Faculty Profiles - SAITO Ryuta

Papers - SAITO Ryuta

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Subcutaneous transplantation of human embryonic stem cells-derived pituitary organoids. Reviewed International journal Open Access

Hiroo Sasaki, Hidetaka Suga, Kazuhito Takeuchi, Yuichi Nagata, Hideyuki Harada, Tatsuma Kondo, Eiji Ito, Sachi Maeda, Mayu Sakakibara, Mika Soen, Tsutomu Miwata, Tomoyoshi Asano, Hajime Ozaki, Shiori Taga, Atsushi Kuwahara, Tokushige Nakano, Hiroshi Arima, Ryuta Saito

Frontiers in endocrinology Vol. 14 page： 1130465 - 1130465 2023.3

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

INTRODUCTION: The pituitary gland, regulating various hormones, is central in the endocrine system. As spontaneous recovery from hypopituitarism is rare, and exogenous-hormone substitution is clumsy, pituitary replacement via regenerative medicine, using pluripotent stem cells, is desirable. We have developed a differentiation method that in mice yields pituitary organoids (POs) derived from human embryonic stem cells (hESC). Efficacy of these POs, transplanted subcutaneously into hypopituitary mice, in reversing hypopituitarism was studied. METHODS: hESC-derived POs were transplanted into inguinal subcutaneous white adipose tissue (ISWAT) and beneath dorsal skin, a relatively avascular region (AR), of hypophysectomized severe combined immunodeficient (SCID) mice. Pituitary function was evaluated thereafter for ¾ 6mo, assaying basal plasma ACTH and ACTH response to corticotropin-releasing hormone (CRH) stimulation. Histopathologic examination of organoids 150d after transplantation assessed engraftment. Some mice received an inhibitor of vascular endothelial growth factor (VEGF) to permit assessment of how angiogenesis contributed to subcutaneous engraftment. RESULTS: During follow-up, both basal and CRH-stimulated plasma ACTH levels were significantly higher in the ISWAT group (p < 0.001 - 0.05 and 0.001 - 0.005, respectively) than in a sham-operated group. ACTH secretion also was higher in the ISWAT group than in the AR group. Histopathologic study found ACTH-producing human pituitary-cell clusters in both groups of allografts, which had acquired a microvasculature. POs qPCR showed expression of angiogenetic factors. Plasma ACTH levels decreased with VEGF-inhibitor administration. CONCLUSIONS: Subcutaneous transplantation of hESC-derived POs into hypopituitary SCID mice efficaciously renders recipients ACTH-sufficient.

DOI： 10.3389/fendo.2023.1130465

Long noncoding RNA profile of the intracranial artery in patients with moyamoya disease. Reviewed International journal

Takashi Mamiya, Fumiaki Kanamori, Kinya Yokoyama, Akinobu Ota, Sivasundaram Karnan, Kenji Uda, Yoshio Araki, Satoshi Maesawa, Kazuhiro Yoshikawa, Ryuta Saito

Journal of neurosurgery Vol. 138 ( 3 ) page： 709 - 716 2023.3

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

OBJECTIVE: Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the internal carotid artery (ICA) and secondary formation of collateral vessels. Revascularization surgery is performed in patients with MMD to prevent stroke; however, the pathogenesis of MMD remains unknown. Recently, long noncoding RNAs (lncRNAs) have been found to play a key role in gene regulation and are implicated in various vascular diseases. However, the lncRNA expression profile in MMD lesions has not been investigated. In this study the authors aimed to determine the characteristics of lncRNA expression in MMD lesions. METHODS: The authors collected microsamples of the middle cerebral artery (MCA) from patients with MMD (n = 21) and patients with control conditions (n = 11) who underwent neurosurgical treatment. Using microarray experiments, the authors compared the profiles of lncRNA expression in the MCAs of the MMD and control patient groups and identified differentially expressed lncRNAs (fold change > 2, q < 0.05). In addition, the neighboring coding genes, whose transcription can be regulated in cis by the identified differentially expressed lncRNAs, were investigated and Gene Ontology (GO) analysis was applied to predict associated biological functions. RESULTS: The authors detected 308 differentially expressed lncRNAs (fold change > 2, q < 0.05), including 306 upregulated and 2 downregulated lncRNAs in the MCA from patients with MMD. Regarding the prediction of biological function, GO analyses with possible coding genes whose transcription was regulated in cis by the identified differentially expressed lncRNAs suggested involvement in the antibacterial humoral response, T-cell receptor signaling pathway, positive regulation of cytokine production, and branching involved in blood vessel morphogenesis. CONCLUSIONS: The profile of lncRNA expression in MMD lesions was different from that in the normal cerebral artery, and differentially expressed lncRNAs were identified. This study provides new insights into the pathophysiology of MMD.

DOI： 10.3171/2022.5.JNS22579

Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a single-center, long-term, retrospective, observational study. Reviewed International journal

Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Tasuku Imai, Yoshio Araki, Fumiaki Kanamori, Kenji Uda, Kinya Yokoyama, Ryuta Saito

Journal of neurosurgery Vol. 138 ( 3 ) page： 724 - 731 2023.3

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

OBJECTIVE: The protocol for antiplatelet therapy after stent-assisted coil embolization (SACE) for intracranial aneurysms is not well established. In particular, the indications for single antiplatelet therapy (SAPT) discontinuation remain controversial. The authors investigated the long-term outcomes of SAPT discontinuation after SACE among patients at a single institution. METHODS: Patients who underwent SACE during the period from 2010 to 2020 and who were followed up for > 1 year were included in this study. The delayed ischemic and hemorrhagic complication rates were examined during follow-up. Moreover, the risk factors of antiplatelet therapy reduction or discontinuation and the outcomes of SAPT discontinuation were examined. RESULTS: In total, 240 patients were included in the analysis. The average patient age was 60.3 years, and the average follow-up period was 46.7 months. Nine (3.8%) patients presented with symptomatic delayed ischemic complication, and 3 (1.3%) patients experienced a decline in modified Rankin Scale score. The stent configuration (T- or Y-stent) was the only risk factor associated with delayed ischemic complication (p < 0.001). SAPT was discontinued in 147 (71.7%) of 205 patients who were followed up for > 2 years, and no ischemic complications were observed. CONCLUSIONS: It is safe to discontinue SAPT in patients without ischemic complications and with stable intraaneurysmal signals on MRA 2 years after SACE. The T- or Y-stent is a high-risk factor for delayed ischemic complications, and antiplatelet therapy reduction or discontinuation should be cautiously considered.

DOI： 10.3171/2022.6.JNS22815

The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery. Reviewed International journal

Hiroo Sasaki, Kazuhito Takeuchi, Yuichi Nagata, Kuniaki Tanahashi, Akihiro Mizuno, Hideyuki Harada, Yugo Kishida, Tadashi Watanabe, Tetsuya Nagatani, Ryuta Saito

Acta neurochirurgica Vol. 165 ( 3 ) page： 667 - 675 2023.3

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

PURPOSE: Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence. METHODS: We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. RESULTS: Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI. CONCLUSIONS: Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.

DOI： 10.1007/s00701-022-05415-3

CD79B Y196 mutation is a potent predictive marker for favorable response to R-MPV in primary central nervous system lymphoma. Reviewed International journal Open Access

Junya Yamaguchi, Fumiharu Ohka, Chalise Lushun, Kazuya Motomura, Kosuke Aoki, Kazuhito Takeuchi, Yuichi Nagata, Satoshi Ito, Nobuhiko Mizutani, Masasuke Ohno, Noriyuki Suzaki, Syuntaro Takasu, Yukio Seki, Takahisa Kano, Kenichi Wakabayashi, Hirofumi Oyama, Shingo Kurahashi, Kuniaki Tanahashi, Masaki Hirano, Hiroyuki Shimizu, Yotaro Kitano, Sachi Maeda, Shintaro Yamazaki, Toshihiko Wakabayashi, Yutaka Kondo, Atsushi Natsume, Ryuta Saito

Cancer medicine Vol. 12 ( 6 ) page： 7116 - 7126 2023.3

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

BACKGROUND: Rituximab, high-dose methotrexate (HD-MTX), procarbazine and vincristine (R-MPV), has significantly prolonged the survival of patients with primary central nervous system lymphoma (PCNSL), but predictive factors for response to R-MPV have not yet been investigated. Herein, we investigated the correlation of MYD88 L265P and CD79B Y196 mutations, which are the most frequently found molecular alterations in PCNSL, with prognosis of patients with PCNSL treated with R-MPV. METHODS: We investigated the long-term clinical course and status of MYD88 and CD79B genes in 85 patients with PCNSL treated with R-MPV or HD-MTX treatment, and the correlation of these genetic mutations with prognosis. RESULTS: R-MPV achieved an excellent tumor control rate (61.6% and 69.9% of 5-year progression-free and overall survival rates, respectively). While MYD88 L265P mutation had no significant effect on survival, patients with CD79B Y196 mutations exhibited prolonged survival (p < 0.05). However, the association of CD79B Y196 mutation with a better prognosis was not observed in the HD-MTX cohort, which indicated that CD79B Y196 mutation was a predictive marker for a favorable response to R-MPV. Furthermore, we established an all-in-one rapid genotyping system for these genetic mutations. CONCLUSIONS: In conclusion, CD79B Y196 mutation is a potent predictive marker for favorable response to R-MPV in PCNSL. The rapid identification of MYD88 L265P and CD79B Y196 mutations can be helpful not only for the accurate molecular diagnosis of PCNSL but also for the prediction of response to R-MPV.

DOI： 10.1002/cam4.5512

Comparative Study of Anterior Transvertebral Foraminotomy and Anterior Cervical Discectomy and Fusion for Unilateral Cervical Spondylotic Radiculopathy. Reviewed International journal Open Access

Sho Akahori, Yusuke Nishimura, Kaoru Eguchi, Yoshitaka Nagashima, Ryo Ando, Takayuki Awaya, Takafumi Tanei, Masahito Hara, Tokumi Kanemura, Masakazu Takayasu, Ryuta Saito

World neurosurgery Vol. 171 page： E516 - E523 2023.3

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

OBJECTIVE: To study the compared surgical and radiographic outcomes of Transvertebral foraminotomy (TVF) with anterior cervical discectomy and fusion (ACDF) in patients with unilateral cervical spondylotic radiculopathy (CSR). METHODS: We performed a retrospective comparative study of 72 consecutive patients with 1- or 2-level CSR treated with ACDF or TVF. 27 patients who underwent TVF (group T) and 45 patients who underwent ACDF (group A) with a minimum 2-year follow-up were enrolled. We evaluated clinical outcomes and radiological assessment. Clinical outcome included Visual analog scale (VAS) scores for axial, arm pain at preoperatively and final follow-up. VAS score for painful swallowing was also evaluated 1 week after surgery. Radiological assessment included C2-7 sagittal Cobb angle (C2-7 CA), range of motion (ROM) of C2-7 CA, the height, angle and ROM of the functional spinal unit (FSU), and tip of the spinous process of the operated segment. We also evaluated the disc height, FSU angle, and ROM of the FSU at the cranial adjacent segment. RESULTS: Both groups had good clinical outcomes. Soft tissue swelling was significantly less prominent in group T than that for group A. VAS scores for painful swallowing is lower in group T without significant difference. The ROM of C2-7 CA, FSU, and spinous processes demonstrated a significant reduction in group A compared with group T.(P < 0.05). Disc height at the cranial adjacent segment was maintained in group T. CONCLUSIONS: TVF is as effective as ACDF for unilateral CSR and preserves whole cervical spine and segmental alignment.

DOI： 10.1016/j.wneu.2022.12.053

Eyelid myokymia caused by a trigeminal schwannoma as determined by the trigeminal-evoked blink reflex. Reviewed International journal

Eiji Ito, Ryotaro Sugita, Ryuta Saito

Clinical case reports Vol. 11 ( 3 ) page： e7086 2023.3

Language：English

A 57-year-old man had trigeminal schwannoma in Meckel's cave with eyelid myokymia only. The evaluation of the trigeminal-evoked blink reflex was useful for confirming eyelid myokymia and contributed to surgical decision-making. In patients with persistent eyelid myokymia, neurophysiological and imaging evaluations may be useful for determining the underlying pathophysiology.

DOI： 10.1002/ccr3.7086

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PubMed

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運動合併症の改善に淡蒼球DBSが有効であったPARK14の1例

近藤初, 坪井崇, 古川宗磨, 小池春樹, 中坪大輔, 前澤聡, 齋藤竜太, 勝野雅央

臨床神経学 Vol. 63 ( 3 ) page： 182 - 182 2023.3

運動合併症の改善に淡蒼球DBSが有効であったPARK14の1例

近藤初, 坪井崇, 古川宗磨, 小池春樹, 中坪大輔, 前澤聡, 齋藤竜太, 勝野雅央

臨床神経学 Vol. 63 ( 3 ) page： 182 - 182 2023.3

The first-in-human phase I study of a brain penetrant mutant IDH1 inhibitor DS-1001 in patients with recurrent or progressive IDH1-mutant gliomas. Reviewed International journal Open Access

Atsushi Natsume, Yoshiki Arakawa, Yoshitaka Narita, Kazuhiko Sugiyama, Nobuhiro Hata, Yoshihiro Muragaki, Naoki Shinojima, Toshihiro Kumabe, Ryuta Saito, Kazuya Motomura, Yohei Mineharu, Yasuji Miyakita, Fumiyuki Yamasaki, Yuko Matsushita, Koichi Ichimura, Kazumi Ito, Masaya Tachibana, Yasuyuki Kakurai, Naoko Okamoto, Takashi Asahi, Soichiro Nishijima, Tomoyuki Yamaguchi, Hiroshi Tsubouchi, Hideo Nakamura, Ryo Nishikawa

Neuro-oncology Vol. 25 ( 2 ) page： 326 - 336 2023.2

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

BACKGROUND: Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in accumulation of oncometabolite D-2-hydroxyglutarate (D-2-HG); this leads to epigenetic dysregulation, oncogenesis, and subsequent clonal expansion. DS-1001 is an oral brain-penetrant mutant IDH1 selective inhibitor. This first-in-human study investigated the safety, pharmacokinetics, pharmacodynamics, and efficacy of DS-1001. METHODS: This was a multicenter, open-label, dose-escalation, phase I study of DS-1001 for recurrent/progressive IDH1-mutant (R132) glioma (N = 47) (NCT03030066). DS-1001 was administered orally at 125-1400 mg twice daily. Dose escalation used a modified continual reassessment method. RESULTS: The maximum tolerated dose was not reached. Eight patients were continuing treatment at the data cut-off. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least one grade 3 AE. No grade 4 or 5 AEs or serious drug-related AEs were reported. Common AEs (>20%) were skin hyperpigmentation, diarrhea, pruritus, alopecia, arthralgia, nausea, headache, rash, and dry skin. The objective response rates were 17.1% for enhancing tumors and 33.3% for non-enhancing tumors. Median progression-free survival was 10.4 months (95% confidence interval [CI], 6.1 to 17.7 months) and not reached (95% CI, 24.1 to not reached) for the enhancing and non-enhancing glioma cohorts, respectively. Seven on-treatment brain tumor samples showed a significantly lower amount of D-2-HG compared with pre-study archived samples. CONCLUSIONS: DS-1001 was well-tolerated with a favorable brain distribution. Recurrent/progressive IDH1-mutant glioma patients responded to treatment. A study of DS-1001 in patients with chemotherapy- and radiotherapy-naïve IDH1-mutated WHO grade 2 glioma is ongoing (NCT04458272).

DOI： 10.1093/neuonc/noac155

A Case of Haemorrhagic-Onset Glioblastoma With Delayed Diagnosis. Reviewed International journal

Mayuko Otomo, Masayuki Kanamori, Shiho Sato, Yoshiteru Shimoda, Mika Watanabe, Tomohiro Kawaguchi, Ryuta Saito, Teiji Tominaga

Cureus Vol. 15 ( 2 ) page： e34672 2023.2

Language：English

Glioblastoma sometimes develops with acute onset due to intracerebral hemorrhage. Although it is sometimes difficult to diagnose patients with hemorrhagic-onset glioblastoma at the acute phase of intracerebral hemorrhage (ICH), the progressive enlargement of perifocal edema or the development of contrast-enhanced lesion triggers the diagnosis of glioblastoma within six months. Herein, we present a rare case of glioblastoma in which the diagnosis was delayed as long as 17 months after ICH. A 62-year-old man presented with a headache and aphasia. Computed tomography revealed ICH in the left temporal lobe. Magnetic resonance (MR) images revealed that the hematoma had a mix of isointense and surrounding hypointense lesions on T1-weighted MR images and gadolinium-enhanced lesions at the wall and the septum of the hematoma. An endoscopic evacuation of the hematoma was performed. No causative lesions were found during intraoperative and histological examinations. After seven months, abnormal signals were completely resolved on MR images, except for the small and stable enhanced lesion on three-dimensional gadolinium-enhanced T1-weighted MR imaging (3D Gd-T1WI) at the base of the hematoma, which did not change in size for seven months. However, a large gadolinium-enhanced lesion at the left temporal lobe developed 17 months after ICH. He underwent total resection of the lesion and was diagnosed with glioblastoma. He received radiation therapy and temozolomide but died of disseminated recurrence 31 months after ICH. In conclusion, this report presents a didactic case of glioblastoma in which the diagnosis of glioblastoma was delayed 17 months after ICH whereas hemorrhagic-onset glioblastoma was previously considered ruled out in cases in which six months or more have passed after ICH. In order not to overlook these cases, follow-up with 3D Gd-T1WI is essential in the case of suspected tumor-related ICH and close follow-up is recommended when the enhanced lesion does not resolve after a long period even if it does not grow.

DOI： 10.7759/cureus.34672

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PubMed

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Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling

Nakashima, T; Funakoshi, Y; Nambu, S; Uneda, A; Katayama, K; Hanaya, R; Imoto, S; Tanaka, S; Saito, R; Yoshimoto, K; Narita, Y; Yoshimoto, K; Narita, Y; Suzuki, H

CANCER SCIENCE Vol. 114 page： 205 - 205 2023.2

Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant

Funakoshi, Y, Nakashima, T, Nambu, S, Uneda, A, Katayama, K, Imoto, S, Hanaya, R, Tanaka, S, Saito, R, Yoshimoto, K, Narita, Y, Suzuki, H

CANCER SCIENCE Vol. 114 page： 203 - 203 2023.2

Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted

Funakoshi, Y, Nambu, S, Nakashima, T, Uneda, A, Katayama, K, Imoto, S, Hanaya, R, Tanaka, S, Saito, R, Yoshimoto, K, Narita, Y, Suzuki, H

CANCER SCIENCE Vol. 114 page： 206 - 206 2023.2

The usefulness of three-dimensional fusion imaging of spinal arteriovenous malformation by a workstation connected to angiography systems. Reviewed

Yoshitaka Nagashima, Takashi Izumi, Yusuke Nishimura, Masahiro Nishihori, Takahiro Oyama, Mamoru Matsuo, Hiroshi Ito, Tomoya Nishii, Ryuta Saito

Nagoya journal of medical science Vol. 85 ( 1 ) page： 127 - 133 2023.2

Language：English

Digital subtraction angiography (DSA) is the most useful technique for diagnosing spinal arteriovenous malformations (AVM). In recent years, with the improvement of imaging capabilities, the usefulness of three-dimensional (3D) imaging by fusing various modalities has been recognized. The use of 3D fusion imaging with a workstation connected to an angiography system has been reported in many cases of intracranial disease, but less frequently for spinal AVM. In this article, we describe two illustrative cases of spinal AVM in which 3D fusion imaging was useful for treatment. Although 3D fusion images using the system have the disadvantage that only a maximum of two images can be fused, it provides spinal surgeons with useful information for preoperative evaluation in a small amount of time.

DOI： 10.18999/nagjms.85.1.127

Characteristic image on cerebral angiography in ruptured blood blister-like aneurysms. Reviewed International journal Open Access

Naoki Kato, Takashi Izumi, Masahiro Nishihori, Shunsaku Goto, Yoshio Araki, Kinya Yokoyama, Ryuta Saito

Clinical neurology and neurosurgery Vol. 225 page： 107583 - 107583 2023.2

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

OBJECTIVE: To evaluate the static and dynamic features of blood blister-like aneurysms (BBAs) using cerebral angiography to identify characteristic features to improve the diagnosis of these uncommon aneurysms. METHODS: Digital subtraction angiography (DSA) images were compared between patients with BBAs (n = 12, group A) and patients with unruptured paraclinoid aneurysms ≤ 5 mm in size treated by endovascular procedures (n = 12, group B). DSA images were assessed for irregularities in the diameter of the parent artery and delayed inflow and outflow of contrast medium in the aneurysm. Enlargement of the aneurysm and morphological changes from the first assessment were also evaluated in patients with BBAs. RESULTS: Compared to the group B, group A had a higher proportion of irregular vessel diameter (p = 0.013) and the delayed contrast medium outflow (p = 0.014). As well, stagnation of contrast medium along the aneurysm wall was a characteristic finding of BBAs, even for small aneurysms. CONCLUSION: Irregular morphological features of the parent artery and delayed contrast medium outflow as characteristic findings of ruptured BBAs may improve the diagnosis of these uncommon aneurysms, which remains challenging in practice.

DOI： 10.1016/j.clineuro.2022.107583

Differences in gaze behaviors between trainees and experts during endovascular therapy for cerebral aneurysms: a preliminary study using a cerebral aneurysm model. Reviewed

Takafumi Otsuka, Takashi Izumi, Masaya Yamamoto, Yusuke Seshita, Takeshi Kohama, Masahiro Nishihori, Tetsuya Tsukada, Ryuta Saito

Nagoya journal of medical science Vol. 85 ( 1 ) page： 50 - 58 2023.2

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

In the neuroendovascular field, the training of operators has become an important issue. Recently, eye-tracking technology has been introduced into various fields of medical education. This study aimed to apply eye-tracking technology to the training of neuroendovascular therapy. Six neurosurgeons, including three neuroendovascular specialists and three trainees, at our institution and related facilities participated in the study. Eye movement was recorded by the eye-tracking device during the microcatheter navigation and coil placement into the silastic aneurysm model under biplane X-ray fluoroscopy. Eye-tracking analysis during neuroendovascular therapy was feasible in all six subjects. In microcatheter navigation, specialists tended to more frequently switch their attention between frontal and lateral images than trainees. In coil embolization, the overall gaze frequency tended to increase, and the average fixation duration tended to decrease as the number of experienced cases increased. Inexperienced operators tend to fix their gaze when they are operators than when they are assistants. More experienced operators tended to look at the microcatheter longer in the coil insertion task. The eye-tracking analysis may be useful for operator training in neuroendovascular therapy. Experts may have moved their eyes more frequently than trainees to gaze at the right place. In the future, it will be necessary to collect gaze data for more operators in various tasks.

DOI： 10.18999/nagjms.85.1.50

Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case. Reviewed International journal Open Access

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

Journal of neurosurgery. Case lessons Vol. 5 ( 7 ) 2023.2

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

BACKGROUND: Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare in the pineal gland. A case of PPTID that disseminated to the lumbosacral spine 13 years after the total resection of a primary intracranial tumor has been reported. OBSERVATIONS: A 14-year-old female presented with headache and diplopia. Magnetic resonance imaging revealed a pineal tumor that induced obstructive hydrocephalus. A biopsy and endoscopic third ventriculostomy were performed. Histological diagnosis revealed a grade II PPTID. Two months later, the tumor was removed via craniotomy because the postoperative Gamma Knife surgery was ineffective. Histological diagnosis confirmed PPTID, although the grade was revised from II to III. Postoperative adjuvant therapy was not performed, because the lesion had been irradiated and gross total tumor removal was achieved. She has had no recurrence in 13 years. However, pain around the anus newly appeared. Magnetic resonance imaging of the spine revealed a solid lesion in the lumbosacral spine. The lesion was subtotally resected, and histological diagnosis revealed grade III PPTID. Postoperative radiotherapy was performed, and she had no recurrence 1 year after radiotherapy. LESSONS: Remote dissemination of PPTID can occur several years after the initial resection. Regular follow-up imaging, including the spinal region, should be encouraged.

DOI： 10.3171/CASE22475

Intra-operative analysis of genetic alterations in brain tumor using rapid quantitative PCR device

Ohka, F, Maeda, S, Yamaguchi, J, Motomura, K, Saito, R

CANCER SCIENCE Vol. 114 page： 1818 - 1818 2023.2

Identification of therapeutic targets exhibiting synthetic lethality with IDH1 inhibitor using the CRISPR/Cas9 system

Maeda, S, Aoki, K, Hinohara, K, Yamaguchi, J, Ohka, F, Natsume, A, Saito, R

CANCER SCIENCE Vol. 114 page： 1460 - 1460 2023.2

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Papers - SAITO Ryuta