Faculty Profiles - SAITO Ryuta

Papers - SAITO Ryuta

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Sacral arteriovenous fistula with lower thoracic cord edema without perimedullary vein enlargement Open Access

Ishii, M, Nishimura, Y, Nagashima, Y, Tanei, T, Nishihori, M, Izumi, T, Saito, R

Surgical Neurology International Vol. 14 page： 295 2023

Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review. Open Access

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

Language：English Publisher：The Japan Neurosurgical Society

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

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. Open Access

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

Language：English Publisher：The Japan Neurosurgical Society

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.

DOI： 10.2176/jns-nmc.2022-0336

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 Open Access

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

Language：English

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.

DOI： 10.3389/fnhum.2022.1065459

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 Open Access

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

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

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1002/epi4.12634

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

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

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

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1016/J.WNEU.2022.08.116

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

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

Language：English Publishing type：Research paper (scientific journal)

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

DOI： 10.1016/j.wneu.2022.08.147

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

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

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

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

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

Language：English

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.

DOI： 10.18999/nagjms.84.4.884

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

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

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

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.18999/nagjms.84.4.762

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

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

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

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

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1097/MD.0000000000030923

Open Access

PubMed

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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

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1007/s10143-022-01820-5

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

Language：English Publishing type：Research paper (scientific journal)

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

DOI： 10.1007/s00701-022-05273-z

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Papers - SAITO Ryuta