研究者詳細 - 齋藤　竜太

論文 - 齋藤　竜太

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Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a single-center, long-term, retrospective, observational study 査読有り国際誌

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

JOURNAL OF NEUROSURGERY 138 巻 ( 3 ) 頁： 724 - 731 2023年3月

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

OBJECTIVE 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.

DOI： 10.3171/2022.6.JNS22815

The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery 査読有り国際誌

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

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

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

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

DOI： 10.1007/s00701-022-05415-3

Mesencephalic developmental venous anomaly causing obstructive hydrocephalus: illustrative case 査読有り国際誌 Open Access

Hiraga, K; Hayashi, S; Oshima, R; Kondo, T; Kanamori, F; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 5 巻 ( 12 ) 2023年3月

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

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.

DOI： 10.3171/CASE22563

Eyelid myokymia caused by a trigeminal schwannoma as determined by the trigeminal-evoked blink reflex 査読有り国際誌 Open Access

Ito, E; Sugita, R; Saito, R

CLINICAL CASE REPORTS 11 巻 ( 3 ) 頁： e7086 2023年3月

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

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

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

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

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

DOI： 10.1002/cam4.5512

Comparative Study of Anterior Transvertebral Foraminotomy and Anterior Cervical Discectomy and Fusion for Unilateral Cervical Spondylotic Radiculopathy 査読有り国際誌 Open Access

Akahori, S; Nishimura, Y; Eguchi, K; Nagashima, Y; Ando, R; Awaya, T; Tanei, T; Hara, M; Kanemura, T; Takayasu, M; Saito, R

WORLD NEUROSURGERY 171 巻頁： E516 - E523 2023年3月

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

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.

DOI： 10.1016/j.wneu.2022.12.053

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 63 巻 ( 3 ) 頁： 182 - 182 2023年3月

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 63 巻 ( 3 ) 頁： 182 - 182 2023年3月

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 査読有り国際誌 Open Access

Natsume, A; Arakawa, Y; Narita, Y; Sugiyama, K; Hata, N; Muragaki, Y; Shinojima, N; Kumabe, T; Saito, R; Motomura, K; Mineharu, Y; Miyakita, Y; Yamasaki, F; Matsushita, Y; Ichimura, K; Ito, K; Tachibana, M; Kakurai, Y; Okamoto, N; Asahi, T; Nishijima, S; Yamaguchi, T; Tsubouchi, H; Nakamura, H; Nishikawa, R

NEURO-ONCOLOGY 25 巻 ( 2 ) 頁： 326 - 336 2023年2月

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

Background: Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in the 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 cutoff. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least 1 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).

DOI： 10.1093/neuonc/noac155

A Case of Haemorrhagic-Onset Glioblastoma With Delayed Diagnosis 査読有り国際誌 Open Access

Otomo, M; Kanamori, M; Sato, S; Shimoda, Y; Watanabe, M; Kawaguchi, T; Saito, R; Tominaga, T

CUREUS JOURNAL OF MEDICAL SCIENCE 15 巻 ( 2 ) 頁： e34672 2023年2月

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 114 巻頁： 205 - 205 2023年2月

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 114 巻頁： 203 - 203 2023年2月

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 114 巻頁： 206 - 206 2023年2月

The usefulness of three-dimensional fusion imaging of spinal arteriovenous malformation by a workstation connected to angiography systems 査読有り Open Access

Nagashima, Y; Izumi, T; Nishimura, Y; Nishihori, M; Oyama, T; Matsuo, M; Ito, H; Nishii, T; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 1 ) 頁： 127 - 133 2023年2月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

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.

DOI： 10.18999/nagjms.85.1.127

Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case 査読有り国際誌 Open Access

Kato, H; Tanei, T; Nishimura, Y; Nagashima, Y; Ishii, M; Nishii, T; Fukaya, N; Abe, T; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 5 巻 ( 7 ) 2023年2月

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

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.

DOI： 10.3171/CASE22475

Differences in gaze behaviors between trainees and experts during endovascular therapy for cerebral aneurysms: a preliminary study using a cerebral aneurysm model 査読有り Open Access

Otsuka, T; Izumi, T; Yamamoto, M; Seshita, Y; Kohama, T; Nishihori, M; Tsukada, T; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 1 ) 頁： 50 - 58 2023年2月

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

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.

DOI： 10.18999/nagjms.85.1.50

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 114 巻頁： 1818 - 1818 2023年2月

Characteristic image on cerebral angiography in ruptured blood blister-like aneurysms 査読有り国際誌 Open Access

Kato, N; Izumi, T; Nishihori, M; Goto, S; Araki, Y; Yokoyama, K; Saito, R

CLINICAL NEUROLOGY AND NEUROSURGERY 225 巻頁： 107583 - 107583 2023年2月

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

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.

DOI： 10.1016/j.clineuro.2022.107583

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 114 巻頁： 1460 - 1460 2023年2月

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 114 巻頁： 205 - 205 2023年2月

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