain penetrant mutant IDH1 inhibitor DS-1001b in patients with recurrent or progressive IDH1 mutant gliomas.

    Atsushi Natsume, Toshihiko Wakabayashi, Yasuji Miyakita, Yoshitaka Narita, Yohei Mineharu, Yoshiki Arakawa, Fumiyuki Yamasaki, Kazuhiko Sugiyama, Nobuhiro Hata, Yoshihiro Muragaki, Ryo Nishikawa, Naoki Shinojima, Toshihiro Kumabe, Ryuta Saito, Kazumi Ito, Masaya Tachibana, Yasuyuki Kakurai, Soichiro Nishijima, Hiroshi Tsubouchi

    JOURNAL OF CLINICAL ONCOLOGY   Vol. 37 ( 15 ) page: .   2019.5

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    DOI: 10.1200/JCO.2019.37.15_suppl.2004

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  245. 脳幹部神経膠腫診断におけるメチオニンPET検査の有用性

    齋藤 竜太, 金森 政之, 高浪 健太郎, 園田 順彦, 冨永 悌二

    Brain Tumor Pathology   Vol. 36 ( Suppl. ) page: 090 - 090   2019.5

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  246. Coexistence of an intracranial germ cell tumor with a growing arteriovenous fistula: a case report. Reviewed

    Ishida T, Endo H, Saito R, Kanamori M, Sato K, Matsumoto Y, Endo T, Fujimura M, Tominaga T

        2019.4

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  247. Incidence of initial spinal metastasis in glioblastoma patients and the importance of spinal screening using MRI. Reviewed International journal

    Ichiyo Shibahara, Ryuta Saito, Yoshinari Osada, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Shunji Mugikura, Mika Watanabe, Teiji Tominaga

    Journal of neuro-oncology   Vol. 141 ( 2 ) page: 337 - 345   2019.1

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    PURPOSE: Intracranial glioblastomas with simultaneous spinal lesions prior to chemoradiation therapy or craniotomy, defined as initial spinal metastasis, are not well understood. Herein, we investigated intracranial glioblastoma and demonstrated the importance of spinal screening using gadolinium enhanced spinal magnetic resonance imaging (Gd-MRI). METHODS: Consecutive adult patients with intracranial glioblastoma were treated between 2010 and 2014 and received spinal screening using Gd-MRI. Spinal screening was performed regardless of spine-related symptoms, and patients presenting with and without initial spinal metastasis (spinal and non-spinal groups, respectively) were compared based on patient demographics, tumor characteristics, radiological and molecular features, and overall survival (OS). RESULTS: During the study period, 116 glioblastoma cases were treated and 87 of these (76%) underwent spinal screening. Among these patients, 11 (13%) were included in the spinal group, and 76 (87%) were included in the non-spinal group. All patients of the spinal group were free of symptoms related to spinal lesions. Compared with the non-spinal group, intracranial lesions of the spinal group presented higher incidences of intracranial dissemination and were located at subventricular zones (P = 0.0012 and 0.020, respectively). MIB-1 labeling index, molecular alterations such as IDH1 mutation, TERT promoter mutation, and immunoreactivity of ATRX and MGMT did not differ between two groups. OS was significantly shorter in the spinal group than in the non-spinal group (P = 0.0054). CONCLUSIONS: This study revealed a relatively high incidence of spinal metastasis. A subset of glioblastoma patients benefited from spinal screening, through which early detection of asymptomatic spinal metastasis was achieved.

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  248. Significance of molecular classification of ependymomas: C11orf95-RELA fusion-negative supratentorial ependymomas are a heterogeneous group of tumors. Reviewed International journal

    Kohei Fukuoka, Yonehiro Kanemura, Tomoko Shofuda, Shintaro Fukushima, Satoshi Yamashita, Daichi Narushima, Mamoru Kato, Mai Honda-Kitahara, Hitoshi Ichikawa, Takashi Kohno, Atsushi Sasaki, Junko Hirato, Takanori Hirose, Takashi Komori, Kaishi Satomi, Akihiko Yoshida, Kai Yamasaki, Yoshiko Nakano, Ai Takada, Taishi Nakamura, Hirokazu Takami, Yuko Matsushita, Tomonari Suzuki, Hideo Nakamura, Keishi Makino, Yukihiko Sonoda, Ryuta Saito, Teiji Tominaga, Yasuhiro Matsusaka, Keiichi Kobayashi, Motoo Nagane, Takuya Furuta, Mitsutoshi Nakada, Yoshitaka Narita, Yuichi Hirose, Shigeo Ohba, Akira Wada, Katsuyoshi Shimizu, Kazuhiko Kurozumi, Isao Date, Junya Fukai, Yousuke Miyairi, Naoki Kagawa, Atsufumi Kawamura, Makiko Yoshida, Namiko Nishida, Takafumi Wataya, Masayoshi Yamaoka, Naohiro Tsuyuguchi, Takehiro Uda, Mayu Takahashi, Yoshiteru Nakano, Takuya Akai, Shuichi Izumoto, Masahiro Nonaka, Kazuhisa Yoshifuji, Yoshinori Kodama, Masayuki Mano, Tatsuya Ozawa, Vijay Ramaswamy, Michael D Taylor, Toshikazu Ushijima, Soichiro Shibui, Mami Yamasaki, Hajime Arai, Hiroaki Sakamoto, Ryo Nishikawa, Koichi Ichimura

    Acta neuropathologica communications   Vol. 6 ( 1 ) page: 134 - 134   2018.12

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    Extensive molecular analyses of ependymal tumors have revealed that supratentorial and posterior fossa ependymomas have distinct molecular profiles and are likely to be different diseases. The presence of C11orf95-RELA fusion genes in a subset of supratentorial ependymomas (ST-EPN) indicated the existence of molecular subgroups. However, the pathogenesis of RELA fusion-negative ependymomas remains elusive. To investigate the molecular pathogenesis of these tumors and validate the molecular classification of ependymal tumors, we conducted thorough molecular analyses of 113 locally diagnosed ependymal tumors from 107 patients in the Japan Pediatric Molecular Neuro-Oncology Group. All tumors were histopathologically reviewed and 12 tumors were re-classified as non-ependymomas. A combination of RT-PCR, FISH, and RNA sequencing identified RELA fusion in 19 of 29 histologically verified ST-EPN cases, whereas another case was diagnosed as ependymoma RELA fusion-positive via the methylation classifier (68.9%). Among the 9 RELA fusion-negative ST-EPN cases, either the YAP1 fusion, BCOR tandem duplication, EP300-BCORL1 fusion, or FOXO1-STK24 fusion was detected in single cases. Methylation classification did not identify a consistent molecular class within this group. Genome-wide methylation profiling successfully sub-classified posterior fossa ependymoma (PF-EPN) into PF-EPN-A (PFA) and PF-EPN-B (PFB). A multivariate analysis using Cox regression confirmed that PFA was the sole molecular marker which was independently associated with patient survival. A clinically applicable pyrosequencing assay was developed to determine the PFB subgroup with 100% specificity using the methylation status of 3 genes, CRIP1, DRD4 and LBX2. Our results emphasized the significance of molecular classification in the diagnosis of ependymomas. RELA fusion-negative ST-EPN appear to be a heterogeneous group of tumors that do not fall into any of the existing molecular subgroups and are unlikely to form a single category.

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  249. Development and evaluation of ultrasound-facilitated drug delivery device Reviewed

    Inoue Kenji, Sato Aya, Saito Ryuta, Jia Wenting, Okuno Saori, Ohashi Yuji, Kamada Kei, Yoshikawa Akira, Tominaga Teiji

    JAPANESE JOURNAL OF APPLIED PHYSICS   Vol. 57 ( 11 )   2018.11

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    We developed a new ultrasound-facilitated delivery (UFD) device with a drug infusion sapphire needle enabling real-time magnetic resonance imaging (MRI) observation and an ultrasound piezoelectric transducer (drive frequency: 260 kHz) with an effective structure for increasing drug diffusion. The sapphire needle (outside diameter: 0.6 mm, inside diameter: 0.3 mm, length: 150 mm) was grown by a micro-pulling-down method. The transducer is composed of two-stacked layers of lead zirconate titanate (PZT) on a brass base. The sound pressure distribution of the developed UFD device in water was measured with a miniature probe hydrophone, showing good agreement with the value simulated by the finite element method (FEM) analysis. The developed UFD device demonstrated high efficiency and reliability of drug diffusion, exhibiting an 8.5% increase in the volume of drug diffusion with 80% higher reproducibility and 66% lower driving voltage than the previous device. Consequently, the operating temperature of the new UFD device was decreased from 60 °C to room temperature.

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  250. DEVELOPMENT OF ULTRASOUND-FACILITATED DRUG DELIVERY DEVICE FOR LOCAL DRUG INFUSION AGAINST BRAIN TUMORS Reviewed

    Saito Ryuta, Sato Aya, Inoue Kenji, Jia Wenting, Okuno Saori, Ohashi Yuji, Kamada Kei, Yoshikawa Akira, Tominaga Teiji

    NEURO-ONCOLOGY   Vol. 20   page: 88   2018.11

  251. SMART (stroke-like migraine attacks after radiation therapy) syndrome responded to steroid pulse therapy: Report of a case and review of the literature. Reviewed International journal

    Wenting Jia, Ryuta Saito, Masayuki Kanamori, Naoya Iwabuchi, Masaki Iwasaki, Teiji Tominaga

    eNeurologicalSci   Vol. 12   page: 1 - 4   2018.9

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    This report presents a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy and reviews the literatures with special emphasis on the use of steroids against SMART syndrome. The patient had a past history of left temporal anaplastic astrocytoma and was treated with surgery followed by local 72 Gy radiation therapy and chemotherapy using Nimustine Hydrochloride. Four years after the surgery, he was suffering from subacute progressing symptoms of headache, right hemianopia, right hemiparesis and aphasia from 2 to 4 days before admission to our hospital. At first he was diagnosed as symptomatic epilepsy but after extensive examination, the final diagnosis was SMART syndrome. His symptoms soon improved with steroid pulse therapy. In the literature, steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. As the lesions of SMART syndrome require differential diagnosis from recurrences, biopsy was performed in some cases. However, lack of benefit and possible detriment is reported with biopsy of SMART lesions. Through this experience we suggest that steroid pulse therapy may provide speedy recovery from symptoms, and it should be considered before other invasive investigations or treatments.

    DOI: 10.1016/j.ensci.2018.05.003

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  252. Indications for salvage surgery during treatment for intracranial germ cell tumors. Reviewed International journal

    Masayuki Kanamori, Toshihiro Kumabe, Mika Watanabe, Masashi Chonan, Ryuta Saito, Yoji Yamashita, Yoshikazu Ogawa, Yukihiko Sonoda, Teiji Tominaga

    Journal of neuro-oncology   Vol. 138 ( 3 ) page: 601 - 607   2018.7

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    This study retrospectively reviewed our single institute experience to clarify the optimal indication and timing of salvage surgery. Retrospective analysis of 159 consecutive cases with germ cell tumors identified 20 cases with salvage surgery. These cases were classified based on the radiological response to neoadjuvant treatment before salvage surgery into increase (growing group, five cases), no change (stable group, seven cases), and decrease (shrinkage group, eight cases) in tumor size. Changes in tumor markers, histological findings, and the pattern of failure after salvage surgery were reviewed. Growing teratoma syndrome (GTS) is defined as enlargement of tumor consisting of mature teratoma after chemotherapy with normalization of tumor markers. In growing group, two cases presented GTS, whereas other three cases did not fulfill the criteria for GTS. All cases in stable and shrinkage group had elevated levels of tumor markers at presentation and decreased levels after neoadjuvant treatment. Histologically, sparse components of mature teratoma with extensive fibrosis were found in cases with GTS and seven of eight cases in shrinkage group, whereas mature teratoma without fibrosis was found in six of seven cases in stable group. Six cases recurred after salvage surgery. We identified three factors as risks for recurrence after salvage surgery, as follows: (1) growing lesion which did not fulfill the criteria for GTS, (2) non-normalized level of tumor marker before salvage surgery, and (3) residual germinoma component. In conclusion, salvage surgery is recommended for patients with GTS, or with normalized tumor markers in stable or shrinkage group.

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  253. [A Case of Ventriculoperitoneal Shunt Dysfunction in an Adult Secondary to Constipation]. Reviewed

    Nakamura L, Saito R, Kanamori M, Morita T, Tashiro R, Tominaga T

    No shinkei geka. Neurological surgery   Vol. 46 ( 5 ) page: 385 - 389   2018.5

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    INTRODUCTION: Ventriculoperitoneal(VP)shunts function because of the pressure differential between the intracranial space and the peritoneal cavity. Although chronic constipation is often a cause of VP shunt dysfunction in children, it is not well recognized in adults. We present a case of shunt dysfunction that not only resolved after resolution of constipation but also resulted in overdrainage. CASE REPORT: A 28-year-old woman who had a VP shunt placed 11 years prior for hydrocephalus was referred to our department because of an enlarged ventricle diagnosed with computed tomography(CT). She had a previous history of pineal germinoma and a VP shunt was placed to treat the associated hydrocephalus. At presentation, she complained of headache and somnolence. Shunt dysfunction was suspected, but no problem was detected in the shunt system, including pressure settings. As constipation was detected, we treated this condition. Soon after, her symptoms resolved and ventricle size normalized. She was discharged without any deficit, but overdrainage was detected with CT obtained 1 month later. CONCLUSION: Although constipation is not a common cause of shunt dysfunction in adult patients, it is important to consider to avoid unnecessary shunt revision. In the present case, resolution of chronic constipation resulted in resolution of shunt dysfunction. This suggests the importance of resolution of constipation in case of shunt adjustment, even in adult cases.

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  254. Clinical Features of Precocious, Synchronous, and Metachronous Brain Metastases and the Role of Tumor Resection. Reviewed International journal

    Ichiyo Shibahara, Masayuki Kanamori, Takashi Watanabe, Akihiro Utsunomiya, Hiroyoshi Suzuki, Ryuta Saito, Yukihiko Sonoda, Hidefumi Jokura, Hiroshi Uenohara, Teiji Tominaga

    World neurosurgery   Vol. 113   page: e1-e9 - e9   2018.5

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    OBJECTIVE: The purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases. METHODS: Brain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group. RESULTS: Of 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035). CONCLUSIONS: The timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.

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  255. [Results for Treatment of Newly-Diagnosed Glioblastoma Using Carmustine Wafers(Gliadel<sup>®</sup>)]. Reviewed

    Kumabe T, Shibahara I, Saito R

    No shinkei geka. Neurological surgery   Vol. 46 ( 5 ) page: 367 - 376   2018.5

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  256. Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia Reviewed

    Takumi Kajitani, Masayuki Kanamori, Ryuta Saito, Yuko Watanabe, Hiroyoshi Suzuki, Mika Watanabe, Shigeo Kure, Teiji Tominaga

    Brain Tumor Pathology   Vol. 35 ( 2 ) page: 1 - 9   2018.4

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    Radiation therapy is sometimes performed to control intracranial acute lymphoblastic leukemia (ALL), but may lead to radiation-induced malignant glioma. The clinical, radiological, histological, and molecular findings are described of three cases of radiation-induced glioblastoma after the treatment for ALL. They received radiation therapy at age 6–8 years. The latency from radiation therapy to the onset of radiation-induced glioblastoma was 5–10 years. Magnetic resonance imaging demonstrated diffuse lesions with multiple small enhanced lesions in all cases. Histological examination showed that the tumors consisted of mainly small round astrocytic atypical cells in one case, and astrocytic atypical cells with elongated cytoplasm and nuclear pleomorphism with small cell component in two cases. Microvascular proliferation was present in all cases. Immunohistochemical analysis for B-Raf V600E, and mutational analysis for the isocitrate dehydrogenase (IDH) 1, IDH2, and H3F3A gene revealed the wild-type alleles in all three cases. The integrated diagnoses were IDH wild-type glioblastoma, and local irradiation and concomitant temozolomide were performed. After the initial treatment, significant shrinkage of the diffuse lesion and enhanced lesion was found in all cases. Radiation-induced glioblastoma occurring after the treatment for ALL had unique clinical, radiological, histological, and molecular characteristics in our three cases.

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  257. Rapid detection of mutation in isocitrate dehydrogenase 1 and 2 genes using mass spectrometry. Reviewed

    Masayuki Kanamori, Masamitsu Maekawa, Ichiyo Shibahara, Ryuta Saito, Masashi Chonan, Miki Shimada, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Nariyasu Mano, Teiji Tominaga

    Brain tumor pathology   Vol. 35 ( 2 ) page: 90 - 96   2018.4

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    The 2016 World Health Organization classification of tumors of the central nervous system was recently revised. Mutations in the isocitrate dehydrogenase 1 (IDH1) and IDH2 genes and chromosome 1p/19q codeletion are especially important for both the integrated diagnosis and the determination of surgical strategy. To establish a method for intraoperative molecular diagnosis, a simple, rapid method was developed for the measurement of 2-hydroxyglutarate (2-HG), a specific oncometabolite formed in the presence of IDH gene mutation, using liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS). This method requires only 10 min to measure the level of 2-HG from tissue preparation to completion of examination. Using this method, the level of 2-HG was analyzed in 105 patients with diffuse infiltrating glioma, and showed that IDH mutated glioma had significantly higher level of 2-HG compared to IDH wild-type glioma. Receiver operating characteristic curve analysis showed the area under the curve, sensitivity, and specificity were 0.9815, 97.5, and 100%, respectively. In contrast, tumor grade and presence of chromosome 1p/19q codeletion in the IDH mutated glioma could not be predicted from the level of 2-HG. Measurement of 2-HG level using LC/ESI-MS/MS can provide rapid and accurate information of mutation status in the IDH gene.

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  258. Convection-enhanced delivery of sulfasalazine prolongs survival in a glioma stem cell brain tumor model. Reviewed International journal

    Shinya Haryu, Ryuta Saito, Wenting Jia, Takuhiro Shoji, Yui Mano, Aya Sato, Masayuki Kanamori, Yukihiko Sonoda, Oltea Sampetrean, Hideyuki Saya, Teiji Tominaga

    Journal of neuro-oncology   Vol. 136 ( 1 ) page: 23 - 31   2018.1

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    Expression of CD44 in glioma cells was previously correlated with tumor grade and is considered a stem cell marker. CD44 stabilizes the cystine-glutamate transporter (xCT) and inhibits apoptosis in cancer stem cells (CSCs). Recently it was found that Sulfasalazine (SSZ), an anti-inflammatory drug, acts as an inhibitor of xCT and therefore has potential as a targeted therapy for CSCs. In this study, we tested an efficacy of SSZ against glioma stem cell model developed in rats. As poor penetration of blood-brain barrier resulted in insufficient efficacy of systemic SSZ treatment, SSZ was delivered locally with convection-enhanced delivery (CED). In vitro, expression of CD44 in glioma cells and efficacy of SSZ against glioma cells and glioma stem cells were confirmed. SSZ demonstrated anti-proliferative activity in a dose dependent manner against these cells. This activity was partially reversible with the addition of antioxidant, N-acetyl-L-cysteine, to the medium. In vivo, CED successfully delivered SSZ into the rat brain parenchyma. When delivered at 5 mM concentration, which was the highest possible concentration when SSZ was dissolved in water, CED of SSZ resulted in almost no tissue damage. Against highly malignant bRiTs-G3 brain tumor xenografted rat model; the glioma stem cell model, CED of SSZ at 5 mM concentration induced apoptosis and prolonged survival. Consequently, CED of SSZ induced glioma stem cell death without evidence of tissue damage to normal brain parenchyma. This strategy may be a promising targeted treatment against glioma stem cells.

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  259. Fingolimod-associated PML with mild IRIS in MS: A clinicopathologic study. Reviewed International journal

    Shuhei Nishiyama, Tatsuro Misu, Yukiko Shishido-Hara, Kazuo Nakamichi, Masayuki Saijo, Yoshiki Takai, Kentarou Takei, Naoki Yamamoto, Hiroshi Kuroda, Ryuta Saito, Mika Watanabe, Teiji Tominaga, Ichiro Nakashima, Kazuo Fujihara, Masashi Aoki

    Neurology(R) neuroimmunology & neuroinflammation   Vol. 5 ( 1 ) page: e415   2018.1

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    Objective: To clarify the clinical, neuropathologic, and virologic characteristics of progressive multifocal leukoencephalopathy (PML) and its immune reconstitution inflammatory syndrome (IRIS) in a patient with fingolimod-treated MS. Methods: A case study. Results: A 34-year-old patient with MS using fingolimod for 4 years had a gradual progression of right hemiparesis and aphasia with a new subcortical white matter lesion in the precentral gyrus by initial MRI. Blood tests were normal, except for lymphopenia (160 cells/μL). One month after the cessation of fingolimod, brain MRI depicted a diffusely exacerbated hyperintensity on fluid-attenuated inversion recovery and diffusion-weighed imaging in the white matter with punctate gadolinium enhancement, suggesting PML-IRIS. A very low level of JC virus (JCV)-DNA (15 copies/mL) was detected in the CSF as judged by quantitative PCR. Brain tissues were biopsied from the left frontal lesion, which showed some small demyelinated foci with predominant loss of myelin-associated glycoprotein with infiltrations of lymphocytes and macrophages, but clear viral inclusion was not observed with hematoxylin-eosin staining. JCV-DNA was uniquely detectable in an active inflammatory demyelinating lesion by in situ hybridization, possibly suggesting an early phase of PML. DNA extracted from the brain sample was positive for JCV-DNA (151 copies/cell). It took 3 months to normalize the blood lymphocyte count. The patient was treated with 1 g of IV methylprednisolone for 3 days and a weekly oral dose (375 mg) of mefloquine, and her symptoms gradually improved. Conclusion: Low CSF JCV-DNA and unfound viral inclusions initially made her diagnosis difficult. The clinical course of fingolimod-associated PML may be associated with mild immune reconstitution.

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  260. Glioblastoma in neurofibromatosis 1 patients without IDH1, BRAF V600E, and TERT promoter mutations. Reviewed

    Ichiyo Shibahara, Yukihiko Sonoda, Hiroyoshi Suzuki, Akifumi Mayama, Masayuki Kanamori, Ryuta Saito, Yasuhiro Suzuki, Shoji Mashiyama, Hiroshi Uenohara, Mika Watanabe, Toshihiro Kumabe, Teiji Tominaga

    Brain tumor pathology   Vol. 35 ( 1 ) page: 10 - 18   2018.1

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    Pilocytic astrocytomas and low-grade gliomas are more common compared with glioblastomas in patients with neurofibromatosis 1 (NF1). A recent genome-wide analysis has shown frequent NF1 gene alterations in the mesenchymal subtype of a glioblastoma; however, little is known about clinicopathological features of glioblastomas in NF1 patients (NF1 glioblastomas). We analyzed four NF1 glioblastomas. Radiographical and intraoperative findings showed well-circumscribed tumors from surrounding brain. Pathological analysis presented a paucity of processes with an eosinophilic cytoplasm, bizarre nuclei, xanthomatous-like appearance, multinucleated giant cells, and histiocytoid appearance. During the follow-up period, one patient died at 49 months and others remained alive for 60, 87, and 106 months; thus, patients with NF1 glioblastoma presented a relatively favorable survival. None of the NF1 glioblastomas harbored isocitrate dehydrogenase 1 (IDH1) gene mutation, v-RAF murine sarcoma viral oncogene homolog B1 (BRAF) gene mutation, and telomerase reverse transcriptase (TERT) gene promoter mutation. We identified that NF1 glioblastoma is a unique subset of glioblastoma.

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  261. Opening the ventricle during surgery diminishes survival among patients with newly diagnosed glioblastoma treated with carmustine wafers: a multi-center retrospective study Reviewed International journal

    Yukihiko Sonoda, Ichiyo Shibahara, Ken-ichiro Matsuda, Ryuta Saito, Tomoyuki Kawataki, Masaya Oda, Yuichi Sato, Hirokazu Sadahiro, Sadahiro Nomura, Toshio Sasajima, Takaaki Beppu, Masayuki Kanamori, Kaori Sakurada, Toshihiro Kumabe, Teiji Tominaga, Hiroyuki Kinouchi, Hiroaki Shimizu, Kuniaki Ogasawara, Michiyasu Suzuki

    JOURNAL OF NEURO-ONCOLOGY   Vol. 134 ( 1 ) page: 83 - 88   2017.8

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    Carmustine wafers (CW) were approved in Japan for newly diagnosed and recurrent malignant gliomas during 2013. The ventricle is often opened during surgery to achieve maximum resection. While not generally recommended in such situations, CW might be safely achieved by occluding an opened ventricle using gelform or collagen sheets. However, whether CW implantation actually confers a survival benefit for patients who undergo surgery with an open ventricle to treat glioblastoma remains unclear. Clinical, imaging, and survival data were collected in this multicenter retrospective study of 122 consecutive patients with newly diagnosed glioblastoma to determine adverse events and efficacy. Overall, 54 adverse events of all grades developed in 35 (28.6%) patients, with the most common being new seizures (16%). Adverse events did not significantly differ between patients with opened and closed ventricles during surgery. The 10- and 21.7-month, median, progression-free (PFS) and overall survival (OS), respectively did not significantly differ according to resection rates. However, median PFS and OS were significantly longer among patients with closed, than open ventricles (12.8 vs. 7.4 months; p = 0.0039 and 26.9 vs. 18.6 months; p = 0.011, respectively). Implanting CW into the resection cavity during concomitant radiochemotherapy with temozolomide seems to yield better survival rates without increased adverse events. Occlusion of the ventricular opening during surgery might be safe for CW implantation, but less so for treating patients with newly diagnosed glioblastoma.

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  262. Distant recurrences limit the survival of patients with thalamic high-grade gliomas after successful resection Reviewed International journal

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga

    NEUROSURGICAL REVIEW   Vol. 40 ( 3 ) page: 469 - 477   2017.7

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    The indications of surgery for thalamic high-grade gliomas are not well established. The present study investigated the outcome of 21 patients treated by surgery and reports the high incidence of distant recurrences including disseminations after successful removal. Twenty-one patients with thalamic high-grade gliomas not invading the pyramidal tract or midbrain underwent cytoreductive surgery at our institute from June 1997 to August 2015. Surgery was performed with the aid of a neuronavigation system, electrophysiological monitoring, and fluorescence navigation. Tumor histology included 12 cases of the World Health Organization grade III and nine cases of grade IV. Gross total resection was achieved in six cases, subtotal in 13, and partial in two. Motor weakness accompanied by sensory disturbance deteriorated immediately after surgery in 13 patients. However, five patients were determined to show deterioration at 2 months after surgery. Postoperative radiation and chemotherapy were given to every patient, and median progression-free survival of patients with grade III and IV tumors was 12.1 and 7.0 months, respectively. Median overall survival of patients with grade III and IV tumors was 25.6 and 12.6 months, respectively. High incidence of distant recurrences was found, with distant lesions at recurrence in 13 of 19 patients with recurrence, suggesting the life-restricting factor in these patients. Thalamic high-grade glioma without invasion into the pyramidal tract and brainstem can be considered as a candidate for surgical resection. Distant lesion limits the survival of patients after successful resection.

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  263. Convection-enhanced delivery of a hydrophilic nitrosourea ameliorates deficits and suppresses tumor growth in experimental spinal cord glioma models Reviewed International journal

    Shogo Ogita, Toshiki Endo, Shinichiro Sugiyama, Ryuta Saito, Tomoo Inoue, Akira Sumiyoshi, Hiroi Nonaka, Ryuta Kawashima, Yukihiko Sonoda, Teiji Tominaga

    ACTA NEUROCHIRURGICA   Vol. 159 ( 5 ) page: 939 - 946   2017.5

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    Convection-enhanced delivery (CED) is a technique allowing local infusion of therapeutic agents into the central nervous system, circumventing the blood-brain or spinal cord barrier.
    To evaluate the utility of nimustine hydrochloride (ACNU) CED in controlling tumor progression in an experimental spinal cord glioma model.
    Toxicity studies were performed in 42 rats following the administration of 4 mu l of ACNU CED into the mid-thoracic spinal cord at concentrations ranging from 0.1 to 10 mg/ml. Behavioral analyses and histological evaluations were performed to assess ACNU toxicity in the spinal cord. A survival study was performed in 32 rats following the implantation of 9 L cells into the T8 spinal cord. Seven days after the implantation, rats were assigned to four groups: ACNU CED (0.25 mg/ml; n = 8); ACNU intravenous (i.v.) (0.4 mg; n = 8); saline CED (n = 8); saline i.v. (n = 8). Hind limb movements were evaluated daily in all rats for 21 days. Tumor sizes were measured histologically.
    The maximum tolerated ACNU concentration was 0.25 mg/ml. Preservation of hind limb motor function and tumor growth suppression was observed in the ACNU CED (0.25 mg/ml) and ACNU i.v. groups. Antitumor effects were more prominent in the ACNU CED group especially in behavioral analyses (P &lt; 0.05; log-rank test).
    ACNU CED had efficacy in controlling tumor growth and preserving neurological function in an experimental spinal cord tumor model. ACNU CED can be a viable treatment option for spinal cord high-grade glioma.

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  264. Intraoperative Visualization of Subependymal Arteries at the Atrium Supplying the Descending Motor Pathway Reviewed International journal

    Mitsuto Hanihara, Sumito Sato, Ichiyo Shibahara, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Hiroyuki Kinouchi, Teiji Tominaga, Toshihiro Kumabe

    WORLD NEUROSURGERY   Vol. 101   page: 296 - 303   2017.5

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    OBJECTIVE: We previously disclosed that damage to the subependymal arteries (SEAs) caused by coagulation of the choroid plexus at the atrium can result in infarction within the lateral posterior choroidal artery territory, followed by hemiparesis. The present study describes the intra-operative anatomical findings of the SEAs and choroid plexus at the atrium, which were verified only by a few cadaveric studies.
    METHODS: Locations of the SEA and descending motor pathway were determined with the neuronavigation system and subcortical electrical stimulation in 8 cases of periatrial brain tumor. Indocyanine green videoangiography was performed to verify the blood flowin the choroid plexus and SEAs.
    RESULTS: Intraoperative visualization of the SEAs was performed successfully in all patients. The neuronavigation system and subcortical electrical stimulation mapping demonstrated that these SEAs penetrated into the descending motor pathway. Indocyanine green depicted the blood flow of the SEAs entering the wall of the lateral ventricle and adjacent brain parenchyma. The blood flow directions between the SEAs and choroid plexus were not uniform, because the SEAs were filled ahead of the choroid plexus in 3 cases, whereas the choroid plexus was filled first in the other 2 cases.
    CONCLUSIONS: Manipulations to the inner side of the choroid plexus at the transition from the atrium to the body of lateral ventricle can damage the SEAs. Not only coagulation of the SEAs themselves, but also coagulation of choroid plexus itself may reduce the blood flow in the SEAs, resulting in ischemic complications at descending motor pathway.

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  265. 術中迅速診断へのmass spectrometryの応用

    金森 政之, 前川 正充, 柴原 一陽, 斎藤 竜太, 園田 順彦, 渡辺 みか, 冨永 悌二

    Brain Tumor Pathology   Vol. 34 ( Suppl. ) page: 105 - 105   2017.5

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  266. Convection-enhanced Delivery of Therapeutics for Malignant Gliomas Reviewed

    Ryuta Saito, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA   Vol. 57 ( 1 ) page: 8 - 16   2017.1

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    Convection-enhanced delivery (CED) circumvents the blood-brain barrier by delivering agents directly into the tumor and surrounding parenchyma. CED can achieve large volumes of distribution by continuous positive-pressure infusion. Although promising as an effective drug delivery method in concept, the administration of therapeutic agents via CED is not without challenges. Limitations of distribution remain a problem in large brains, such as those of humans. Accurate and consistent delivery of an agent is another challenge associated with CED. Similar to the difficulties caused by immunosuppressive environments associated with gliomas, there are several mechanisms that make effective local drug distribution difficult in malignant gliomas. In this review, methods for local drug application targeting gliomas are discussed with special emphasis on CED. Although early clinical trials have failed to demonstrate the efficacy of CED against gliomas, CED potentially can be a platform for translating the molecular understanding of glioblastomas achieved in the laboratory into effective clinical treatments. Several clinical studies using CED of chemotherapeutic agents are ongoing. Successful delivery of effective agents should prove the efficacy of CED in the near future.

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  267. Extremely Late Recurrence 21 Years after Total Removal of Immature Teratoma: A Case Report and Literature Review Reviewed

    Yui Mano, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Yukihiko Sonoda, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA   Vol. 57 ( 1 ) page: 51 - 56   2017.1

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    Immature teratoma (IMT) is normally treated by resection and adjuvant therapy. The present unusual case of recurrent germinoma occurred 21 years after total resection of pineal IMT. A 3-year-old boy presented with headache, disturbance of consciousness, and Parinaud's syndrome. Magnetic resonance (MR) imaging revealed a pineal mass lesion, and total resection of the tumor was achieved. The histological diagnosis was mature teratoma. He did not receive further treatment, and did well without recurrence for 20 years. However, he suffered headache 21 years after resection, and MR imaging revealed a homogeneously enhanced pineal mass with low minimum apparent diffusion coefficient value and proton MR spectroscopy showed a huge lipid peak. The levels of tumor markers were not elevated. Cerebrospinal fluid (CSF) cytology found atypical cells with large nuclei and irregularly shaped nucleoli. To elucidate the relationship between the primary and recurrent tumors, we reviewed the histological specimens and CSF cytology at the initial treatment and found a subset of incompletely differentiated components resembling fetal tissues in the histological specimen and atypical large cells in the CSF. Based on these radiological and histological findings, we presume that the recurrent disease was disseminated germinoma after the resection of disseminated IMT. He received chemotherapy and craniospinal radiation therapy, and the enhanced lesion and atypical cells in the CSF disappeared. This case demonstrates that disseminated IMT can be controlled for the long term without adjuvant therapy, but may recur as germinoma. Tumor dormancy may account for this unusual course.

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  1. 振戦優位型パーキンソン病(TD-PD)におけるMRガイド下集束超音波治療(MRgFUS)の適応判断と治療効果

    中坪 大輔, 津川 隆彦, 加藤 祥子, 前澤 聡, 坪井 崇, 鈴木 将史, 鳥居 潤, 武藤 学, 伊藤 芳記, 若林 俊彦, 勝野 雅央, 齋藤 竜太

    パーキンソン病・運動障害疾患コングレスプログラム・抄録集   Vol. 17回   page: 101 - 101   2023.7

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  2. がんゲノム診断とバイオインフォマティクス 大規模全ゲノムおよびトランスクリプトーム解析によるGlioblastoma,IDH-wild typeの多様性の解明

    中島 拓真, 舟越 勇介, 畝田 篤仁, 田中 將太, 石田 穣治, 齋藤 竜太, 花谷 亮典, 吉本 幸司, 成田 善孝, 鈴木 啓道

    Brain Tumor Pathology   Vol. 40 ( Suppl. ) page: 066 - 066   2023.5

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  3. Efficacy of Spinal Cord Stimulation Using Differential Target Multiplexed Stimulation for Intractable Pain of Hereditary Neuropathy with Liability to Pressure Palsies: A Case Report.

    Takafumi Tanei, Yusuke Nishimura, Yoshitaka Nagashima, Motonori Ishii, Tomoya Nishii, Nobuhisa Fukaya, Takashi Abe, Hiroyuki Kato, Satoshi Maesawa, Ryuta Saito

    NMC case report journal   Vol. 10 ( 0 ) page: 203 - 208   2023

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    Hereditary neuropathy with liability to pressure palsies is an extremely rare genetic disorder; it is an autosomal dominant disorder with a high incidence of neuropathic and/or musculoskeletal pain. A case of achieving pain relief by spinal cord stimulation using differential target multiplexed stimulation for a 44-year-old female patient with hereditary neuropathy with liability to pressure palsies who was experiencing severe pain in her back, face, and all four limbs is presented. In her early teens, the initial symptoms were numbness and weakness of a limb after movement, which improved spontaneously. Transient pain in her back followed by systemic and persistent muscle weakness and pain developed. Deletion of the gene for peripheral myelin protein 22 was detected by peripheral nerve biopsy. The diagnosis of hereditary neuropathy with liability to pressure palsies was made in her early thirties. A spinal cord stimulation trial was performed because her severe pain continued despite administering many medications. Therefore, two spinal cord stimulation systems were implanted at the C3-5 and Th8-9 levels by two procedures. Pain in her back, arms, and legs decreased from 8 to 1, 5 to 1, and 6 to 2 on the numerical rating scale, respectively. Furthermore, opioid usage was tapered. The pain of hereditary neuropathy with liability to pressure palsies has a complicated pathogenesis and is resistant to pharmacological treatment. Spinal cord stimulation using differential target multiplexed stimulation may be a viable treatment option.

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  4. Relief of Central Poststroke Pain Affecting Both the Arm and Leg on One Side by Double-independent Dual-lead Spinal Cord Stimulation Using Fast-acting Subperception Therapy Stimulation: A Case Report.

    Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Yoshitaka Nagashima, Tomotaka Ishizaki, Manabu Mutoh, Yoshiki Ito, Ryuta Saito

    NMC case report journal   Vol. 10 ( 0 ) page: 15 - 20   2023

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    Central poststroke pain is a chronic, intractable, central neuropathic pain. Spinal cord stimulation is a neuromodulation therapy for chronic neuropathic pain. The conventional stimulation method induces a sense of paresthesia. Fast-acting subperception therapy is one of the latest new stimulation methods without paresthesia. A case of achieving pain relief of central poststroke pain affecting both the arm and leg on one side by double-independent dual-lead spinal cord stimulation using fast-acting subperception therapy stimulation is presented. A 67-year-old woman had central poststroke pain due to a right thalamic hemorrhage. The numerical rating scale scores of the left arm and leg were 6 and 7, respectively. Using dual-lead stimulation at the Th 9-11 levels, a spinal cord stimulation trial was performed. Fast-acting subperception therapy stimulation achieved pain reduction in the left leg from 7 to 3. Therefore, a pulse generator was implanted, and the pain relief continued for 6 months. Then, two additional leads were implanted at the C 3-5 levels, and pain in the arm decreased from 6 to 4. Independent setting and adjustments of the dual-lead stimulation were required because the thresholds of paresthesia perception were significantly different. To achieve pain relief in both the arm and leg, double-independent dual-lead stimulation placed at cervical and thoracic levels is an effective treatment. Fast-acting subperception therapy stimulation may be effective for central poststroke pain, especially in cases where the paresthesia is perceived as uncomfortable or the conventional stimulation itself is ineffective.

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  5. Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report. International journal

    Kentaro Wada, Takafumi Tanei, Kenichi Hattori, Hisashi Hatano, Shigeru Fujitani, Risa Ito, Hiroaki Kubo, Yusuke Nishimura, Satoshi Maesawa, Ryuta Saito

    Surgical neurology international   Vol. 14   page: 85 - 85   2023

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    BACKGROUND: An arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare vascular malformation. Definitive diagnosis and curative treatment of CCJ AVF are challenging. CASE DESCRIPTION: A 77-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed an AVF at the CCJ, which drained into a radicular vein. The lesion was fed by a vertebral artery, anterior and lateral spinal arteries (LSAs), and the occipital artery (OA). There were two unique structures: the LSA originating from the posterior inferior cerebellar artery of the extracranial V3 segment and the OA feeding the shunt. Curative treatment involved two steps: endovascular embolization of feeders using Onyx and surgical shunt disconnection. Feeding arteries were blackened by Onyx, which helped identify the location of the shunt. The shunt was located behind the first cervical (C1) spinal nerve, and the draining vein was confirmed on the deep side of the nerve. A clip was applied to the draining vein distal to the shunt. Tiny vessels supplying the shunt were then coagulated referring to blackened arteries. CONCLUSION: A radicular AVF at the CCJ along the C1 spinal nerve had unique vascular structures. Definitive diagnosis and curative treatment were achieved by combining endovascular embolization using Onyx and direct surgery.

    DOI: 10.25259/SNI_122_2023

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  6. 頭蓋咽頭腫に対する神経内視鏡治療-機能温存と根治性-

    竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本内分泌学会雑誌   Vol. 99 ( 1 )   2023

  7. 頭蓋咽頭腫に対する内視鏡治療の役割 長期成績と内分泌機能保持への挑戦

    竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 原田英幸, 近藤辰磨, 齋藤竜太

    日本間脳下垂体腫瘍学会プログラム・抄録集   Vol. 33rd   2023

  8. Fully endoscopic trans-Magendie foraminal approach for dorsal brainstem lesions

    永田雄一, 竹内和人, 伊藤英治, 原田英幸, 近藤辰磨, 齋藤竜太

    日本頭蓋底外科学会プログラム・抄録集   Vol. 35th   2023

  9. Two cases of NF2 with papilledema due to cerebrospinal fluid malabsorption without ventricular enlargement

    伊藤英治, 齋藤清, 竹林成典, LUSHUN Chalise, 竹内和人, 永田雄一, 齋藤竜太

    日本頭蓋底外科学会プログラム・抄録集   Vol. 35th   2023

  10. 機能性PitNETに対する海綿静脈洞内側壁摘出の病理学的意義

    永田雄一, 竹内和人, 伊藤英治, 原田英幸, 近藤辰磨, 齋藤竜太

    Brain Tumor Pathology. Supplement   Vol. 40   2023

  11. 機能性PitNETに対する治療戦略

    永田雄一, 竹内和人, 伊藤英治, 佐々木博勇, 原田英幸, 近藤辰磨, 齋藤竜太

    日本間脳下垂体腫瘍学会プログラム・抄録集   Vol. 33rd   2023

  12. 機能性PitNETに対する治療戦略

    永田雄一, 竹内和人, 伊藤英治, 佐々木博勇, 原田英幸, 近藤辰磨, 齋藤竜太

    日本内分泌学会雑誌   Vol. 99 ( 1 )   2023

  13. 巨大下垂体腺腫摘出後の還流止血による術後血腫形成予防効果の検討

    原田英幸, 竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 近藤辰磨, 齋藤竜太

    日本間脳下垂体腫瘍学会プログラム・抄録集   Vol. 33rd   2023

  14. The efficacy of endoscopic use in the treatment of pediatric craniopharyngioma

    竹内和人, 永田雄一, 原田英幸, 伊藤英治, 齋藤竜太

    小児の脳神経(Web)   Vol. 48 ( 2 )   2023

  15. 前床突起に発生した結節性筋膜炎の1例

    伊藤英治, 棚橋邦明, 竹内和人, 永田雄一, 原田英幸, 近藤辰磨, 齋藤竜太

    Brain Tumor Pathology. Supplement   Vol. 40   2023

  16. 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

    日本間脳下垂体腫瘍学会プログラム・抄録集   Vol. 33rd   2023

  17. Endoscopic skull base surgery for parasellar lesions

    竹内和人, 永田雄一, 伊藤英治, 原田英幸, 近藤辰磨, 齋藤竜太

    日本頭蓋底外科学会プログラム・抄録集   Vol. 35th   2023

  18. ヒトES細胞由来下垂体細胞のマウス皮下移植の有効性

    佐々木博勇, 竹内和人, 永田雄一, 原田英幸, 近藤辰磨, 伊藤英治, 三輪田勤, 淺野友良, 須賀英隆, 有馬寛, 齋藤竜太

    日本内分泌学会雑誌   Vol. 99 ( 1 )   2023

  19. Speech-language Pathology Rehabilitation in a Case of Jefferson Fracture Complicated with Lower Cranial Nerve Palsies.

    Shota Horiike, Yasuhiro Nakajima, Mamoru Matsuo, Akinori Kageyama, Ayako Motomura, Takashi Tsujiuchi, Ryuta Saito

    NMC case report journal   Vol. 10 ( 0 ) page: 157 - 162   2023

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    A 68-year-old man presented with a Jefferson fracture leading to lower cranial nerve palsies affecting the ninth, tenth, and twelfth cranial nerves with a traumatic basilar impression. On the X day, the patient underwent occipitocervical posterior fixation surgery; the surgery was uneventful. However, just after the surgery, epipharyngeal palsy and airway obstruction occurred. Consequently, tracheostomy was needed. On the X+8 day, speech-language pathology (SLP) therapy was initiated for decannulation. On the X+21 day, the patient could clear all the checkpoints and was decannulated. On the X+36 day, the patient was discharged home and SLP therapy was continued. On the X+171 day, his SLP therapy was halted. However, the patient continued to complain that he could not speak as fast as before, and his quality of life remained compromised. Some studies reported that lower cranial nerve palsies affecting the ninth to the twelfth cranial nerve occur in conjunction with Jefferson fractures. Thus, SLP therapy is crucial for Jefferson fracture cases.

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  20. Simultaneous Aneurysmal Subarachnoid Hemorrhage and Epistaxis in an Untreated Prolactinoma: A Case Report and Literature Review.

    Masahiro Nishihori, Takashi Izumi, Kazuhito Takeuchi, Shunsaku Goto, Fumiaki Kanamori, Kenji Uda, Kinya Yokoyama, Yoshio Araki, Ryuta Saito

    NMC case report journal   Vol. 10 ( 0 ) page: 163 - 168   2023

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    A 61-year-old man presented with massive epistaxis, amaurosis, nausea, and severe headache. A detailed examination revealed a subarachnoid hemorrhage and prolactinoma. Angiography showed a small internal carotid artery pseudoaneurysm and inadequate collateral circulation; thus, uncomplicated coil embolization was performed. Considering the side effects of medication, such as cerebrospinal fluid rhinorrhea, the patient was followed up for asymptomatic prolactinoma without medication after discharge. At 40 months later, aneurysm recurrence was confirmed. Flow diverter device placement was performed, and the outcomes were excellent. In the present report, we described a rare case of a ruptured internal carotid artery aneurysm in an untreated prolactinoma and discussed the literature.

    DOI: 10.2176/jns-nmc.2022-0355

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  21. Sacral arteriovenous fistula with lower thoracic cord edema without perimedullary vein enlargement

    Ishii, M, Nishimura, Y, Nagashima, Y, Tanei, T, Nishihori, M, Izumi, T, Saito, R

    Surgical Neurology International   Vol. 14   page: 295   2023

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  22. Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review.

    Hayato Yokoyama, Masahiro Nishihori, Takashi Izumi, Shunsaku Goto, Michihiro Kurimoto, Mihoko Kato, Fumiaki Kanamori, Kenji Uda, Kinya Yokoyama, Yoshio Araki, Ryuta Saito

    NMC case report journal   Vol. 10 ( 0 ) page: 177 - 183   2023

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    Intracranial aneurysms (IA) in infants are reportedly rare at 0.5% to 4.5% of all aneurysms. Furthermore, subarachnoid hemorrhage in infants younger than three months are even rarer as it has been reported in approximately 20 cases only till date. A 3-month-old infant with seizures and impaired consciousness was admitted to our hospital. Three-dimensional computed tomography angiography (3D-CTA) revealed a dissecting aneurysm with a maximum diameter of 13 mm in the right M2. Internal trapping using detachable coil were successfully performed, following which he was discharged without significant neurological deficit after one month of onset. Thus, we have reported a rare case of a large ruptured dissecting IA in a 3-month-old infant, in the right middle cerebral artery (MCA), successfully treated with an endovascular therapy, along with a literature review.

    DOI: 10.2176/jns-nmc.2022-0369

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  23. A case of a recurrent ameloblastoma in the left maxillary sinus using a skull base surgical approach

    西尾直樹, 重山真由, 岩味健一郎, 伊藤英治, 向山宣昭, 横井紗矢香, 和田明久, 齋藤竜太, 曾根三千彦

    日本頭蓋底外科学会プログラム・抄録集   Vol. 35th   2023

  24. Development of machine learning models for predicting unfavorable functional outcomes in patients with chronic subdural hematomas

    Fuse Y, Nagashima Y, Nishiwaki H, Ohka F, Muramatsu Y, Araki Y, Nishimura Y, Ienaga J, Nagatani T, Seki Y, Watanabe K, Ohno K, Saito R

        2022.11

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    Abstract

    Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. Data were retrospectively collected from patients who underwent CSDH surgery at two institutions: one for internal validation and the other for external validation. The poor functional outcome was defined as a modified Rankin scale score of 3–6 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n = 188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. The prediction performance of these models was also validated in an external cohort (n = 99). The area under the curve of the receiver operating characteristic curve (ROC-AUC) of each machine learning-based model was found to be high in both validations (internal: 0.906–0.925, external: 0.833–0.860). In external validation, the SVM model demonstrated the highest ROC-AUC of 0.860 and accuracy of 0.919. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery.

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  25. 星細胞腫IDH変異型の全ゲノムシークエンスと包括的な分子学的解析(Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant)

    舟越 勇介, 中島 拓真, 南部 翔平, 畝田 篤仁, 片山 琴絵, 井元 清哉, 花谷 亮典, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1038   2022.9

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  26. ゲノムおよびトランスクリプトーム解析による膠芽腫の分子的多様性の解明(Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling)

    中島 拓真, 舟越 勇介, 南部 翔平, 畝田 篤仁, 片山 琴絵, 花谷 亮典, 井元 清哉, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1040   2022.9

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  27. Oligodendroglioma,IDH-mutant and 1p/19q-codeletedのマルチオミクス解析による全ゲノム解析の全貌(Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted)

    舟越 勇介, 南部 翔平, 中島 拓真, 畝田 篤仁, 片山 琴絵, 井元 清哉, 花谷 亮典, 田中 將太, 齋藤 竜太, 吉本 幸司, 成田 善孝, 鈴木 啓道

    日本癌学会総会記事   Vol. 81回   page: E - 1041   2022.9

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  28. 経鼻頭蓋底術後髄液漏の検討―失敗を活かすために―

    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   Vol. 98 ( S.HPT ) page: 25 - 27   2022.8

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    DOI: 10.1507/endocrine.98.s.hpt_25

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  29. Medical Management of a Mural Thrombus Inducing Repeated Ischemic Strokes in a Patient with Congenital Afibrinogenemia

    Nishihori M, Araki Y, Suzuki N, Tamura S, Hattori M, Izumi T, Goto S, Yokoyama K, Uda K, Matsushita T, Saito R

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   Vol. 31 ( 7 ) page: 106526   2022.7

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    Objectives: Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment. Case description: A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events. Conclusion: This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.

    DOI: 10.1016/j.jstrokecerebrovasdis.2022.106526

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  30. 特集 脊椎脊髄疾患の再手術症例における手術のコツと留意点 頸椎症における再手術

    西村 由介, 永島 吉孝, 齋藤 竜太

    脊椎脊髄ジャーナル   Vol. 34 ( 12 ) page: 896 - 901   2022.3

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  31. Contrast-Enhanced Magnetic Resonance Imaging Suggested a Possibility of Transvenous Embolization in the Superior Petrosal Sinus Dural Arteriovenous Fistula: A Case Report.

    Masahiro Nishihori, Takashi Izumi, Tetsuya Tsukada, Yutaka Kato, Kenji Uda, Kinya Yokoyama, Yoshio Araki, Ryuta Saito

    Journal of neuroendovascular therapy   Vol. 16 ( 3 ) page: 163 - 169   2022

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    OBJECTIVE: Superior petrosal sinus dural arteriovenous fistula (SPS-DAVF) is a rare subtype of intracranial DAVF that sometimes leads to hemorrhagic symptoms following deep venous drainage. Here we report the case of SPS-DAVF with retrograde venous reflux to the cerebellar vein. Preoperative contrast-enhanced MRI was a decisive factor in a safe and effective treatment. CASE PRESENTATION: A 37-year-old woman was referred to our hospital with abnormal MRI findings, which was performed when she had a mild headache during her check-up. DSA revealed left-sided SPS-DAVF, which was diagnosed as Cognard type IIb. Both CTA and DSA could not detect the whole SPS but only the shunt pouch. Using contrast-enhanced MRI, we were able to visualize the presence of the SPS and its continuity within the shunt pouch. 3D-T1 turbo spin echo (SPACE) showed a low-intensity area in the SPS, which was not seen in the 3D-T1 fast field echo (FFE). During the procedure, there was a point where it was difficult to advance the microcatheter, which coincided with the low-intensity area. We achieved effective transvenous embolization from the occluded venous access by devising a surgical technique. CONCLUSION: In addition to the contrast-enhanced 3D-T1 FFE, 3D-T1 SPACE might provide beneficial information for endovascular therapy in the evaluation of venous sinuses, which could not be detected by standard examinations.

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  32. Atypical radiographic case of arachnoid web without scalpel sign. International journal

    Yoshitaka Nagashima, Yusuke Nishimura, Hiroshi Ito, Takahiro Oyama, Tomoya Nishii, Tomomi Gonda, Hiroyuki Kato, Ryuta Saito

    Surgical neurology international   Vol. 13   page: 108 - 108   2022

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    BACKGROUND: Spinal arachnoid webs (SAW) occur when abnormally thickened bands of arachnoid membranes commonly located dorsal to the thoracic spine cause blockage of normal cerebrospinal fluid (CSF) flow, resulting in focal cord compression and myelopathy. The pathognomonic MR finding for SAW is the "positive scalpel sign" comprised of an enlarged dorsal CSF space with a normal ventral subarachnoid space. The main differential diagnostic consideration for SAW is idiopathic spinal cord herniation (ISCH); however, for ISCH, MR studies classically demonstrate ventral displacement of the spinal cord through an anterior dural defect. Here, we describe a 60-year-old female with an atypical SAW at the T3-T4 level (i.e., the preoperative MR failed to demonstrate the "positive scalpel sign"). Nevertheless, at surgery, intraoperative ultrasonography confirmed that SAW was present and was decompressed/marsupialized/removed. CASE DESCRIPTION: A 60-year-old female presented with sensory impairment to both lower extremities. The thoracic MR images showed an enlarged dorsal CSF space at the T3-T4 level but without the "scalpel sign" suggesting "interruption" of CSF flow by thickened bands of focal dorsal arachnoidal tissues. Although the initial preoperative diagnosis was ISCH, intraoperative ultrasound (IOUS) confirmed the presence of a thickened arachnoid band, confirming the diagnosis of a SAW that was appropriately decompressed/resected. CONCLUSION: Correctly, establishing the preoperative diagnosis of a SAW based on MR imaging may sometimes be difficult as the typical "scalpel sign" may not be present in all patients. Notably, in cases like this one, IOUS may critically confirm the diagnosis of SAW thus leading to appropriate SAW decompression/removal.

    DOI: 10.25259/SNI_179_2022

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  33. 11C-methionine- and 18F-FDG-PET double-negative metastatic brain tumor from lung adenocarcinoma with paradoxical high 18F-FDG uptake: A case report. International journal

    Kuniaki Tanahashi, Masaki Hirano, Lushun Chalise, Takahiko Tsugawa, Yuka Okumura, Tetsunari Hase, Fumiharu Ohka, Kazuya Motomura, Kazuhito Takeuchi, Yuichi Nagata, Norimoto Nakahara, Naozumi Hashimoto, Ryuta Saito

    Surgical neurology international   Vol. 13   page: 372 - 372   2022

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    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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  34. Delayed Recurrence of Choroid Plexus Carcinoma in the Sacral Spinal Cord 17 Years after Its Initial Presentation

    Arata NAGAI, Masayuki KANAMORI, Yoshiteru SHIMODA, Mika WATANABE, Ryuta SAITO, Toshihiro KUMABE, Toshimi AIZAWA, Teiji TOMINAGA

    NMC Case Report Journal   Vol. 9 ( 0 ) page: 301 - 306   2022

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    Choroid plexus carcinomas (CPCs) are rare malignant tumors of neuro-ectodermal origin, accounting for less than 1% of all intracranial tumors. The recurrence rates of CPCs are very high and typically occur in the short-term following surgery, even after gross total removal. Here we present a rare case of CPC with spinal metastasis, which occurred long after its initial presentation. A 25-year-old woman with a history of increased intracranial pressure underwent resection for a tumor of the fourth ventricle, with a histopathological diagnosis of CPC. After tumor resection, she received 30 Gy of radiation therapy to the craniospinal axis and 20 Gy to the primary site, followed by nimustine hydrochloride chemotherapy. The residual lesion completely responded to these treatments. She suffered sensory loss in the sacral region 13 years later, followed by refractory skin ulcer in the sacral region 17 years after the initial treatments. Magnetic resonance imaging at 17 years after the initial treatments showed tumor in the sacral region, which was enlarged upon follow-up after 18 months, causing incontinence and loss of urinary intention. She underwent tumor resection, with a histological diagnosis of recurrent CPC. She received salvage re-irradiation. This case shows that CPC can spread via the cerebrospinal fluid pathways and cause spinal metastasis, with relatively slow clinical course. The present case suggests that patients with CPCs may need long-term follow-up imaging of the total neural axis to identify late recurrence at both the primary site and spinal metastasis.

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  35. Diagnosis and Treatment Strategies for Arachnoiditis Ossificans Following Subarachnoid Hemorrhage: A Case Report.

    Yoshitaka Nagashima, Yusuke Nishimura, Hiroshi Ito, Tomoya Nishii, Takahiro Oyama, Ryuta Saito

    NMC case report journal   Vol. 9 ( 0 ) page: 295 - 299   2022

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    Arachnoiditis ossificans (AO) is a rare disease, wherein ossified lesions in the subarachnoid space obstruct the flow of spinal fluid or compress the spinal cord, thereby causing myelopathy. Here we describe a rare case of AO and discuss the diagnosis and treatment strategies for this disease. A 66-year-old man with a history of subarachnoid hemorrhage presented with gait disturbance and dysuria for 7 months. Spinal magnetic resonance imaging and computed tomography (CT) myelography showed syringomyelia at the T5-T8 level and dorsally tethered spinal cord at the T8-T10 level. Preoperative noncontrast CT was not performed. The patient was diagnosed with adhesive arachnoiditis and underwent arachnoidolysis. However, intraoperative findings showed the presence of ossification lesions on the dorsal surface of the spinal cord, and intraoperative ultrasound (IOU) showed a hyperintense lesion with acoustic shadowing on the dorsal surface of the spinal cord, with limited visibility of the spinal cord. After removal of the lesions, IOU showed untethered and well-decompressed spinal cord and restoration of cerebrospinal fluid pulsation. Based on these findings, the patient was finally diagnosed with AO, which is an extremely rare disease, with an unknown frequency of occurrence. Therefore, all patients with adhesive spinal arachnoiditis require a preoperative noncontrast CT scan to evaluate for ossification lesions. In this case, we were fortunate to be able to treat AO with IOU, which demonstrated specific findings.

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  36. Dural Arteriovenous Fistula Mimicking a Brain Tumor on Methionine-positron Emission Tomography: A Case Report.

    Taketo Hanyu, Masahiro Nishihori, Takashi Izumi, Kazuya Motomura, Fumiharu Ohka, Shunsaku Goto, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Ryuta Saito

    NMC case report journal   Vol. 9 ( 0 ) page: 289 - 294   2022

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    In this article, we report a case wherein a brain tumor was suspected based on computed tomography and magnetic resonance imaging findings. We made an initial diagnosis of malignant brain tumor based on methionine-positron emission tomography (PET) findings, but the correct diagnosis was dural arteriovenous fistula (DAVF). The patient was a 45-year-old man with DAVF who developed headache. Methionine-PET imaging showed high methionine uptake in the lesion. Although the tumor was strongly suspected from the findings of methionine-PET, the diagnosis of DAVF could be made correctly only by interpreting digital subtraction angiography and computed tomographic angiography. The findings of methionine-PET, which is considered useful in the diagnosis and denial of brain tumors, made the diagnosis of DAVF more difficult. The increased uptake of methionine-PET in DAVF is an important finding because, to our knowledge, this study is the first to report such finding. The results of this study might be useful for differential diagnoses when the diagnosis is uncertain.

    DOI: 10.2176/jns-nmc.2022-0055

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  37. Laminectomy triggers symptomatic growth of spinal schwannoma in a patient with schwannomatosis. International journal

    Takahiro Oyama, Yusuke Nishimura, Yoshitaka Nagashima, Tomoya Nishii, Masahito Hara, Masakazu Takayasu, Ayako Sakakibara, Ryuta Saito

    Surgical neurology international   Vol. 13   page: 261 - 261   2022

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    BACKGROUND: Schwannomatosis (SWN) is genetically similar to neurofibromatosis type 2 (NF2) and represents a NF2 gene mutation. Previous studies have shown that these mutations in both neurons and Schwann cells can lead to the development of schwannomas after nerve crush injuries. Here, we reviewed the potential pathoanatomical mechanisms for the development of a trauma-induced spinal schwannomas in a 55-year-old male with SWN. CASE DESCRIPTION: A 49-year-old male had originally undergone a L3-L5 lumbar laminectomy for stenosis; the schwannomas seen on the preoperative magnetic resonance imaging (MRI) were not resected. Now at age 55, he newly presented with low back pain and numbness in the left L5 dermatome, and he was diagnosed with an L4 vertebral level cauda equina tumor on MRI. Following gross-total resection, the histopathological assessment revealed a Ki-67 labeling index 5-10% in hotspots (i.e., slightly higher than the normal range of schwannomas) and a 20% mosaic loss of SMARCB1. Based on these criteria, he was diagnosed as having SWN. CONCLUSION: In this patient with SWN, compression/physical trauma to nerves of the cauda equina during the L3-L5 laminectomy 6 years ago likely caused the progression of schwannoma.

    DOI: 10.25259/SNI_453_2022

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  38. Spinal Cord Stimulation for Neuropathic Pain following a Spinal Cord Lesion with Past Spinal Surgical Histories Using a Paddle Lead Placed on the Rostral Side of the Lesion: Report of Three Cases.

    Nobuhisa Fukaya, Takafumi Tanei, Yusuke Nishimura, Masahito Hara, Nobuhiro Hata, Yoshitaka Nagashima, Satoshi Maesawa, Yoshio Araki, Ryuta Saito

    NMC case report journal   Vol. 9 ( 0 ) page: 349 - 355   2022

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    Spinal cord parenchymal lesions may induce intractable neuropathic pain. However, the efficacy of conventional spinal cord stimulation for the neuropathic pain following spinal cord lesions remains to be controversial. In this study, we present three cases of spinal cord stimulation using a paddle lead at the rostral side of the spinal lesion causing pain symptoms. Good pain reductions were achieved using conventional stimulation in one case and using differential target multiplexed stimulation in two cases. Case 1: A 55-year-old man presented with neuropathic pain affecting his bilateral upper extremities due to a traumatic cervical spinal cord injury. Conventional stimulation via a paddle-type electrode was able to reduce the pain from 8 to 4 via a visual analog scale. Case 2: A 67-year-old man had undergone three spinal surgeries. He presented with pain and numbness of bilateral lower extremities due to a spinal cord lesion by thoracic disc herniation. Differential target multiplexed stimulation via a paddle-type electrode achieved excellent pain reduction, that is, from 9 to 2 on the visual analog scale. Case 3: An 80-year-old man presented with pain in his bilateral upper extremities due to a cervical spinal cord lesion caused by compression and spinal canal stenosis. Posterior cervical decompression and paddle-type electrode placement were performed simultaneously. Differential target multiplexed stimulation was able to achieve excellent pain reduction, from 7 to 2 on the visual analog scale. Spinal cord stimulation using a paddle lead at the rostral side of the spinal lesion and differential target multiplexed stimulation may provide significant opportunities for patients with intractable neuropathic pain following spinal cord lesions.

    DOI: 10.2176/jns-nmc.2022-0218

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  39. 脳深部病変に対するシリンダー手術の現状と課題

    竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本脳腫瘍の外科学会プログラム・抄録集   Vol. 27th   2022

  40. 脳幹部海綿状血管腫治療における内視鏡の役割

    竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本脳腫瘍の外科学会プログラム・抄録集   Vol. 27th   2022

  41. Utility of 5-ALA and ICG for neuroendoscopic surgery of brain parenchymal tumor

    原田英幸, 竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 近藤辰磨, 齋藤竜太

    日本神経内視鏡学会プログラム・抄録集   Vol. 29th   2022

  42. 巨大下垂体腺腫に対する治療戦略

    永田雄一, 竹内和人, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本脳腫瘍の外科学会プログラム・抄録集   Vol. 27th   2022

  43. Sellar reconstruction with dural suturing technique in endoscopic endonasal approach

    永田雄一, 竹内和人, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本神経内視鏡学会プログラム・抄録集   Vol. 29th   2022

  44. 中枢神経原発胚細胞腫瘍における内視鏡生検術の臨床成績

    大岡史治, 竹内和人, 本村和也, 伊藤英治, 永田雄一, 山口純矢, 佐々木博勇, 木部祐士, 原田英幸, 清水大輝, 平松拓, 鈴木一秋, 齋藤竜太

    日本脳腫瘍の外科学会プログラム・抄録集   Vol. 27th   2022

  45. Inovation of the surgical instruments for Cylinder surgery

    竹内和人, 永田雄一, 伊藤英治, 佐々木博勇, 原田英幸, 齋藤竜太

    日本神経内視鏡学会プログラム・抄録集   Vol. 29th   2022

  46. Is Duragen Useful for Postoperative Hematoma Formation after TSS?

    佐々木博勇, 竹内和人, 永田雄一, 原田英幸, 近藤辰磨, 伊藤英治, 齋藤竜太

    日本神経内視鏡学会プログラム・抄録集   Vol. 29th   2022

  47. Atypical Incomplete Detachment Following PulseRider Deployment.

    Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Ryuta Saito

    Journal of neuroendovascular therapy   Vol. 16 ( 8 ) page: 409 - 412   2022

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    OBJECTIVE: Owing to the limited time since the introduction of the PulseRider (PR), inconsequential or rare complications that clinicians should be aware of remain unreported yet. Here, we report a rare complication of incomplete detachment. CASE PRESENTATION: A 50-year-old male underwent PR-assisted coil embolization for a basilar tip aneurysm. Coiling was completed, and the detachment procedure was performed using a detachment machine; the success signal was observed. The delivery microcatheter was subsequently advanced back up to the proximal markers, and no reapproximation of the proximal markers, which indicates successful detachment, was observed. However, only one of the proximal markers returned to the microcatheter, and incomplete detachment of only one leg was detected. Ultimately, electrical detachment was not possible, and physical separation by tension was achieved. CONCLUSION: Our case report presents a rare case of a detachment problem in the PR. The PR could not be detached, although the signal revealed successful detachment. Therefore, careful withdrawal of the delivery wire by checking not only the proximal markers but also the behavior of the e