Faculty Profiles - SAITO Ryuta

Papers - SAITO Ryuta

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

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

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

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.

DOI： 10.25259/SNI_971_2022

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

Language：Japanese Publisher：The Japanese Society for Pediatric Neurosurgery

<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>

DOI： 10.34544/jspn.47.3_309

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

Language：Japanese Publisher：The Japanese Society of Spinal Surgery

<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>

DOI： 10.2531/spinalsurg.36.296

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

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

Journal of Neurosurgery: Case Lessons Vol. 3 ( 19 ) 2022

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 Open Access

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

Language：English

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

Atypical radiographic case of arachnoid web without scalpel sign. International journal Open Access

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

Language：English

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

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

Language：English Publisher：The Japan Neurosurgical Society

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

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

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

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

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.

DOI： 10.14245/ns.2142860.430

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. International journal Open Access

Tomoya Nishii, Yoshitaka Nagashima, Yusuke Nishimura, Hiroshi Ito, Takahiro Oyama, Mamoru Matsuo, Ayako Sakakibara, Satoko Shimada, Ryuta Saito

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

Language：English

Solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) have been classified as one entity by the World Health Organization in 2016 due to gene fusion between NAB2 and STAT6. In the Central Nervous System (CNS), a hypocellular, collagenized tumor with a classic SFT phenotype is considered grade I, whereas more densely cellular tumors mostly corresponding to the HPC phenotype are classified as grade II or III (anaplastic) depending in mitotic count (<5 vs. >5 mitoses per 10 high-power fields). Herein, we report two cases of targeted SFT/HPC in which pathological differences and WHO grading affect clinical features. A 75-year-old woman presented with headache and had an intradural extramedullary tumor at the C1 to C2 level. The tumor was well-circumscribed and attached only to the dura mater. It was totally removed and diagnosed SFT/HPC grade I. In contrast, a 68-year-old woman presented with numbness in the right upper limb and had an intradural extramedullary tumor at the medulla to C3 levels The tumor was irregularly marginated and strongly adherent to the spinal cord and involved the vertebral artery. It was sub totally removed and diagnosed SFT/HPC grade II. To the best of our knowledge, there are only 12 cases of SFT/HPC at the craniocervical junction, including the present two cases, of which four that were adherent to the spinal cord or involved the vertebral artery were grade II or III. Although the location of the tumor was almost the same, there were significant differences in the intraoperative findings according to the WHO grading.

DOI： 10.21037/jss-21-83

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

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

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

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.

DOI： 10.3389/fnhum.2021.753836

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

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

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.

DOI： 10.1007/s00701-021-04984-z

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

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

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japan Neurosurgical Society

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.

DOI： 10.2176/nmc.ra.2021-0187

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

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

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

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.

DOI： 10.1093/neuonc/noab155

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

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

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

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.

DOI： 10.1016/j.bbrc.2021.08.042

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

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

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japan Neurosurgical Society

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.

DOI： 10.2176/nmc.oa.2021-0049

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

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

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

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

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

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.

DOI： 10.1158/0008-5472.CAN-21-0985

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

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

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.

DOI： 10.2176/nmc.tn.2021-0054

[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

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

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.

DOI： 10.11477/mf.1436204463

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