研究者詳細 - 齋藤　竜太

論文 - 齋藤　竜太

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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

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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

てんかんの分類と症候学

前澤聡, 齋藤竜太

脳神経外科速報 34(3) 巻頁： 286 - 292 2024年

薬剤抵抗性てんかんにおける視床,及び脳内深部構造の病態関与についての神経回路画像解析と神経修飾治療による病態制御の可能性の検討

前澤聡, Bagarinao E., 夏目淳, 臼井直敬, 齋藤竜太

てんかん治療研究振興財団研究年報 35 巻頁： 37 - 46 2024年

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

Endoscopic debulking canalization for optic pathway glioma with obstructive hydrocephalus 査読有り国際誌

Takeuchi, K; Ohka, F; Nagata, Y; Ito, E; Harada, H; Saito, R

CHILDS NERVOUS SYSTEM 39 巻 ( 12 ) 頁： 3421 - 3425 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：Child S Nervous System

Optic pathway gliomas (OPGs) are benign tumors that can stop growing or even shrink. In recent years, surgical resection has not been considered the first-line treatment because of its high risk of complications. Chemotherapy is the mainstay of treatment for growing OPGs. Surgical treatment for OPGs with obstructive hydrocephalus is required. Ventriculoperitoneal shunting is effective for all types of hydrocephalus. However, long-term management is required, especially in pediatric cases, and there is a risk of shunt-related complications over a long lifespan. Debulking surgery for OPGs allows us to avoid shunt placement by creating a waterway and releasing the hydrocephalus. To reduce the surgical risk and invasiveness, we used an endoscopic canalization technique with a small-diameter cylinder. In this article, we present a case of endoscopic canalization of an obstructive hydrocephalus caused by OPGs in a 14-year-old female to illustrate our surgical technique. (Trial registration Registry name and number: Efficacy and safety of the neuro-endoscopic treatment for brain tumors (2019–0254)).

DOI： 10.1007/s00381-023-06053-5

Clinical Efficiency of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Aneurysm: Comparison with the Conventional Method 査読有り国際誌 Open Access

Ishikawa, K; Izumi, T; Nishihori, M; Imaizumi, T; Goto, S; Suzuki, K; Yokoyama, K; Kanamori, F; Uda, K; Araki, Y; Saito, R

CLINICAL NEURORADIOLOGY 33 巻 ( 4 ) 頁： 1143 - 1150 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：Clinical Neuroradiology

Purpose: Artificial intelligence (AI)-based three-dimensional angiography (3D-A) was reported to demonstrate visualization of cerebral vasculature equivalent to that of three-dimensional digital subtraction angiography (3D-DSA). However, the applicability and efficacy of the AI-based 3D‑A algorithm have not yet been investigated for 3D-DSA micro imaging. In this study, we evaluated the usefulness of the AI-based 3D‑A in 3D-DSA micro imaging. Materials and Methods: The 3D-DSA micro datasets of 20 consecutive patients with cerebral aneurysm (CA) were reconstructed with 3D-DSA and 3D‑A. Three reviewers compared 3D-DSA and 3D‑A in terms of qualitative parameters (degrees of visualization of CA and the anterior choroidal artery [AChA]) and quantitative parameters (aneurysm diameter, neck diameter, parent vessel diameter, and visible length of AChA). Results: Qualitative evaluation of diagnostic potential revealed that visualization of CA and the proximal to middle parts of the AChA with 3D‑A was equal to that with conventional 3D-DSA; in contrast, visualization of the distal part of the AChA was lower with 3D‑A than with 3D-DSA. Further, regarding quantitative evaluation, the aneurysm diameter, neck diameter, and parent vessel diameter were comparable between 3D‑A and 3D-DSA; in contrast, the visible length of the AChA was lower with 3D‑A than with 3D-DSA. Conclusions: The AI-based 3D‑A technique is feasible and evaluable visualization of cerebral vasculature with respect to quantitative and qualitative parameters in 3D-DSA micro imaging. However, the 3D‑A technique offers lower visualization of such as the distal portion of the AChA than 3D-DSA.

DOI： 10.1007/s00062-023-01325-8

Lateral Lumbar Interbody Fusion within Three-level for Patients with Neurological Symptoms due to Vertebral Fragility Fractures in the Lumbar Spine 査読有り Open Access

Nagashima, Y; Nishimura, Y; Kanemura, T; Hata, N; Satake, K; Akahori, S; Ishii, M; Anei, T; Akayasu, M; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 12 ) 頁： 548 - 554 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：Neurologia Medico-Chirurgica

There is a lack of agreement on whether minimally invasive lateral lumbar intervertebral fusion (LLIF) is a suitable treatment option for vertebral fragility fractures (VFFs). Hence, we sought to evaluate the efficacy and safety of LLIF in the management of VFF with neurological deficits in the lumbar spine. Between April 2015 and March 2020, we conducted a retrospective observational study of patients with VFF treated with three-level or less LLIF. The participants had previously received conservative treatment but had not been able to control their neurological symptoms. To assess the outcomes of the LLIF procedures, the patients were followed up for a minimum of 1 year. Clinical and radiological results, which include the timing and location of the bony fusion, were analyzed. The study involved 19 patients with 23 vertebral fracture levels. The residual height of the fractured vertebra was found to be 57.0 ± 12.3% of the height of the adjacent level. The mean Japanese Orthopedic Association score significantly improved postoperatively. Postoperative radiological parameters were significantly maintained at 1 year, and lumbar lordosis was maintained at the last follow-up (45.0 ± 26.7). In total 31 LLIF levels, bone fusion was observed in four levels at 6 months postoperatively, in 16 levels at 1 year, and in 23 levels at the last follow-up. The facet joint had the highest bony fusion location. LLIF within three levels can be safely performed in certain VFF cases with sufficient residual vertebral height.

DOI： 10.2176/jns-nmc.2023-0064

山口純矢, 大岡史治, 齋藤竜太

日本臨床 81 巻 ( 増刊9 臨床脳腫瘍学 ) 頁： 244 - 246 2023年12月

大岡史治, 山口純矢, 齋藤竜太

日本臨床 81 巻 ( 増刊9 臨床脳腫瘍学 ) 頁： 455 - 460 2023年12月

Deep learning based identification of pituitary adenoma on surgical endoscopic images: a pilot study 査読有り

Fuse, Y; Takeuchi, K; Hashimoto, N; Nagata, Y; Takagi, Y; Nagatani, T; Takeuchi, I; Saito, R

NEUROSURGICAL REVIEW 46 巻 ( 1 ) 頁： 291 2023年11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：Neurosurgical Review

Accurate tumor identification during surgical excision is necessary for neurosurgeons to determine the extent of resection without damaging the surrounding tissues. No conventional technologies have achieved reliable performance for pituitary adenomas. This study proposes a deep learning approach using intraoperative endoscopic images to discriminate pituitary adenomas from non-tumorous tissue inside the sella turcica. Static images were extracted from 50 intraoperative videos of patients with pituitary adenomas. All patients underwent endoscopic transsphenoidal surgery with a 4 K ultrahigh-definition endoscope. The tumor and non-tumorous tissue within the sella turcica were delineated on static images. Using intraoperative images, we developed and validated deep learning models to identify tumorous tissue. Model performance was evaluated using a fivefold per-patient methodology. As a proof-of-concept, the model’s predictions were pathologically cross-referenced with a medical professional’s diagnosis using the intraoperative images of a prospectively enrolled patient. In total, 605 static images were obtained. Among the cropped 117,223 patches, 58,088 were labeled as tumors, while the remaining 59,135 were labeled as non-tumorous tissues. The evaluation of the image dataset revealed that the wide-ResNet model had the highest accuracy of 0.768, with an F1 score of 0.766. A preliminary evaluation on one patient indicated alignment between the ground truth set by neurosurgeons, the model’s predictions, and histopathological findings. Our deep learning algorithm has a positive tumor discrimination performance in intraoperative 4-K endoscopic images in patients with pituitary adenomas.

DOI： 10.1007/s10143-023-02196-w

その他リンク： https://link.springer.com/article/10.1007/s10143-023-02196-w/fulltext.html

Difference of coil distribution made by finishing coils in large size aneurysm model with radiolucent coils 査読有り Open Access

Matsuno, H; Izumi, T; Nishihori, M; Goto, S; Araki, Y; Yokoyama, K; Uda, K; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 4 ) 頁： 725 - 732 2023年11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：Nagoya Journal of Medical Science

We conducted a study to understand the characteristics of the finishing coils to select the appropriate coil for the final stage of embolization. Consequently, experimental embolization was performed on a 10 mm spherical silicone aneurysm filled with radiolucent coils, which simulated a volume embolization ratio of 20%. Nine different coils (i-ED complex ∞ SilkySoft, SilkySoft, ExtraSoft, V-Trak HyperSoft helical, Barricade 10 complex finishing, Optima complex 10 soft, Target 360 Ultra, Galaxy G3 mini, and Axium prime 3D ExtraSoft) were analyzed six times at random. After each coil insertion, indices that include area, Feret diameter, circularity, and centroid center of mass were calculated using biplane x-ray images. Furthermore, these data were analyzed using the spring constant k, which represents the stiffness of the coil. In multiple comparisons, a significant difference was observed in the area analysis. The i-ED complex ∞ SilkySoft was more widespread than Target 360 Ultra (p < 0.05). However, no significant differences were observed in the other indices. The spring constant k value of Target 360 Ultra was 2.5 times larger than that of the i-ED complex ∞ SilkySoft, and it negatively correlated with the area index rather than with the other indices. Notably, it was suggested that the smaller the spring constant k, the wider the distribution of the finishing coils. Although there was little difference between the coils, some coils had characteristics suggesting that good embolization could be expected using appropriate finishing coils.

DOI： 10.18999/nagjms.85.4.725

DISSECTING THE INTRA- AND INTER-TUMORAL HETEROGENEITY UNDERLYING GLIOBLASTOMA PATHOGENESIS UTILIZING MULTI-OMICS ANALYSIS

Nakashima, T; Funakoshi, Y; Yajima, H; Yamamoto, R; Sugihara, Y; Nambu, S; Arakawa, Y; Tanaka, S; Ishida, J; Saito, R; Hanaya, R; Yoshimoto, K; Narita, Y; Suzuki, H

NEURO-ONCOLOGY 25 巻 2023年11月

INTRA-OPERATIVE ANALYSES OF GENETIC ALTERATIONS IN THE CENTRAL NERVOUS SYSTEM TUMORS USING RAPID QUANTITATIVE PCR DEVICE

Ohka, F, Maeda, S, Yamaguchi, J, Shimizu, H, Motomura, K, Takeuchi, K, Nagata, Y, Nishikawa, T, Kibe, Y, Takido, Y, Saito, R

NEURO-ONCOLOGY 25 巻 2023年11月

DISSECTING THE INTRA- AND INTER-TUMORAL HETEROGENEITY UNDERLYING GLIOBLASTOMA PATHOGENESIS UTILIZING MULTI-OMICS ANALYSIS

Nakashima, T, Funakoshi, Y, Yajima, H, Yamamoto, R, Sugihara, Y, Nambu, S, Arakawa, Y, Tanaka, S, Ishida, J, Saito, R, Hanaya, R, Yoshimoto, K, Narita, Y, Suzuki, H

NEURO-ONCOLOGY 25 巻 2023年11月

ESTABLISHMENT OF ORGANOID MODELS OF PATIENT-DERIVED GH-PRODUCING PITUITARY ADENOMA

Maeda, S, Ohka, F, Kanamori, F, Okumura, Y, Takeuchi, K, Nagata, Y, Motomura, K, Yamaguchi, J, Kibe, Y, Harada, H, Shimizu, H, Takido, Y, Saito, R

NEURO-ONCOLOGY 25 巻 2023年11月

GLIOBLASTOMA, IDH-WILDTYPE WITHOUT KEY MOLECULAR FEATURES

Saito, R, Motomura, K, Ohka, F, Yamaguchi, J, Maeda, S, Nishikawa, T, Mizutani, K, Kibe, Y, Shimizu, H, Takido, Y

NEURO-ONCOLOGY 25 巻 2023年11月

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