研究者詳細 - 齋藤　竜太

論文 - 齋藤　竜太

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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 査読有り国際誌 Open Access

Takeuchi, Y; Saito, R; Kanamori, M; Niizuma, K; Mugikura, S; Endo, H

JOURNAL OF NEUROSURGERY-CASE LESSONS 7 巻 ( 9 ) 2024年2月

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

BACKGROUND 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 国際誌 Open Access

Kanamori, M; Morishita, Y; Shimoda, Y; Yamamori, E; Sato, S; Osada, Y; Osawa, SI; Shibahara, I; Saito, R; Sonoda, Y; Kumabe, T; Endo, H

ACTA NEUROCHIRURGICA 166 巻 ( 1 ) 頁： 83 - 83 2024年2月

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

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 査読有り国際誌

Takeuchi, K; Nagata, Y; Sasagawa, Y; Ito, E; Yamamoto, T; Mizuno, A; Sasaki, H; Kondo, T; Araki, Y; Nakada, M; Saito, R

JOURNAL OF NEUROSURGERY 140 巻 ( 2 ) 頁： 469 - 477 2024年2月

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

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 査読有り

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

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 1 ) 頁： 82 - 90 2024年2月

担当区分：最終著者記述言語：英語出版者・発行元：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 査読有り

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

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 1 ) 頁： e52524 2024年1月

Boltless nylon-suture technique for stereotactic electroencephalography as a safe, effective alternative when the anchor bolt is inappropriate 査読有り

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

ACTA NEUROCHIRURGICA 166 巻 ( 1 ) 頁： 18 2024年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Acta Neurochirurgica

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 査読有り Open Access

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

CEREBRAL CORTEX 34 巻 ( 1 ) 2024年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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 査読有り

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

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 1 ) 頁： e51850 2024年1月

Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial 査読有り国際誌 Open Access

Nagashima, Y; Araki, Y; Nishida, K; Kuramitsu, S; Wakabayashi, K; Shimato, S; Kinkori, T; Nishizawa, T; Kano, T; Hasegawa, T; Noda, A; Maeda, K; Yamamoto, Y; Suzuki, O; Koketsu, N; Okada, T; Iwasaki, M; Nakabayashi, K; Fujitani, S; Maki, H; Kuwatsuka, Y; Nishihori, M; Tanei, T; Nishikawa, T; Nishimura, Y; Saito, R

TRIALS 25 巻 ( 1 ) 頁： 6 - 6 2024年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Trials

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 査読有り国際誌

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

JOURNAL OF NEUROSURGERY-PEDIATRICS 33 巻 ( 1 ) 頁： 29 - 34 2024年1月

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

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 査読有り国際誌 Open Access

Mamiya, T; Araki, Y; Taoka, T; Fujita, N; Yokoyama, K; Uda, K; Muraoka, S; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Izumi, T; Kato, K; Saito, R

CLINICAL NEUROLOGY AND NEUROSURGERY 236 巻頁： 108110 - 108110 2024年1月

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

Objective: 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

後頭骨プレート設置困難な症例に対するO-arm navigation systemの活用

永島吉孝, 西村由介, 深谷宜央, 石井元規, 西井智哉, 松尾衛, 阿部節, 加藤寛之, 齋藤竜太

脊髄外科 38 巻 ( 1 ) 頁： 71 - 72 2024年

A Case of Papillary Craniopharyngioma Mimicking Rathke's Cleft Cyst. 査読有り

Harada H, Takeuchi K, Nagata Y, Inoshita N, Ito E, Okumura E, Kondo T, Sato Y, Saito R

NMC case report journal 11 巻 ( 0 ) 頁： 191 - 194 2024年

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

Sakamoto Y, Okamoto S, Saito R

Surgical neurology international 15 巻頁： 300 2024年

記述言語：英語出版者・発行元：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

同側内頚動脈閉塞症に合併した後交通動脈中間部破裂動脈瘤に対するバイパス術併用コイル塞栓術の1例査読有り

蜂谷慶, 今井資, 雄山隆弘, 川端哲平, 野田智之, 齋藤竜太, 槇英樹

脳卒中の外科 52 巻 ( 2 ) 頁： 123 - 128 2024年

記述言語：日本語出版者・発行元：一般社団法人日本脳卒中の外科学会

後交通動脈中間部の動脈瘤はまれである．今回，同側内頚動脈閉塞に合併した後交通動脈中間部の動脈瘤破裂によるくも膜下出血を経験したため報告する．症例は70歳代，男性．右内頚動脈閉塞に合併した後交通動脈中間部脳動脈瘤破裂によるくも膜下出血に対し，浅側頭動脈-中大脳動脈吻合術後に後方循環経由でコイル塞栓術を行った．症候性血管攣縮は認めず，治療直後は不完全閉塞であったが，術後4年で動脈瘤は完全閉塞し再発なく，バイパス血管の閉塞も認めていない．内頚動脈閉塞による血行力学的負荷で発生した同側の真の後交通動脈瘤の血管内治療は動脈瘤の不完全閉塞や母血管閉塞リスクがあるが，バイパス術併用は周術期および血管攣縮期の虚血リスク低減のみならず中長期的な動脈瘤再発予防にも寄与する可能性があり有効なオプションとなり得る．

DOI： 10.2335/scs.52.123

CiNii Research

妊娠中に坐骨神経痛で発症した腰椎椎間板ヘルニアに対し手術加療を行った1例

濱﨑一, 吉田光宏, 中林規容, 相見有理, 石田衛, 寺尾和一, 齋藤竜太

脊髄外科 38 巻 ( 1 ) 頁： 61 - 65 2024年

T細胞疲弊化と固形がんに対するCAR-T細胞療法の課題招待有り

倉光俊一郎, 山口純矢, 野平翔太, 大野真佐輔, 藤田貢, 齋藤竜太

日本造血・免疫細胞療法学会雑誌 13 巻 ( 1 ) 頁： 33 - 41 2024年

担当区分：最終著者記述言語：日本語出版者・発行元：一般社団法人日本造血・免疫細胞療法学会

CD19を標的としたキメラ型抗原受容体（chimeric antigen receptor，CAR）-T細胞療法は血液がん領域において高率な抗腫瘍効果を示し，早くから固形がんへの適応拡大が期待されてきたが，以後目立った成果をあげられずに現在に至っている。固形がんにおける免疫抑制性がん微小環境におけるT細胞疲弊がCAR-T細胞療法を含む免疫療法の有効性を損なう主因の一つであり，そのメカニズム解明が目下の課題である。 本稿ではT細胞受容体（T cell receptor，TCR）-T細胞，CAR-T細胞における既知の疲弊機序に加え，近年明らかとなったCAR-T細胞のNK様疲弊について述べ，それらの知見に基づく疲弊化克服への戦略について概説する。

DOI： 10.7889/tct-23-029

CiNii Research

researchmap

くも膜下出血後の脳血管攣縮予防におけるクラゾセンタンの初期治療経験

渡邊亨, 荒木芳生, 宇田憲司, 家永惇平, 加藤信靖, 礒澤佑一郎, 酒井洋輔, 塚田哲也, 石川隆之, 坂本悠介, 村岡真輔, 永谷哲也, 関行雄, 齋藤竜太

脳卒中の外科 52 巻 ( 4 ) 頁： 258 - 264 2024年

記述言語：日本語出版者・発行元：一般社団法人日本脳卒中の外科学会

クラゾセンタンはくも膜下出血後のスパズムに伴う遅発性脳虚血（delayed cerebral ischemia：DCI）および新規脳梗塞の発症を抑制するために使用される新規薬剤である．この研究ではクラゾセンタンを使用した当科での約 1 年間の初期治療経験について調査した．評価項目は患者背景，臨床的特徴，画像上スパズム，DCI/新規脳梗塞，体液貯留に伴う合併症，その他の合併症とした．対象は 32 例で 25 例にクラゾセンタンが使用された．クラゾセンタン使用群では 10 例（31％）に画像上スパズムが認められ，1 例（4％）に DCI，4 例（16％）に新規脳梗塞を認めた．体液貯留合併症は 13例（52％）で発生した．患者背景，臨床的特徴，クラゾセンタン以外の併用薬などで第III相試験と差はあるものの，結果は DCI や新規脳梗塞の予防におけるクラゾセンタンの有効性が示されるものであった．体液貯留合併症を回避するための理想的な体液管理プロトコルを確立するには，より多くの症例を蓄積する必要があると考えられた．

DOI： 10.2335/scs.52.258

CiNii Research

小児・AYA世代脳腫瘍に対する外科治療

隈部俊宏, 柴原一陽, 金森政之, 齋藤竜太, 園田順彦, 遠藤英徳

日本小児血液・がん学会雑誌 61 巻 ( 3 ) 頁： 238 - 244 2024年

記述言語：日本語出版者・発行元：日本小児血液・がん学会

最も手術療法が重要と考えられ“surgical disease”と評され稀少疾患である上衣腫に関して，症例を提示するとともに，手術の意義を表明するために，1997年12月から2023年5月までの間に神経上皮性腫瘍に対して単一術者が行った235症例・341回の再手術に占める上衣腫の頻度を検討した．その結果，上衣腫は再手術を行ったWHO grade 2, 3の92症例の内10例・11%を占め，再手術回数は136回の内32回・24%を占めた．このように上衣腫に対しての局所腫瘍制御目的の手術は大きな意義を持っていることがわかった．小児・AYA世代脳腫瘍治療の目標は，生命予後の延長と，治療自体による悪影響を軽減することにある．この目標を叶えるために，局所腫瘍制御が手術によって可能であるならば，もしくは寄与するならば，我々脳神経外科医は全力をあげて安全で確実な手術を行わなければならない．

DOI： 10.11412/jspho.61.238

CiNii Research

Hemifacial spasm caused by multiple vascular attachments due to remote compression effects of a dermoid cyst in the cerebellar hemisphere: illustrative case 査読有り国際誌 Open Access

Hirayama, K; Tanei, T; Kato, T; Hasegawa, T; Ito, E; Nishimura, Y; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 6 巻 ( 23 ) 2023年12月

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

BACKGROUND 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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論文 - 齋藤 竜太

<齋藤　竜太>

論文 - 齋藤　竜太