Faculty Profiles - SAITO Ryuta

Papers - SAITO Ryuta

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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 Open Access

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

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

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

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

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

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

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.

DOI： 10.1007/s00701-024-05981-8

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

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

OBJECTIVE: Surgical treatment of brainstem cavernous malformations (CMs) is challenging. Surgery using the endoscopic transsphenoidal transclival approach (eTSTCA) is reported as a useful alternative for ventral brainstem CMs. However, CMs located in the ventral midline of the brainstem are rare, and only a small number of case reports on these CMs treated with the eTSTCA exist. The efficacy and safety of the eTSTCA have not yet been fully examined. METHODS: A retrospective analysis was performed for 5 consecutive patients who underwent surgery via the eTSTCA for treating ventral pontine CMs. RESULTS: The average maximum CM diameter was 26.0 mm (18-38 mm). All patients underwent MR-diffusion tensor imaging, which confirmed that the corticospinal tract (CST) deviated posteriorly or laterally to the CM. Direct brainstem cortical stimulation was performed to localize the CST before making the cortical incision. After the excision of the CM, the cavity was filled with artificial CSF to make an aqueous surgical field (wet-field technique) for observing the tumor cavity and confirming complete hemostasis and resection. Total removal was achieved in all patients. The preoperative modified Rankin Scale score was 3 in 3 patients and 4 in 2 patients, whereas it was 1 in 2 patients and 0 in 3 patients 3 months after surgery. Postoperative CSF leakage was observed in 1 patient, and transient abducens nerve palsy was observed in 1 patient. No other intra- or postoperative complications were observed. CONCLUSIONS: MR-diffusion tensor imaging and direct brainstem cortical stimulation were useful to ascertain the proximity of the CST to the CM. The endoscope provides a clear view even underwater, and it was safe and effective to observe the entire CM cavity and confirm complete hemostasis without additional retraction of the brainstem parenchyma, including the CST. The eTSTCA provides a direct access point to the lesion and may be a safer alternative treatment for patients whose CST deviates laterally or posteriorly to the CM.

DOI： 10.3171/2023.6.JNS23324

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

Authorship：Last author Language：English Publisher：Nagoya Journal of Medical Science

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.

DOI： 10.18999/nagjms.86.1.82

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

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

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

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.

DOI： 10.1007/s00701-024-05889-3

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

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

CEREBRAL CORTEX Vol. 34 ( 1 ) 2024.1

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

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.

DOI： 10.1093/cercor/bhad488

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

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

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

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

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.

DOI： 10.1186/s13063-023-07889-7

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

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

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.

DOI： 10.3171/2023.8.PEDS23295

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

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

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

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.

DOI： 10.1016/j.clineuro.2023.108110

Utilization of the O-arm Navigation System in a Case with Challenging Occipital Plate Placement

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

Spinal Surgery Vol. 38 ( 1 ) page： 71 - 72 2024

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

Hideyuki Harada, Kazuhito Takeuchi, Yuichi Nagata, Naoko Inoshita, Eiji Ito, Eriko Okumura, Tatsuma Kondo, Yoshiki Sato, Ryuta Saito

NMC case report journal Vol. 11 ( 0 ) page： 191 - 194 2024

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

Craniopharyngioma (CP) and Rathke's cleft cyst (RCC) are both suprasellar lesions. They are sometimes difficult to distinguish due to their similar findings. We report a case of papillary craniopharyngioma (pCP) with the clinical findings suggesting RCC. A 42-year-old female with intellectual disability presented to our hospital with severe visual dysfunction. Preoperative images revealed a suprasellar cystic lesion without calcification. We performed transsphenoidal surgery. Since the cyst had condensed-milk-like content suggesting RCC, we performed cyst fenestration and wash without removal of the cyst wall. Thereafter, we found fish-egg-like structures on the cyst wall. The histopathological analysis revealed that they had papillary structures surrounded by hyperplastic squamous epithelium with parakeratosis. Immunostaining for BRAF V600E was positive, leading to the diagnosis of pCP. After the surgery, her visual function improved and follow-up Magnetic resonance imaging at 18 months postoperatively showed no apparent recurrence. The presence of condensed-milk-like content suggests a likelihood of RCC indicating that aggressive resection may not be necessary. In contrast, the existence of fish-egg-like structures suggests pCP and requires careful follow-up.

DOI： 10.2176/jns-nmc.2024-0057

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Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note. Reviewed Open Access

Sakamoto Y, Okamoto S, Saito R

Surgical neurology international Vol. 15 page： 300 2024

Language：English Publisher：Surgical Neurology International

Background: Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow. Methods: A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch – right MCA anastomosis, followed by a right STA frontal branch – left radial artery graft (RAG) – left MCA bonnet bypass using small intermittent skin incisions. Results: We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an end-to-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications. Conclusion: The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

DOI： 10.25259/SNI_528_2024

Open Access

Scopus

PubMed

A Case of Ruptured Middle Portion Posterior Communicating Artery Aneurysm with Ipsilateral Internal Carotid Artery Occlusion Treated by Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Endovascular Treatment Reviewed

HACHIYA Kei, IMAI Tasuku, OYAMA Takahiro, KAWABATA Teppei, NODA Tomoyuki, SAITO Ryuta, MAKI Hideki

Surgery for Cerebral Stroke Vol. 52 ( 2 ) page： 123 - 128 2024

Language：Japanese Publisher：The Japanese Society on Surgery for Cerebral Stroke

We report a case of low-flow bypass and endovascular coiling for ruptured middle portion posterior communicating artery (PCoA) aneurysm with an ipsilateral internal carotid artery occlusion. A male in his 70s, who presented with headache was referred to our hospital. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage and a cerebral aneurysm in the middle portion of the PCoA, along with an ipsilateral internal carotid artery occlusion. First, we performed a right superficial temporal artery–middle cerebral artery bypass to minimize the risk of perioperative cerebral ischemia and symptomatic vasospasm; subsequently, coil embolization through the posterior circulation was performed. The patient showed a successful recovery at the 3-month follow-up and showed no recurrence 4 years after the treatment. Coil embolization for the middle portion in a PCoA aneurysm has a risk of parent artery occlusion and can result in an incomplete occlusion owing to the small diameter of the PCoA. However, the combination of bypass surgery with coil embolization can be an effective treatment option. This approach reduces the likelihood of perioperative ischemic stroke, symptomatic vasospasm, and recurrence, particularly when the pathogenesis of the aneurysm is hemodynamic stress caused by an occluded artery.

DOI： 10.2335/scs.52.123

CiNii Research

A Case Report and Review of Surgical Treatment for a Lumbar Disc Herniation with Sciatica in Pregnancy

Hamasaki Hajime, Yoshida Mitsuhiro, Nakabayashi Kiyo, Aimi Yuri, Ishida Mamoru, Terao Kazuichi, Saito Ryuta

Spinal Surgery Vol. 38 ( 1 ) page： 61 - 65 2024

Authorship：Last author Language：Japanese Publisher：The Japanese Society of Spinal Surgery

Use of drugs and radiological diagnoses are restricted for lumbar disc herniation during pregnancy. Fluoroscopy is avoided as much as possible. We report a case of lumbar disc herniation in a pregnant woman who underwent surgery. A 32-year-old woman, 16 weeks pregnant, who presented to an orthopedic clinic with left lower back and limb pain lasting for a month. Lumbar magnetic resonance imaging showed left posterolateral lumbar disc herniation at L5/S1. Conservative management failed, and she could not tolerate this uncontrollable intense pain until delivery ; therefore, the patient was referred to our department for surgery. She was not paralyzed but was unable to walk because of severe pain. The left straight leg raising test result was <30°. The preoperative Japan Orthopedic Association (JOA) score was 8/29. After consultation with an anesthesiologist and an obstetrician/gynecologist at our hospital, we decided to check the fetal heart sounds and echo findings before and after surgery. Surgery was performed under intravenous anesthesia using the standard Love’s method. The intraoperative position was prone on a four-point trestle table. The vertebral level was checked once, taking care not to irradiate the pelvic cavity. Postoperatively, the sciatica disappeared, the JOA score improved to 29 points, and the patient was discharged without symptoms on the eighth postoperative day. During pregnancy, radiation exposure must be avoided as much as possible, considering its influence on the fetus. As the weeks of pregnancy progress, surgery in the left lateral position is recommended to avoid elevating the intra-abdominal pressure or compressing the inferior vena cava. In our case, the patient’s body shape was almost the same as before she became pregnant. Therefore, we concluded the patient could undergo surgery in the prone position. In cases of herniated discs with severe pain that do not respond to conservative treatment, surgery is extremely useful and safe even during pregnancy.

DOI： 10.2531/spinalsurg.38.61

CiNii Research

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

Authorship：Last author Language：Japanese Publisher：Japanese Society for Transplantation and Cellular Therapy

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.

DOI： 10.7889/tct-23-029

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Initial Treatment Experience with Clazosentan for Cerebral Vasospasm after Subarachnoid Hemorrhage

WATANABE Toru, ARAKI Yoshio, UDA Kenji, IENAGA Junpei, KATO Nobuyasu, ISOZAWA Yuichiro, SAKAI Yosuke, TSUKADA Tetsuya, ISHIKAWA Takayuki, SAKAMOTO Yusuke, MURAOKA Shinsuke, NAGATANI Tetsuya, SEKI Yukio, SAITO Ryuta

Surgery for Cerebral Stroke Vol. 52 ( 4 ) page： 258 - 264 2024

Language：Japanese Publisher：The Japanese Society on Surgery for Cerebral Stroke

Clazosentan is used to suppress the onset of cerebral vasospasm, delayed cerebral ischemia (DCI), and new cerebral infarctions after subarachnoid hemorrhage. Here we retrospectively examine our initial experience using this drug in our department. Evaluation items included patient background factors, clinical characteristics, spasms on imaging, DCI/new cerebral infarction, complications associated with fluid retention, and other complications. Thirty-two patients were included; among them, clazosentan was administered to 25. In the clazosentan group, 10 patients (31%) exhibited spasms on imaging, one (4%) experienced DCI, and four (16%) had a new cerebral infarction. Complications associated with fluid retention occurred in 13 patients (52%). Although differences were observed in the phase III study in patient background factors, clinical characteristics, and concomitant medications, clazosentan effectively prevented DCI and new cerebral infarctions. Additional cases should be examined to establish an ideal body fluid management protocol.

DOI： 10.2335/scs.52.258

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Brain tumor surgeries for pediatric/adolescent and young adult patients

Kumabe Toshihiro, Shibahara Ichiyo, Kanamori Masayuki, Saito Ryuta, Sonoda Yukihiko, Endo Hidenori

The Japanese Journal of Pediatric Hematology / Oncology Vol. 61 ( 3 ) page： 238 - 244 2024

Language：Japanese Publisher：The Japanese Society of Pediatric Hematology / Oncology

The authors present a case of ependymoma, which is a rare surgical disease. To determine the significance of ependymoma surgery, we evaluated the frequency of repeat ependymoma surgeries proportionate to that of 235 neuroepithelial tumors/341 surgeries performed by the first author between 1997 and 2023. Repeat ependymoma surgeries accounted for 10/92 (11%) cases with WHO grades 2 and 3 (32 of 136 repeat surgeries [24%]). Ependymoma surgery to achieve local tumor control is of great significance. The treatment of pediatric/adolescent and young adult brain tumors aims to prolong the prognosis and reduce the treatment side effects. Therefore, neurosurgeons must maximize tumor resection while minimizing surgical morbidity, if surgery contributes to local tumor control.

DOI： 10.11412/jspho.61.238

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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 Open Access

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

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

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

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.

DOI： 10.3171/CASE23592

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