Faculty Profiles - SAITO Ryuta

Papers - SAITO Ryuta

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Comparative Study of Surgical Outcomes of Occipitocervical and Atlantoaxial Fusion for Retro-Odontoid Pseudotumor Reviewed Open Access

Nishii, T, Nishimura, Y, Nagashima, Y, Tanei, T, Hara, M, Takayasu, M, Kanemura, T, Saito, R

World Neurosurgery Vol. 178 page： E230 - E238 2023.10

Focus disconnection of the SEEG-identified epileptic network by radiofrequency thermal coagulation Reviewed Open Access

Ishizaki, T, Maesawa, S, Yamamoto, H, Hashida, M, Mutoh, M, Ito, Y, Tanei, T, Natsume, J, Saito, R

Seizure Vol. 111 page： 17 - 20 2023.10

Paroxysmal Sympathetic Hyperactivity in Stroke Reviewed

Muraoka, S., Kumagai, Y., Koketsu, N., Araki, Y., Saito, R.

World Neurosurgery Vol. 178 page： 28 - 36 2023.10

Development and validation of machine learning models to predict postoperative infarction in moyamoya disease. Reviewed International journal

Yutaro Fuse, Kazuki Ishii, Fumiaki Kanamori, Shintaro Oyama, Takahiro Imaizumi, Yoshio Araki, Kinya Yokoyama, Syuntaro Takasu, Yukio Seki, Ryuta Saito

Journal of neurosurgery Vol. 141 ( 4 ) page： 927 - 935 2023.10

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

OBJECTIVE: Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ability to predict its occurrence based on these limited predictors remains inadequately explored. This study aimed to assess the feasibility of machine learning algorithms for predicting cerebral infarction after revascularization surgery in patients with MMD. METHODS: This retrospective study was conducted across two centers and harnessed data from 512 patients with MMD who had undergone revascularization surgery. The patient cohort was partitioned into internal and external datasets. Using perioperative clinical data from the internal cohort, three distinct machine learning algorithms-namely the support vector machine, random forest, and light gradient-boosting machine models-were trained and cross-validated to predict the occurrence of postoperative cerebral infarction. Predictive performance validity was subsequently assessed using an external dataset. Shapley additive explanations (SHAP) analysis was conducted to augment the prediction model's transparency and to quantify the impact of each input variable on shaping both the aggregate and individual patient predictions. RESULTS: In the cohort of 512 patients, 33 (6.4%) experienced postrevascularization cerebral infarction. The cross-validation outcomes revealed that, among the three models, the support vector machine model achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at mean ± SD 0.785 ± 0.052. Notably, during external validation, the light gradient-boosting machine model exhibited the highest accuracy at 0.903 and the largest ROC-AUC at 0.710. The top-performing prediction model utilized five input variables: postoperative serum gamma-glutamyl transpeptidase value, positive posterior cerebral artery (PCA) involvement on preoperative MRA, infarction as the rationale for surgery, presence of an infarction scar on preoperative MRI, and preoperative modified Rankin Scale score. Furthermore, the SHAP analysis identified presence of PCA involvement, infarction as the rationale for surgery, and presence of an infarction scar on preoperative MRI as positive influences on postoperative cerebral infarction. CONCLUSIONS: This study indicates the usefulness of employing machine learning techniques with routine perioperative data to predict the occurrence of cerebral infarction after revascularization procedures in patients with MMD.

DOI： 10.3171/2024.1.JNS232173

Simulation of the occipital transtentorial approach incorporating visualization of the cerebellar tentorium using three-dimensional computed tomography angiography and gadolinium-enhanced T1-weighted magnetic resonance imaging: technical note. International journal Open Access

Yuto Shingai, Masayuki Kanamori, Yoshiteru Shimoda, Shingo Kayano, Hitoshi Nemoto, Shunji Mugikura, Ryuta Saito, Teiji Tominaga

Neurosurgical review Vol. 46 ( 1 ) page： 259 - 259 2023.9

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

The occipital transtentorial approach (OTA) is one of the useful approaches to the lesions of the pineal region, dorsal brainstem, and supracerebellar region. However, a wide operative field is sometimes difficult to obtain due to the tentorial sinus and bridging veins. This study evaluated the usefulness of preoperative simulation of OTA, specifically including the cerebellar tentorium in 9 patients. All patients underwent computed tomography angiography and venography and gadolinium-enhanced three-dimensional T1-weighted magnetic resonance images (Gd-3D-T1WI). The images were fused, and the cerebellar tentorium, vessels, and tumor were manually extracted from Gd-3D-T1WI to obtain the simulation images. Visualization of the cerebellar tentorium could discriminate between bridging veins from the occipital lobe and cerebellum, and recognize the site of bridging to the tentorial sinus and variants which may interfere with the tentorial incision. Simulation of the tentorial incision was also possible based on the relationships between the tumor, tentorial sinus, bridging vein, and cerebellar tentorium. The simulation suggested that safe tentorial incision was difficult in two sides because of the crossed tentorial sinus draining the left basal vein and draining veins from the glioblastoma. The OTA was performed in eight cases, and no difficulty was experienced in the tentorial incision in all cases. The simulation findings of the bridging vein and tentorial sinus were consistent with the intraoperative findings. Preoperative simulation including the cerebellar tentorium is useful for determining the optimum and safe side and required extent of the tentorial incision necessary for tumor resection with the OTA.

DOI： 10.1007/s10143-023-02170-6

Efficacy of the latest new stimulation patterns of spinal cord stimulation for intractable neuropathic pain compared to conventional stimulation: study protocol for a clinical trial. Reviewed International journal Open Access

Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Yoshitaka Nagashima, Tomotaka Ishizaki, Masahiko Ando, Yachiyo Kuwatsuka, Atsushi Hashizume, Shimon Kurasawa, Ryuta Saito

Trials Vol. 24 ( 1 ) page： 604 - 604 2023.9

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

BACKGROUND: Spinal cord stimulation (SCS) is one of the neuromodulation therapies for chronic neuropathic pain. The conventional paresthesia-based SCS involves the application of tonic stimulation that induces a sense of paresthesia. Recently, new SCS stimulation patterns without paresthesia have been developed. Differential target multiplexed (DTM) stimulation and fast-acting subperception therapy (FAST) stimulation are the latest paresthesia-free SCS patterns. METHODS: A single-center, open-label, crossover, randomized clinical trial to investigate the superiority of SCS using the latest new stimulation patterns over conventional tonic stimulation for neuropathic pain is planned. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). In the SCS trial, participants will be randomly assigned to 4 groups receiving stimulation, including tonic, DTM, and FAST. Each stimulation will then be performed for 2 days, and a visual analog scale (VAS) for pain will be evaluated before and after each stimulation pattern. A stimulation-off period for 1 day is set between each stimulation pattern to wash out the residual previous stimulation effects. Pain improvement is defined as more than 33% reduction in the pain VAS. The primary analysis will compare pain improvement between the new stimulation patterns and the conventional tonic stimulation pattern in the SCS trial. The secondary outcomes will be evaluated as follows: (1) the relationships between causative disease and improvement rate by each stimulation pattern; (2) comparison of pain improvement between the DTM and FAST stimulation patterns in all cases and by causative disease; (3) changes in assessment items preoperatively to 24 months after the implantation; (4) preoperative factors associated with long-term effects defined as continuing for more than 12 months; and (5) adverse events related to this study 3 months after the implantation. DISCUSSION: This study aims to clarify the effectiveness of the latest new stimulation patterns compared to the conventional tonic stimulation. In addition, which stimulation pattern is most effective for which kind of causative disease will be clarified. TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT) 1,042,220,094. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is an approved member of the Primary Registry Network of WHO ICTRP.

DOI： 10.1186/s13063-023-07637-x

Predictive factors of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping Reviewed

Motomura, K, Kawamura, A, Ohka, F, Aoki, K, Nishikawa, T, Yamaguchi, J, Kibe, Y, Shimizu, H, Maeda, S, Saito, R

Journal of Neuropsychology Vol. 18 Suppl 1 ( S1 ) page： 73 - 84 2023.9

[Ependymoma in WHO Classification of Tumours 5th Edition]. Invited Reviewed

Saito R

No shinkei geka. Neurological surgery Vol. 51 ( 5 ) page： 867 - 875 2023.9

本態性振戦およびジストニア性振戦の9軸モーションセンサを用いた特徴抽出

坪井崇, 澤田桂都, 星野聖奈, 樋口萌花, 武藤学, 伊藤芳記, 石崎友崇, 種井隆文, 中坪大輔, 前澤聡, 鈴木将史, 佐藤茉紀, 玉腰大悟, 平賀経太, 佐竹勇紀, 齋藤竜太, 勝野雅央

臨床神経学 Vol. 63 ( Suppl. ) page： S246 - S246 2023.9

再生医療実現に向けたヒト多能性幹細胞由来下垂体細胞の皮下移植

佐々木博勇, 須賀英隆, 竹内和人, 永田雄一, 原田英幸, 近藤辰磨, 伊藤英治, 有馬寛, 齋藤竜太

日本内分泌学会雑誌 Vol. 99 ( S.HPT ) page： 4 - 6 2023.8

特集覚醒下手術の最前線--臨床的意義と神経科学言語機能温存を目指したlower grade gliomaに対する覚醒下手術

本村和也, 齋藤竜太

医学のあゆみ Vol. 286 ( 9 ) page： 707 - 713 2023.8

TUG1-mediated R-loop resolution at microsatellite loci as a prerequisite for cancer cell proliferation. Reviewed International journal Open Access

Miho M Suzuki, Kenta Iijima, Koichi Ogami, Keiko Shinjo, Yoshiteru Murofushi, Jingqi Xie, Xuebing Wang, Yotaro Kitano, Akira Mamiya, Yuji Kibe, Tatsunori Nishimura, Fumiharu Ohka, Ryuta Saito, Shinya Sato, Junya Kobayashi, Ryoji Yao, Kanjiro Miyata, Kazunori Kataoka, Hiroshi I Suzuki, Yutaka Kondo

Nature communications Vol. 14 ( 1 ) page： 4521 - 4521 2023.8

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

Oncogene-induced DNA replication stress (RS) and consequent pathogenic R-loop formation are known to impede S phase progression. Nonetheless, cancer cells continuously proliferate under such high-stressed conditions through incompletely understood mechanisms. Here, we report taurine upregulated gene 1 (TUG1) long noncoding RNA (lncRNA), which is highly expressed in many types of cancers, as an important regulator of intrinsic R-loop in cancer cells. Under RS conditions, TUG1 is rapidly upregulated via activation of the ATR-CHK1 signaling pathway, interacts with RPA and DHX9, and engages in resolving R-loops at certain loci, particularly at the CA repeat microsatellite loci. Depletion of TUG1 leads to overabundant R-loops and enhanced RS, leading to substantial inhibition of tumor growth. Our data reveal a role of TUG1 as molecule important for resolving R-loop accumulation in cancer cells and suggest targeting TUG1 as a potent therapeutic approach for cancer treatment.

DOI： 10.1038/s41467-023-40243-8

Transarterial embolization and transvenous embolization for transverse-sigmoid sinus dural arteriovenous fistulas with cortical venous reflux: A comparative study. Reviewed International journal

Tetsuya Tsukada, Takashi Izumi, Masahiro Nishihori, Yoshio Araki, Kenji Uda, Kinya Yokoyama, Ryuta Saito

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences page： 15910199231195135 - 15910199231195135 2023.8

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

BACKGROUND: Dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) carry a high risk for neurological sequelae or death. Recently, transverse-sigmoid sinus DAVFs were shown as good indications for transarterial embolization (TAE) with ONYX. Here, we compared the effectiveness and safety of conventional transvenous embolization (TVE) with those of TAE with ONYX for transverse-sigmoid sinus DAVFs with CVR. METHODS: Sixty-one patients with transverse-sigmoid sinus DAVFs were treated from April 2013 to May 2020. Among them, 37 patients with CVR were included. Transarterial embolization and TVE were compared in terms of complete occlusion and residual CVR immediately after treatment, complications with worsening modified Rankin Scale (mRS) ≥ 1, amount of contrast media used during treatment, radiation exposure, and surgical procedure time. RESULTS: Ten patients were treated with 10 TAEs using ONYX and 27 patients with 29 TVEs. Transarterial embolization and TVE showed no differences in the overall complete occlusion rate (80% [8/10 patients] vs. 80% [23/27], respectively), whereas the residual rate of existing CVR was 10% (1/10 patient) vs. 3.4% (1/27) in the TAE and TVE groups, respectively. No complications with worsening mRS ≥1 occurred in either group. Among the parameters of amount of contrast media, radiation dose, and operative time, only radiation dose in the TAE group was lower than that in the TVE group (median: 2239 mGy vs. 3268 mGy, respectively; p = 0.07). CONCLUSION: For transverse-sigmoid sinus DAVFs with CVR, TAE treatment reduced radiation exposure. However, both TAE and TVE achieved high complete occlusion rates and low complication rates.

DOI： 10.1177/15910199231195135

Real-world data of clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. Reviewed International journal

Shinsuke Muraoka, Takumi Asai, Takahiko Fukui, Shinji Ota, Shinji Shimato, Naoki Koketsu, Toshihisa Nishizawa, Yoshio Araki, Ryuta Saito

Neurosurgical review Vol. 46 ( 1 ) page： 195 - 195 2023.8

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

Aneurysmal subarachnoid hemorrhage (aSAH) may lead to cerebral vasospasm, significantly associated with morbidity and mortality. In double-blind, placebo-controlled phase 3 studies, clazosentan reduces cerebral vasospasm-related morbidity and all-cause mortality in patients with aSAH. There are no reports about the clinical efficacy of clazosentan combination therapy with some other drugs. Initially, we explored the efficacy of clazosentan combination therapy with cilostazol, statin, and antiepileptic drugs. Subsequently, we assessed the add-on effect of fasudil to clazosentan combination therapy for aSAH patients. This multicenter, retrospective, observational cohort study included Japanese patients with aSAH between June 2022 and March 2023. The primary outcome was the ordinal score on the modified Rankin Scale (mRS; range, 0-6, with elevated scores indicating greater disability) at discharge. Among the 47 cases (women 74.5%; age 64.4 ± 15.0 years) undergoing clazosentan combination therapy, 29 (61.7%) resulted in favorable outcomes. Overall, vasospasm occurred in 16 cases (34.0%), with four cases (8.5%) developing vasospasm-related delayed cerebral ischemia (DCI). Both hypotension and vasospasm-related DCI were related to unfavorable outcome at discharge. Fasudil were added in 18 (38.3%) cases. Despite adding fasudil to clazosentan combination therapy, the incidence of aSAH-related vasospasm did not decrease. Added-on fasudil to combination therapy related to pulmonary edema, vasospasm, and vasospasm-related DCI, and unfavorable outcomes. Clazosentan combination therapy could potentially result in favorable outcomes for aSAH patients to prevent post-aSAH vasospasm-related DCI. The add-on effect of fasudil to combination therapy did not demonstrate a significant impact in reducing aSAH-related vasospasm or improving outcomes at discharge.

DOI： 10.1007/s10143-023-02104-2

Moyamoya disease-specific extracellular vesicle-derived microRNAs in the cerebrospinal fluid revealed by comprehensive expression analysis through microRNA sequencing. Reviewed International journal

Shinji Ota, Kinya Yokoyama, Fumiaki Kanamori, Takashi Mamiya, Kenji Uda, Yoshio Araki, Toshihiko Wakabayashi, Kazuhiro Yoshikawa, Ryuta Saito

Acta neurochirurgica Vol. 165 ( 8 ) page： 2045 - 2055 2023.8

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

PURPOSE: To examine the specific changes that occur in the expression levels of extracellular vesicle-derived microRNAs (miRNAs) in intracranial cerebrospinal fluid (CSF) in moyamoya disease. METHODS: Patients with arteriosclerotic cerebral ischemia were used as controls to eliminate the effects of cerebral ischemia. Intracranial CSF was collected from moyamoya disease and control patients during bypass surgery. Extracellular vesicles (EVs) were extracted from the CSF. Comprehensive expression analysis of miRNAs extracted from EVs by next-generation sequencing (NGS) and validation by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed. RESULTS: Experiments were conducted on eight cases of moyamoya disease and four control cases. In the comprehensive miRNA expression analysis, 153 miRNAs were upregulated, and 98 miRNAs were downregulated in moyamoya disease compared to the control cases (q-value < 0.05 and |log2 fold change|> 1). qRT-PCR performed on the four most variable miRNAs (hsa-miR-421, hsa-miR-361-5p, hsa-miR-320a, and hsa-miR-29b-3p) associated with vascular lesions among the differentially expressed miRNAs gave the same results as miRNA sequencing. On gene ontology (GO) analysis for the target genes, cytoplasmic stress granule was the most significant GO term. CONCLUSIONS: This study is the first comprehensive expression analysis of EV-derived miRNAs in the CSF of moyamoya disease patients using NGS. The miRNAs identified here may be related to the etiology and pathophysiology of moyamoya disease.

DOI： 10.1007/s00701-023-05579-6

Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy. Open Access

Motonori Ishii, Yusuke Nishimura, Masahito Hara, Yu Yamamoto, Yoshitaka Nagashima, Takafumi Tanei, Masakazu Takayasu, Ryuta Saito

Neurologia medico-chirurgica Vol. 63 ( 8 ) page： 350 - 355 2023.8

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

Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

DOI： 10.2176/jns-nmc.2022-0313

Latest classification of ependymoma in the molecular era and advances in its treatment: a review. Invited Reviewed International journal

Junya Yamaguchi, Fumiharu Ohka, Kazuya Motomura, Ryuta Saito

Japanese journal of clinical oncology Vol. 53 ( 8 ) page： 653 - 663 2023.7

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

Ependymoma is a rare central nervous system (CNS) tumour occurring in all age groups and is one of the most common paediatric malignant brain tumours. Unlike other malignant brain tumours, ependymomas have few identified point mutations and genetic and epigenetic features. With advances in molecular understanding, the latest 2021 World Health Organization (WHO) classification of CNS tumours divided ependymomas into 10 diagnostic categories based on the histology, molecular information and location; this accurately reflected the prognosis and biology of this tumour. Although maximal surgical resection followed by radiotherapy is considered the standard treatment method, and chemotherapy is considered ineffective, the validation of the role of these treatment modalities continues. Although the rarity and long-term clinical course of ependymoma make designing and conducting prospective clinical trials challenging, knowledge is steadily accumulating and progress is being made. Much of the clinical knowledge obtained from clinical trials to date was based on the previous histology-based WHO classifications, and the addition of new molecular information may lead to more complex treatment strategies. Therefore, this review presents the latest findings on the molecular classification of ependymomas and advances in its treatment.

DOI： 10.1093/jjco/hyad056

Direct Screw Osteosynthesis for an Elderly Osteoporotic Patient With C2 Complex Fracture Reviewed

Nagashima, Y; Nishimura, Y; Matsuo, M; Tanei, T; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE Vol. 15 ( 7 ) page： e42510 2023.7

Brain metastasis and intracranial leptomeningeal metastasis from malignant peripheral nerve sheath tumors: illustrative cases. Reviewed International journal Open Access

Masasuke Ohno, Shoichi Haimoto, Satoshi Tsukushi, Waki Hosoda, Fumiharu Ohka, Ryuta Saito

Journal of neurosurgery. Case lessons Vol. 6 ( 3 ) 2023.7

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

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft-tissue tumors. Intracranial metastasis from MPNSTs is quite rare. OBSERVATIONS: The authors report on a 73-year-old male whose MPNST metastasized to the brain and a 32-year-old male with leptomeningeal metastasis from MPNST and review 41 cases of MPNST that developed intracranial metastasis, as reported in the literature. LESSONS: Brain metastasis and leptomeningeal metastasis of MPNSTs show different clinical courses and require pathology-specific treatment.

DOI： 10.3171/CASE23148

The Significance of Photodynamic Diagnosis Using 5-aminolevulinic Acid in The Resection of Glioblastoma

Kanamori Masayuki, Saito Ryuta, Shimoda Yoshiteru, Tominaga Teiji

The Journal of Japan Society for Laser Surgery and Medicine Vol. 44 ( 2 ) page： 164 - 170 2023.7

Language：Japanese Publisher：Japan Society for Laser Surgery and Medicine

<p>This study elucidated the relationship between the findings of photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) and tumor control in 41 patients undergoing resection of newly diagnosed glioblastoma. All patients underwent maximal resection of contrast-enhanced lesions by PDD using 5-ALA. Intraoperative PDD findings, postoperative lesions with contrast-enhanced residuals, and recurrence sites were analyzed. Residual fluorescent lesion was correlated with the total resection of contrast-enhanced lesion seen in magnetic resonance images. In addition, recurrent disease tended to develop within the lesions with residual fluorescence after resection under white light or blue light. These findings suggested that tumor evaluation using PDD with 5-ALA may aid in the determination of the extent of resection in enhanced lesion and in the prediction of sites for intensification of local treatment.</p>

DOI： 10.2530/jslsm.jslsm-44_0015

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