研究者詳細 - 齋藤　竜太

Regression of bilateral persistent primitive ophthalmic artery: a case report

Femoral Nerve Injury After Prone-Position Lumbar Discectomy: A Case Report Highlighting the Role of Ultrasound in Recovery Monitoring.

Matsuo M, Nagashima Y, Nishimura Y, Saito R

Cureus 16 巻 ( 12 ) 頁： e76653 2024年12月

Takeuchi, I; Izumi, T; Nishihori, M; Goto, S; Hanyu, T; Suzuki, K; Takayanagi, K; Kawasaki, Y; Saito, R

SURGICAL AND RADIOLOGIC ANATOMY 47 巻 ( 1 ) 頁： 42 2024年12月

Prognosis and Treatment Effectiveness of Austrian Syndrome: A Case Report and Systematic Review.

Fukui T, Muraoka S, Asai T, Nisizawa T, Araki Y, Saito R

Cureus 16 巻 ( 12 ) 頁： e74971 2024年12月

Real-world clinical results of CGRP monoclonal antibody treatment for medication overuse headache of migraine without abrupt drug discontinuation and no hospitalization. 国際誌 Open Access

Tanei T, Fuse Y, Maesawa S, Nishimura Y, Ishizaki T, Nagashima Y, Mutoh M, Ito Y, Hashida M, Suzuki T, Yamamoto S, Wakabayashi T, Saito R

Heliyon 10 巻 ( 22 ) 頁： e40190 2024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：Heliyon

Background: Abrupt discontinuation of overused medications is standard treatment for medication overuse headache (MOH), but discontinuation is difficult to maintain. The aim was to evaluate the real-world clinical results of anti-calcitonin gene-related peptide monoclonal antibody (CGRP-mAb) treatment for migraine with MOH without abrupt drug discontinuation and no hospitalization. Methods: Data were collected before starting CGRP-mAb injections (baseline) and 1 month after each injection. The following items were compared between baseline and after the first, second, and third CGRP-mAb injections, monthly headache days (MHD), monthly migraine days (MMD), monthly acute medication use (AMU) days, monthly total amount of AMU tablets, headache impact test-6 (HIT-6), and the migraine-specific quality of life questionnaire (MSQ). Achieving reduction rates ≥50 % in the frequency of each headache and migraine was defined as a good response. Achieving reduction rates of both AMU days and tablets ≥50 % was defined as effective in reducing AMU. Results: This study included 33 patients with migraine with MOH. After the third CGRP-mAb injection, MHD and MMD were significantly decreased from median 30.0 to 9.5 days, and 10.0 to 1.5 days, respectively. In addition, monthly AMU days and tablets were significantly decreased from median 28.0 to 8.0 days, and 30.0 to 9.5 tablets, respectively. After the third CGRP-mAb injection, the good MHD and MMD responder rates were 75.0 % and 85.7 %, respectively. The rate of reducing AMU was 78.6 %. HIT-6 and MSQ scores decreased significantly from baseline to after each CGRP-mAb injection. Conclusions: When CGRP-mAb was administered to migraine with MOH, frequency of headache symptoms and AMU were reduced without abrupt drug discontinuation and no hospitalization.

DOI： 10.1016/j.heliyon.2024.e40190

Image-based Re-evaluation of the JCOG0911 Study Focusing on Tumor Volume and Survival, Disease Progression Diagnosis, and Radiomic Prognostication for Newly Diagnosed Glioblastoma

Kinoshita, M; Fushimi, Y; Masumoto, T; Sasaki, K; Sekita, T; Natsume, A; Wakabashi, T; Komori, T; Tsuzuki, S; Muragaki, Y; Motomura, K; Saito, R; Sato, K; Beppu, T; Takahashi, M; Kuroda, JI; Sonoda, Y; Kobayashi, K; Mishima, K; Mitsuya, K; Yamasaki, F; Inoue, A; Matsutani, T; Nakamura, H; Yamaguchi, S; Ishikawa, E; Nakaya, M; Tanaka, S; Ujifuku, K; Uchida, H; Kanamori, M; Otani, R; Kijima, N; Nishida, N; Yoshino, A; Mineharu, Y; Arakawa, Y; Fukuda, H; Narita, Y

MAGNETIC RESONANCE IN MEDICAL SCIENCES advpub 巻 ( 0 ) 2024年11月

DIAGNOSIS AND TREATMENT OF BRAIN TUMORS USING METHIONINE PET

Shiba, Y; Maeda, S; Yamaguchi, J; Deguchi, S; Ohka, F; Saito, R

NEURO-ONCOLOGY 26 巻 2024年11月

INTRA-OPERATIVE GENETIC ANALYSES FOR DECISION-MAKING DURING TUMOR REMOVAL OF ADULT-TYPE DIFFUSE GLIOMA USING RAPID QUANTITATIVE PCR DEVICE

Ohka, F; Maeda, S; Shimizu, H; Motomura, K; Takeuchi, K; Nagata, Y; Deguchi, S; Shiba, Y; Yamaguchi, J; Takido, Y; Nakamura, A; Ito, S; Saito, R

NEURO-ONCOLOGY 26 巻 2024年11月

ESTABLISHMENT OF PITUITARY NEUROENDOCRINE TUMOR (PITNET) ORGANOID MODELS

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

NEURO-ONCOLOGY 26 巻 2024年11月

ESTABLISHMENT OF AN APPROPRIATE GLIOMA SURGERY SYSTEM CONSIDERING MOLECULAR AND FUNCTIONAL BOUNDARIES

Saito, R; Motomura, K; Ohka, F; Deguchi, S; Shiba, Y; Yamaguchi, J; Nishikawa, T; Kibe, Y; Shimizu, H; Maeda, S

NEURO-ONCOLOGY 26 巻 2024年11月

DISTANT PARENCHYMAL RECURRENCE DURING LONG-TERM USE OF TTFIELDS TREATMENT FOR GLIOBLASTOMA

Takido, Y; Ohka, F; Deguchi, S; Motomura, K; Mitsuya, K; Shiba, Y; Takeuchi, K; Nagata, Y; Yamaguchi, J; Kibe, Y; Fuse, Y; Maeda, S; Shimizu, H; Nohira, S; Yamamoto, R; Ito, S; Nakamura, A; Saito, R

NEURO-ONCOLOGY 26 巻 2024年11月

Comparison of the inter-laminar approach and laminotomy open approach for filum terminale lipoma: A retrospective analysis 査読有り国際誌

Nawashiro, T; Kurimoto, M; Nagakura, M; Kato, M; Aoki, K; Saito, R

CHILDS NERVOUS SYSTEM 40 巻 ( 11 ) 頁： 3801 - 3810 2024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：Child's Nervous System

Purpose: Filum terminale lipoma (FTL) causes spinal-cord tethering and is associated with tethered-cord syndrome, which is treated by dissection of the entrapment. The conventional treatment for FTL involves dissection of the spinal cord through a laminotomy open approach (LOA). However, in recent years, the interlaminar approach (ILA) has gained popularity as a minimally invasive surgery. This study compares the effectiveness of the minimally invasive ILA with the conventional LOA in treating FTL. Methods: We retrospectively evaluated data on the ILA and LOA for FTL at our center. In total, 103 participants were enrolled, including 55 in the ILA group and 48 in the LOA group. Results: The ILA required significantly less surgical time and resulted in less blood loss. The improvement rate of symptoms in symptomatic patients was 84%, and for urinary symptoms and abnormal urodynamic study findings, it was 77%. The postoperative maintenance rate for asymptomatic patients was 100%. Postoperative complications of ILA included delayed wound healing in two patients (3.6%). Conclusion: Compared with LOA, ILA offers advantages in terms of shorter operative time and less blood loss, with no significant difference in long-term symptom-improvement rates between the groups.

DOI： 10.1007/s00381-024-06507-4

Three-dimensional spiral-shaping method of microcatheter for paraclinoid aneurysms: assessment using silicone models

Imaoka, E; Nishihori, M; Izumi, T; Goto, S; Araki, Y; Yokoyama, K; Uda, K; Kanamori, F; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 4 ) 頁： 655 - 664 2024年11月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Selecting an appropriate microcatheter tip shape for paraclinoid aneurysms is difficult. Therefore, we devised an original simple and uniform three-dimensional (3D) spiral-shaping method of microcatheter and validated the characteristics and usefulness of this method for coil embolization of paraclinoid aneurysms using patient-specific silicone models. These silicone models were produced based on clinical data from four patients with four paraclinoid aneurysms that underwent endovascular treatment using the 3D spiral-shaping method. These models were classified into four types: superior, medial, inferior, and lateral corresponding to the aneurysm protrusion and locations (C3 or C2 segments by Fisher’s classification). Employing a pulsatile pump setup, two operators assessed the following items: navigation methods (pull and wire guiding), catheterization times, microcatheter tip position in the aneurysm, and the feasibility of inserting a framing coil by simple technique compared with three other shapes (straight, 90, pigtail). Three-dimensional spiral-shaped microcatheter could be placed in the medial and inferior type models of C3 segments and superior type model of C2 segment by the pullback method. Catheterization times using a 3D spiral-shaped catheter were significantly shorter than other shaped ones in the superior type models. No significant difference was found in another silicone model. Three-dimensional spiral- and pigtail-shaped catheters tended to position the tip at the center of the aneurysm. In conclusion, 3D spiral-shaped microcatheter was especially effective for the superior projected aneurysm at the C2 segment. The 3D spiral-shaping method can provide easy and secure navigation of the microcatheter into the paraclinoid aneurysms, ensuring optimal positioning for coil insertion.

DOI： 10.18999/nagjms.86.4.655

Efficacy and safety of endovascular coil embolization for unruptured middle cerebral artery aneurysms: middle-term clinical and imaging outcomes with 3 years mean follow-up periods, a 16-year experience

Hanyu, T; Izumi, T; Tanei, T; Nishihori, M; Goto, S; Araki, Y; Yokoyama, K; Miyachi, S; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 4 ) 頁： 596 - 607 2024年11月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

The anatomical characteristics of middle cerebral artery aneurysms make endovascular treatment difficult. This study evaluated the efficacy and safety of endovascular treatment of unruptured middle cerebral artery aneurysm in preventing rupture. A retrospective review of patients who underwent coil embolization for unruptured middle cerebral artery aneurysm between 2006 and 2022 at Nagoya University Hospital with at least 12 months followed up was conducted. Imaging and clinical outcomes were described using the Raymond classification and the modified Rankin Scale, respectively. Good imaging outcome was defined as complete occlusion or neck remnant and clinical outcome as modified Rankin Scale score of 0–2. Patients were divided into initial and recurrent group based on the number of treatments, pre- and post-stent groups based on when stents became available in Japan. A total of 77 patients (80 with aneurysms) were included in the final analysis. Their average age was 60.3 years, and their average follow-up period was 38 months. Favorable clinical outcomes were achieved for 96.2% among 66 (97.0%) initial and 11 (91.7%) recurrent aneurysms. Furthermore, good imaging outcomes were obtained in 90.0 %, and 5% had permanent symptomatic ischemic complications. The pre-stent group had a significantly higher proportion of patients with narrow-neck aneurysms than the post-stent group. There were no significant differences in terms of imaging and clinical outcomes or complication rates. The present study demonstrated that endovascular treatment of unruptured middle cerebral artery aneurysm was safe and effective in preventing rupture. The wide-neck aneurysm was also well embolized by using adjunctive technique.

DOI： 10.18999/nagjms.86.4.596

Novel case of ependymoma-like tumor with mesenchymal differentiation harboring ZFTA::RELA fusion in an adult 査読有り

Dual phenotypes in recurrent astrocytoma, IDH-mutant; coexistence of IDH-mutant and IDH-wildtype components: a case report with genetic and epigenetic analysis 国際誌 Open Access

Yamaguchi, J; Ohka, F; Seki, M; Motomura, K; Deguchi, S; Shiba, Y; Okumura, Y; Kibe, Y; Shimizu, H; Maeda, S; Takido, Y; Yamamoto, R; Nakamura, A; Karube, K; Saito, R

ACTA NEUROPATHOLOGICA COMMUNICATIONS 12 巻 ( 1 ) 頁： 169 - 169 2024年10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 Neuropathologica Communications

Mutations in the isocitrate dehydrogenase (IDH) gene are recognized as the key drivers in the oncogenesis of astrocytoma and oligodendroglioma. However, the significance of IDH mutation in tumor maintenance and malignant transformation has not been elucidated. We encountered a unique case of IDH-mutant astrocytoma that, upon malignant transformation, presented two distinct intratumoral components: one IDH-wildtype and one IDH-mutant. The IDH-wild-type component exhibited histological findings similar to those of small cell-type glioblastoma with a higher Ki-67 index than the IDH-mutant component. Despite their genetic divergence, both components exhibited similar comprehensive methylation profiles within the CpG island and were classified into methylation class of “Astrocytoma, IDH-mutant; High Grade” by the German Cancer Center (DKFZ) classifier v11.4. Phylogenetic analysis demonstrated that the IDH-wildtype component emerged as a subclonal component of the primary tumor. Detailed molecular analyses revealed that the loss of the IDH mutation was induced by the hemizygous loss of the entire arm of chromosome 2, on which IDH1 gene is located. Notably, the IDH-wild-type subclones uniquely acquired CDKN2A/B homozygous deletion and PDGFRA amplification, which is a marker of the aggressive phenotype of astrocytoma, IDH-mutant. Because these genetic abnormalities can drive oncogenic pathways, such as the PI3K/AKT/mTOR and RB signaling pathway, IDH-mutant gliomas that acquired these mutations were no longer dependent on the initial driver mutation, the IDH mutation. Molecular analysis of this unique case provides insight that in a subset of astrocytoma, IDH-mutant that acquired these genetic abnormalities, IDH mutation may not play a pivotal role in tumor growth and acquisition of these genetic abnormalities may contribute to the acquisition of resistance to IDH inhibitors.

DOI： 10.1186/s40478-024-01879-9

Recurrent symptomatic intracranial hemorrhage in high-grade astrocytoma with piloid features: illustrative case 査読有り Open Access

Niwa, H; Kato, T; Hasegawa, T; Kuwabara, K; Ohka, F; Hirato, J; Sasaki, S; Ichimura, K; Yoshioka, T; Naito, T; Mizuno, A; Kageyama, A; Oishi, H; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 8 巻 ( 15 ) 2024年10月

記述言語：英語出版者・発行元：Journal of Neurosurgery: Case Lessons

BACKGROUND High-grade astrocytoma with piloid features (HGAP) is a novel condition introduced in the 2021 World Health Organization classification. Given that it has been recently classified, reports clarifying its clinical features or diagnostic criteria are lacking, especially in cases of atypical presentation. Herein, the authors present a rare case of HGAP with repeated symptomatic hemorrhages. OBSERVATIONS A woman in her 20s presented with an acute headache and vertigo. Computed tomography and magnetic resonance imaging revealed a 2.5 × 2.8 × 2.3–cm hemorrhagic cerebellar mass with calcifications. After moderate improvement of her symptoms, she developed recurrent hemorrhage, and the tumor size increased (3.0 × 3.6 × 4.0 cm) 18 days later, necessitating resection. Pathological and molecular analyses confirmed the diagnosis of HGAP with an FGFR1-TACC1 fusion, MTAP/CDKN2A/B deletion, and SETD2 rearrangement. Radiologically, the presence of calcification and cystic components and the absence of perilesional edema were atypical features of previously reported HGAP. LESSONS Although recurrent symptomatic intracranial hemorrhages are rare in HGAP, enhancing lesions on magnetic resonance imaging suggest the need for resection to obtain tissue for molecular diagnosis and guide adjuvant treatment strategies.

DOI： 10.3171/CASE24395

Exo- and endoscopic two-step approach for meningeal tumours invading the lateral wall of large dural venous sinuses: how I do it 査読有り国際誌 Open Access

Iwami, K; Watanabe, T; Takeuchi, K; Saito, R

ACTA NEUROCHIRURGICA 166 巻 ( 1 ) 頁： 397 - 397 2024年10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: Treating meningeal tumours invading the large dural venous sinuses is a subject of debate regarding the approach for removing the intra-sinus components. Additionally, directly observing the invasion site of tumours invading the lateral wall of the sinus is difficult. Method: We describe our exo- and endoscopic two-step approach (EETA): an exoscope is used to remove the extra-sinus component, while an endoscope is used to observe the invaded lateral wall and remove the intra-sinus component. Conclusion: EETA can be a viable option for treating meningeal tumours invading the venous sinus owing to its high resection rate and low invasiveness.

DOI： 10.1007/s00701-024-06298-2

Four-dimensional digital subtraction angiography for the vascular anatomical diagnosis of dural arteriovenous malformation: Comparison with the conventional method 国際誌 Open Access

Ishikawa, K; Nishihori, M; Izumi, T; Oshima, R; Uemura, T; Kanamori, F; Uda, K; Yokoyama, K; Araki, Y; Saito, R

INTERVENTIONAL NEURORADIOLOGY 30 巻 ( 5 ) 頁： 738 - 745 2024年10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：Interventional Neuroradiology

Background: Two-dimensional digital subtraction angiography (2D-DSA) and conventional three-dimensional digital subtraction angiography (3D-DSA) are used for the detailed analysis of dural arteriovenous fistula (DAVF). Recently, four-dimensional digital subtraction angiography (4D-DSA), a novel technology, has been attracting attention. The current study aimed to evaluate the capability of 4D-DSA in assessing anatomical angioarchitecture in DAVF. Methods: In total, 10 consecutive patients with DAVF who underwent 3D-DSA and 4D-DSA at a single institution were included in the analysis. Initially, one-slice multiplanar reconstruction (MPR) images obtained via 4D-DSA and 3D-DSA were compared to investigate the visibility of the feeding artery, fistulous point, and draining vein. Next, 4D-DSA images alone were compared and evaluated with and the MPR images of conventional 3D-DSA in terms of diagnosis of the angioarchitecture. Results: In total, six men and four women (with a mean age of 65.6 ± 10.0 years) were included in the study. The MPR image obtained via 3D-DSA had a significantly better visibility of the feeding artery and fistulous point than that acquired via 4D-DSA (p < 0.05). As for the draining vein, the score was equivalent and not significant. The diagnosis of the vascular architecture of only 4D-DSA images was nearly equivalent to that of MPR images of 3D-DSA. There were no inter-rater differences. Conclusion: The MPR images obtained via 4D-DSA may be slightly inferior to those acquired via 3D-DSA in identifying fine angioarchitecture in DAVF. However, they were comparable in terms of diagnostic accuracy.

DOI： 10.1177/15910199221145526

Yajima, H; Takayanagi, S; Takami, H; Tanaka, S; Nomura, M; Satomi, K; Ikemura, M; Nobusawa, S; Saito, R; Kondo, A; Saito, N

BRAIN TUMOR PATHOLOGY 41 巻 ( 3-4 ) 頁： 139 - 144 2024年10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：Brain Tumor Pathology

High-grade supratentorial tumors harboring ZFTA::NCOA1/2 fusion in infants presenting with mixed histology of embryonal-appearing components resembling ependymoma and mesenchymal sarcomatous components have recently been reported as ependymoma-like tumors with mesenchymal differentiation (ELTMDs). In contrast, we describe herein a pathologically similar case with a novel ZFTA::RELA fusion in an adult. A frontal lobe lesion was resected from a 30-year-old woman and displayed mixed components on pathological examination, showing ependymoma-like and sarcomatous parts. The absence of perivascular pseudorosettes was inconsistent with a diagnosis of ependymoma. Fluorescence in situ hybridization analysis confirmed ZFTA::RELA fusion. The DKFZ methylation classifier (v12.8) did not categorize this case among established methylation classes. In addition, t-distributed stochastic neighbor embedding analysis using DNA methylation data revealed that the present case was distant from ependymomas but close to two previously reported cases of ELTMD involving ZFTA::NCOA1/2 fusion. Taken together, we concluded that this tumor should be considered under the entity of ELTMD. This represents the first description of an adult patient with ELTMD harboring ZFTA::RELA fusion analyzed by DNA methylation profiling, supporting the establishment of ELTMD as a possible new tumor type.

DOI： 10.1007/s10014-024-00489-6

Clinical significance of cerebral microbleeds in patients with germinoma who underwent long-term follow-up 査読有り国際誌 Open Access

Kanamori, M; Mugikura, S; Iizuka, O; Mori, N; Shimoda, Y; Shibahara, I; Umezawa, R; Jingu, K; Saito, R; Sonoda, Y; Kumabe, T; Suzuki, K; Endo, H

JOURNAL OF NEURO-ONCOLOGY 170 巻 ( 1 ) 頁： 173 - 184 2024年10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 Neuro-Oncology

Purpose: This study identified the factors affecting cerebral microbleed (CMBs) development. Moreover, their effects on intelligence and memory and association with stroke in patients with germinoma who had long-term follow-up were evaluated. Methods: This study included 64 patients with germinoma who were histologically and clinically diagnosed with and treated for germinoma. These patients were evaluated cross-sectionally, with a focus on CMBs on susceptibility-weighted magnetic resonance imaging (SWI), brain atrophy assessed through volumetric analysis, and intelligence and memory. Results: The follow-up period was from 32 to 412 (median: 175.5) months. In total, 43 (67%) patients had 509 CMBs and 21 did not have CMBs. Moderate correlations were observed between the number of CMBs and time from initial treatments and recurrence was found to be a risk factor for CMB development. Increased temporal CMBs had a marginal effect on the processing speed and visual memory, whereas brain atrophy had a statistically significant effect on verbal, visual, and general memory and a marginal effect on processing speed. Before SWI acquisition and during the follow-up periods, eight strokes occurred in four patients. All of these patients had ≥ 15 CMBs on SWI before stroke onset. Meanwhile, 33 patients with < 14 CMBs or 21 patients without CMBs did not experience stroke. Conclusion: Patients with a longer time from treatment initiation had a higher number of CMBs, and recurrence was a significant risk factor for CMB development. Furthermore, brain atrophy had a stronger effect on memory than CMBs. Increased CMBs predict the stroke onset.

DOI： 10.1007/s11060-024-04753-9

Epileptic foci and networks in children with epilepsy after acute encephalopathy with biphasic seizures and late reduced diffusion 査読有り国際誌

Mitsumatsu, T; Ito, Y; Maki, Y; Yamamoto, H; Sawamura, F; Ishizaki, T; Maesawa, S; Bagarinao, E; Nakata, T; Kidokoro, H; Saito, R; Natsume, J

BRAIN & DEVELOPMENT 46 巻 ( 9 ) 頁： 302 - 307 2024年10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：Brain and Development

Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) develops along with status epilepticus and widespread subcortical white matter edema. We aimed to evaluate the epileptic foci and networks in two patients with epilepsy after AESD using simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI). Methods: Statistically significant blood oxygen level-dependent (BOLD) responses related to interictal epileptiform discharges (IEDs) were analyzed using an event-related design of hemodynamic response functions with multiple peaks. Results: Patient 1 developed focal seizures at age 10 years, one year after AESD onset. Positive BOLD changes were observed in the bilateral frontotemporal lobes, left parietal lobe, and left insula. BOLD changes were also observed in the subcortical structures. Patient 2 developed epileptic spasms at age two years, one month after AESD onset. Following total corpus callosotomy (CC) at age three years, the epileptic spasms resolved, and neurodevelopmental improvement was observed. Before CC, positive BOLD changes were observed bilaterally in the frontotemporal lobes. BOLD changes were also observed in the subcortical structures. After CC, the positive BOLD changes were localized in the temporal lobe ipsilateral to the IEDs, and the negative BOLD changes were mainly in the cortex and subcortical structures of the hemisphere ipsilateral to IEDs. Conclusion: EEG-fMRI revealed multiple epileptic foci and extensive epileptic networks, including subcortical structures in two cases with post-AESD epilepsy. CC may be effective in disconnecting the bilaterally synchronous epileptic networks of epileptic spasms after AESD, and pre-and post-operative changes in EEG-fMRI may reflect improvements in epileptic symptoms.

DOI： 10.1016/j.braindev.2024.07.003

Fact-finding survey of gynecologic oncologist on appearance care for cancer patients in Japan

Kuji, S; Nozawa, K; Toma, S; Arao, H; Imoto, S; Kajiyama, H; Kitano, A; Kodera, Y; Saito, R; Sakai, R; Taketomi, A; Nakayama, R; Hiyama, E; Futamura, M; Matsui, M; Yonemura, M; Oya, M; Suzuki, N

INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 34 巻 ( SUPPL_3 ) 頁： A328 - A328 2024年10月

がん診療ガイドライン作成・改訂に関する問題点と対応について脳腫瘍診療ガイドラインの現状と課題

園田順彦, 中田光俊, 田中將太, 篠山隆司, 吉本幸司, 成田善孝, 荒川芳輝, 山崎文之, 齋藤竜太, 阿部竜也, 黒住和彦, 市川智継, 永根基雄

日本癌治療学会学術集会抄録集 62回巻頁： GL - 4 2024年10月

下垂体腫瘍に対する治療

竹内和人, 永田雄一, 齋藤竜太

日本内分泌学会雑誌 100 巻 ( 2 ) 頁： 565 - 565 2024年10月

Cost of medical care for malignant brain tumors at hospitals in the Japan Clinical Oncology Group brain-tumor study group 査読有り Open Access

Motomura, K; Sasaki, K; Sugii, N; Yamaguchi, S; Inoue, H; Oshima, A; Tanaka, K; Otani, Y; Shirahata, M; Shibahara, I; Nagane, M; Tsuzuki, S; Matsutani, T; Tsukamoto, Y; Kijima, N; Asano, K; Ohno, M; Inoue, A; Mineharu, Y; Miyake, K; Mitobe, Y; Hanihara, M; Kawanishi, Y; Deguchi, S; Saito, M; Matsuda, R; Ujifuku, K; Arita, H; Sato, Y; Yamashita, S; Yonezawa, U; Yamaguchi, J; Momii, Y; Ogawa, T; Kambe, A; Ohba, S; Fukai, J; Saito, N; Kinoshita, M; Sumi, K; Otani, R; Uzuka, T; Takebe, N; Koizumi, S; Saito, R; Arakawa, Y; Narita, Y

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 54 巻 ( 10 ) 頁： 1123 - 1131 2024年9月

記述言語：英語出版者・発行元：Japanese Journal of Clinical Oncology

Background: This study aimed to investigate what treatment are selected for malignant brain tumors, particularly glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL), in real-world Japan and the costs involved. Methods: We conducted a questionnaire survey regarding treatment selections for newly diagnosed GBM and PCNSL treated between July 2021 and June 2022 among 47 institutions in the Japan Clinical Oncology Group-Brain Tumor Study Group. We calculated the total cost and cost per month of the initial therapy for newly diagnosed GBM or PCNSL. Results: The most used regimen (46.8%) for GBM in patients aged ≤74 years was 'Surgery + radiotherapy concomitant with temozolomide'. This regimen's total cost was 7.50 million JPY (Japanese yen). Adding carmustine wafer implantation (used in 15.0%), TTFields (used in 14.1%), and bevacizumab (BEV) (used in 14.5%) to the standard treatment of GBM increased the cost by 1.24 million JPY for initial treatment, and 1.44 and 0.22 million JPY per month, respectively. Regarding PCNSL, 'Surgery (biopsy) + rituximab, methotrexate, procarbazine, and vincristine (R-MPV) therapy' was the most used regimen (42.5%) for patients of all ages. This regimen incurred 1.07 million JPY per month. The three PCNSL regimens based on R-MPV therapy were in ultra-high-cost medical care (exceeding 1 million JPY per month). Conclusions: Treatment of malignant brain tumors is generally expensive, and cost-ineffective treatments such as BEV are frequently used. We believe that the results of this study can be used to design future economic health studies examining the cost-effectiveness of malignant brain tumors.

DOI： 10.1093/jjco/hyae116

Isolation of ependymal cilia from mouse brain 査読有り国際誌 Open Access

Mizuno, A; Takeuchi, K; Nagata, Y; Harada, H; Yamamoto, T; Ishikawa, T; Maeda, S; Ohka, F; Ueno, H; Saito, R

JOURNAL OF NEUROSCIENCE METHODS 409 巻頁： 110198 - 110198 2024年9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 Neuroscience Methods

Background: Ependymal cilia play a major role in the circulation of cerebrospinal fluid. Although isolation of cilia is an essential technique for investigating ciliary structure, to the best of our knowledge, no report on the isolation and structural analysis of ependymal cilia from mouse brain is available. New method: We developed a novel method for isolating ependymal cilia from mouse brain ventricles. We isolated ependymal cilia by partially opening the lateral ventricles and gently applying shear stress, followed by pipetting and ultracentrifugation. Results: Using this new method, we were able to observe cilia separately. The results demonstrated that our method successfully isolated intact ependymal cilia with preserved morphology and ultrastructure. In this procedure, the ventricular ependymal cell layer was partially detached. Comparison with existing methods: Compared to existing methods for isolating cilia from other tissues, our method is meticulously tailored for extracting ependymal cilia from the mouse brain. Designed with a keen understanding of the fragility of the ventricular ependyma, our method prioritizes minimizing tissue damage during the isolation procedure. Conclusions: We isolated ependymal cilia from mouse brain by applying shear stress selectively to the ventricles. Our method can be used to conduct more detailed studies on the structure of ependymal cilia.

DOI： 10.1016/j.jneumeth.2024.110198

A Combination Technique of N-butyl-2-cyanoacrylate and Minimal Coils with Flow Control for Parent Artery Occlusion of a Giant Internal Carotid Artery Aneurysm: A Technical Note Open Access

Hanyu, T; Izumi, T; Tanei, T; Nishihori, M; Gotoh, S; Araki, Y; Yokoyama, K; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 64 巻 ( 9 ) 頁： 347 - 351 2024年9月

記述言語：英語出版者・発行元：Neurologia Medico-Chirurgica

Parent artery occlusion for large or giant internal carotid artery aneurysms remains a necessary procedure in the era of flow diverters. Endovascular parent artery occlusion is currently performed using detachable balloons or coils, which are difficult to obtain or costly. At our institution, we have devised a technique for combining n-butyl-2-cyanoacrylate and coils with flow control to solve this problem. Patients who underwent parent artery occlusion for large or giant internal carotid artery aneurysms with a follow-up period of more than 12 months were included. Imaging outcomes were evaluated for complete or incomplete aneurysmal occlusion and with or without aneurysmal shrinkage. The clinical outcome was based on changes in the modified Rankin Scale. Ten patients (ten aneurysms) were in-cluded. Their average age and average follow-up period were 68.4 years and 36 months, respectively. Complete occlusion and favorable clinical outcome were observed in all cases. The parent artery occlusion using a combination of coils and n-butyl-2-cyanoacrylate with flow control technique is effective for both imaging and clinical outcomes.

DOI： 10.2176/jns-nmc.2024-0046

てんかんのDBS治療てんかんに対する視床DBS治療のエビデンス

前澤聡, 石崎友崇, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 353 - 354 2024年9月

SEEG合併症対策出血症例から学ぶ安全なプランニングルールの検討

鈴木崇宏, 石崎友崇, 前澤聡, 種井隆文, 武藤学, 伊藤芳記, 橋田美紀, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 571 - 571 2024年9月

難治てんかんに対するニューロモデュレーションの現在名古屋大学の治療戦略

石崎友崇, 前澤聡, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 450 - 450 2024年9月

脳腫瘍に対する全ゲノム解析(Whole-genome sequencing analysis of brain tumors)

鈴木啓道, 中島拓真, 舟越勇介, 金森政之, 柴原一陽, 鈴木智成, 木下学, 園田順彦, 荒川芳輝, 永根基雄, 田中將太, 石田穣治, 齋藤竜太, 花谷亮典, 吉本幸司, 成田善孝

日本癌学会総会記事 83回巻頁： S08 - 3 2024年9月

死亡後画像診断センターに搬送されたてんかん関連異状死の特徴(Characteristics of deceased subjects transported to a postmortem imaging center due to unusual death related to epilepsy)

伊藤芳記, 秦誠宏, 前澤聡, 種井隆文, 石崎友崇, 武藤学, 橋田美紀, 鈴木崇宏, 小林豊, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 579 - 579 2024年9月

定位手術用ロボットアームNeuromateによる視床前核脳深部刺激療法(ANT-DBS)の導入経験

石崎友崇, 前澤聡, 鈴木崇宏, 橋田美紀, 伊藤芳記, 武藤学, 種井隆文, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 523 - 523 2024年9月

側頭葉外術中皮質脳波が示唆するtemporal plus epilepsyについての検討

橋田美紀, 石崎友崇, 鈴木崇宏, 伊藤芳記, 武藤学, 種井隆文, 前澤聡, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 570 - 570 2024年9月

ニューロメートで切り拓く定位的てんかん外科手術の未来

石崎友崇, 前澤聡, 齋藤竜太

てんかん研究 42 巻 ( 2 ) 頁： 446 - 446 2024年9月

Intracranial Myeloid Sarcoma Arising Intraaxially From Acute Myeloid Leukemia: A Case Report and Literature Review 査読有り

Kageyama, A; Motomura, K; Motomura, A; Nakajima, Y; Tsujiuchi, T; Matsuo, M; Akahori, S; Watarai, M; Kojima, I; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 8 ) 頁： e67884 2024年8月

神経内視鏡画像における機能性下垂体腫瘍を含めた手術支援AIシステムの構築

布施佑太郎, 竹内和人, 橋本典明, 永田雄一, 永谷哲也, 竹内一郎, 齋藤竜太

日本内分泌学会雑誌 100 巻 ( S.HPT ) 頁： 19 - 21 2024年8月

The indication of palliative whole-brain radiotherapy for patients with brain metastases: a simple prognostic scoring system in the era of stereotactic radiosurgery 査読有り Open Access

Hirose, T; Deguchi, S; Yasui, K; Inoue, M; Onoe, T; Ogawa, H; Asakura, H; Mitsuya, K; Harada, H; Murayama, S; Hayashi, N; Nishimura, T; Saito, R

BMC CANCER 24 巻 ( 1 ) 頁： 940 2024年8月

記述言語：英語出版者・発行元：BMC Cancer

Background: Stereotactic irradiation has become the mainstay treatment for brain metastases (BM), and whole-brain radiotherapy (WBRT) is often used for symptom palliation. However, the survival time of patients with BM undergoing palliative WBRT (pWBRT) is limited, making it difficult to select patients who should receive treatment. Methods: We collected patient data from 2016 to 2022 at the Shizuoka Cancer Center and retrospectively analyzed the factors related to survival time. Overall survival (OS) was defined as the survival time after WBRT. Results: A total of 301 patients (median age, 66 years) who underwent pWBRT were included. The primary cancers were lung, breast, gastrointestinal tract, and other cancers in 203 (67%), 38 (13%), 33 (11%), and 27 (9%) patients, respectively. Median OS of all patients was 4.1 months. In the multivariate analysis, male sex (hazard ratio [HR]:1.4), Karnofsky Performance Status (KPS) ≤ 60 (HR:1.7), presence of extracranial metastasis (ECM) (HR:1.6), neutrophil-lymphocyte ratio (NLR) ≥ 5 (HR:1.6), and lactate dehydrogenase (LDH) ≥ upper limit of normal (ULN) (HR:1.3) were significantly associated with shorter OS (all P < 0.05). To predict the OS, we created a prognostic scoring system (PSS). We gave one point to each independent prognostic factor. Median OS for patients with scores of 0–2, 3, and 4–5 were 9.0, 3.5 and 1.7 months, respectively (P < 0.001). Conclusions: Male sex, KPS ≤ 60, presence of ECM, NLR ≥ 5, and LDH ≥ ULN were poor prognostic factors for patients with BM undergoing pWBRT. By PSS combining these factors, it may be possible to select patients who should undergo pWBRT.

DOI： 10.1186/s12885-024-12729-1

Tertiary Lymphoid Structures in Brain Metastases of Lung Cancer: Prognostic Significance and Correlation With Clinical Outcomes 査読有り国際誌 Open Access

Nohira, S; Kuramitsu, S; Ohno, M; Fujita, M; Yamashita, K; Nagasaka, T; Haimoto, S; Sakakura, N; Matsushita, H; Saito, R

ANTICANCER RESEARCH 44 巻 ( 8 ) 頁： 3615 - 3621 2024年8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：Anticancer Research

Background/Aim: The prognosis of patients with brain metastases (BMs) originating from lung cancer remains poor, despite advancements in treatment strategies. The role of tertiary lymphoid structures (TLSs) within the tumor immune microenvironment of BMs has not been extensively explored. Patients and Methods: This study utilized patient-derived clinical samples from 17 patients with histologically confirmed BMs of lung cancer, undergoing surgical resection. Immunohistochemistry was employed to analyze the presence and characteristics of TLS and tumor-infiltrating lymphocytes (TILs) within BM tissues, correlating these with clinical outcomes. Results: TLSs, albeit in their immature form, were identified within BM tissues, distinguishing them from their mature counterparts in primary lung cancer tissues. A significant correlation between TLS density (but not TIL density) and improved postoperative survival was observed, underscoring the potential of TLS density as an independent prognostic marker. Furthermore, TLS density did not correlate with the Graded Prognostic Assessment (GPA) index, suggesting its unique prognostic value beyond conventional predictors. Conclusion: Our findings reveal the presence of TLSs in lung cancer-derived BMs and highlight their prognostic significance, independent of the GPA index. The identification of TLS within the unique central nervous system tumor microenvironment offers new insights into the immune landscape of BMs and suggests potential avenues for immunotherapeutic interventions targeting these structures to improve patient outcomes.

DOI： 10.21873/anticanres.17184

Clinical and molecular features of patients with IDH1 wild-type primary glioblastoma presenting unexpected short-term survival after gross total resection 査読有り

Toyoda, M; Shibahara, I; Shigeeda, R; Fujitani, K; Tanihata, Y; Hyakutake, Y; Handa, H; Komai, H; Sato, S; Inukai, M; Hide, T; Shimoda, Y; Kanamori, M; Endo, H; Saito, R; Matsuda, KI; Sonoda, Y; Kumabe, T

JOURNAL OF NEURO-ONCOLOGY 169 巻 ( 1 ) 頁： 39 - 50 2024年8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 Neuro-Oncology

Background: This study investigated the factors influencing short-term survivors (STS) after gross total resection (GTR) in patients with IDH1 wild-type primary glioblastoma. Methods: We analyzed five independent cohorts who underwent GTR, including 83 patients from Kitasato University (K-cohort), and four validation cohorts of 148 patients from co-investigators (V-cohort), 66 patients from the Kansai Molecular Diagnosis Network for the Central Nervous System tumors, 109 patients from the Cancer Genome Atlas, and 40 patients from the Glioma Longitudinal AnalySiS. The study defined STS as those who had an overall survival ≤ 12 months after GTR with subsequent radiation therapy, and concurrent and adjuvant temozolomide (TMZ). Results: The study included 446 patients with glioblastoma. All cohorts experienced unexpected STS after GTR, with a range of 15.0–23.9% of the cases. Molecular profiling revealed no significant difference in major genetic alterations between the STS and non-STS groups, including MGMT, TERT, EGFR, PTEN, and CDKN2A. Clinically, the STS group had a higher incidence of non-local recurrence early in their treatment course, with 60.0% of non-local recurrence in the K-cohort and 43.5% in the V-cohort. Conclusions: The study revealed that unexpected STS after GTR in patients with glioblastoma is not uncommon and such tumors tend to present early non-local recurrence. Interestingly, we did not find any significant genetic alterations in the STS group, indicating that such major alterations are characteristics of GB rather than being reliable predictors for recurrence patterns or development of unexpected STS.

DOI： 10.1007/s11060-024-04687-2

その他リンク： https://link.springer.com/article/10.1007/s11060-024-04687-2/fulltext.html

Microsurgical Management of Craniocervical Dural Arteriovenous Fistula: A Case Report and Literature Review 査読有り

Araki, Y; Putra, MB; Tsukada, T; Niryana, IW; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 7 ) 頁： e65547 2024年7月

The Potential Role of Preoperative Posterior Cerebral Artery Involvement in Predicting Postoperative Transient Neurological Deficits and Ischemic Stroke After Indirect Revascularization in Patients With Moyamoya Disease 査読有り国際誌

Araki, Y; Yokoyama, K; Uda, K; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Goto, S; Tsukada, T; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Tanei, T; Nagashima, Y; Muraoka, S; Izumi, T; Seki, Y; Saito, R

WORLD NEUROSURGERY 187 巻頁： E610 - E619 2024年7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：World Neurosurgery

Objective: Transient neurological deficits (TNDs) are known to develop after direct bypass for Moyamoya disease and may be risk factors for subsequent stroke. However, the factors involved in the development of TNDs and stroke after indirect revascularization alone, including their association with subsequent stroke, remain unclear. The purpose of this study was to investigate this issue. Methods: The subjects of the study were 30 patients with Moyamoya disease who underwent a total of 40 indirect revascularization procedures at our institution. Clinical and radiological data were collected retrospectively. To examine factors associated with the development of postoperative TND/stroke/asymptomatic disease, the clinical characteristics of each group were statistically compared. Results: The mean age at surgery was 7 years (range 1–63). TNDs developed after surgery in 9 out of 40 patients (22.5%). Stroke in the acute postoperative period occurred in 3 patients (7.5%), all of whom experienced cerebral infarctions. Demographic data and preoperative clinical information were not different between the groups. However, posterior cerebral artery involvement on preoperative imaging was significantly associated with the development of TNDs and stroke (P = 0.006). Furthermore, postoperative stroke was associated with unfavorable outcomes (P = 0.025). Conclusions: Posterior cerebral artery involvement is significantly associated with the occurrence of TNDs. In contrast, TNDs after indirect revascularization have little relationship with the subsequent development of stroke. TNDs usually resolve without new strokes, and a better understanding of this particular pathology could help establish an optimal treatment regimen.

DOI： 10.1016/j.wneu.2024.04.135

[Prediction of the Natural Course of Meningioma Using CT and MR Images]. 査読有り

Deguchi S, Mitsuya K, Saito R

No shinkei geka. Neurological surgery 52 巻 ( 4 ) 頁： 699 - 704 2024年7月

Decreased heart rate variability in sympathetic dominant states in Parkinson's disease and isolated REM sleep behavior disorder 査読有り

Suzuki, M; Nakamura, T; Ohba, C; Hatanaka, M; Tsuboi, T; Hirayama, M; Nakatsubo, D; Maesawa, S; Saito, R; Katsuno, M

PARKINSONISM & RELATED DISORDERS 124 巻頁： 107020 2024年7月

記述言語：英語出版者・発行元：Parkinsonism and Related Disorders

Introduction: Parkinson's disease (PD) presents with decreased heart rate variability (HRV) from its early stages. However, most of its evidence originates from HRV measurements in parasympathetic dominant states. In this study, we aimed to examine whether HRV in sympathetic dominant states during the head-up tilt table test (HUT) serves as a marker of autonomic dysfunction in PD and isolated REM sleep behavior disorder (iRBD). Methods: We retrospectively assessed 102 patients with PD, 10 patients with iRBD, and 43 healthy controls. We then measured the coefficient of variation of RR intervals as an HRV parameter in sympathetic dominant states (CVRR-S) and parasympathetic dominant states (CVRR-P). Furthermore, we evaluated parameters of cardiac autonomic function, including HUT and the heart-to-mediastinum (H/M) ratio of cardiac metaiodobenzylguanidine scintigraphy. Results: Patients with iRBD and PD at Hoehn and Yahr stage I exhibited a significantly decreased CVRR-S compared to healthy controls (controls vs. iRBD vs. PD; 1.82 ± 0.64 % vs. 1.13 ± 0.41 % vs. 1.15 ± 0.51 %, p < 0.001), although no further deterioration was observed in PD at more severe Hoehn and Yahr stages. CVRR-S showed a significant correlation with the H/M ratio in PD (r = 0.51, p < 0.001). Additionally, receiver operating characteristic (ROC) analysis revealed a larger area under the ROC curve in CVRR-S compared to that in CVRR-P for discriminating PD or iRBD from healthy controls. Conclusion: HRV in sympathetic dominant states shows the potential to be a marker of autonomic dysfunction in iRBD and early-stage PD, aiding in early diagnosis and patient stratification.

DOI： 10.1016/j.parkreldis.2024.107020

特集頭蓋頸椎移行部病変頭蓋頸椎移行部の解剖学的特徴(正常解剖)

Epilepsy in Patients with Gliomas Open Access

Ehara, T; Ohka, F; Motomura, K; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 64 巻 ( 7 ) 頁： 253 - 260 2024年7月

記述言語：英語出版者・発行元：Neurologia Medico-Chirurgica

Brain tumor-related epilepsy (BTRE) is a complication that significantly impairs the quality of life and course of treatment of patients with brain tumors. Several recent studies have shed further light on the mechanisms and pathways by which genes and biological molecules in the tumor microenviron-ment can cause epilepsy. Moreover, epileptic seizures have been found to promote the growth of brain tumors, making the control of epilepsy a critical factor in treating brain tumors. In this study, we summarize the previous research and recent findings concerning BTRE. Expectedly, a deeper under-standing of the underlying genetic and molecular mechanisms leads to safer and more effective treatments for suppressing epileptic symptoms and tumor growth.

DOI： 10.2176/jns-nmc.2023-0299

Navigation-assisted occipitocervical fixation and decompression in a patient with polyostotic fibrous dysplasia 査読有り Open Access

Nagashima, Y; Nishimura, Y; Abe, T; Saito, R

JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 15 巻 ( 3 ) 頁： 380 - 383 2024年7月

記述言語：英語出版者・発行元：Journal of Craniovertebral Junction and Spine

Fibrous dysplasia (FD) is a rare skeletal disorder characterized by the replacement of normal bone with fibrous connective tissue, leading to abnormal bone formation. This case report details the successful treatment of a 61-year-old woman with FD at the craniovertebral junction (CVJ). The patient, who had a history of intracranial meningioma and had already been diagnosed with FD, experienced worsening gait disturbance and muscle weakness following a fall. Imaging studies revealed extensive polyostotic FD lesions in the skull and cervical spine, along with a C2 odontoid fracture causing spinal cord compression. The patient underwent occipitocervical fixation and decompression surgery. Intraoperative O-arm navigation was used to ensure accurate screw placement and effective decompression. This procedure allowed for proper positioning of the C2 and C3 pedicle screws, resection of the hyperplastic occipital bone and C1 posterior arch, and placement of the occipital plate with avoiding the cyst components. At a 2-year follow-up, there were no signs of screw loosening, and the patient showed marked clinical improvement. This case emphasizes the importance of tailored surgical strategies and the use of advanced navigational technologies in managing complex FD cases, particularly those involving the CVJ. It also highlights the challenges of treating polyostotic FD, where complete resection is often unfeasible. The successful outcome in this case supports the use of decompressive surgery combined with stabilization to relieve symptoms and prevent further complications.

DOI： 10.4103/jcvjs.jcvjs_104_24

Case report: Endoscopic endonasal transposterior clinoid approach for resection of posterior clinoid process meningioma: technical notes and literature review 査読有り国際誌 Open Access

Awyono, S; Takeuchi, K; Ito, E; Nagata, Y; Golden, N; Mahadewa, TGB; Saito, R

FRONTIERS IN ONCOLOGY 14 巻頁： 1368277 - 1368277 2024年6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：Frontiers in Oncology

Background: Posterior clinoid process (PCP) meningioma is an exceedingly rare entity. It remains the most challenging skull base lesion for neurosurgeons due to its treacherous location that insinuates amongst critical neurovascular structures. This article will describe the technical notes using the endoscopic endonasal approach that provide the earliest devascularization and detachment of the tumor PCP meningioma. Methods: We are introducing the surgical implementation of an endoscopic endonasal approach to removing PCP meningioma. Furthermore, we perform a literature review of posterior clinoid process meningioma that undergoes surgical intervention, then summarize the benefits and limitations of each approach. Results: We present a case of right PCP meningioma that was removed using an endoscopic endonasal approach through the transposterior clinoid corridor in a 52-year-old-woman. We describe the technical notes in performing this approach to have the earliest devascularization and detachment of the tumor by performing posterior clinoidectomy. Safe tumor removal is performed with a wide and clear view of the surrounding neurovascular structure. Based on our database search, we found nine articles reported on the surgical management of PCP meningiomas, with a total number of 15 cases. All of the reported cases performed the tumor removal using the transcranial approach. Conclusion: The endoscopic endonasal transposterior clinoid approach circumvents all disadvantages faced by the traditional transcranial approach, providing the earliest approach to devascularized and detaching the tumor from its attachment at PCP. This approach demonstrates safety and efficacy, making it an acceptable alternative for PCP meningioma resections.

DOI： 10.3389/fonc.2024.1368277

西村由介, 齋藤竜太

脊椎脊髄ジャーナル 37 巻 ( 4 ) 頁： 216 - 223 2024年5月

Protective Mechanism of Stem Cells from Human Exfoliated Deciduous Teeth in Treating Spinal Cord Injury 査読有り

Nishii, T; Osuka, K; Nishimura, Y; Ohmichi, Y; Ohmichi, M; Suzuki, C; Nagashima, Y; Oyama, T; Abe, T; Kato, H; Saito, R

JOURNAL OF NEUROTRAUMA 41 巻 ( 9-10 ) 頁： 1196 - 1210 2024年5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：Journal of Neurotrauma

Spinal cord injury (SCI) induces devastating permanent deficits. Recently, cell transplantation therapy has become a notable treatment for SCI. Although stem cells from human exfoliated deciduous teeth (SHED) are an attractive therapy, their precise mechanism of action remains to be elucidated. In this study, we explored one of the neuroprotective mechanisms of SHED treatment at the subacute stage after SCI. We used a rat clip compression SCI model. The animals were randomly divided into three groups: SCI, SCI + phosphate-buffered saline (PBS), and SCI + SHED. The SHED or PBS intramedullary injection was administered immediately after SCI. After SCI, we explored the effects of SHED on motor function, as assessed by the Basso-Beattie-Bresnahan score and the inclined plane method, the signal transduction pathway, especially the Janus kinase (JAK) and the signal transducer and activator of transcription 3 (STAT3) pathway, the apoptotic pathway, and the expression of neurocan, one of the chondroitin sulfate proteoglycans. SHED treatment significantly improved functional recovery from Day 14 relative to the controls. Western blot analysis showed that SHED significantly reduced the expression of glial fibrillary acidic protein (GFAP) and phosphorylated STAT3 (p-STAT3) at Tyr705 on Day 10 but not on Day 5. However, SHED had no effect on the expression levels of Iba-1 on Days 5 or 10. Immunohistochemistry revealed that p-STAT3 at Tyr705 was mainly expressed in GFAP-positive astrocytes on Day 10 after SCI, and its expression was reduced by administration of SHED. Moreover, SHED treatment significantly induced expression of cleaved caspase 3 in GFAP-positive astrocytes only in the epicenter lesions on Day 10 after SCI but not on Day 5. The expression of neurocan was also significantly reduced by SHED injection on Day 10 after SCI. Our results show that SHED plays an important role in reducing astrogliosis and glial scar formation between Days 5 and 10 after SCI, possibly via apoptosis of astrocytes, ultimately resulting in improvement in neurological functions thereafter. Our data revealed one of the neuroprotective mechanisms of SHED at the subacute stage after SCI, which improved functional recovery after SCI, a serious condition.

DOI： 10.1089/neu.2023.0251

Risk factors for nausea and vomiting requiring the daily administration of 5-HT(3) receptor antagonists in radiotherapy combined with temozolomide for high-grade glioma. 査読有り

Takagi M, Sagara A, Kumakura Y, Watanabe M, Inoue R, Miyazaki M, Ohka F, Motomura K, Natsume A, Wakabayashi T, Saito R, Yamada K

Nagoya journal of medical science 86 巻 ( 2 ) 頁： 304 - 313 2024年5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

Radiotherapy combined with temozolomide (TMZ+RT) is the primary treatment for high-grade glioma. TMZ is classified as a moderate emetic risk agent and, thus, supportive care for nausea and vomiting is important. In Nagoya University Hospital, all patients are treated with a 5-hydroxy-tryptamine 3 receptor antagonist (5-HT3RA) for the first 3 days. The daily administration of 5-HT3RA is resumed after the 4th day based on the condition of patients during TMZ+RT. Therefore, the present study investigated risk factors for nausea and vomiting in patients requiring the daily administration of 5-HT3RA. Patients with high-grade glioma who received TMZ+RT between January 2014 and December 2019 at our hospital were included. Patients were divided into two groups: a control group (patients who did not resume 5-HT3RA) and resuming 5-HT3RA group (patients who resumed 5-HT3RA after the 4th day), and both groups were compared to identify risk factors for nausea and vomiting during TMZ+RT. There were 78 patients in the control group (68%) and 36 in the resuming 5-HT3RA group (32%). A multivariate analysis of patient backgrounds in the two groups identified age <18 years, PS 2 or more, and occipital lobe tumors as risk factors for nausea and vomiting. Nausea and vomiting were attenuated in 30 patients (83%) in the resuming 5-HT3RA group following the resumption of 5-HT3RA. The results obtained highlight the importance of extracting patients with these risk factors before the initiation of therapy and the early resumption or daily administration of 5-HT3RA according to the condition of each patient.

DOI： 10.18999/nagjms.86.2.304

Giant pituitary neuroendocrine tumor治療における合併症

Hormone Concentration Measurement in Intracranial Dural Arteriovenous Fistulae 査読有り

Kropp, AE; Nishihori, M; Izumi, T; Goto, S; Yokoyama, K; Saito, R

WORLD NEUROSURGERY 185 巻頁： E451 - E460 2024年5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：World Neurosurgery

Objective: Intracranial dural arteriovenous fistulae (DAVFs) represent a subset of cerebral vascular malformations associated with significant morbidity and mortality. In Japan, DAVF exhibits sex-based differences in anatomical distribution, with female predominance in the cavernous sinus (CS) and male predominance in the transverse sinus (TS). Nevertheless, the pathophysiology of DAVF is not fully understood, and hormonal influences are hypothesized to play a role in its development. This study aimed to investigate changes in the concentrations of sex steroid hormones between intracranial and peripheral sampling sites in patients with CS- and TS-DAVF. Methods: We recruited 19 patients with CS-DAVF (n = 12) and TS-DAVF (n = 7) in this study. Blood hormone measurements were obtained from peripheral and jugular bulb samples during endovascular intervention. Hormone concentrations were analyzed using enzyme-linked immunosorbent assay kits, and statistical analyses were performed. Results: Our study revealed a higher prevalence of CS-DAVF in females and TS-DAVF in males, which is consistent with previous studies. Estradiol concentration was significantly lower in the jugular bulb compared with in the periphery in both patients with CS- and TS-DAVF. This decrease in estradiol was observed irrespective of the patient's sex and independent of follicle-stimulating hormone levels. Conclusions: These findings indicate a local decrease in estradiol levels within the intracranial vasculature of patients with DAVF. This suggests a potential multifactorial role of estradiol in the pathomechanism of DAVFs, warranting further investigation to understand its influence on DAVF formation and potential targeted therapies, thereby enhancing patient outcomes.

DOI： 10.1016/J.WNEu.2024.02.052

永田雄一, 竹内和人, 伊藤英治, 原田英幸, 近藤辰磨, 齋藤竜太

日本内分泌学会雑誌 100 巻 ( 1 ) 頁： 332 - 332 2024年5月

Obstructive Hydrocephalus Due to Aggressive Posterior Fossa Tumor Exhibiting Histological Characteristics of Pilocytic Astrocytoma in Two Adult Neurofibromatosis Type 1 (NF1) Cases 査読有り国際誌

Nawa, S; Ohka, F; Motomura, K; Takeuchi, K; Nagata, Y; Yamaguchi, J; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 4 ) 頁： e58697 2024年4月

Pediatric-type high-grade gliomas with PDGFRA amplification in adult patients with Li-Fraumeni syndrome: clinical and molecular characterization of three cases 査読有り国際誌 Open Access

Kibe, Y; Ohka, F; Aoki, K; Yamaguchi, J; Motomura, K; Ito, E; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Shiba, Y; Maeda, S; Nishikawa, T; Shimizu, H; Saito, R

ACTA NEUROPATHOLOGICA COMMUNICATIONS 12 巻 ( 1 ) 頁： 57 - 57 2024年4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 Neuropathologica Communications

Li-Fraumeni syndrome (LFS) is an autosomal dominant tumor predisposition syndrome caused by heterozygous germline mutations or deletions in the TP53 tumor suppressor gene. Central nervous system tumors, such as choroid plexus tumors, medulloblastomas, and diffuse gliomas, are frequently found in patients with LFS. Although molecular profiles of diffuse gliomas that develop in pediatric patients with LFS have been elucidated, those in adults are limited. Recently, diffuse gliomas have been divided into pediatric- and adult-type gliomas, based on their distinct molecular profiles. In the present study, we investigated the molecular profiles of high-grade gliomas in three adults with LFS. These tumors revealed characteristic histopathological findings of high-grade glioma or glioblastoma and harbored wild-type IDH1/2 according to whole exome sequencing (WES). However, these tumors did not exhibit the key molecular alterations of glioblastoma, IDH-wildtype such as TERT promoter mutation, EGFR amplification, or chromosome 7 gain and 10 loss. Although WES revealed no other characteristic gene mutations or copy number alterations in high-grade gliomas, such as those in histone H3 genes, PDGFRA amplification was found in all three cases together with uniparental disomy of chromosome 17p, where the TP53 gene is located. DNA methylation analyses revealed that all tumors exhibited DNA methylation profiles similar to those of pediatric-type high-grade glioma H3-wildtype and IDH-wildtype (pHGG H3-/IDH-wt), RTK1 subtype. These data suggest that high-grade gliomas developed in adult patients with LFS may be involved in pHGG H3-/IDH-wt. PDGFRA and homozygous alterations in TP53 may play pivotal roles in the development of this type of glioma in adult patients with LFS.

DOI： 10.1186/s40478-024-01762-7

Development of a rapid and comprehensive genomic profiling test supporting diagnosis and research for gliomas 査読有り Open Access

Nakashima, T; Yamamoto, R; Ohno, M; Sugino, H; Takahashi, M; Funakoshi, Y; Nambu, S; Uneda, A; Yanagisawa, S; Uzuka, T; Arakawa, Y; Hanaya, R; Ishida, J; Yoshimoto, K; Saito, R; Narita, Y; Suzuki, H

BRAIN TUMOR PATHOLOGY 41 巻 ( 2 ) 頁： 50 - 60 2024年4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：Brain Tumor Pathology

A prompt and reliable molecular diagnosis for brain tumors has become crucial in precision medicine. While Comprehensive Genomic Profiling (CGP) has become feasible, there remains room for enhancement in brain tumor diagnosis due to the partial lack of essential genes and limitations in broad copy number analysis. In addition, the long turnaround time of commercially available CGPs poses an additional obstacle to the timely implementation of results in clinics. To address these challenges, we developed a CGP encompassing 113 genes, genome-wide copy number changes, and MGMT promoter methylation. Our CGP incorporates not only diagnostic genes but also supplementary genes valuable for research. Our CGP enables us to simultaneous identification of mutations, gene fusions, focal and broad copy number alterations, and MGMT promoter methylation status, with results delivered within a minimum of 4 days. Validation of our CGP, through comparisons with whole-genome sequencing, RNA sequencing, and pyrosequencing, has certified its accuracy and reliability. We applied our CGP for 23 consecutive cases of intracranial mass lesions, which demonstrated its efficacy in aiding diagnosis and prognostication. Our CGP offers a comprehensive and rapid molecular profiling for gliomas, which could potentially apply to clinical practices and research primarily in the field of brain tumors.

DOI： 10.1007/s10014-023-00476-3

脳腫瘍2 小児上衣腫に対する手術摘出度と分子学的マーカーを用いた治療層別化による集学的治療の安全性と有効性を評価する第II相試験

齋藤竜太, 谷口理恵子, 前林勝也, 五味玲, 義岡孝子, 信澤純人, 市村幸一, 山崎夏維, 荒川芳輝, 隈部俊宏

小児の脳神経 49 巻 ( 2 ) 頁： 131 - 131 2024年4月

Cerebellar and thalamic connector hubs facilitate the involvement of visual and cognitive networks in essential tremor 査読有り国際共著

Bagarinao, E; Maesawa, S; Kato, S; Mutoh, M; Ito, Y; Ishizaki, T; Tanei, T; Tsuboi, T; Suzuki, M; Watanabe, H; Hoshiyama, M; Isoda, H; Katsuno, M; Sobue, G; Saito, R

PARKINSONISM & RELATED DISORDERS 121 巻頁： 106034 2024年4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：Parkinsonism and Related Disorders

Introduction: Connector hubs are specialized brain regions that connect multiple brain networks and therefore have the potential to affect the functions of multiple systems. This study aims to examine the involvement of connector hub regions in essential tremor. Methods: We examined whole-brain functional connectivity alterations across multiple brain networks in 27 patients with essential tremor and 27 age- and sex-matched healthy controls to identify affected hub regions using a network metric called functional connectivity overlap ratio estimated from resting-state functional MRI. We also evaluated the relationships of affected hubs with cognitive and tremor scores in all patients and with motor function improvement scores in 15 patients who underwent postoperative follow-up evaluations after focused ultrasound thalamotomy. Results: We have identified affected connector hubs in the cerebellum and thalamus. Specifically, the dentate nucleus in the cerebellum and the dorsomedial thalamus exhibited more extensive connections with the sensorimotor network in patients. Moreover, the connections of the thalamic pulvinar with the visual network were also significantly widespread in the patient group. The connections of these connector hub regions with cognitive networks were negatively associated (FDR q < 0.05) with cognitive, tremor, and motor function improvement scores. Conclusion: In patients with essential tremor, connector hub regions within the cerebellum and thalamus exhibited widespread functional connections with sensorimotor and visual networks, leading to alternative pathways outside the classical tremor axis. Their connections with cognitive networks also affect patients’ cognitive function.

DOI： 10.1016/j.parkreldis.2024.106034

Outcomes and Prognostic Factors of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor at 2-year Follow-up 査読有り Open Access

Hashida, M; Maesawa, S; Kato, S; Nakatsubo, D; Tsugawa, T; Torii, J; Tanei, T; Ishizaki, T; Mutoh, M; To, Y; Tsuboi, T; Mizuno, S; Suzuki, M; Wakabayashi, T; Katsuno, M; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 64 巻 ( 4 ) 頁： 137 - 146 2024年4月

担当区分：最終著者記述言語：英語出版者・発行元：一般社団法人日本脳神経外科学会

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Fur-thermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤25, T-max ≥52.5°C, anterior-posterior size of lesion ≥3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysar-thria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.

DOI： 10.2176/jns-nmc.2023-0202

Characteristics of deceased subjects transported to a postmortem imaging center due to unusual death related to epilepsy 査読有り Open Access

Ito, Y; Hata, N; Maesawa, S; Tanei, T; Ishizaki, T; Mutoh, M; Hashida, M; Kobayashi, Y; Saito, R

EPILEPSIA OPEN 9 巻 ( 2 ) 頁： 592 - 601 2024年4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：Epilepsia Open

Objective: Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy and identify factors that may contribute to these deaths and may also include sudden unexpected death in epilepsy (SUDEP). Methods: We analyzed 5291 cases in which a postmortem imaging (PMI) study was performed using plane CT, because of an unexplained death. A rapid troponin T assay was performed using peripheral blood samples. Clinical information including the cause of death suspected by the attending physician, body position, place of death, medical history, and antiseizure medications was evaluated. Results: A total of 132 (2.6%) patients had an obvious history of epilepsy, while 5159 individuals had no history of epilepsy (97.4%). Cerebrovascular disease was the cause of death in 1.6% of patients in the group with epilepsy, and this was significantly lower than that in the non-epilepsy group. However, drowning was significantly higher (9.1% vs. 4.4%). Unspecified cause of death was significantly more frequent in the epilepsy group (78.0% vs. 57.8%). Furthermore, the proportion of patients who demonstrated elevation of troponin T levels without prior cardiac disease was significantly higher in the epilepsy group (37.9% vs. 31.1%). At discovery of death, prone position was dominant (30.3%), with deaths occurring most commonly in the bedroom (49.2%). No antiseizure medication had been prescribed in 12% of cases, while 29.5% of patients were taking multiple antiseizure medications. Significance: The prevalence of epilepsy in individuals experiencing unusual death was higher than in the general population. Despite PMI studies, no definitive cause of death was identified in a significant proportion of cases. The high troponin T levels may be explained by long intervals between death and examination or by higher incidence of myocardial damage at the time of death. Plain Language Summary: This study investigated unusual deaths in epilepsy patients, analyzing 5291 postmortem imaging cases. The results showed that 132 cases (2.6%) had a clear history of epilepsy. In these cases, only 22% cases were explained after postmortem examination, which is less than in non-epilepsy group (42.2%). Cerebrovascular disease was less common in the epilepsy group, while drowning was more common. Elevated troponin T levels, which suggest possibility of myocardial damage or long intervals between death and examination, were also more frequent in the epilepsy group compared to non-epilepsy group.

DOI： 10.1002/epi4.12891

脳腫瘍1 高速定量PCR装置を用いた小児脳腫瘍の迅速遺伝子解析法の確立

大岡史治, 前田紗知, 清水大輝, 本村和也, 芝良樹, 山口純矢, 竹内和人, 永田雄一, 木部祐士, 滝戸悠平, 齋藤竜太

小児の脳神経 49 巻 ( 2 ) 頁： 168 - 168 2024年4月

Molecular insights and the role of 18F-FDG-PET/CT in the diagnosis of spinal gliomas 査読有り

Nagashima, Y; Nishimura, Y; Eguchi, K; Yamaguchi, J; Haimoto, S; Ohka, F; Motomura, K; Abe, T; Matsuo, M; Tsukamoto, E; Hara, M; Saito, R

ACTA NEUROCHIRURGICA 166 巻 ( 1 ) 頁： 154 2024年3月

担当区分：最終著者記述言語：英語出版者・発行元：Acta Neurochirurgica

Background: In recent years, molecular findings on spinal gliomas have become increasingly important. This study aimed to investigate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in the diagnosis of spinal glioma. Methods: This study included patients diagnosed with spinal cord glioma who underwent 18F-FDG-PET examination at the Department of Neurosurgery, Nagoya University Hospital between January 2016 and November 2023. The gliomas were divided into two groups, high-grade and low-grade, based on pathological and molecular studies. The maximum standardized uptake values (SUVmax) of the tumors were quantified and subsequently represented using receiver operating characteristic (ROC) curves. Results: Eighteen participants were included in this study. Of the participants, seven had high-grade glioma with an SUVmax of 6.76 ± 0.72, and eleven had low-grade glioma with an SUVmax of 4.02 ± 1.78, and a statistically significant difference between the two groups. The ROC curve delineated an SUVmax cutoff value of 5.650, with an area under the curve (AUC) of approximately 0.909. Based on the cutoff value, the results of the diagnostic performance rendered a sensitivity and negative predictive value of 1.0, whereas the specificity and positive predictive value were 0.909 and 0.875, respectively. Conclusions: The present study shows that 18F-FDG-PET exhibits a markedly sensitive and negative predictive value in the assessment of spinal gliomas. Additionally, these findings have potential implications for the qualitative assessment of spinal gliomas using 18F-FDG-PET/CT. This imaging modality may be useful for making timely treatment decisions in situations where a detailed diagnosis by molecular analysis is not possible.

DOI： 10.1007/s00701-024-06039-5

Neonatal Ventricular Reservoir Implantation for Hydrocephalus Management in Chiari III Malformations: A Case Report 査読有り国際誌

Ito, R; Fuse, Y; Ito, K; Hatano, H; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE 16 巻 ( 3 ) 頁： e55896 2024年3月

Delayed leukoencephalopathy following non-coil embolization flow diverter stent deployment for an intracranial aneurysm 査読有り

Muraoka, S; Asai, T; Hamasaki, H; Fukui, T; Suzuki, N; Nishizawa, T; Araki, Y; Saito, R

NEURORADIOLOGY 66 巻 ( 3 ) 頁： 427 - 429 2024年3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：Neuroradiology

This report examines delayed leukoencephalopathy as a postoperative complication after the use of flow diverter (FD) devices for endovascular cerebral aneurysm treatment. A case involving a 78-year-old female treated with a pipeline embolization device for a left internal carotid artery aneurysm is presented. Despite adherence to dual anti-platelet therapy, the patient developed intermittent headaches and memory issues 3 months post-operation. MRI revealed T1-enhancing foci and T2 hyperintense signal abnormalities in the left cerebral hemisphere, without new ischemic lesions, indicating potential embolic events or foreign body reactions. Following aphasia, a change from clopidogrel to prasugrel and the initiation of steroid pulse therapy led to the resolution of symptoms and MRI abnormalities over 6 months. This case underscores the reversibility of delayed leukoencephalopathy with appropriate intervention.

DOI： 10.1007/s00234-024-03281-7

Awake Craniotomy for Gliomas in the Non-Dominant Right Hemisphere: A Comprehensive Review 査読有り国際共著 Open Access

Mamadaliev, DM; Saito, R; Motomura, K; Ohka, F; Scalia, G; Umana, GE; Conti, A; Chaurasia, B

CANCERS 16 巻 ( 6 ) 2024年3月

記述言語：英語出版者・発行元：Cancers

Awake surgery has become a standard practice for managing diffuse low-grade gliomas (LGGs), particularly in eloquent brain areas, and is established as a gold standard technique for left-dominant-hemisphere tumors. However, the intraoperative monitoring of functions in the right non-dominant hemisphere (RndH) is often neglected, highlighting the need for a better understanding of neurocognitive testing for complex functions in the right hemisphere. This article aims to comprehensively review the current literature on the benefits of awake craniotomy in gliomas of the non-dominant right hemisphere. A systematic review was conducted using the PubMed and ScienceDirect databases with keywords such as “right hemisphere”, “awake surgery”, “direct electrical brain stimulation and mapping”, and “glioma”. The search focused on anatomical and surgical aspects, including indications, tools, and techniques of awake surgery in right cerebral hemisphere gliomas. The literature search identified 74 sources, including original articles, books, monographs, and review articles. Two papers reported large series of language assessment cases in 246 patients undergoing awake surgery with detailed neurological semiology and mapping techniques, while the remaining studies were predominantly neuroradiological and neuroimaging in nature. Awake craniotomy for non-dominant-hemisphere gliomas is an essential tool. The term “non-dominant” should be revised, as this hemisphere contributes significantly to essential cognitive functions in the human brain.

DOI： 10.3390/cancers16061161

Analysis of genomic landscape and tumor evolution in astroblastoma by whole-genome sequencing

Yamamoto, R; Nakashima, T; Sugihara, Y; Funakoshi, Y; Yajima, H; Tateishi, K; Suzuki, T; Saito, R; Narita, Y; Nobusawa, S; Suzuki, H

CANCER SCIENCE 115 巻頁： 386 - 386 2024年3月

Multi-omics analysis dissecting the intra- and inter-tumoral heterogeneity underlying glioblastoma pathogenesis

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

CANCER SCIENCE 115 巻頁： 1690 - 1690 2024年3月

Establishment of organoids and elucidation of the mechanism of malignant transformation of choroid plexus tumors

Maeda, S; Ohoka, F; Motomura, K; Yamaguchi, J; Saito, R

CANCER SCIENCE 115 巻頁： 2084 - 2084 2024年3月

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

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

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

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

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

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

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

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

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

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

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

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

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

IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMAS, H3 G34-MUTANT

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

NEURO-ONCOLOGY 25 巻 2023年11月

Epileptogenic zone in Broca's area is resectable under awake surgery in accordance with the hodotopic framework: A case report 査読有り

Suzuki, T; Ishizaki, T; Maesawa, S; Hashida, M; Mutoh, M; Ito, Y; Tanei, T; Saito, R

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY 112 巻頁： 84 - 87 2023年11月

Minor Suture Fusion is Associated With Chiari Malformation in Nonsyndromic Craniosynostosis 査読有り国際誌 Open Access

Mizutani, K; Kurimoto, M; Nagakura, M; Nawashiro, T; Nagai, T; Aoki, K; Kato, M; Saito, R

JOURNAL OF CRANIOFACIAL SURGERY 34 巻 ( 8 ) 頁： 2308 - 2312 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：Journal of Craniofacial Surgery

Here, we focused on the association between minor suture fusion and Chiari malformation (CM) occurrence in nonsyndromic craniosynostosis (NSC), and evaluated how the minor suture affects the posterior cranial fossa by measuring the posterior fossa deflection angle (PFA). In this retrospective study, the clinical records of 137 patients who underwent surgery for NSC at Aichi Children's Health and Medical Center between April 2010 and May 2022 were analyzed. Clinical data from Aichi Developmental Disability Center Central Hospital was collected for 23 patients as the external validation set. Among the 137 patients, 123 were diagnosed with NSC and the remaining 14 with syndromic craniosynostosis. Of the 123 NSC patients, 23 patients presented with CM. Multivariate analysis showed that occipito-mastoid fusion was the only significant risk factor for CM (P=0.0218). Within the NSC group, CM patients had a significantly increased PFA (6.33±8.10 deg) compared with those without CM (2.76±3.29 deg, P=0.0487). Nonsyndromic craniosynostosis patients with occipito-mastoid suture fusion had a significantly increased PFA (6.50±7.60 deg) compared with those without occipito-mastoid fusion (2.60±3.23 deg, P=0.0164). In the validation cohort, occipito-mastoid suture fusion was validated as an independent risk factor for CM in univariate analysis. Minor suture fusion may cause CM associated with NSC. Chiari malformation could develop due to an increased PFA due to minor suture fusion, which causes growth disturbance in the affected side and compensatory dilation in the contralateral side within the posterior cranial fossa.

DOI： 10.1097/SCS.0000000000009552

Local Delivery of Nimustine Hydrochloride against Brain Tumors: Basic Characterization Study Open Access

Shao, XD; Saito, R; Sato, A; Okuno, S; Saigusa, D; Saito, R; Uruno, A; Osada, Y; Kanamori, M; Tominaga, T

TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 261 巻 ( 3 ) 頁： 187 - 194 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：Tohoku Journal of Experimental Medicine

Convection-enhanced delivery (CED) delivers agents directly into tumors and the surrounding parenchyma. Although a promising concept, clinical applications are often hampered by insufficient treatment efficacy. Toward developing an effective CED-based strategy for delivering drugs with proven clinical efficacy, we performed a basic characterization study to explore the locally delivered characteristics of the water soluble nitrosourea nimustine hydrochloride (ACNU). First, ACNU distribution after CED in rodent brain was studied using mass spectrometry imaging. Clearance of14C-labeled ACNU after CED in striatum was also studied. ACNU was robustly distributed in rodent brain similar to the distribution of the hydrophilic dye Evans blue after CED, and locally delivered ACNU was observed for over 24 h at the delivery site. Subsequently, to investigate the potential of ACNU to induce an immunostimulative microenvironment, Fas and transforming growth factor-β1 (TGF-β1) was assessed in vitro. We found that ACNU significantly inhibited TGF-β1 secretion and reduced Fas expression. Further, after CED of ACNU in 9L-derived intracranial tumors, the infiltration of CD4/CD8 lymphocytes in tumors was evaluated by immunofluorescence. CED of ACNU in xenografted intracranial tumors induced tumor infiltration of CD4/ CD8 lymphocytes. ACNU has a robust distribution in rodent brain by CED, and delayed clearance of the drug was observed at the local infusion site. Further, local delivery of ACNU affects the tumor microenvironment and induces immune cell migration in tumor. These characteristics make ACNU a promising agent for CED.

DOI： 10.1620/tjem.2023.J069

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

IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMAS, H3 G34-MUTANT

Kibe, Y; Ohka, F; Motomura, K; Aoki, K; Maeda, S; Yamaguchi, J; Shimizu, H; 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

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

Higher abundance of Campylobacter in the oral microbiome of Japanese patients with moyamoya disease 査読有り Open Access

Takayanagi, K; Kanamori, F; Ishii, K; Yokoyama, K; Araki, Y; Sumitomo, M; Maeda, S; Goto, S; Ota, S; Nagata, Y; Nishihori, M; Maesawa, S; Izumi, T; Takasu, S; Saito, R

SCIENTIFIC REPORTS 13 巻 ( 1 ) 頁： 18545 2023年10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：Scientific Reports

Genetic factors alone cannot explain the pathophysiology of moyamoya disease (MMD), and environmental factors such as an immune response are thought to be involved. Oral and gut microbiomes have attracted attention as environmental factors in the pathophysiology of some vascular and autoimmune diseases. However, the relationship between MMD and these microbiomes is yet to be thoroughly investigated. This prospective case–control study aimed to compare the microbiomes of Japanese patients with MMD with those of healthy individuals to identify the specific bacteria involved in MMD. Saliva and fecal samples were collected from 16 patients with MMD who had not undergone revascularization surgery. Fifteen healthy individuals were matched for age, sex, and body mass index. The microbiomes were determined using 16S rRNA sequencing and analyzed using QIIME2. Differentially abundant microbes were identified using LEfSE and ANCOM-BC. In the oral microbiome, the two analytical methods showed that Campylobacter was more abundant in patients with MMD than in healthy individuals. Differences in the gut microbiome were smaller than those in the oral microbiome. In conclusion, the oral microbiome profiles of patients with MMD significantly differ from those of healthy individuals. Campylobacter spp. could be a substantial environmental factor in the pathophysiology of MMD.

DOI： 10.1038/s41598-023-45755-3

Development of machine learning models for predicting unfavorable functional outcomes from preoperative data in patients with chronic subdural hematomas 査読有り Open Access

Fuse, Y; Nagashima, Y; Nishiwaki, H; Ohka, F; Muramatsu, Y; Araki, Y; Nishimura, Y; Ienaga, J; Nagatani, T; Seki, Y; Watanabe, K; Ohno, K; Saito, R

SCIENTIFIC REPORTS 13 巻 ( 1 ) 頁： 16997 2023年10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：Scientific Reports

Chronic subdural hematoma (CSDH) often causes neurological deterioration and is treated with hematoma evacuation. This study aimed to assess the feasibility of various machine learning models to preoperatively predict the functional outcome of patients with CSDH. Data were retrospectively collected from patients who underwent CSDH surgery at two institutions: one for internal validation and the other for external validation. The poor functional outcome was defined as a modified Rankin scale score of 3–6 upon hospital discharge. The unfavorable outcome was predicted using four machine learning algorithms on an internal held-out cohort (n = 188): logistic regression, support vector machine (SVM), random forest, and light gradient boosting machine. The prediction performance of these models was also validated in an external cohort (n = 99). The area under the curve of the receiver operating characteristic curve (ROC-AUC) of each machine learning-based model was found to be high in both validations (internal: 0.906–0.925, external: 0.833–0.860). In external validation, the SVM model demonstrated the highest ROC-AUC of 0.860 and accuracy of 0.919. This study revealed the potential of machine learning algorithms in predicting unfavorable outcomes at discharge among patients with CSDH undergoing burr hole surgery.

DOI： 10.1038/s41598-023-44029-2

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

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

WORLD NEUROSURGERY 178 巻頁： E230 - E238 2023年10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：World Neurosurgery

Objective: To compare the surgical and radiographic outcomes of occipitocervical fusion (OCF) with those of atlantoaxial fusion (AAF) in patients with cervical myelopathy caused by retroodontoid pseudotumors (ROPs). Methods: This retrospective, comparative study included 26 patients; 12 underwent occipitocervical fusion (OCF) (group O) and 14 retroodontoid pseudotumor (AAF) (group A) with a minimum 2-year follow-up. Neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) score. Radiologic assessment included the maximum anteroposterior (AP) diameter of the anteroposterior-retroodontoid pseudotumor (AP-ROP), C2-7 angle, O-C2 angle, C1-2 angle, atlantodental interval (ADI), range of motion (ROM) of the ADI, C2–C7 sagittal vertical axis (C2-7 SVA), and T1 slope. Global spinal alignments (pelvic incidence [PI] minus lumbar lordosis [LL] [PI–LL], pelvic tilt, sacral slope, and C7 sagittal vertical axis) were also compared between the groups. Results: Both groups had equally good clinical outcomes with equal complication rates. Three patients had a three-level fusion, 5 cases had a four-level fusion, and 4 cases had more than five-level fusion in group O. All cases had a single-level fusion in group A. Surgical time was significantly shorter in group A. AP-ROP was significantly downsized postoperatively in both groups and was more prominent in group O. C2-7 SVA was significantly increased and C2-7A ROM was significantly reduced in group O at the final follow-up. The PI-LL showed a significant increase in group O at the final follow-up. Conclusions: Although OCF and AAF were similarly effective for cervical myelopathy with ROP, AAF was less invasive, and spinal alignment was better maintained postoperatively in AAF than OCF.

DOI： 10.1016/j.wneu.2023.07.038

Focus disconnection of the SEEG-identified epileptic network by radiofrequency thermal coagulation 査読有り Open Access

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

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY 111 巻頁： 17 - 20 2023年10月

Paroxysmal Sympathetic Hyperactivity in Stroke 査読有り

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

WORLD NEUROSURGERY 178 巻頁： 28 - 36 2023年10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：World Neurosurgery

Objective: Paroxysmal sympathetic hyperactivity (PSH) is a life-threatening neurological emergency associated with severe brain injury. Stroke-related PSH, particularly post-aneurysmal subarachnoid hemorrhage (aSAH) PSH, has been relatively understudied and is often misdiagnosed as an aSAH-related hyperadrenergic crisis. This study aims to clarify the feature of stroke-related PSH. Methods: This study discusses the case of a patient with post-aSAH PSH and identifies 19 articles (25 cases) on stroke-related PSH by searching the PubMed database from 1980 to 2021. Results: In the total cohort, 15 (60.0%) patients were male and the average age was 40.1 ± 16.6 years. The primary diagnoses included intracranial hemorrhage (13 cases, 52.0%), cerebral infarction (7 cases, 28.0%), subarachnoid hemorrhage (4 cases, 16.0%), and intraventricular hemorrhage (1 case, 4.0%). The sites of stroke damage were predominantly the cerebral lobe (10 cases, 40.0%), basal ganglia (8 cases, 32.0%), and the pons (4 cases, 16.0%). The median time of PSH onset after admission was 5 (1–180) days. Most cases employed combination therapy with sedation drugs, beta-blockers, gabapentin, and clonidine. On the Glasgow Outcome Scale, outcomes included death (4 cases, 21.1%), vegetative state (2 cases, 10.5%), severe disability (7 cases, 36.8%), and in only one case (5.3%) was a good recovery noted. Conclusions: The clinical features and treatment of post-aSAH PSH differed from those of aSAH-related hyperadrenergic crises. Early diagnosis and treatment can prevent severe complications. PSH should be acknowledged as a potential complication of aSAH. Differential diagnosis can aid in developing individualized treatment plans and improving patient prognosis.

DOI： 10.1016/j.wneu.2023.07.002

Development and validation of machine learning models to predict postoperative infarction in moyamoya disease 査読有り国際誌

Fuse, Y; Ishii, K; Kanamori, F; Oyama, S; Imaizumi, T; Araki, Y; Yokoyama, K; Takasu, S; Seki, Y; Saito, R

JOURNAL OF NEUROSURGERY 141 巻 ( 4 ) 頁： 927 - 935 2023年10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 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 国際誌 Open Access

Shingai, Y; Kanamori, M; Shimoda, Y; Kayano, S; Nemoto, H; Mugikura, S; Saito, R; Tominaga, T

NEUROSURGICAL REVIEW 46 巻 ( 1 ) 頁： 259 - 259 2023年9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

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 査読有り国際誌 Open Access

Tanei, T; Maesawa, S; Nishimura, Y; Nagashima, Y; Ishizaki, T; Ando, M; Kuwatsuka, Y; Hashizume, A; Kurasawa, S; Saito, R

TRIALS 24 巻 ( 1 ) 頁： 604 - 604 2023年9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: 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 査読有り

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

JOURNAL OF NEUROPSYCHOLOGY 18 Suppl 1 巻 ( S1 ) 頁： 73 - 84 2023年9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：Journal of Neuropsychology

Patients with diffuse frontal gliomas often present with post-operative apathy after tumour removal. However, the association between apathy and tumour removal of gliomas from the frontal lobe remains unknown. This study aimed to investigate the factors influencing post-operative apathy after tumour removal in patients with diffuse frontal gliomas. We compared the demographics and clinical characteristics of patients with and without post-operative apathy in a cohort of 54 patients who underwent awake brain mapping for frontal gliomas. The frequency of clinical parameters such as left-sided involvement, high-grade tumour types (WHO grades III, IV), main tumour location in the anterior cingulate gyrus (ACC) and/or dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) was significantly greater in the apathetic group compared to the non-apathetic group. The apathetic group scored significantly lower on neuropsychological assessments such as the Letter Fluency Test among the Word Fluency Tests than the non-pathetic group (p =.000). Moreover, the scores of Parts 3, and 3–1 of the Stroop test were significantly lower in the apathetic group than those in the non-apathetic group (p =.023,.027, respectively). Multivariate model analysis revealed that the appearance of post-operative apathy was significantly related to side of the of lesion [left vs. right, hazard ratio (HR) = 8.00, 95% confidence interval (CI) = 1.36–46.96, p =.021], location of the main tumour in the frontal lobe (ACC/DLPFC/OFC vs. others, HR = 7.99, 95% CI = 2.16–29.59, p =.002), and the Letter Fluency Test (HR =.37, 95% CI =.15–.90, p =.028). Post-operative apathy is significantly associated with ACC and/or DLPFC and OFC in the left hemisphere of diffuse frontal gliomas. Apathy in frontal gliomas is correlated with a decline in the Letter Fluency Test scores. Therefore, this instrument is a potential predictor of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping.

DOI： 10.1111/jnp.12345

[Ependymoma in WHO Classification of Tumours 5th Edition]. 招待有り査読有り

Saito R

No shinkei geka. Neurological surgery 51 巻 ( 5 ) 頁： 867 - 875 2023年9月

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 63 巻 ( Suppl. ) 頁： S246 - S246 2023年9月

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 99 巻 ( S.HPT ) 頁： 4 - 6 2023年8月

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 286 巻 ( 9 ) 頁： 707 - 713 2023年8月

TUG1-mediated R-loop resolution at microsatellite loci as a prerequisite for cancer cell proliferation 査読有り国際誌 Open Access

Suzuki, MM; Iijima, K; Ogami, K; Shinjo, K; Murofushi, Y; Xie, JQ; Wang, XB; Kitano, Y; Mamiya, A; Kibe, Y; Nishimura, T; Ohka, F; Saito, R; Sato, S; Kobayashi, J; Yao, R; Miyata, K; Kataoka, K; Suzuki, HI; Kondo, Y

NATURE COMMUNICATIONS 14 巻 ( 1 ) 頁： 4521 - 4521 2023年8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：Nature Communications

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 査読有り国際誌

Tsukada, T; Izumi, T; Nishihori, M; Araki, Y; Uda, K; Yokoyama, K; Saito, R

INTERVENTIONAL NEURORADIOLOGY 頁： 15910199231195135 - 15910199231195135 2023年8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：Interventional Neuroradiology

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 査読有り国際誌

Muraoka, S; Asai, T; Fukui, T; Ota, S; Shimato, S; Koketsu, N; Nishizawa, T; Araki, Y; Saito, R

NEUROSURGICAL REVIEW 46 巻 ( 1 ) 頁： 195 - 195 2023年8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

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 査読有り国際誌

Ota, S; Yokoyama, K; Kanamori, F; Mamiya, T; Uda, K; Araki, Y; Wakabayashi, T; Yoshikawa, K; Saito, R

ACTA NEUROCHIRURGICA 165 巻 ( 8 ) 頁： 2045 - 2055 2023年8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

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

Ishii, M; Nishimura, Y; Hara, M; Yamamoto, Y; Nagashima, Y; Tanei, T; Takayasu, M; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 8 ) 頁： 350 - 355 2023年8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

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 招待有り査読有り国際誌

Yamaguchi, J; Ohka, F; Motomura, K; Saito, R

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 53 巻 ( 8 ) 頁： 653 - 663 2023年7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：Japanese Journal of Clinical Oncology

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 査読有り

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

CUREUS JOURNAL OF MEDICAL SCIENCE 15 巻 ( 7 ) 頁： e42510 2023年7月

Brain metastasis and intracranial leptomeningeal metastasis from malignant peripheral nerve sheath tumors: illustrative cases 査読有り国際誌 Open Access

Ohno, M; Haimoto, S; Tsukushi, S; Hosoda, W; Ohka, F; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 6 巻 ( 3 ) 2023年7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

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

膠芽腫摘出における5-アミノレブリン酸による蛍光診断の意義

金森政之, 斎藤竜太, 下田由輝, 冨永悌二

日本レーザー医学会誌 44 巻 ( 2 ) 頁： 164 - 170 2023年7月

記述言語：日本語出版者・発行元：特定非営利活動法人日本レーザー医学会

初発膠芽腫摘出における5-アミノレブリン酸（5-ALA）による蛍光診断所見と腫瘍制御の関係を明らかにすることを目的とした．当施設で5-ALAによる蛍光診断下に造影病変の可及的切除を施行した初発膠芽腫41例を対象とし，術中蛍光診断所見と術後造影の残存，再発部位について解析した．結果，蛍光病変全摘出はMRI上の造影病変全摘出と相関していた．さらに肉眼的全摘出・追加切除後の蛍光残存部分から再発する傾向が認められた．以上より，5-ALAによる蛍光診断所見から，術中の摘出度判断，および局所治療を強化すべき部位の推定につながる可能性が示唆された．

DOI： 10.2530/jslsm.jslsm-44_0015

Two-Piece Craniotomy Is Associated With Improved Postoperative Outcomes of Combined Revascularization in Patients With Moyamoya Disease 査読有り

Surgical reconstruction for spheno-orbital meningioma extending into the sphenoid sinus with hyperostosis 査読有り国際誌

Maki, T; Ito, E; Saito, K; Saito, R

CLINICAL CASE REPORTS 11 巻 ( 7 ) 頁： e7705 2023年7月

Kanamori, F; Takasu, S; Hatano, N; Araki, Y; Seki, Y; Saito, R

STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY 3 巻 ( 4 ) 2023年7月

振戦優位型パーキンソン病(TD-PD)におけるMRガイド下集束超音波治療(MRgFUS)の適応判断と治療効果

中坪大輔, 津川隆彦, 加藤祥子, 前澤聡, 坪井崇, 鈴木将史, 鳥居潤, 武藤学, 伊藤芳記, 若林俊彦, 勝野雅央, 齋藤竜太

パーキンソン病・運動障害疾患コングレスプログラム・抄録集 17回巻頁： 101 - 101 2023年7月

Connectivity alteration in thalamic nuclei and default mode network-related area in memory processes in mesial temporal lobe epilepsy using magnetoencephalography 査読有り国際誌 Open Access

Ishizaki, T; Maesawa, S; Nakatsubo, D; Yamamoto, H; Torii, J; Mutoh, M; Natsume, J; Hoshiyama, M; Saito, R

SCIENTIFIC REPORTS 13 巻 ( 1 ) 頁： 10632 - 10632 2023年6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：Scientific Reports

This work aimed to investigate the involvement of the thalamic nuclei in mesial temporal lobe epilepsy (MTLE) and identify the influence of interictal epileptic discharges on the neural basis of memory processing by evaluating the functional connectivity (FC) between the thalamic nuclei and default mode network-related area (DMNRA) using magnetoencephalography. Preoperative datasets of nine patients with MTLE with seizure-free status after surgery and those of nine healthy controls were analyzed. The FC between the thalamic nuclei (anterior nucleus [ANT], mediodorsal nucleus [MD], intralaminar nuclei [IL]), hippocampus, and DMNRA was examined for each of the resting, pre-spike, spike, and post-spike periods in the delta to ripple bands using magnetoencephalography. The FC between the ANT, MD, hippocampus, and medial prefrontal cortex increased in the gamma to ripple bands, whereas the FC between the ANT, IL, and DMNRA decreased in the delta to beta bands, compared with that of the healthy controls at rest. Compared with the rest period, the pre-spike period had significantly decreased FC between the ANT, MD, and DMNRA in the ripple band. Different FC changes between the thalamic nuclei, hippocampus, and DMNRA of specific connections in a particular band may reflect impairment or compensation in the memory processes.

DOI： 10.1038/s41598-023-37834-2

Differential target multiplexed spinal cord stimulation using a paddle-type lead placed at the appropriate site for neuropathic pain after spinal cord injury in patients with past spinal surgical histories: study protocol for an exploratory clinical trial 査読有り国際誌 Open Access

Tanei, T; Maesawa, S; Nishimura, Y; Nagashima, Y; Ishizaki, T; Ando, M; Kuwatsuka, Y; Hashizume, A; Kurasawa, S; Saito, R

TRIALS 24 巻 ( 1 ) 頁： 395 - 395 2023年6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: Neuropathic pain after spinal cord injury (SCI), both traumatic and non-traumatic, is refractory to various treatments. Spinal cord stimulation (SCS) is one of the neuromodulation therapies for neuropathic pain, although SCS has insufficient efficacy for neuropathic pain after SCI. The reasons are presumed to be inappropriate locations of SCS leads and conventional tonic stimulation itself does not have a sufficient analgesic effect for the pain. In patients with past spinal surgical histories, the cylinder-type leads are likely to be placed on the caudal side of the SCI because of surgical adhesions. Differential target multiplexed (DTM) stimulation is one of the latest new stimulation patterns that is superior to conventional stimulation. Methods: A single-center, open-label, randomized, two-way crossover trial is planned to investigate the efficacy of SCS using DTM stimulation placing a paddle lead at the appropriate site for neuropathic pain after SCI in patients with spinal surgical histories. The paddle-type lead delivers energy more efficiently than a cylinder-type lead. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). The primary outcome is rates of achieving pain improvement with more than 33% reduction 3 months after SCS system implantation. The secondary outcomes are to be evaluated as follows: (1) effectiveness of DTM and tonic stimulations during the SCS trial; (2) changes of assessment items from 1 to 24 months; (3) relationships between the result of the SCS trial and the effects 3 months after SCS system implantation; (4) preoperative factors associated with a long-term effect, defined as continuing for more than 12 months; and (5) whether gait function improves from 1 to 24 months. Discussion: A paddle-type lead placed on the rostral side of SCI and using DTM stimulation may provide significant pain relief for patients with intractable neuropathic pain after SCI in patients with past spinal surgical histories. Trial registration: Japan Registry of Clinical Trials (jRCT) jRCT 1042220093. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.

DOI： 10.1186/s13063-023-07433-7

Rapid detection of the MYD88 L265P mutation for pre- and intra-operative diagnosis of primary central nervous system lymphoma 査読有り国際誌 Open Access

Yamaguchi, J; Ohka, F; Kitano, Y; Maeda, S; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Hattori, H; Tsujiuchi, T; Motomura, A; Nishikawa, T; Kibe, Y; Shinjo, K; Kondo, Y; Saito, R

CANCER SCIENCE 114 巻 ( 6 ) 頁： 2544 - 2551 2023年6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：Cancer Science

The myeloid differentiation primary response gene 88 (MYD88) L265P mutation is a disease-specific mutation of primary central nervous system lymphoma (PCNSL) among the central nervous system tumors. Accordingly, this mutation is considered a reliable diagnostic molecular marker of PCNSL. As the intra-operative diagnosis of PCNSL is sometimes difficult to achieve using histological examinations alone, intra-operative detection of the MYD88 L265P mutation could be effective for the accurate diagnosis of PCNSL. Herein, we aimed to develop a novel rapid genotyping system (GeneSoC) using real-time polymerase chain reaction (PCR) based on microfluidic thermal cycling technology. This real-time PCR system shortened the analysis time, which enabled the detection of the MYD88 L265P mutation within 15 min. Rapid detection of the MYD88 L265P mutation was performed intra-operatively using GeneSoC in 24 consecutive cases with suspected malignant brain tumors, including 10 cases with suspected PCNSL before surgery. The MYD88 L265P mutation was detected in eight cases in which tumors were pathologically diagnosed as PCNSL after the operation, while wild-type MYD88 was detected in 16 cases. Although two of the 16 cases with wild-type MYD88 were pathologically diagnosed as PCNSL after the operation, MYD88 L265P could be detected in all eight PCNSL cases harboring MYD88 L265P. The MYD88 L265P mutation could also be detected using cell-free DNA derived from the cerebrospinal fluid of two PCNSL cases. Detection of the MYD88 L265P mutation using GeneSoC might not only improve the accuracy of intra-operative diagnosis of PCNSL but also help the future pre-operative diagnosis through liquid biopsy of cerebrospinal fluid.

DOI： 10.1111/cas.15762

Efficacy and safety of bevacizumab, irinotecan, and temozolomide combination for relapsed or refractory pediatric central nervous system embryonal tumor: a single-institution study 査読有り国際誌

Shiba, Y; Motomura, K; Taniguchi, R; Kurimoto, M; Mizutani, K; Ohka, F; Aoki, K; Ito, E; Nishikawa, T; Yamaguchi, J; Kibe, Y; Shimizu, H; Maeda, S; Nakashima, T; Suzuki, H; Muramatsu, H; Takahashi, Y; Saito, R

JOURNAL OF NEUROSURGERY-PEDIATRICS 31 巻 ( 6 ) 頁： 624 - 632 2023年6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 This study aimed to evaluate the efficacy and safety of combination therapy with bevacizumab (Bev), irinotecan (CPT-11), and temozolomide (TMZ) in children with central nervous system (CNS) embryonal tumor relapse. METHODS The authors retrospectively examined 13 consecutive pediatric patients with relapsed or refractory CNS embryonal tumors who received combination therapy comprising Bev, CPT-11, and TMZ. Specifically, 9 patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumor (AT/RT), and 1 had CNS embryonal tumor with rhabdoid features. Of the 9 medulloblastoma cases, 2 were categorized in the Sonic hedgehog subgroup and 6 in molecular subgroup 3 for medulloblastoma. RESULTS The complete and partial objective response rates were 66.6% in patients with medulloblastoma and 75.0% in patients with AT/RT or CNS embryonal tumors with rhabdoid features. Furthermore, the 12- and 24-month progression-free survival rates were 69.2% and 51.9% for all patients with recurrent or refractory CNS embryonal tumors, respectively. In contrast, the 12- and 24-month overall survival rates were 67.1% and 58.7%, respectively, for all patients with relapsed or refractory CNS embryonal tumors. The authors observed grade 3 neutropenia, thrombocytopenia, proteinuria, hypertension, diarrhea, and constipation in 23.1%, 7.7%, 23.1%, 7.7%, 7.7%, and 7.7% of patients, respectively. Furthermore, grade 4 neutropenia was observed in 7.1% of patients. Nonhematological adverse effects, such as nausea and constipation, were mild and controlled with standard antiemetics. CONCLUSIONS This study demonstrated favorable survival outcomes in patients with relapsed or refractory pediatric CNS embryonal tumors and thus helped to investigate the efficacy of combination therapy comprising Bev, CPT-11, and TMZ. Moreover, combination chemotherapy had high objective response rates, and all adverse events were tolerable. To date, data supporting the efficacy and safety of this regimen in the relapsed or refractory AT/RT population are limited. These findings suggest the potential efficacy and safety of combination chemotherapy in patients with relapsed or refractory pediatric CNS embryonal tumors.

DOI： 10.3171/2023.1.PEDS22345

Radiographic Prediction of the Occipito-C2 Angle Variation with Changes in Distance between the Mandible and Cervical Vertebrae: A Preliminary Study Open Access

Nagashima, Y; Nishimura, Y; Awaya, T; Hata, N; Tanei, T; Ishii, M; Oyama, T; Nishii, T; Fukaya, N; Abe, T; Kato, H; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 5 ) 頁： 200 - 205 2023年5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

The Occipito(O)-C2 angle reflects the correct craniocervical spine alignment; however, the poor image quality of standard intraoperative fluoroscopy at times lead to inaccurate measurements. Herein, we preliminarily investigated the relationship between the O-C2 angle and the Gonion-C2 distance, which is based on the positioning of the mandible and the cervical spine. We enrolled patients who underwent cervical spine radiography in neutral, flexion, and extension positions from January 2020 to Oc-tober 2020. The difference by posture changes for each parameter was defined as the Δ value, and the Spearman’s rank correlation coefficient was determined. Furthermore, we determined the cutoff value of the ΔGonion-C2 distance to predict a decrease of > 10° in the ΔO-C2 angle, which is reported to be related to dysphagia and dyspnea. Seventy-four patients were included. Spearman’s rank correlations for the neutral, flexion, and extension positions were 0.630 (P < 0.001), 0.471 (P < 0.001), and 0.625 (P < 0.001), respectively, while the cutoff values of the ΔGonion-C2 distance for predicting > 10° in the ΔO-C2 angle were 9.3 mm for the neutral flexion change (sensitivity: 0.435, specificity: 0.882) and 8.3 mm for the extension-neutral change (sensitivity: 0.712, specificity: 0.909). The O-C2 angle and Gonion-C2 distances correlated; however, this correlation was weaker in the flexed position. Nevertheless, the ΔGonion-C2 distance can be used as a warning sign for postoperative complications after posterior oc-cipital bone fusion surgery, because a decrease of > 10° in the ΔO-C2 angle can be predicted with high specificity.

DOI： 10.2176/jns-nmc.2022-0251

Clinical Impacts of Stereotactic Electroencephalography on Epilepsy Surgery and Associated Issues in the Current Situation in Japan Open Access

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

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 5 ) 頁： 179 - 190 2023年5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

Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demon-strative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under lim-ited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.

DOI： 10.2176/jns-nmc.2022-0271

[Intraoperative Functional Monitoring in Brain Tumor Surgery]. 招待有り査読有り

Motomura K, Saito R

No shinkei geka. Neurological surgery 51 巻 ( 3 ) 頁： 481 - 489 2023年5月

Secondary aneurysmal bone cyst of the frontal bone with fibrous dysplasia showing rapid expansion: a case report 査読有り

Koketsu, Y; Tanei, T; Kuwabara, K; Hasegawa, T; Kato, T; Maesawa, S; Nishimura, Y; Araki, Y; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 2 ) 頁： 395 - 401 2023年5月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

A 19-year-old woman presented with swelling of the left forehead without pain. She did not have any relevant past or family history. Computed tomography showed destruction of the outer cortex of the frontal bone. A solitary mass lesion with a fluid collection was detected with magnetic resonance imaging. Because the swelling of the left forehead had enlarged rapidly with osteolytic changes, surgical removal of the lesion was performed. The lesion appeared to be enveloped in a fibrous capsule. The soft lesion was removed from the frontal bone. The outer frontal bone was absent, although the inner frontal bone was preserved. Then, the frontal bone was resected with margins from the edge of the erosion. The dura mater under the lesion was intact. A cranioplasty was performed using titanium mesh. On histological examination, the trabecular bones revealed irregular shapes and arrangements, indicating fibrous dysplasia. There was a continuous high-cell-concentration pathological lesion outside the fibrous dysplasia. There were numerous cells, such as mononuclear cells, osteoclast-like multinucleated giant cells, foam cells, and red blood cells. The osteoclast-like multinucleated giant cells and other cells did not show significant nuclear atypia. Immunostaining with H3.3G34W was negative, and the ubiquitin-specific peptidase 6/Tre-2 gene showed no rearrangements. The histopathological diagnosis was secondary aneurysmal bone cyst with fibrous dysplasia. Additional postsurgical therapy was not performed. There has been no evidence of recurrence of the lesion for two years

DOI： 10.18999/nagjms.85.2.395

Erratum (vol 63, pg 158, 2023) Open Access

Yoshikawa, S; Nishimura, Y; Nagashima, Y; Ito, H; Oyama, T; Nishii, T; Gonda, T; Ryu, H; Nomura, K; Hara, M; Takayasu, M; Ginsberg, HJ; Kanemura, T; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 5 ) 頁： 220 - 220 2023年5月

掲載種別：研究論文（学術雑誌）出版者・発行元：Neurologia Medico-Chirurgica

The author’s affiliation information listed at the top of the article was given incorrectly. The authors regret the errors. <Incorrect> Satoshi YOSHIKAWA, 1 Yusuke NISHIMURA, 2 Yoshitaka NAGASHIMA, 2 Hiroshi ITO, 2 Takahiro OYAMA, 2 Tomoya NISHII, 2 Tomomi GONDA, 2 Hiroshi RYU, 1 Kei NOMURA, 1 Masahito HARA, 3 Masakazu TAKAYASU, 4 Howard J GINSBERG, 5 Tokumi KANEMURA, 6 and Ryuta SAITO 2 1 Department of Neurosurgery, General Aoyama Hospital, Toyokawa, Aichi, Japan 2 Department of Neurosurgery, Nagoya University Hospital, Nagoya, Aichi, Japan 3 Department of Neurosurgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan 4 Department of Neurosurgery, Inazawa Manucipal Hospital, Inazawa, Aichi, Japan 5 Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada 6 Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Aichi, Japan The correct affiliation list and numbers given to each author are as follows: <Correct> Satoshi YOSHIKAWA, 1,2 Yusuke NISHIMURA, 2 Yoshitaka NAGASHIMA, 2 Hiroshi ITO, 2 Takahiro OYAMA, 2 Tomoya NISHII, 2 To momi GONDA, 2 Hiroshi RYU, 1 Kei NOMURA, 1 Masahito HARA, 3 Masakazu TAKAYASU, 4 Howard J GINSBERG, 5 Tokumi KANEMURA, 6 and Ryuta SAITO 2 1 Department of Neurosurgery, General Aoyama Hospital, Toyokawa, Aichi, Japan 2 Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan 3 Department of Neurosurgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan 4 Department of Neurosurgery, Inazawa Manucipal Hospital, Inazawa, Aichi, Japan 5 Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada 6 Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Aichi, Japan.

DOI： 10.2176/jns-nmc.er.2021-0390

Effects of superficial temporal artery to middle cerebral artery bypass on postoperative infarction rates among young children (≤ 5 years old) with moyamoya disease 査読有り国際誌

Takasu, S; Kanamori, F; Hatano, N; Seki, Y; Saito, R

NEUROSURGICAL REVIEW 46 巻 ( 1 ) 頁： 87 - 87 2023年4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

Revascularization surgery for young children with moyamoya disease (MMD) is challenging. Although indirect revascularization is preferred because of the technical difficulty in direct anastomosis, higher risks of postoperative infarction remain a problem. We aimed to investigate the effect of superficial temporal artery to middle cerebral artery (STA-MCA) bypass on postoperative outcomes during the acute postoperative period in young children ≤ 5 years old with MMD. This retrospective study included consecutive young children with MMD who underwent surgical revascularization of the anterior cerebral circulation. Groups were determined according to the procedures performed, namely, the combined (STA-MCA bypass with indirect revascularization) and the indirect revascularization groups. The incidences of radiological or symptomatic infarction, transient neurological events, and new neurological deficits that remained at discharge were compared between groups. Of 38 surgical procedures, there were 23 combined and 15 indirect revascularizations. The median age of the patients was 3.0 years, which was significantly different between groups (P <.01). When comparing the postoperative outcomes between groups, the incidences of radiological and symptomatic infarction and new neurological deficits that remained at discharge were significantly lower in the combined revascularization group (P <.05). Logistic regression analysis adjusted for potential confounders found that surgical modality was a statistically significant independent risk factor associated with radiological and symptomatic infarctions (indirect/combined, odds ratio: 10.2; 95% confidence interval: 1.30–79.7; P <.05). STA-MCA bypass combined with indirect revascularization can reduce the incidence of postoperative infarction in young children with MMD and might lead to better neurological outcomes.

DOI： 10.1007/s10143-023-01999-1

Machine learning models predict delayed hyponatremia post-transsphenoidal surgery using clinically available features 査読有り国際誌

Fuse, Y; Takeuchi, K; Nishiwaki, H; Imaizumi, T; Nagata, Y; Ohno, K; Saito, R

PITUITARY 26 巻 ( 2 ) 頁： 237 - 249 2023年4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：Pituitary

Purpose: Delayed hyponatremia (DHN), a unique complication, is the leading cause of unexpected readmission after pituitary surgery. Therefore, this study aimed to develop tools for predicting postoperative DHN in patients undergoing endoscopic transsphenoidal surgery (eTSS) for pituitary neuroendocrine tumors (PitNETs). Methods: This was a single-center, retrospective study involving 193 patients with PitNETs who underwent eTSS. The objective variable was DHN, defined as serum sodium levels < 135 mmol/L at ≥ 1 time between post operative days 3 and 9. We trained four machine learning models to predict this objective variable using the clinical variables available preoperatively and on the first postoperative day. The clinical variables included patient characteristics, pituitary-related hormone levels, blood test results, radiological findings, and postoperative complications. Results: The random forest (RF) model demonstrated the highest (0.759 ± 0.039) area under the curve of the receiver operating characteristic curve (ROC-AUC), followed by the support vector machine (0.747 ± 0.034), the light gradient boosting machine (LGBM: 0.738 ± 0.026), and the logistic regression (0.710 ± 0.028). The highest accuracy (0.746 ± 0.029) was observed in the LGBM model. The best-performing RF model was based on 24 features, nine of which were clinically available preoperatively. Conclusions: The proposed machine learning models with pre- and post-resection features predicted DHN after the resection of PitNETs.

DOI： 10.1007/s11102-023-01311-w

Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy 査読有り国際誌

Yamamoto, S; Nagashima, Y; Maki, H; Nishimura, Y; Araki, Y; Nishihori, M; Noda, T; Imai, T; Kawabata, T; Ueno, M; Nishida, Y; Saito, R

ACTA NEUROCHIRURGICA 165 巻 ( 4 ) 頁： 841 - 848 2023年4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: In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle. Methods: This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications. Results: Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon’s decision or patient requests. Among the 55 punctures, 43.0 ± 16.0 ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4 ml in the BTS-alone group and 49.4 ± 12.9 ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein. Conclusions: The BTS technique is an effective alternative to reoperation with BHC.

DOI： 10.1007/s00701-023-05543-4

Clinical characteristics and radiological features of glioblastoma, IDH-wildtype, grade 4 with histologically lower-grade gliomas 査読有り

Motomura, K; Kibe, Y; Ohka, F; Aoki, K; Yamaguchi, J; Saito, R

BRAIN TUMOR PATHOLOGY 40 巻 ( 2 ) 頁： 48 - 55 2023年4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：Brain Tumor Pathology

The 2021 World Health Organization (WHO) classification of central nervous system tumors applied molecular criteria and further integrated histological and molecular diagnosis of gliomas. This classification allows for the diagnosis of isocitrate dehydrogenase wild-type (IDHwt) glioblastoma (GBM), and WHO grade 4 with histologically lower-grade gliomas (LrGGs), even in the absence of high-grade histopathologic features, such as necrosis and/or microvascular proliferation. They contain at least one of the following molecular features: epidermal growth factor receptor amplification, chromosome 7 gain/10 loss, or telomerase reverse transcriptase promoter mutation. In the imaging features at the time of histological diagnosis, a gliomatosis cerebri growth pattern was frequently observed in these tumors. Furthermore, this growth pattern was significantly higher in IDHwt GBM, WHO grade 4, with histological grade II gliomas. Although the exact prognosis of IDHwt GBM, WHO grade 4, with histologically LGGs remains unknown, its OS was approximately 1–2 years similar to that of histologically IDHwt GBM, WHO grade 4, despite histopathological features similar to IDHmut LrGGs. These findings reinforce the need for the analysis of molecular features, regardless of presenting similar clinical characteristics and imaging features to IDHmut LrGGs.

DOI： 10.1007/s10014-023-00458-5

Easy-to-use machine learning system for the prediction of IDH mutation and 1p/19q codeletion using MRI images of adult-type diffuse gliomas 査読有り

Nishikawa, T; Ohka, F; Aoki, K; Suzuki, H; Motomura, K; Yamaguchi, J; Maeda, S; Kibe, Y; Shimizu, H; Natsume, A; Innan, H; Saito, R

BRAIN TUMOR PATHOLOGY 40 巻 ( 2 ) 頁： 85 - 92 2023年4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：Brain Tumor Pathology

Adult-type diffuse gliomas are divided into Astrocytoma, IDH-mutant, Oligodendroglioma, IDH-mutant and 1p/19q-codeleted and Glioblastoma, IDH-wildtype based on the IDH mutation, and 1p/19q codeletion status. To determine the treatment strategy for these tumors, pre-operative prediction of IDH mutation and 1p/19q codeletion status might be effective. Computer-aided diagnosis (CADx) systems using machine learning have been noted as innovative diagnostic methods. However, it is difficult to promote the clinical application of machine learning systems at each institute because the support of various specialists is essential. In this study, we established an easy-to-use computer-aided diagnosis system using Microsoft Azure Machine Learning Studio (MAMLS) to predict these statuses. We constructed an analysis model using 258 adult-type diffuse glioma cases from The Cancer Genome Atlas (TCGA) cohort. Using MRI T2-weighted images, the overall accuracy, sensitivity, and specificity for the prediction of IDH mutation and 1p/19q codeletion were 86.9%, 80.9%, and 92.0%, and 94.7%, 94.1%, and 95.1%, respectively. We also constructed an reliable analysis model for the prediction of IDH mutation and 1p/19q codeletion using an independent Nagoya cohort including 202 cases. These analysis models were established within 30 min. This easy-to-use CADx system might be useful for the clinical application of CADx in various institutes.

DOI： 10.1007/s10014-023-00459-4

Evaluation of Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlation Analysis of CT and MRI Findings Open Access

Yoshikawa, S; Nishimura, Y; Nagashima, Y; Ito, H; Oyama, T; Nishii, T; Gonda, T; Ryu, H; Nomura, K; Hara, M; Takayasu, M; Ginsberg, HJ; Kanemura, T; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 63 巻 ( 4 ) 頁： 158 - 164 2023年4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

The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morpho-logical traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgi-cally repaired TL burst fractures between January 2013 and December 2020 were retrospectively ana-lyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic mor-phological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were consider-ably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (lo-cal kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multi-variate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities.

DOI： 10.2176/jns-nmc.2021-0390

Increased cerebrospinal fluid S100B protein levels in patients with trigeminal neuralgia and hemifacial spasm 査読有り国際誌

Ito, E; Seki, Y; Saito, K; Saito, R

ACTA NEUROCHIRURGICA 165 巻 ( 4 ) 頁： 959 - 965 2023年4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: The pathophysiology of neurovascular compression syndrome has not been fully elucidated, and cerebrospinal fluid levels of nerve tissue-related markers involved in this disorder have not yet been reported. Methods: We measured cerebrospinal fluid levels of S100B protein, neuron-specific enolase, and myelin basic protein in 21 patients with trigeminal neuralgia, 9 patients with hemifacial spasms, and 10 patients with non-ruptured intracranial aneurysms (control). Cerebrospinal fluid levels of these markers were determined using commercially available assay kits. Results: Both trigeminal neuralgia and hemifacial spasm groups showed significantly increased cerebrospinal fluid levels of S100B compared with the control group (1120 [IQR 391–1420], 766 [IQR 583–1500], and 255 [IQR 190–285] pg/mL, respectively; p = 0.001). There were no statistically significant differences in cerebrospinal fluid levels of neuron-specific enolase or myelin basic protein among the groups. Conclusion: Cerebrospinal fluid S100B levels were significantly higher in patients with trigeminal neuralgia and hemifacial spasm than in controls, which suggests the involvement of S100B in the underlying pathophysiology of neurovascular compression syndrome.

DOI： 10.1007/s00701-022-05434-0

Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis 査読有り国際誌 Open Access

Kanamori, M; Shimoda, Y; Umezawa, R; Iizuka, O; Mugikura, S; Suzuki, K; Ariga, H; Jingu, K; Saito, R; Sonoda, Y; Kumabe, T; Tominaga, T

JOURNAL OF RADIATION RESEARCH 64 巻 ( 2 ) 頁： 428 - 437 2023年3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 Radiation Research

This study investigated the effectiveness and safety of low-dose salvage craniospinal irradiation (CSI) for recurrent germinoma. We retrospectively reviewed long-term tumor control and late adverse effects in 15 recurrent germinoma patients treated at our hospital between 1983 and 2019. Following the first recurrence of germinoma, seven were treated with 24–30 Gy of salvage CSI, three underwent non-CSI, and five were treated with only chemotherapy. CSI achieved a significantly better recurrence-free survival rate after the first recurrence compared to other strategies (100% vs 33%, p < 0.001: log-rank test). To evaluate the safety of salvage CSI, we assessed the outcomes at the final follow-up of seven patients who received salvage CSI at first recurrence and three patients who received salvage CSI at second recurrence. The median follow-up period was 220 months after initial treatment. Five patients who received 40–50 Gy of radiation therapy or underwent multiple radiation therapy before salvage CSI were classified into Group A, whereas five patients treated with platinum-based chemotherapy and 24–32 Gy of radiation therapy to the primary site, whole ventricle, or whole brain were classified into Group B. In Group A, one had endocrine dysfunction and the other had visual dysfunction. None were socially independent. Meanwhile, in Group B, no endocrine or visual dysfunction was found, and three patients were socially independent. Salvage CSI achieved excellent tumor control in recurrent germinoma and was safe in patients initially treated with low-dose radiation therapy and chemotherapy.

DOI： 10.1093/jrr/rrac095

Subcutaneous transplantation of human embryonic stem cells-derived pituitary organoids 査読有り国際誌 Open Access

Sasaki, H; Suga, H; Takeuchi, K; Nagata, Y; Harada, H; Kondo, T; Ito, E; Maeda, S; Sakakibara, M; Soen, M; Miwata, T; Asano, T; Ozaki, H; Taga, S; Kuwahara, A; Nakano, T; Arima, H; Saito, R

FRONTIERS IN ENDOCRINOLOGY 14 巻頁： 1130465 - 1130465 2023年3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：Frontiers in Endocrinology

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 査読有り国際誌

Mamiya, T; Kanamori, F; Yokoyama, K; Ota, A; Karnan, S; Uda, K; Araki, Y; Maesawa, S; Yoshikawa, K; Saito, R

JOURNAL OF NEUROSURGERY 138 巻 ( 3 ) 頁： 709 - 716 2023年3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 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 査読有り国際誌

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

JOURNAL OF NEUROSURGERY 138 巻 ( 3 ) 頁： 724 - 731 2023年3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 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 査読有り国際誌

Sasaki, H; Takeuchi, K; Nagata, Y; Tanahashi, K; Mizuno, A; Harada, H; Kishida, Y; Watanabe, T; Nagatani, T; Saito, R

ACTA NEUROCHIRURGICA 165 巻 ( 3 ) 頁： 667 - 675 2023年3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

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 査読有り国際誌 Open Access

Yamaguchi, J; Ohka, F; Lushun, C; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Ohno, M; Suzaki, N; Takasu, S; Seki, Y; Kano, T; Wakabayashi, K; Oyama, H; Kurahashi, S; Tanahashi, K; Hirano, M; Shimizu, H; Kitano, Y; Maeda, S; Yamazaki, S; Wakabayashi, T; Kondo, Y; Natsume, A; Saito, R

CANCER MEDICINE 12 巻 ( 6 ) 頁： 7116 - 7126 2023年3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：Cancer Medicine

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 査読有り国際誌 Open Access

Akahori, S; Nishimura, Y; Eguchi, K; Nagashima, Y; Ando, R; Awaya, T; Tanei, T; Hara, M; Kanemura, T; Takayasu, M; Saito, R

WORLD NEUROSURGERY 171 巻頁： E516 - E523 2023年3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：World Neurosurgery

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 査読有り国際誌

Ito, E; Sugita, R; Saito, R

CLINICAL CASE REPORTS 11 巻 ( 3 ) 頁： e7086 2023年3月

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 63 巻 ( 3 ) 頁： 182 - 182 2023年3月

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 63 巻 ( 3 ) 頁： 182 - 182 2023年3月

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 査読有り国際誌 Open Access

Natsume, A; Arakawa, Y; Narita, Y; Sugiyama, K; Hata, N; Muragaki, Y; Shinojima, N; Kumabe, T; Saito, R; Motomura, K; Mineharu, Y; Miyakita, Y; Yamasaki, F; Matsushita, Y; Ichimura, K; Ito, K; Tachibana, M; Kakurai, Y; Okamoto, N; Asahi, T; Nishijima, S; Yamaguchi, T; Tsubouchi, H; Nakamura, H; Nishikawa, R

NEURO-ONCOLOGY 25 巻 ( 2 ) 頁： 326 - 336 2023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：Neuro-Oncology

Background: Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in the 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 cutoff. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least 1 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 査読有り国際誌

Otomo, M; Kanamori, M; Sato, S; Shimoda, Y; Watanabe, M; Kawaguchi, T; Saito, R; Tominaga, T

CUREUS JOURNAL OF MEDICAL SCIENCE 15 巻 ( 2 ) 頁： e34672 2023年2月

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 114 巻頁： 205 - 205 2023年2月

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 114 巻頁： 203 - 203 2023年2月

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 114 巻頁： 206 - 206 2023年2月

The usefulness of three-dimensional fusion imaging of spinal arteriovenous malformation by a workstation connected to angiography systems 査読有り

Nagashima, Y; Izumi, T; Nishimura, Y; Nishihori, M; Oyama, T; Matsuo, M; Ito, H; Nishii, T; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 1 ) 頁： 127 - 133 2023年2月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

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 査読有り国際誌 Open Access

Kato, N; Izumi, T; Nishihori, M; Goto, S; Araki, Y; Yokoyama, K; Saito, R

CLINICAL NEUROLOGY AND NEUROSURGERY 225 巻頁： 107583 - 107583 2023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：Clinical Neurology and Neurosurgery

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 査読有り

Otsuka, T; Izumi, T; Yamamoto, M; Seshita, Y; Kohama, T; Nishihori, M; Tsukada, T; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 85 巻 ( 1 ) 頁： 50 - 58 2023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：Nagoya Journal of Medical Science

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 査読有り国際誌 Open Access

Kato, H; Tanei, T; Nishimura, Y; Nagashima, Y; Ishii, M; Nishii, T; Fukaya, N; Abe, T; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 5 巻 ( 7 ) 2023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 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 114 巻頁： 1818 - 1818 2023年2月

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 114 巻頁： 1460 - 1460 2023年2月

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 114 巻頁： 205 - 205 2023年2月

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 114 巻頁： 1460 - 1460 2023年2月

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 114 巻頁： 1818 - 1818 2023年2月

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 114 巻頁： 206 - 206 2023年2月

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 114 巻頁： 203 - 203 2023年2月

A multicenter, randomized, placebo-controlled phase IIb trial of an autologous formalin-fixed tumor vaccine for newly diagnosed glioblastomas. 査読有り国際誌

Yoshihiro Muragaki, Eiichi Ishikawa, Takashi Maruyama, Masayuki Nitta, Taiichi Saito, Soko Ikuta, Takashi Komori, Takakazu Kawamata, Tetsuya Yamamoto, Koji Tsuboi, Akira Matsumura, Hideo Nakamura, Junichiro Kuroda, Tatsuya Abe, Yasutomo Momii, Ryuta Saito, Teiji Tominaga, Yusuke Tabei, Ichiro Suzuki, Yoshiki Arakawa, Susumu Miyamoto, Masao Matsutani, Katsuyuki Karasawa, Yoichi Nakazato, Katsuya Maebayashi, Koichi Hashimoto, Tadao Ohno

Journal of neurosurgery 頁： 1 - 11 2023年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: An autologous formalin-fixed tumor vaccine (AFTV) derived from resected glioblastoma (GBM) tissue can be used against unidentified tumor antigens. Thus, the authors conducted a multicenter double-blind phase IIb trial to investigate the efficacy of an AFTV. METHODS: Eligible patients were adults with supratentorial GBMs, 16-75 years of age, with Karnofsky Performance Scale (KPS) scores ≥ 60%, and no long-term steroid administration. An AFTV comprising fixed paraffin-embedded tumor tissue with immune adjuvants or an identical placebo without fixed tumor tissue was injected intradermally over three courses before and after chemoradiotherapy. The primary and secondary end points were overall survival (OS), progression-free survival (PFS), and 3-year survival rate. RESULTS: Sixty-three patients were enrolled. The average patient age was 61 years. The median KPS score was 80%, and the median resection rate was 95%. The full analysis set of 57 patients indicated no significant difference in OS (p = 0.64) for the AFTV group (median OS 25.6 months, 3-year OS rate 38%) compared with the placebo group (31.5 months and 41%, respectively) and no difference in PFS (median PFS 13.3 months in both groups, p = 0.98). For patients with imaging-based total tumor removal, the 3-year PFS rate was 81% in the AFTV group versus 46% in the placebo group (p = 0.067), whereas the 3-year OS rate was 80% versus 54% (p = 0.16), respectively. Similar results were obtained in the p53-negative subgroups. Severe adverse effects were not observed. CONCLUSIONS: The AFTV may have potential effects in certain patient subgroups. A phase III study for patients with total tumor removal remains warranted to confirm these findings. Clinical trial registration no.: UMIN000010602 (UMIN Clinical Trials Registry).

DOI： 10.3171/2022.12.JNS221221

Imaging features of localized IDH wild-type histologically diffuse astrocytomas: a single-institution case series 査読有り国際誌 Open Access

Kibe, Y; Motomura, K; Ohka, F; Aoki, K; Shimizu, H; Yamaguchi, J; Nishikawa, T; Saito, R

SCIENTIFIC REPORTS 13 巻 ( 1 ) 頁： 23 - 23 2023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：Scientific Reports

Isocitrate dehydrogenase wild-type (IDHwt) diffuse astrocytomas feature highly infiltrative patterns, such as a gliomatosis cerebri growth pattern with widespread involvement. Among these tumors, localized IDHwt histologically diffuse astrocytomas are rarer than the infiltrative type. The aim of this study was to assess and describe the clinical, radiographic, histopathological, and molecular characteristics of this rare type of IDHwt histologically diffuse astrocytomas and thereby provide more information on how its features affect clinical prognoses and outcomes. We retrospectively analyzed the records of five patients with localized IDHwt histologically diffuse astrocytomas between July 2017 and January 2020. All patients were female, and their mean age at the time of the initial treatment was 55.0 years. All patients had focal disease that did not include gliomatosis cerebri or multifocal disease. All patients received a histopathological diagnosis of diffuse astrocytomas at the time of the initial treatment. For recurrent tumors, second surgeries were performed at a mean of 12.4 months after the initial surgery. A histopathological diagnosis of glioblastoma was made in four patients and one of gliosarcoma in one patient. The initial status of IDH1, IDH2, H3F3A, HIST1H3B, and BRAF was “wild-type” in all patients. TERT promoter mutations (C250T or C228T) were detected in four patients. No tumors harbored a 1p/19q codeletion, EGFR amplification, or chromosome 7 gain/10 loss (+ 7/ − 10). We assessed clinical cases of localized IDHwt histologically diffuse astrocytomas that resulted in malignant recurrence and a poor clinical prognosis similar to that of glioblastomas. Our case series suggests that even in patients with histologically diffuse astrocytomas and those who present with radiographic imaging findings suggestive of a localized tumor mass, physicians should consider the possibility of IDHwt histologically diffuse astrocytomas.

DOI： 10.1038/s41598-022-25928-2

Concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated with miliary tuberculosis 査読有り国際誌

Muraoka, S; Oguri, T; Kimura, R; Sakurai, K; Suzuki, Y; Shimizu, H; Shinoda, S; Koketsu, N; Araki, Y; Saito, R

ACTA NEUROCHIRURGICA 165 巻 ( 3 ) 頁： 647 - 650 2023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：Acta Neurochirurgica

Cerebrovascular complications of central nervous system tuberculosis (TB) are predictors of poor prognosis and adverse outcomes. These complications are mainly intracranial arterial involvement, with occasional venous involvement. Here, we present a 67-year-old woman with concurrent cerebral infarction and intracranial tuberculoma induced by the carotid plaque complicated by miliary tuberculosis. Mycobacterium tuberculosis was observed on the luminal side of the carotid plaques in pathological specimens. Treatment with anti-TB drugs alone would likely not cure the patient, as M. tuberculosis would continue to disseminate. Endarterectomy could directly remove the embolic source, and a complete cure was achieved.

DOI： 10.1007/s00701-023-05489-7

Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor 査読有り国際誌

Torii, J; Maesawa, S; Nakatsubo, D; Tsugawa, T; Kato, S; Ishizaki, T; Takai, S; Shibata, M; Wakabayashi, T; Tsuboi, T; Suzuki, M; Saito, R

JOURNAL OF NEUROSURGERY 138 巻 ( 1 ) 頁： 38 - 49 2023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

OBJECTIVE The efficacy of magnetic resonance–guided focused ultrasound (MRgFUS) ablation for essential tremor (ET) is well known; however, no prognostic factors have been established. The authors aimed to retrospectively investigate MRgFUS ablation outcomes and associated factors and to define the cutoff values for each prognostic factor. METHODS Sixty-four Japanese patients who underwent unilateral ventral intermediate nucleus thalamotomy with MRgFUS for ET were included. Follow-up evaluations were performed at 1 week and 1, 3, 6, 12, and 24 months postoperatively. Tremor suppression was evaluated using the Clinical Rating Scale for Tremor (CRST), and adverse effects were recorded postoperatively. Outcome-associated factors were examined preoperatively, intraoperatively, and postoperatively using multivariate analyses. The cutoff values for the prognostic factors were calculated using receiver operating characteristics. RESULTS Percentage improvements in the CRST scores of the affected upper limb were 82.4%, 72.2%, 68.6%, and 65.9% at 1, 3, 6, and 12 months, respectively. Preoperatively, a high skull density ratio (SDR) (p ≤ 0.047), low CRST part B score (used to assess tremors during several tasks) (cutoff value 25, p ≤ 0.041), and nonoccurrence of resting tremors (p = 0.027) were significantly associated with improved tremor control. An intraoperatively high maximum mean temperature (cutoff value 52.5°C, p ≤ 0.047), postoperatively large lesion (cutoff value 3.9 mm in the anterior-posterior direction, p ≤ 0.002; cutoff value 5.0–5.55 mm in the superior-inferior direction, p ≤ 0.026), and small transducer focus correction (p ≤ 0.015) were also associated with improved tremor control. No valid cutoff value was found for SDR. Adverse effects (limb weakness, sensory disturbance, ataxia/walking disturbance, dysgeusia, dysarthria, and facial swelling) occurred transiently and were associated with high SDR, high temperature, high number of sonication sessions, large lesion, and occurrence of resting tremor. Patients who developed leg weakness experienced greater percentage improvement in tremors at 3 months postoperatively than those who did not. CONCLUSIONS MRgFUS ablation could be used to achieve good tremor control with acceptable adverse effects in Japanese patients with ET. The relatively low SDR in Asian ethnic groups as compared with that of Western populations makes treatment difficult; however, the cutoff values obtained in this study may be useful for achieving good treatment outcomes even in such patients.

DOI： 10.3171/2022.3.JNS212460

[Seizure Semiology and Functional Anatomy in the Cerebral Cortex].

Maesawa S, Ishizaki T, Saito R

No shinkei geka. Neurological surgery 51 巻 ( 1 ) 頁： 17 - 28 2023年1月

振戦優位型パーキンソン病(TD-PD)におけるMRガイド下集束超音波治療(MRgFUS)の適応判断と治療効果の検討

中坪大輔, 前澤聡, 津川隆彦, 加藤祥子, 鳥居潤, 武藤学, 伊藤芳記, 坪井崇, 鈴木将史, 若林俊彦, 勝野雅央, 齊藤竜太

日本定位・機能神経外科学会プログラム・抄録集 62回巻頁： 133 - 133 2023年1月

再発小児悪性脳腫瘍に対する手術療法

園田順彦, 松田憲一朗, 伊藤美以子, 齋藤竜太, 金森政之, 金村米博, 冨永悌二

小児の脳神経 48 巻 ( 1 ) 頁： 33 - 38 2023年

記述言語：日本語出版者・発行元：一般社団法人日本小児神経外科学会

7例の小児悪性脳腫瘍を対象に再手術の有用性に関して検討を行った．上衣腫4例の再発までの期間は10～35か月であり，3例は長期生存を得ているが1例は髄腔内播種を来し死亡した．膠芽腫の2例は再発までの期間が短く，全生存期間は1年前後と不良であった．分子生物学的にはIDH1変異，H3 G34変異が認められた．1歳の髄芽腫は分子生物学的にはSHH TP53野生型であり，再摘出と化学療法のみで経過観察とし長期間にわたり寛解を得ている．全例，手術合併症は軽度で，生存例はKPS80以上を維持できている．

DOI： 10.34544/jspn.48.1_33

Speech-language Pathology Rehabilitation in a Case of Jefferson Fracture Complicated with Lower Cranial Nerve Palsies.

Investigation of cystine as differential diagnostic biomarker between astrocytomas and oligodendrogliomas based on global- and targeted analysis using liquid chromatography/tandem mass spectrometric analysis 査読有り

Masahiro Watanabe, Masamitsu Maekawa, Masayuki Kanamori, Minami Yamauchi, Ai Abe, Yoshiteru Shimoda, Ryuta Saito, Hidenori Endo, Nariyasu Mano

Advances in Biomarker Sciences and Technology 5 巻頁： 76 - 85 2023年

Usefulness of Stanch Belt Plus in Postoperative Management after Endovascular Neurosurgery 査読有り国際誌

Nishihori, M; Kawase, R; Izumi, T; Nakase, H; Onishi, E; Saito, R

JOURNAL OF NEUROENDOVASCULAR THERAPY 17 巻 ( 12 ) 頁： 281 - 285 2023年

Latest Treatments and Expectations for Precision Medicine against Malignant Glioma 招待有り査読有り Open Access

Saito R

Japanese Journal of Neurosurgery 32 巻 ( 3 ) 頁： 148 - 153 2023年

担当区分：筆頭著者,　最終著者,　責任著者記述言語：日本語出版者・発行元：Japanese Journal of Neurosurgery

Malignant glioma is one of the most intractable malignant neoplasms. Standard treatment consists of surgery, radiotherapy, and chemotherapy, although substantial therapeutic effects cannot be expected. In particular, the blood‒brain barrier（BBB）protects the central nervous system, reducing the effectiveness of chemotherapy. Temozolomide is the standard treatment, but it only prolongs the median survival time by about two months compared to surgery and radiation. Molecular‒targeted therapies, which have revo-lutionized the treatment of many cancer types, have all failed to treat malignant gliomas, and the focus is now on the spatial and temporal diversity of tumors. In addition, the problem of drug penetration across the BBB has been refocused. Precision medicine is also attracting great expectations, but panel testing can only be done once. Even if an expert panel recommends a treatment, there is a problem in that most treatments have to rely on investigational therapies. It is also known that even if there is a draggable genetic abnormality in tumors, drugs targeting those abnormalities are often ineffective against brain tumors. Therefore, it is necessary that all novel therapeutic approaches, such as virus therapy, neutron capture therapy, and drug delivery techniques like convection‒enhanced delivery, be employed to improve treatment outcomes in malignant glioma. （Received September 12, 2022；accepted January 25, 2023）.

DOI： 10.7887/jcns.32.148

Unique vascular structures of a radicular arteriovenous fistula at the craniocervical junction along the first cervical spinal nerve: A case report. 国際誌 Open Access

Wada K, Tanei T, Hattori K, Hatano H, Fujitani S, Ito R, Kubo H, Nishimura Y, Maesawa S, Saito R

Surgical neurology international 14 巻頁： 85 - 85 2023年

記述言語：英語出版者・発行元：Surgical Neurology International

Background: An arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is a rare vascular malformation. Definitive diagnosis and curative treatment of CCJ AVF are challenging. Case Description: A 77-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed an AVF at the CCJ, which drained into a radicular vein. The lesion was fed by a vertebral artery, anterior and lateral spinal arteries (LSAs), and the occipital artery (OA). There were two unique structures: the LSA originating from the posterior inferior cerebellar artery of the extracranial V3 segment and the OA feeding the shunt. Curative treatment involved two steps: endovascular embolization of feeders using Onyx and surgical shunt disconnection. Feeding arteries were blackened by Onyx, which helped identify the location of the shunt. The shunt was located behind the first cervical (C1) spinal nerve, and the draining vein was confirmed on the deep side of the nerve. A clip was applied to the draining vein distal to the shunt. Tiny vessels supplying the shunt were then coagulated referring to blackened arteries. Conclusion: A radicular AVF at the CCJ along the C1 spinal nerve had unique vascular structures. Definitive diagnosis and curative treatment were achieved by combining endovascular embolization using Onyx and direct surgery.

DOI： 10.25259/SNI_122_2023

Horiike S, Nakajima Y, Matsuo M, Kageyama A, Motomura A, Tsujiuchi T, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 157 - 162 2023年

Simultaneous Aneurysmal Subarachnoid Hemorrhage and Epistaxis in an Untreated Prolactinoma: A Case Report and Literature Review.

Nishihori M, Izumi T, Takeuchi K, Goto S, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 163 - 168 2023年

Sacral arteriovenous fistula with lower thoracic cord edema without perimedullary vein enlargement. Open Access

Ishii M, Nishimura Y, Nagashima Y, Tanei T, Nishihori M, Izumi T, Saito R

Surgical neurology international 14 巻頁： 295 2023年

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

Background: Sacral dural arteriovenous fistulas (AVFs) are often undiagnosed at the initial presentation due to their rarity. Case Description: For 1 year, a 71-year-old man developed progressive motor and sensory disturbances in both legs. Magnetic resonance imaging showed spinal cord edema with mild contrast enhancement at the T9–10 and T12 levels. Although mild venous dilatation was observed only at the cauda equina level, it was not initially recognized as abnormal. Blood and cerebrospinal fluid tests and spinal angiography of the lower thoracic to upper lumbar levels were nonspecific. The patient was unsuccessfully treated with three courses of high-dose intravenous methylprednisolone. Ultimately, following repeat spinal angiography (i.e., including the bilateral internal iliac arteries) that revealed a low-flow sacral dural AVF supplied by the right lateral sacral artery, the patient underwent successful surgical venous AVF occlusion/transection. Conclusion: In cases of spinal cord edema without perimedullary abnormal flow voids, careful spinal angiography including the sacral spine is necessary even if only minimal venous dilation is initially observed at the cauda equina level.

DOI： 10.25259/SNI_606_2023

Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review.

Yokoyama H, Nishihori M, Izumi T, Goto S, Kurimoto M, Kato M, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 177 - 183 2023年

Relief of Central Poststroke Pain Affecting Both the Arm and Leg on One Side by Double-independent Dual-lead Spinal Cord Stimulation Using Fast-acting Subperception Therapy Stimulation: A Case Report.

Tanei T, Maesawa S, Nishimura Y, Nagashima Y, Ishizaki T, Mutoh M, Ito Y, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 15 - 20 2023年

Efficacy of Spinal Cord Stimulation Using Differential Target Multiplexed Stimulation for Intractable Pain of Hereditary Neuropathy with Liability to Pressure Palsies: A Case Report.

Tanei T, Nishimura Y, Nagashima Y, Ishii M, Nishii T, Fukaya N, Abe T, Kato H, Maesawa S, Saito R

NMC case report journal 10 巻 ( 0 ) 頁： 203 - 208 2023年

A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy 国際誌 Open Access

Maesawa, S; Torii, J; Nakatsubo, D; Noda, H; Mutoh, M; Ito, Y; Ishizaki, T; Tsuboi, T; Suzuki, M; Tanei, T; Katsuno, M; Saito, R

FRONTIERS IN HUMAN NEUROSCIENCE 16 巻頁： 1065459 - 1065459 2022年12月

記述言語：英語出版者・発行元：Frontiers in Human Neuroscience

Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.

DOI： 10.3389/fnhum.2022.1065459

Human herpesvirus 6 DNA was not detected in a brain specimen from a patient with mesial temporal sclerosis after status epilepticus due to human herpesvirus 6 infection 国際誌 Open Access

Kawamura, Y; Maesawa, S; Numoto, S; Saito, R; Yoshikawa, T; Okumura, A

EPILEPSIA OPEN 7 巻 ( 4 ) 頁： 817 - 821 2022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：Epilepsia Open

We performed virological analysis of resected brain tissues from a patient with temporal lobe epilepsy associated with mesial temporal sclerosis after febrile status epilepticus caused by human herpesvirus 6 infection. The patient had febrile status epilepticus at 9 months of age associated with human herpesvirus 6 infection. Magnetic resonance imaging revealed reduced water diffusion in the right temporal lobe and hippocampus. Polymerase chain reaction analysis detected 1.6 × 105 copies/μg of human herpesvirus 6 DNA in whole blood, but none in the cerebrospinal fluid. The patient developed temporal lobe epilepsy associated with mesial temporal sclerosis at 67 months of age, necessitating surgical treatment. Anterior temporal lobectomy was performed at 171 months of age. Real-time polymerase chain reaction analysis of resected brain tissues revealed no viral DNA. In our patient, human herpesvirus 6 infection triggered febrile status epilepticus, while direct evidence to prove contribution of HHV-6 to the development of MTS was not obtained.

DOI： 10.1002/epi4.12634

脊椎脊髄疾患における3Dプリンター活用の実際と現状

永島吉孝, 西村由介, 赤堀翔, 竹内和人, 宇田憲司, 伊藤洋, 齋藤竜太

脊髄外科 36 巻 ( 3 ) 頁： 296 - 301 2022年12月

脊椎脊髄疾患における3Dプリンター活用の実際と現状

永島吉孝, 西村由介, 赤堀翔, 竹内和人, 宇田憲司, 伊藤洋, 齋藤竜太

脊髄外科 36 巻 ( 3 ) 頁： 296 - 301 2022年12月

Magnetic Resonance Imaging Scans of Cervical Spinal Cord Ependymoma with Changing Radiological Features over a Short Period of Time 国際誌

Nagashima, Y; Nishimura, Y; Saito, R

WORLD NEUROSURGERY 167 巻頁： 95 - 97 2022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：World Neurosurgery

In a 30-year-old woman with cervical ependymoma, magnetic resonance imaging (MRI) features changed over a short period of time. A T2-weighted MRI scan obtained 1 month before surgery showed an intramedullary tumor with mixed intensity suggesting solid and cystic components at the C4-7 level. Gadolinium-enhanced MRI showed ring enhancement, including a cystic component at the C4-7 level. However, fluorodeoxyglucose positron emission tomography revealed uptake at the C5 level, and another gadolinium-enhanced MRI scan performed 24 days after the previous scan showed only enhanced lesions corresponding to the solid component at the C5-6 level. These images changed over a short time because the spontaneous hematoma, which was enhanced on the first MRI scan, had disappeared later. Fluorodeoxyglucose positron emission tomography or repeated gadolinium-enhanced MRI may be useful if the initial MRI scan suggests the presence of a hematoma in spinal ependymoma.

DOI： 10.1016/J.WNEU.2022.08.116

Endoscopic Trans-Mini-Cylinder Biopsy for Intraparenchymal Brain Lesions 国際誌 Open Access

Takeuchi, K; Ohka, F; Nagata, Y; Maeda, S; Tanahashi, K; Araki, Y; Yamamoto, T; Sasaki, H; Mizuno, A; Harada, H; Saito, R

WORLD NEUROSURGERY 167 巻頁： E1147 - E1153 2022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：World Neurosurgery

Objective: The biopsy procedure is intended to obtain an adequate specimen volume from the targeted area while ensuring minimal damage to the normal brain. We performed navigation-guided endoscopic biopsy using a small-diameter cylinder to reduce the invasiveness of the biopsy procedure and ensure a sufficient amount of tissue is collected. We examined whether it is possible to reduce brain tissue injury by using a small-diameter cylinder and improve safety and effectiveness by using an endoscope to directly observe the lesion and achieve hemostasis. Methods: Patients who underwent endoscopic biopsy surgery using a 6-mm-diameter cylinder for intraparenchymal lesions were enrolled in this study. Postoperative hematoma formation and the extent of trajectory scarring were assessed. Results: Fifty-two procedures performed on 51 patients were analyzed in this study. Postoperative neurological deterioration was not observed in any patient. A pathological diagnosis was made for all patients. Postoperative computed tomography revealed no hematoma after 49 procedures and a small hematoma after 3 procedures, and no patients required additional treatment. A postoperative trajectory scar less than 5 mm in diameter was observed after 30 procedures, a scar of 5–10 mm was observed after 19 procedures, a scar larger than 10 mm was observed after 3 procedures at 1 week after surgery, and 40, 6 and 0 scars were observed at 3 months after surgery. Conclusions: Endoscopic biopsy using a small-diameter cylinder is a possible alternative biopsy technique for intraparenchymal lesions. This surgical technique is useful, especially in patients at risk of hemorrhagic complications.

DOI： 10.1016/j.wneu.2022.08.147

ROLE OF CD79B Y196 MUTATION IN PCNSL AS A POTENT PREDICTIVE MARKER FOR FAVORABLE RESPONSE TO R-MPV TREATMENT AND DEVELOPMENT OF RAPID ALL-IN-ONE GENOTYPING SYSTEM FOR MOLECULAR MARKERS OF PCNSL

Yamaguchi, J, Ohka, F, Lushun, C, Motomura, K, Aoki, K, Takeuchi, K, Nagata, Y, Ito, S, Mizutani, N, Ohno, M, Suzaki, N, Takasu, S, Seki, Y, Tanahashi, K, Hirano, M, Shimizu, H, Kitano, Y, Maeda, S, Yamazaki, S, Wakabayashi, T, Kondo, Y, Saito, R

NEURO-ONCOLOGY 24 巻頁： 18 - 18 2022年11月

ROLE OF CD79B Y196 MUTATION IN PCNSL AS A POTENT PREDICTIVE MARKER FOR FAVORABLE RESPONSE TO R-MPV TREATMENT AND DEVELOPMENT OF RAPID ALL-IN-ONE GENOTYPING SYSTEM FOR MOLECULAR MARKERS OF PCNSL

Yamaguchi, J; Ohka, F; Lushun, C; Motomura, K; Aoki, K; Takeuchi, K; Nagata, Y; Ito, S; Mizutani, N; Ohno, M; Suzaki, N; Takasu, S; Seki, Y; Tanahashi, K; Hirano, M; Shimizu, H; Kitano, Y; Maeda, S; Yamazaki, S; Wakabayashi, T; Kondo, Y; Saito, R

NEURO-ONCOLOGY 24 巻頁： 18 - 18 2022年11月

Abnormal foreshortening of a Flow Re-Direction Endoluminal Device caused by in-stent thrombosis immediately after deployment br

Otsuka, T; Izumi, T; Nishihori, M; Tsukada, T; Goto, S; Ikezawa, M; Kato, N; Nakano, M; Uda, K; Yokoyama, K; Araki, Y; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 4 ) 頁： 884 - 889 2022年11月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Thromboembolic complications are a concern in the treatment of cerebral aneurysms using a flow diverter. In this study, we report a case of abnormal foreshortening of a Flow Re-Direction Endoluminal Device (FRED) caused by in-stent thrombosis immediately after its deployment. A 72-year-old woman had a large cavernous carotid aneurysm, which caused ptosis and diplopia. FRED deployment was planned, and dual antiplatelet therapy was initiated 2 weeks before the procedure. Under systemic heparinization, FRED was deployed with local compaction over the aneurysm orifice. Cone-beam computed tomography subsequently revealed slightly poor wall apposition at the proximal side. While the balloon catheter was prepared for angioplasty, the stent became abnormally foreshortened, the proximal side slipped into the aneurysm, and the internal carotid artery became occluded. FRED was removed using a snare wire, and recanalization was obtained. The lumen of the removed FRED was filled with thrombus. The antiplatelet therapy was changed to triple regimen, and a Pipeline Flex embolization device was placed 1 month later. At that time, no thromboembolic complications were noted. It was considered that thrombotic occlusion was followed by foreshortening of FRED on the distal side because of antegrade blood flow. Multiple factors, such as increased mesh density by locally compacted stent deployment, slightly poor wall apposition, clopidogrel resistance, and the dual-layer structure of FRED, may have been involved in thrombus formation.

DOI： 10.18999/nagjms.84.4.884

CLINICAL AND MOLECULAR FEATURES OF GLIOBLASTOMA, IDH-WILDTYPE ARISING IN THE SETTING OF LI FRAUMENI SYNDROME

Kibe, Y; Ohka, F; Motomura, K; Aoki, K; Maeda, S; Yamaguchi, J; Nishikawa, T; Mizutani, K; Shimizu, H; Hiramatsu, T; Suzuki, K; Saito, R

NEURO-ONCOLOGY 24 巻頁： 154 - 154 2022年11月

Efficacy of comparing coil behavior and distribution using the silicone aneurysm model: difference of coil distribution in the early filling stage

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

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 4 ) 頁： 762 - 771 2022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

This study sought to establish an experimental aneurysm model of visualizing coil insertion using radiolucent nylon coils. Moreover, this study aimed to clarify the characteristics and differences of each coil and use them clinically as indices of coil selection. The coil insertion test was performed on the 10 mm spherical silicone aneurysm model filled to a nylon coil volume embolization ratio of 11.8%. Five types of coil were randomly tested six times, and the distribution of the coils was analyzed by fluoroscopy imaging. Indices of “Area (mm2),” “Feret’s diameter (mm),” and “Circularity” were calculated from the fluoroscopic images. Among the indices, only “Area” showed a significant difference between coils (p = 0.002). On multivariate analysis, “Area” of the ED Infini was larger than those of Target XL soft and Galaxy G3 (p = 0.018 and 0.026, respectively). Furthermore, the area of the 360 soft was larger than that of G3 (p = 0.049). Analysis of the correlation between these values and the coil configuration showed that “Area” was negatively correlated with the stock-wire diameter (r = −0.50; p = 0.004) and primary coil configuration (r = −0.65; p < 0.001). When inserting the coils in the early stage, although the difference between each coil is relatively difficult to obtain, knowledge on the proper use of the coils with differences in characteristics can help in selecting the coil most appropriate for the conditions.

DOI： 10.18999/nagjms.84.4.762

IDENTIFICATION OF A NOVEL THERAPEUTIC TARGET THAT IS SYNTHETICALLY LETHAL WITH MUTANT IDH INHIBITOR IN GLIOMA USING THE CRISPR/CAS9 GENOME EDITING TECHNOLOGY

Maeda, S; Aoki, K; Hinohara, K; Yamaguchi, J; Ohka, F; Motomura, K; Kibe, Y; Natsume, A; Saito, R

NEURO-ONCOLOGY 24 巻頁： 107 - 107 2022年11月

IDENTIFICATION OF A NOVEL THERAPEUTIC TARGET THAT IS SYNTHETICALLY LETHAL WITH MUTANT IDH INHIBITOR IN GLIOMA USING THE CRISPR/CAS9 GENOME EDITING TECHNOLOGY

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

NEURO-ONCOLOGY 24 巻頁： 107 - 107 2022年11月

CLINICAL AND MOLECULAR FEATURES OF GLIOBLASTOMA, IDH-WILDTYPE ARISING IN THE SETTING OF LI FRAUMENI SYNDROME

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

NEURO-ONCOLOGY 24 巻頁： 154 - 154 2022年11月

Persistence of tolvaptan medication for autosomal dominant polycystic kidney disease: A retrospective cohort study using Shizuoka Kokuho Database. 国際誌

Ryuta Saito, Hiroyuki Yamamoto, Nao Ichihara, Hiraku Kumamaru, Shiori Nishimura, Koki Shimada, Kiyoshi Mori, Yoshiki Miyachi, Hiroaki Miyata

Medicine 101 巻 ( 40 ) 頁： e30923 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Autosomal dominant polycystic kidney disease (ADPKD) is a rare hereditary disease leading to end-stage renal failure in approximately half of patients by seventy years of age. It is important to continuously take tolvaptan to control disease progression. However, adherence to tolvaptan in a real-world setting, rather than randomized controlled trials (RCTs), has not been sufficiently reported. We aimed to investigate tolvaptan persistence among patients with ADPKD using a large claims database. Using the Shizuoka Kokuho Database, we identified patients diagnosed with ADPKD who were prescribed tolvaptan from March 2014-September 2018 in Japan. The persistence rate of tolvaptan medication was estimated by Kaplan-Meier analysis, and patient background factors associated with treatment discontinuation were exploratively evaluated with log-rank tests. We identified 1714 eligible patients with ADPKD, and among them, 25 patients used tolvaptan medication. We followed up these patients, whose median treatment duration was 21 months. The persistence rates at 12, 24, and 36 months were estimated to be 70.8% (95% confidence interval: 48.2-93.4), 46.5% (23.2-66.9), and 38.7% (16.4-60.8), respectively. In the exploratory analysis, there were no factors that were obviously associated with tolvaptan discontinuation. The persistence rate of tolvaptan in patients with ADPKD in a real-world setting may be lower than that in previous RCTs. Our innovative method, particularly in Japan, to analyze adherence using large claims data should change the way clinical epidemiological research and health policies of rare diseases are designed in the future.

DOI： 10.1097/MD.0000000000030923

Wearable sensor device-based detection of decreased heart rate variability in Parkinson's disease 国際誌

The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor 査読有り国際誌

Shinoda, S; Muraoka, S; Shimizu, H; Koketsu, N; Araki, Y; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 5 ) 頁： 2995 - 3002 2022年10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

Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5–6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.

DOI： 10.1007/s10143-022-01820-5

Suzuki, M; Nakamura, T; Hirayama, M; Ueda, M; Hatanaka, M; Harada, Y; Nakatochi, M; Nakatsubo, D; Maesawa, S; Saito, R; Fujiwara, K; Katsuno, M

JOURNAL OF NEURAL TRANSMISSION 129 巻 ( 10 ) 頁： 1299 - 1306 2022年10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 Neural Transmission

The evidence that heart rate variability (HRV) decreases during early Parkinson's disease (PD) largely depends on electrocardiogram data. In this study, we examined HRV in PD using wearable sensors and assessed various evaluation methods for detecting disease-related alterations. We evaluated 27 patients with PD and 23 disease controls. The wearable sensors POLAR V800 HR and POLAR H10 were used for the HRV measurements. The participants wore the two sensors for approximately 24 h, and long-term HRV data were acquired. We analyzed the standard deviation of normal R-R intervals (SDNN) and coefficient of variation of R-R intervals (CVRR) for every 100 consecutive beats. Focusing on the fluctuation of SDNN and CVRR, we extracted the minimum, first decile, first quartile, and median values of SDNN and CVRR. The area under the receiver operating characteristic curve (AUC) for each HRV parameter was calculated to differentiate PD from the disease controls. The minimum values of SDNN and CVRR had the highest AUC (SDNN: AUC 0.90, 95% confidence interval [CI] 0.78–0.96; CVRR: AUC 0.90, CI 0.76–0.96) among the evaluation methods tested. The minimum values of SDNN and CVRR were significantly decreased in PD (SDNN: 9.5 ± 4.0 ms vs. 4.4 ± 2.0 ms, p < 0.0001; CVRR: 1.15 ± 0.33% vs. 0.65 ± 0.24%, p < 0.0001). We detected decreased HRV in PD using wearable sensors. Analyzing the minimum values of the HRV parameter in long-term recordings appears to be appropriate for detecting the decrease in HRV in PD.

DOI： 10.1007/s00702-022-02528-y

Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations 国際誌

Takeuchi, K; Nagata, Y; Tanahashi, K; Araki, Y; Mizuno, A; Sasaki, H; Harada, H; Ito, K; Saito, R

ACTA NEUROCHIRURGICA 164 巻 ( 10 ) 頁： 2587 - 2594 2022年10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

Objective: Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique. Methods: We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the “wet-field technique.” Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records. Results: The average maximum CM diameter was 35.3 mm (range: 10–65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed. Conclusions: The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.

DOI： 10.1007/s00701-022-05273-z

Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study 査読有り国際誌 Open Access

Maki, Y; Natsume, J; Ito, Y; Okai, Y; Bagarinao, E; Yamamoto, H; Ogaya, S; Takeuchi, T; Fukasawa, T; Sawamura, F; Mitsumatsu, T; Maesawa, S; Saito, R; Takahashi, Y; Kidokoro, H

AMERICAN JOURNAL OF NEURORADIOLOGY 43 巻 ( 10 ) 頁： 1502 - 1507 2022年10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：American Journal of Neuroradiology

BACKGROUND AND PURPOSE: West syndrome is a developmental and epileptic encephalopathy characterized by epileptic spasms, neurodevelopmental regression, and a specific EEG pattern called hypsarrhythmia. Our aim was to investigate the brain activities related to hypsarrhythmia at onset and focal epileptiform discharges in the remote period in children with West syndrome using simultaneous electroencephalography and fMRI recordings. MATERIALS AND METHODS: Fourteen children with West syndrome underwent simultaneous electroencephalography and fMRI at the onset of West syndrome. Statistically significant blood oxygen level-dependent responses related to hypsarrhythmia were analyzed using an event-related design of 4 hemodynamic response functions with peaks at 3, 5, 7, and 9 seconds after the onset of each event. Six of 14 children had focal epileptiform discharges after treatment and underwent simultaneous electroencephalography and fMRI from 12 to 25 months of age. RESULTS: At onset, positive blood oxygen level-dependent responses were seen in the brainstem (14/14 patients), thalami (13/14), basal ganglia (13/14), and hippocampi (13/14), in addition to multiple cerebral cortices. Group analysis using hemodynamic response functions with peaks at 3, 5, and 7 seconds showed positive blood oxygen level-dependent responses in the brainstem, thalamus, and hippocampus, while positive blood oxygen level-dependent responses in multiple cerebral cortices were seen using hemodynamic response functions with peaks at 5 and 7 seconds. In the remote period, 3 of 6 children had focal epileptiform discharge- related positive blood oxygen level-dependent responses in the thalamus, hippocampus, and brainstem. CONCLUSIONS: Positive blood oxygen level-dependent responses with hypsarrhythmia appeared in the brainstem, thalamus, and hippocampus on earlier hemodynamic response functions than the cerebral cortices, suggesting the propagation of epileptogenic activities from the deep brain structures to the neocortices. Activation of the hippocampus, thalamus, and brainstem was still seen in half of the patients with focal epileptiform discharges after adrenocorticotropic hormone therapy.

DOI： 10.3174/ajnr.A7646

小児脳幹部神経膠腫に対する脳内広範囲薬剤送達技術を用いた塩酸ニムスチン局所投与多施設共同第II相医師主導治験

齋藤竜太, 金森政之, 峰晴陽平, 荒川芳輝, 千葉謙太郎, 藍原康雄, 柴原一陽, 隈部俊宏, 松田憲一朗, 園田順彦, 高橋史朗, 冨永悌二

日本癌治療学会学術集会抄録集 60回巻頁： EN6 - 4 2022年10月

小児脳幹部神経膠腫に対する脳内広範囲薬剤送達技術を用いた塩酸ニムスチン局所投与多施設共同第II相医師主導治験

齋藤竜太, 金森政之, 峰晴陽平, 荒川芳輝, 千葉謙太郎, 藍原康雄, 柴原一陽, 隈部俊宏, 松田憲一朗, 園田順彦, 高橋史朗, 冨永悌二

日本癌治療学会学術集会抄録集 60回巻頁： EN6 - 4 2022年10月

機能的脳神経外科治療が検討された振戦性疾患の診断と治療方針

坪井崇, 鈴木将史, 佐藤茉紀, 平賀経太, 佐竹勇紀, 服部誠, 原一洋, 鳥居潤, 中坪大輔, 前澤聡, 斎藤竜太, 勝野雅央

臨床神経学 62 巻 ( Suppl. ) 頁： S256 - S256 2022年10月

機能的脳神経外科治療が検討された振戦性疾患の診断と治療方針

坪井崇, 鈴木将史, 佐藤茉紀, 平賀経太, 佐竹勇紀, 服部誠, 原一洋, 鳥居潤, 中坪大輔, 前澤聡, 斎藤竜太, 勝野雅央

臨床神経学 62 巻 ( Suppl. ) 頁： S256 - S256 2022年10月

The usefulness and safety of dexmedetomidine for postoperative sedation in pediatric patients with moyamoya disease 国際誌

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

JOURNAL OF NEUROSURGERY-PEDIATRICS 30 巻 ( 3 ) 頁： 301 - 307 2022年9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 After revascularization surgery in pediatric patients with moyamoya disease (MMD), resting and avoiding crying is important. However, this inaction is often difficult because of pain or anxiety. Dexmedetomidine (DEX), which has sedative and analgesic properties, may be useful in reducing those uncomfortable conditions; however, its common side effects include bradycardia and hypotension, which have a risk of decreasing the cerebral blood flow. The aim of this study was to investigate the efficacy and safety of using DEX for pediatric patients with MMD in the acute period after revascularization surgery. METHODS This retrospective study included pediatric patients with MMD who underwent revascularization surgery. Based on whether DEX was used for light sedation during postoperative days (PODs) 0–1 after extubation, the patients were divided into DEX or control groups. For neurological outcomes, the incidence of symptomatic cerebral infarction and transient neurological events (TNEs) during PODs 0–1 and the entire hospitalization were investigated. In addition, the Richmond Agitation-Sedation Scale (RASS) was used to assess the effect of DEX, and bradycardia and hypotension were evaluated as side effects. RESULTS A total of 84 surgical procedures were included in this study (27 in the DEX group and 57 in the control group). During PODs 0–1, symptomatic infarction was not observed in either group. The incidence of TNEs was almost the same in both groups: 2 (7.4%) of the 27 procedures in the DEX group and 4 (7.0%) of the 57 procedures in the control group (p > 0.99). Moreover, the incidences of symptomatic infarction and TNEs during the entire hospitalization did not differ significantly (symptomatic infarction, p > 0.99; TNEs, p = 0.20). Regarding the DEX effect, the median RASS scores during PODs 0–1 were −1.0 (drowsy) in the DEX group and +1.0 (restless) in the control group, showing a significant difference (p < 0.01). Regarding side effects, bradycardia was observed only in 3 (11.1%) of the 27 procedures in the DEX group (p = 0.03), and hypotension was not observed in any of the cases. CONCLUSIONS In pediatric patients with MMD who are extubated after revascularization surgery, DEX produced appropriate light sedation and analgesia. The risk for symptomatic infarction is almost the same in cases in which DEX is used and those in which it is not; however, neurosurgeons should be cautious of bradycardia and TNEs as potential side effects.

DOI： 10.3171/2022.6.PEDS2241

ゲノムおよびトランスクリプトーム解析による膠芽腫の分子的多様性の解明(Dissecting the molecular complexity underlying glioblastoma by genomic and transcriptome profiling)

中島拓真, 舟越勇介, 南部翔平, 畝田篤仁, 片山琴絵, 花谷亮典, 井元清哉, 田中將太, 齋藤竜太, 吉本幸司, 成田善孝, 鈴木啓道

日本癌学会総会記事 81回巻頁： E - 1040 2022年9月

星細胞腫IDH変異型の全ゲノムシークエンスと包括的な分子学的解析(Whole-genome sequencing and comprehensive molecular profiling of Astrocytoma, IDH-mutant)

舟越勇介, 中島拓真, 南部翔平, 畝田篤仁, 片山琴絵, 井元清哉, 花谷亮典, 田中將太, 齋藤竜太, 吉本幸司, 成田善孝, 鈴木啓道

日本癌学会総会記事 81回巻頁： E - 1038 2022年9月

Oligodendroglioma,IDH-mutant and 1p/19q-codeletedのマルチオミクス解析による全ゲノム解析の全貌(Whole genome multi-omics landscape of Oligodenderoglioma, IDH-mutant and 1p/19q-codeleted)

舟越勇介, 南部翔平, 中島拓真, 畝田篤仁, 片山琴絵, 井元清哉, 花谷亮典, 田中將太, 齋藤竜太, 吉本幸司, 成田善孝, 鈴木啓道

日本癌学会総会記事 81回巻頁： E - 1041 2022年9月

True Angina Pectoris Immediately After Cervical Disc Herniation Surgery for Preoperative Cervical Angina Symptoms: A Case Report 国際誌

Abe, T; Tanei, T; Nishimura, Y; Saito, R

CUREUS JOURNAL OF MEDICAL SCIENCE 14 巻 ( 8 ) 頁： e28313 2022年8月

経鼻頭蓋底術後髄液漏の検討

竹内和人, 永田雄一, 佐々木博勇, 水野晃宏, 齋藤竜太

日本内分泌学会雑誌 98 巻 ( S.HPT ) 頁： 25 - 27 2022年8月

ラトケ嚢胞に類似した所見を示した頭蓋咽頭腫の一例

原田英幸, 竹内和人, 永田雄一, 棚橋邦明, 佐々木博勇, 水野晃宏, 井下尚子, 齋藤竜太

日本内分泌学会雑誌 98 巻 ( S.HPT ) 頁： 72 - 73 2022年8月

Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab: illustrative case. 国際誌 Open Access

Ohno M, Kuramitsu S, Iwakoshi A, Yamaguchi J, Ohka F, Saito R

Journal of neurosurgery. Case lessons 4 巻 ( 6 ) 2022年8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 Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab. OBSERVATIONS A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months. LESSONS Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary. https://thejns.org/doi/abs/10.3171/CASE22256.

DOI： 10.3171/CASE22256

Spontaneous regression of asymptomatic tumefactive perivascular spaces in the anterior temporal lobe

Hashida, M; Nagashima, Y; Nishimura, Y; Eguchi, K; Taoka, T; Kawai, H; Saito, R

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 3 ) 頁： 678 - 685 2022年8月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Perivascular spaces are fluid-filled spaces that surround the perforating vessels of the brain and are normal findings on brain imaging. These are usually asymptomatic and are considered a manifestation of aging. Perivascular spaces occasionally undergo significant enlargement and are referred to as tumefactive perivascular spaces, which are often indistinguishable from neoplastic lesions. Spontaneous regression of tumefactive perivascular spaces during follow-up is rare. We report the imaging findings and clinical course of a patient who showed spontaneous regression of tumefactive perivascular spaces in the anterior temporal lobe, together with a literature review and discussion regarding the characteristics and pathogenesis of spontaneous regression of tumefactive perivascular spaces. Most studies in the available literature report tumefactive perivascular spaces in the anterior temporal lobe; in our view, the characteristics of anterior temporal lobe tumefactive perivascular spaces may differ from those of tumefactive perivascular spaces that occur at other locations.

DOI： 10.18999/nagjms.84.3.678

Radiological Analysis of Minimally Invasive Microscopic Laminectomy for Lumbar Canal Stenosis with a Focus on Multilevel Stenosis and Spondylolisthesis 国際誌 Open Access

Awaya, T; Nishimura, Y; Eguchi, K; Nagashima, Y; Ando, R; Akahori, S; Yoshikawa, S; Haimoto, S; Hara, M; Takayasu, M; Saito, R

WORLD NEUROSURGERY 164 巻頁： E224 - E234 2022年8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：World Neurosurgery

Objective: We retrospectively compared the radiological and clinical outcomes of two different surgical techniques (lumbar spinous process splitting laminectomy [LSPSL] and unilateral laminotomy for bilateral decompression [ULBD]) to treat lumbar spinal canal stenosis (LCS). Methods: We performed a retrospective comparative study of 141 consecutive patients with an average age of 70.8 ± 9.4 years who had undergone LSPSL or ULBD for LCS between April 2015 and April 2019. None of the patients had developed remote fractures of the spinous processes using either technique. These cases were divided into 2 groups: group L, 73 patients who had undergone LSPSL from April 2015 to April 2017; and group U, 68 patients who had undergone ULBD from May 2017 to April 2019. The clinical and radiological outcomes and surgical complications at the 1-year postoperative follow-up period were evaluated. Results: We found no significant differences in the operative time between the 2 groups. However, group U had had significantly less blood loss than group L. The facet joints were significantly well preserved in group U. We examined the multilevel and spondylolisthesis cases separately and found that both surgical procedures were equally effective and that the visual analog scale scores for back or leg pain and Japanese Orthopaedic Association scores had significantly improved postoperatively in each group. Group U showed better outcomes in terms of LCS recurrence, with 3 patients in the group L requiring repeat surgery. Conclusions: We found both ULBD and LSPSL to be safe and effective techniques for LCS, even for patients with spondylolisthesis and multilevel disease. ULBD was superior in terms of recurrence prevention, preservation of the facet joints, and less blood loss.

DOI： 10.1016/j.wneu.2022.04.079

Role of the parietooccipital fissure and its implications in the pathophysiology of posterior medial temporal gliomas 国際誌

Shibahara, I; Saito, R; Kanamori, M; Sonoda, Y; Sato, S; Hide, T; Tominaga, T; Kumabe, T

JOURNAL OF NEUROSURGERY 137 巻 ( 2 ) 頁： 505 - 514 2022年8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 The parietooccipital fissure is an anatomical landmark that divides the temporal, occipital, and parietal lobes. More than 40% of gliomas are located in these three lobes, and the temporal lobe is the most common location. The parietooccipital fissure is located just posterior to the medial temporal lobe, but little is known about the clinical significance of this fissure in gliomas. The authors investigated the anatomical correlations between the parietooccipital fissure and posterior medial temporal gliomas to reveal the radiological features and unique invasion patterns of these gliomas. METHODS The authors retrospectively reviewed records of all posterior medial temporal glioma patients treated at their institutions and examined the parietooccipital fissure. To clarify how the surrounding structures were invaded in each case, the authors categorized tumor invasion as being toward the parietal lobe, occipital lobe, isthmus of the cingulate gyrus, insula/basal ganglia, or splenium of the corpus callosum. DSI Studio was used to visualize the fiber tractography running through the posterior medial temporal lobe. RESULTS Twenty-four patients with posterior medial temporal gliomas were identified. All patients presented with a parietooccipital fissure as an uninterrupted straight sulcus and as the posterior border of the tumor. Invasion direction was toward the parietal lobe in 13 patients, the occipital lobe in 4 patients, the isthmus of the cingulate gyrus in 19 patients, the insula/basal ganglia in 3 patients, and the splenium of the corpus callosum in 8 patients. Although the isthmus of the cingulate gyrus and the occipital lobe are located just posterior to the posterior medial temporal lobe, there was a significantly greater preponderance of invasion toward the isthmus of the cingulate gyrus than toward the occipital lobe (p = 0.00030, McNemar test). Based on Schramm's classification for the medial temporal tumors, 4 patients had type A and 20 patients had type D tumors. The parietooccipital fissure determined the posterior border of the tumors, resulting in a unique and identical radiological feature. Diffusion spectrum imaging (DSI) tractography indicated that the fibers running through the posterior medial temporal lobe toward the occipital lobe had to detour laterally around the bottom of the parietooccipital fissure. CONCLUSIONS Posterior medial temporal gliomas present identical invasion patterns, resulting in unique radiological features that are strongly affected by the parietooccipital fissure. The parietooccipital fissure is a key anatomical landmark for understanding the complex infiltrating architecture of posterior medial temporal gliomas.

DOI： 10.3171/2021.7.JNS21990

術中皮質脳波によるてんかん原生領域の評価に基づいたてんかん外科手術

石崎友崇, 前澤聡, 山本啓之, 鳥居潤, 武藤学, 伊藤芳記, 夏目淳, 寳珠山稔, 齋藤竜太

てんかん研究 40 巻 ( 2 ) 頁： 389 - 389 2022年8月

Medical Management of a Mural Thrombus Inducing Repeated Ischemic Strokes in a Patient with Congenital Afibrinogenemia 査読有り国際誌

Nishihori, M; Araki, Y; Suzuki, N; Tamura, S; Hattori, M; Izumi, T; Goto, S; Yokoyama, K; Uda, K; Matsushita, T; Saito, R

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 31 巻 ( 7 ) 頁： 106526 - 106526 2022年7月

記述言語：英語出版者・発行元：Journal of Stroke and Cerebrovascular Diseases

Objectives: Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment. Case description: A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events. Conclusion: This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106526

特集癒着性くも膜炎の病態と治療法を学ぼう術後に生じる癒着性くも膜炎

西村由介, 永島吉孝, 齋藤竜太

脊椎脊髄ジャーナル 35 巻 ( 2 ) 頁： 99 - 105 2022年6月

Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review 国際誌 Open Access

Kibe, Y; Tanahashi, K; Ohtakara, K; Okumura, Y; Ohka, F; Takeuchi, K; Nagata, Y; Motomura, K; Akahori, S; Mizuno, A; Sasaki, H; Shimizu, H; Yamaguchi, J; Nishikawa, T; Yokota, K; Saito, R

BMC NEUROLOGY 22 巻 ( 1 ) 頁： 223 - 223 2022年6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：BMC Neurology

Background: Eccrine spiradenocarcinoma (SC), also known as malignant eccrine spiradenoma, is a rare malignant cutaneous adnexal neoplasm arising from long-standing benign eccrine spiradenoma. Malignant skin tumors rarely show direct intracranial invasion. However, once the intracranial structure is infiltrated, curative excision with sufficient margins can become extremely difficult, particularly when the venous sinuses are involved. No effective adjuvant therapies have yet been established. Here, we report an extremely rare case of scalp eccrine SC with direct intracranial invasion, which does not appear to have been reported previously. Case presentation: An 81-year-old woman presented with a large swelling on the parietal scalp 12 years after resection of spiradenoma from the same site. The tumor showed intracranial invasion with involvement of the superior sagittal sinus and repeated recurrences after four surgeries with preservation of the sinus. The histopathological diagnosis was eccrine SC. Adjuvant high-precision external beam radiotherapy (EBRT) proved effective after the third surgery, achieving remission of the residual tumor. The patient died 7 years after the first surgery for SC. Conclusions: Scalp SC with direct intracranial invasion is extremely rare. Radical resection with tumor-free margins is the mainstay of treatment, but the involvement of venous sinuses makes this unfeasible. High-precision EBRT in combination with maximal resection preserving the venous sinuses could be a treatment option for local tumor control.

DOI： 10.1186/s12883-022-02749-4

Phase II single-arm, multi-center, physician-initiated clinical trial of convection-enhanced delivery of nimustine hydrochloride (ACNU) against diffuse intrinsic pontine gliomas

Saito, R; Kanamori, M; Mineharu, Y; Arakawa, Y; Chiba, K; Aihara, Y; Shibahara, I; Kumabe, T; Matsuda, K; Sonoda, Y; Takahashi, F; Tominaga, T

JOURNAL OF CLINICAL ONCOLOGY 40 巻 ( 16 ) 2022年6月

Quick and simple dural threading technique for transsphenoidal surgery - dural tenting, haemostasis and skull base reconstruction 国際誌

Takeuchi, K; Nagata, Y; Tanahashi, K; Saito, R

ACTA NEUROCHIRURGICA 164 巻 ( 6 ) 頁： 1619 - 1622 2022年6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: Dural suturing is one of the most robust reconstruction methods in transsphenoidal surgery; however, the technique is considered difficult, primarily due to the restricted range of needle movement. Method: We performed dural threading during transsphenoidal surgery by holding the needle with forceps as a hook and moving the needle in a distal to proximal direction. Conclusion: Our dural suturing technique is simple and quick. It can be used not only for dural closure but also for other procedures, such as controlling haemostasis from the intercavernous sinus and dural tenting.

DOI： 10.1007/s00701-022-05227-5

Evaluation of the differences in pressure applied to the vessel wall by different types of balloon remodeling microcatheters in an experimental model 国際誌 Open Access

Ikezawa, M; Izumi, T; Nishihori, M; Tsukada, T; Tamari, Y; Araki, Y; Yokoyama, K; Uda, K; Goto, S; Kropp, AE; Otsuka, T; Kato, N; Nakano, M; Saito, R

INTERVENTIONAL NEURORADIOLOGY 28 巻 ( 3 ) 頁： 323 - 331 2022年6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：Interventional Neuroradiology

Background: We examined compliance differences among balloon remodeling microcatheters, which have not been established previously. Methods: Straight and 120° angulated vascular models were created in a 3 mm diameter tube with 3 mm hole (vascular model A), a tube with a 4 mm hole (vascular model B), and a 4 mm diameter tube (vascular model C). We compared the pressure exerted when each balloon was herniated 1 or 2 mm between three compliant balloons (SHOURYU SR, TransForm C, and Scepter C) and four super-compliant balloons (HyperForm, SHOURYU HR, TransForm SC, and Scepter XC). Results: In vascular model A, there was a significant difference in the pressure exerted by compliant balloons and super-compliant balloons in both the straight and angulated models. In the straight model (1 and 2 mm), the lowest pressure was exerted by HyperForm (super-compliant balloons group) and SHOURYU SR (compliant balloons group). The lowest pressure was exerted in the angulated model by HyperForm (super-compliant balloons group) and Scepter C (compliant balloons group). The Scepter balloon exerted higher pressure in the straight model than other balloon remodeling microcatheters but less in the angulated model. In vascular model B, the pressure decreased in all balloons compared with model A. In vascular model C, the pressure increased in all balloons compared with model A. Conclusions: Pressure differed across balloon remodeling microcatheters. In addition, vessel shape and diameter, and hole size, affected the results. Our findings can help select balloon remodeling microcatheters.

DOI： 10.1177/15910199211031765

Changes in cerebral blood flow in the postoperative chronic phase after combined cerebral revascularization for moyamoya disease with ischaemic onset 国際誌

Araki, Y; Mamiya, T; Fujita, N; Uda, K; Yokoyama, K; Kanamori, F; Takayanagi, K; Ishii, K; Nishihori, M; Takeuch, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Tanei, T; Sumitomo, M; Okamoto, S; Izumi, T; Kato, K; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 3 ) 頁： 2471 - 2480 2022年6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

The purpose of this study was to examine the effects of combined revascularization for ischaemic-onset moyamoya disease (MMD) on cerebral haemodynamics by comparing cerebral blood flow (CBF) during the postoperative chronic phase with preoperative CBF. A retrospective cohort of 24 MMD patients (representing 31 surgeries) who received single photon emission computed tomography (SPECT) before and more than 6 months after surgery was investigated. The CBF value of each vascular territory was extracted from SPECT data, and the value relative to the ipsilateral cerebellar value (relative CBF, or RCBF) was calculated. The correlation between the revascularization effect and the proportional change in RCBF before and after surgery (calculated as post-RCBF/pre-RCBF (“post/pre-RCBF”)) was analysed. Furthermore, the relationships between changes in neurological symptoms and post/pre-RCBF were investigated. Preoperative and postoperative mean RCBF values were 0.92 ± 0.15 and 0.96 ± 0.13 (p = 0.619) in the anterior cerebral artery territory, 0.99 ± 0.17 and 1.01 ± 0.17 (p = 0.598) in the middle cerebral artery territory and 1.15 ± 0.22 and 1.14 ± 0.19 (p = 0.062) in the posterior cerebral artery territory, respectively. No significant correlation was found between the revascularization score and post/pre-RCBF. The revascularization score and post/pre-RCBF were not significant predictors of worsening neurological symptoms postoperatively. No significant change in RCBF was observed in any vascular territory in the chronic phase after revascularization. Combined revascularization may assist in the redirection of blood flow from the internal to the external carotid system and contribute to CBF maintenance.

DOI： 10.1007/s10143-022-01774-8

Recent Molecular and Genetic Findings in Intramedullary Spinal Cord Tumors 国際誌 Open Access

Nagashima, Y; Nishimura, Y; Eguchi, K; Yamaguchi, J; Haimoto, S; Ohka, F; Takayasu, M; Saito, R

NEUROSPINE 19 巻 ( 2 ) 頁： 262 - 271 2022年6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：Neurospine

The study of genetic alterations and molecular biology in central nervous system (CNS) tumors has improved the accuracy of estimations of patient prognosis and tumor categorization. Therefore, the updated 2021 World Health Organization (WHO) classification includes various diagnostic genes, molecules, and pathways for diagnosis, as well as histological findings. These findings are expected both to have diagnostic applications and to facilitate new targeted therapies that target tumor-specific genetic changes and molecular biology. Intramedullary spinal cord tumors (IMSCTs) are rare CNS tumors that are difficult to treat because they occur in eloquent areas. Although the genetic underpinnings of IMSCTs remain unclear compared to their intracranial counterparts, the genetic characteristics of these tumors are gradually being revealed. Here, we describe the major changes in the new 2021 WHO classification and review the major types of IMSCTs, with an emphasis on their clinical features and genetic alterations.

DOI： 10.14245/ns.2244168.084

Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions 国際誌 Open Access

Motomura, K; Ohka, F; Aoki, K; Saito, R

FRONTIERS IN NEUROLOGY 13 巻頁： 874826 - 874826 2022年5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：Frontiers in Neurology

Gliomas are a category of infiltrating glial neoplasms that are often located within or near the eloquent areas involved in motor, language, and neurocognitive functions. Surgical resection being the first-line treatment for gliomas, plays a crucial role in patient outcome. The role of the extent of resection (EOR) was evaluated, and we reported significant correlations between a higher EOR and better clinical prognosis of gliomas. However, recurrence is inevitable, even after aggressive tumor removal. Thus, efforts have been made to achieve extended tumor resection beyond contrast-enhanced mass lesions in magnetic resonance imaging (MRI)-defined areas, a process known as supratotal resection. Since it has been reported that tumor cells invade beyond regions visible as abnormal areas on MRI, imaging underestimates the true spatial extent of tumors. Furthermore, tumor cells have the potential to spread 10–20 mm away from the MRI-verified tumor boundary. The primary goal of supratotal resection is to maximize EOR and prolong the progression-free and overall survival of patients with gliomas. The available data, as well as our own work, clearly show that supratotal resection of gliomas is a feasible technique that has improved with the aid of awake functional mapping using intraoperative direct electrical stimulation. Awake brain mapping has enabled neurosurgeons achieve supratotal resection with favorable motor, language, and neurocognitive outcomes, ensuring a better quality of life in patients with gliomas.

DOI： 10.3389/fneur.2022.874826

Blood flow stagnation after treatment of a giant internal carotid artery aneurysm: a computed fluid dynamics analysis 国際誌 Open Access

Muraoka, S; Takagi, R; Araki, Y; Uda, K; Sumitomo, M; Okamoto, S; Nishihori, M; Izumi, T; Nakamura, M; Saito, R

SCIENTIFIC REPORTS 12 巻 ( 1 ) 頁： 7283 - 7283 2022年5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：Scientific Reports

Balloon test occlusion (BTO) is an angiographic test to evaluate ischemic tolerance after permanent occlusion of an internal carotid artery (ICA). BTO can simulate ischemia caused by parent artery occlusion and can be used to select a suitable bypass surgery using specific criteria. On the other hand, a postoperative thrombus can form despite proper case selection, optimal radiological evaluation, and an appropriate surgical strategy. Postoperative ischemic complications related to perforating branches are clinically significant. This simulation study aimed to analyze postoperative flow characteristics and elucidate the cause of ischemic complications related to the perforating branch using computational fluid dynamics (CFD). An unexpected postoperative thrombus formation related to the perforating branch occurred after treating a giant aneurysm in the cavernous portion of the ICA in a patient. Three-dimensional digital subtraction angiography was used to acquire flow data and set up the CFD simulation. The flow simulations were performed at various bypass flow rates. The CFD analysis indicated flow stagnation in the ICA only when surgical treatment using a low-flow bypass graft was performed. Thrombus formation may lead to ischemic complications related to the perforating branch, such as the anterior choroidal artery. BTO did not reflect the influence of bypass blood flow. Therefore, recognizing that blood flow stagnation may occur and comprehensively deciding on the surgical strategy by CFD analysis can be helpful to prevent ischemic complications in patients with giant aneurysms.

DOI： 10.1038/s41598-022-11321-6

脳腫瘍研究のcutting edge-先端画像、実験/分子病理、デジタル病理- 神経膠腫の術中迅速遺伝子変異解析を目指した高速リアルタイムPCR法の確立

前田紗知, 大岡史治, 北野詳太郎, 本村和也, 青木恒介, 西川知秀, 山口純矢, 木部祐士, 齋藤竜太

Brain Tumor Pathology 39 巻 ( Suppl. ) 頁： 069 - 069 2022年5月

術中所見はラトケ嚢胞、されど病理は頭蓋咽頭腫

永田雄一, 竹内和人, 棚橋邦明, 佐々木博勇, 原田英幸, 井下尚子, 齋藤竜太

Brain Tumor Pathology 39 巻 ( Suppl. ) 頁： 110 - 110 2022年5月

Angiographic characteristics of improper watershed shift after STA-MCA bypass in a patient with moyamoya disease: illustrative case 国際誌 Open Access

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

Journal of Neurosurgery: Case Lessons 3 巻 ( 16 ) 2022年4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 In patients with moyamoya disease (MMD) who receive superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, hypoperfusion remote from the anastomosis site rarely occurs. Watershed shift due to direct bypass has been proposed as the mechanism; however, no report has confirmed this phenomenon using angiography. OBSERVATIONS A 48-year-old man presented with transient weakness in his left arm. Angiography revealed severe bilateral stenosis of the MCAs and moyamoya vessels. The right anterior cerebral artery (ACA) had short stenosis at A2 but ample blood supply to the cortical area of the right ACA and MCA regions. The patient was diagnosed with MMD and received a single STA-MCA bypass. The next day, he had difficulty communicating, and a cerebral infarction away from the anastomosis site was identified. Perfusion examination revealed hyperperfusion around the direct bypass and hypoperfusion away from the anastomosis site. Angiography revealed bypass patency; however, the original anterograde flow of the right ACA decreased significantly at the stenosed point, indicating an improper watershed shift. LESSONS STA-MCA bypass for patients with MMD can cause an improper watershed shift decreasing cerebral flow. Donor flow should be prepared based on each angiographic characteristic, and the risk of the improper watershed shift should be considered.

DOI： 10.3171/CASE22104

Risk Factors for Cerebral Infarction Early After Revascularization in Children Younger than 5 Years with Moyamoya Disease 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

WORLD NEUROSURGERY 160 巻頁： E220 - E226 2022年4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：World Neurosurgery

Objective: Cerebral revascularization is necessary for pediatric patients younger than 5 years with moyamoya disease (MMD). However, they have a high risk of developing cerebral infarction early after surgery. This study aimed to analyze the risk factors for developing cerebral infarction among these patients. Methods: The charts of 21 consecutive patients with MMD (39 surgeries) younger than 5 years who had undergone revascularization at our hospital were retrospectively analyzed. Because cerebral infarction occurring within 1 month after surgery was the primary end point, other clinical information was evaluated, including each surgical procedure. Multivariate analysis of the risk factors for postoperative cerebral infarction was performed. Results: Cerebral infarction occurred after 7 of 39 surgeries (17.9%). Of the 39 surgeries, 23 (59%) included direct and indirect combined revascularization. The incidence of cerebral infarction did not differ significantly between the combined (21.7%) and indirect (12.5%) groups (P = 0.46). Logistic regression showed no association between the revascularization procedure and the occurrence of cerebral infarction after surgery (P = 0.3). However, younger age at surgery was correlated with a higher risk of developing cerebral infarction in the early postoperative period (P = 0.05). Conclusions: No differences were found in the risk of developing cerebral infarction early after surgery as a result of surgical procedures. However, younger patients had higher postoperative risk. Further multicenter research should examine this issue for young pediatric patients with moyamoya at high risk of developing cerebral infarction.

DOI： 10.1016/j.wneu.2021.12.115

Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Open Access

Nagata, Y; Takeuchi, K; Sasaki, H; Mizuno, A; Harada, H; Tanahashi, K; Araki, Y; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 62 巻 ( 4 ) 頁： 203 - 208 2022年4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

Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, se-cure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent colla-gen matrix. The collagen matrix harvested from this area was pathologically examined; neovasculari-zation and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, ne-ovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.

DOI： 10.2176/jns-nmc.2021-0355

Challenging direct bypass surgery for very young children with moyamoya disease: technical notes 国際誌

Araki, Y; Uda, K; Yokoyama, K; Kanamori, F; Kurimoto, M; Shiba, Y; Mamiya, T; Nishihori, M; Takeuchi, K; Tanahashi, K; Nagata, Y; Nishimura, Y; Okamoto, S; Sumitomo, M; Izumi, T; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 2 ) 頁： 1799 - 1807 2022年4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

Cerebral revascularization for moyamoya disease (MMD) is an effective treatment for improving cerebral ischaemia and preventing rebleeding. Although direct bypass surgery is commonly performed on older children and adults, it is challenging in very young children due to the high difficulty level of the procedure. The subjects were MMD patients under 3 years of age on whom surgery was performed by a single surgeon (Y.A.). Preoperative clinical findings, information related to direct bypass surgery, bypass patency, and the incidence of postoperative stroke were investigated. Combined revascularization, including direct bypass surgery, was performed on 3 MMD patients (3 sides) under 3 years of age. The average diameter of the grafts used in direct bypass was 0.8 mm. The average recipient diameter was 0.8 ± 0.17 (range 0.6–1) mm. In all cases, the anastomotic procedure was completed using 11–0 monofilament nylon thread, and patency was confirmed. Direct bypass for MMD patients under 3 years old is technically challenging. However, despite the anatomical differences between very young children and elderly individuals, direct bypass surgery could certainly be completed. In addition, a rapid recovery from cerebral blood flow insufficiency could yield a promising neurological outcome.

DOI： 10.1007/s10143-021-01685-0

Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads 国際誌 Open Access

Uda, K; Tanahashi, K; Mamiya, T; Kanamori, F; Yokoyama, K; Nishihori, M; Izumi, T; Araki, Y; Saito, R

NEUROSURGICAL REVIEW 45 巻 ( 2 ) 頁： 1617 - 1624 2022年4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

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA–SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO− and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO−, and StA. In all parameters, ApA-ZO− extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO−, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon’s anastomosis skill level.

DOI： 10.1007/s10143-021-01686-z

A novel endoscopic ventriculocisternostomy and stenting technique with a transparent acryl puncture needle for a trapped temporal horn: a technical report and literature review

Yamamoto Taiki, Takeuchi Kazuhito, Nagata Yuichi, Mizuno Akihiro, Harada Hideyuki, Saito Ryuta

NEUROSURGICAL REVIEW 45 巻 ( 2 ) 頁： 1783 - 1789 2022年4月

記述言語：日本語出版者・発行元：Neurosurgical Review

Trapped temporal horn is a rare type of noncommunicating focal hydrocephalus, and no standard treatment has been established yet for trapped temporal horn. Recent studies have shown the efficacy of endoscopic ventriculocisternostomy by opening the choroidal fissure; however, some surgical complications were reported during the procedure. Thus, we aimed to report a novel endoscopic ventriculocisternostomy and stenting technique for trapped temporal horn. In this technique, a 5.8-mm transparent acryl puncture needle with a 2.7-mm 0° rigid endoscope was used to open the choroidal fissure. It can fenestrate the choroidal fissure under real-time endoscopic observation of the critical neurovascular structures over the choroidal fissure. Moreover, the dull tip of the needle is less likely to injure the critical neurovascular structures, resulting in safer ventriculocisternostomy than the previously reported technique. Then, a stent is placed along the tract to prevent future obstruction of the stoma. Six trapped temporal horns in four patients were treated using the technique. All the patients showed improved symptoms with no surgical complications. None of the patients showed recurrence of trapped temporal horn during the mean follow-up period of 39.3 months. The combination of endoscopic ventriculocisternostomy and stenting with a transparent acryl puncture needle is a safe and effective treatment option for trapped temporal horn.

DOI： 10.1007/s10143-021-01634-x

3D培養法を用いた新規下垂体腺腫オルガノイドモデルの作成

佐々木博勇, 竹内和人, 棚橋邦明, 永田雄一, 水野晃宏, 原田英幸, 須賀英隆, 齋藤竜太

日本内分泌学会雑誌 98 巻 ( 1 ) 頁： 329 - 329 2022年4月

小児頭蓋咽頭腫の長期成績からみた課題と展望小児頭蓋咽頭腫に対する神経内視鏡治療の実際と展望

竹内和人, 永田雄一, 加藤美穂子, 佐々木博勇, 齋藤竜太

小児の脳神経 47 巻 ( 2 ) 頁： 201 - 201 2022年4月

機能性下垂体腺腫に対する外科治療術前評価から根治切除に向けて

永田雄一, 竹内和人, 棚橋邦明, 佐々木博勇, 水野晃宏, 原田英幸, 齋藤竜太

日本内分泌学会雑誌 98 巻 ( 1 ) 頁： 278 - 278 2022年4月

頭蓋咽頭腫術後下垂体機能温存に上下垂体動脈血流が重要である

竹内和人, 永田雄一, 水野晃宏, 佐々木博勇, 原田英幸, 齋藤竜太

日本内分泌学会雑誌 98 巻 ( 1 ) 頁： 309 - 309 2022年4月

特集脊椎脊髄疾患の再手術症例における手術のコツと留意点頸椎症における再手術

西村由介, 永島吉孝, 齋藤竜太

脊椎脊髄ジャーナル 34 巻 ( 12 ) 頁： 896 - 901 2022年3月

Increased Risk of Thyroid Dysfunction by PD-1 and CTLA-4 Blockade in Patients Without Thyroid Autoantibodies at Baseline 国際誌 Open Access

Iwama, S; Kobayashi, T; Yasuda, Y; Okuji, T; Ito, M; Ando, M; Zhou, X; Yamagami, A; Onoue, T; Kawaguchi, Y; Miyata, T; Sugiyama, M; Takagi, H; Hagiwara, D; Suga, H; Banno, R; Hase, T; Morise, M; Wakahara, K; Yokota, K; Kato, M; Nishio, N; Tanaka, C; Miyata, K; Ogura, A; Ito, T; Sawada, T; Shimokata, T; Niimi, K; Ohka, F; Ishigami, M; Gotoh, M; Hashimoto, N; Saito, R; Kiyoi, H; Kajiyama, H; Ando, Y; Hibi, H; Sone, M; Akiyama, M; Kodera, Y; Arima, H

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM 107 巻 ( 4 ) 頁： E1620 - E1630 2022年3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 Clinical Endocrinology and Metabolism

Background: Previous studies showed that although the risk of thyroid dysfunction [thyroid immune-related adverse events (irAEs)] induced by anti-programmed cell death-1 antibodies (PD-1-Ab) was as low as 2% to 7% in patients negative for anti-thyroid antibodies (ATAs) at baseline, it was much higher (30%-50%) in patients positive for ATAs. However, whether a similar increase occurs with combination therapy using PD-1-Ab plus anti-cytotoxic T-lymphocyte antigen-4 antibody (CTLA-4-Ab) is unknown. Methods: A total of 451 patients with malignancies treated with PD-1-Ab, CTLA-4-Ab, or a combination of PD-1-Ab and CTLA-4-Ab (PD-1/CTLA-4-Abs) were evaluated for ATAs at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then observed until the last clinical visit. Results: Of the 451 patients, 51 developed thyroid irAEs after immunotherapy [41 of 416 (9.9%) treated with PD-1-Ab, 0 of 8 (0%) treated with CTLA-4-Ab, and 10 of 27 (37.0%) treated with PD-1/CTLA-4-Abs]. The cumulative incidence of thyroid irAEs was significantly higher in patients who were positive vs negative for ATAs at baseline after both PD-1-Ab [28/87 (32.2%) vs 13/329 (4.0%), P < 0.001] and PD-1/CTLA-4-Abs [6/10 (60.0%) vs 4/17 (23.5%), P < 0.05] treatments. The risk of thyroid irAEs induced by PD-1/CTLA-4Abs, which was significantly higher than that induced by PD-1-Ab, in patients negative for ATAs at baseline was not statistically different from that induced by PD-1-Ab in patients positive for ATAs at baseline. Conclusions: This study showed that the incidence of thyroid irAEs was high and not negligible after PD-1/CTLA-4-Abs treatment even in patients negative for ATAs at baseline.

DOI： 10.1210/clinem/dgab829

Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case. 国際誌 Open Access

Araki Y, Yokoyama K, Uda K, Kanamori F, Mamiya T, Takayanagi K, Ishii K, Nishihori M, Takeuchi K, Tanahashi K, Nagata Y, Tanei T, Nishimura Y, Izumi T, Saito R

Journal of neurosurgery. Case lessons 3 巻 ( 12 ) 2022年3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 Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA). OBSERVATIONS A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18. LESSONS Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.

DOI： 10.3171/CASE21704

Mesencephalic developmental venous anomaly causing obstructive hydrocephalus: illustrative case 査読有り国際誌 Open Access

Hiraga, K; Hayashi, S; Oshima, R; Kondo, T; Kanamori, F; Saito, R

JOURNAL OF NEUROSURGERY-CASE LESSONS 5 巻 ( 12 ) 2022年3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 Developmental venous anomalies (DVAs) are congenital anatomical variants of the normal deep parenchymal veins. DVAs are occasionally found incidentally on brain imaging, and most cases are asymptomatic. However, they rarely cause central nervous disorders. Herein, a case of mesencephalic DVA that caused aqueduct stenosis and hydrocephalus and discuss its diagnosis and treatment is reported. OBSERVATIONS The patient was a 48-year-old female who presented with depression. Computed tomography and magnetic resonance imaging (MRI) of the head revealed obstructive hydrocephalus. Contrast-enhanced MRI revealed an abnormally distended linear region with enhancement on the top of the cerebral aqueduct, which was confirmed as a DVA by digital subtraction angiography. An endoscopic third ventriculostomy (ETV) was performed to improve the patient’s symptoms. Intraoperative endoscopic imaging showed obstruction of the cerebral aqueduct by the DVA. LESSONS This report describes a rare case of obstructive hydrocephalus caused by DVA. It highlights the usefulness of contrast-enhanced MRI for diagnosing cerebral aqueduct obstructions due to DVAs and the effectiveness of ETV as a treatment option.

DOI： 10.3171/CASE22563

Surgical management of brain metastasis as a part of systematic metastases from adenoid cystic carcinoma of the external auditory canal: illustrative case. 国際誌 Open Access

Kuramitsu S, Motomura K, Nakajima Y, Tsujiuchi T, Motomura A, Matsuo M, Fukaya N, Kageyama A, Kojima I, Ohno M, Saito R

Journal of neurosurgery. Case lessons 3 巻 ( 11 ) 2022年3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 Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is a rare tumor that accounts for approximately 5% of all EAC tumors. ACC is generally known as a slow-growing tumor, but patients often experience recurrence or distant metastasis in the long clinical course. While the major pattern of recurrence is pulmonary metastasis, brain metastasis of ACC of the EAC is rare. OBSERVATIONS The authors describe the case of a 72-year-old male who was diagnosed with ACC of the EAC. Approximately 7 years later, brain magnetic resonance imaging revealed an intra-axial homogenously enhancing mass lesion that had no direct connection with the skull base in the left frontal lobe. The patient underwent tumor resection and histopathological examination revealed a mixture of cribriform and tubular patterns. The image and pathological characteristics of the tumor were similar to those of primary ACC or ACC from other sites of origin. LESSONS While patients with ACC of the EAC often experience recurrence or distant metastasis in the long clinical course, they survive for a relatively long period of time, even though an optimal treatment has not been established. The authors therefore recommend surgical resection for brain metastasis of ACC of the EAC to improve neurological symptoms.

DOI： 10.3171/CASE21673

Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor 国際誌

その他リンク： https://thejns.org/downloadpdf/journals/j-neurosurg-case-lessons/3/11/article-CASE21673.xml

Kato, S; Maesawa, S; Bagarinao, E; Nakatsubo, D; Tsugawa, T; Mizuno, S; Kawabata, K; Tsuboi, T; Suzuki, M; Shibata, M; Takai, S; Ishizaki, T; Torii, J; Mutoh, M; Saito, R; Wakabayashi, T; Katsuno, M; Ozaki, N; Watanabe, H; Sobue, G

JOURNAL OF NEUROSURGERY 138 巻 ( 2 ) 頁： 306 - 317 2022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 Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs). METHODS Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined. RESULTS Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post- MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs. CONCLUSIONS The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the patho-physiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.

DOI： 10.3171/2022.5.JNS22411

Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case. 国際誌 Open Access

Araki Y, Yokoyama K, Uda K, Kanamori F, Kurimoto M, Shiba Y, Mamiya T, Takayanagi K, Ishii K, Nishihori M, Takeuchi K, Tanahashi K, Nagata Y, Nishimura Y, Okamoto S, Sumitomo M, Izumi T, Saito R

Journal of neurosurgery. Case lessons 3 巻 ( 3 ) 2022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: Case Lessons

BACKGROUND Transient neurological deficits (TNDs) develop after cerebral revascularization in patients with moyamoya disease (MMD). The authors report a rare pediatric MMD case with extensive decreased cerebral blood flow (CBF) and prolonged TNDs after combined revascularization. OBSERVATIONS A 9-year-old boy presented with transient left upper limb weakness, and MMD was diagnosed. A right-sided combined surgery was performed. Two years after the surgery, frequent but transient facial (right-sided) and upper limb weakness appeared. The left internal carotid artery terminal stenosis had progressed. Therefore, a left combined revascularization was performed. The patient’s motor aphasia and right upper limb weakness persisted for approximately 10 days after surgery. Magnetic resonance angiography showed that the direct bypass was patent, but extensive decreases in left CBF were observed using single photon emission tomography. With adequate fluid therapy and blood pressure control, the neurological symptoms eventually disappeared, and CBF improved. LESSONS The environment of cerebral hemodynamics is heterogeneous after cerebral revascularization for MMD, and the exact mechanism of CBF decreases was not identified. TNDs are significantly associated with the onset of stroke during the early postoperative period. Therefore, appropriate treatment is desired after determining complex cerebral hemodynamics using CBF studies.

DOI： 10.3171/CASE21628

Reliability of IDH1-R132H and ATRX and/or p53 immunohistochemistry for molecular subclassification of Grade 2/3 gliomas

Nishikawa, T; Watanabe, R; Kitano, Y; Yamamichi, A; Motomura, K; Ohka, F; Aoki, K; Hirano, M; Kato, A; Yamaguchi, J; Maeda, S; Kibe, Y; Saito, R; Wakabayashi, T; Kato, Y; Sato, S; Ogino, T; Natsume, A; Ito, I

BRAIN TUMOR PATHOLOGY 39 巻 ( 1 ) 頁： 14 - 24 2022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：Brain Tumor Pathology

Since the World Health Organization 2016 classification (2016 WHO), genetic status has been incorporated into the diagnosis of Grade 2/3 gliomas (lower-grade gliomas). Therefore, immunohistochemistry (IHC) of IDH1-R132H, ATRX, and p53 have been used in place of genetic status. We report the associations between histological findings, IHC, and genetic status. We performed IHC of IDH1-R132H, ATRX, and p53 in 76 lower-grade gliomas and discussed its validity based on the 2016 WHO and the upcoming 2021 WHO classification. The sensitivity and specificity of anti-ATRX, p53, and IDH1-R132H IHC were 40.9%/98.1%, 78.6%/85.4%, and 90.5%/84.6%, respectively. Among 21 IDH1-mutant gliomas without 1p/19q codeletion, two gliomas (9.5%) mimicked the so-called classic for oligodendroglioma (CFO) in their morphology. Of the 42 gliomas with 1p/19q codeletion, four cases were difficult to diagnose as oligodendroglioma through morphological examination. Moreover, there were three confusing cases with ATRX mutations but with retained ATRX-IHC positivity. The lessons learned from this study are as follows: (1) ATRX-IHC and p53-IHC should be supplementary to morphological diagnosis, (2) rare IDH mutations other than IDH1 R132H should be considered, and (3) there is no complete alternative test to detect molecular features of glioblastoma under the 2021 WHO classification.

DOI： 10.1007/s10014-021-00418-x

Multitier Network Analysis Using Resting-state Functional MRI for Epilepsy Surgery Open Access

Maesawa, S; Bagarinao, E; Nakatsubo, D; Ishizaki, T; Takai, S; Torii, J; Kato, S; Shibata, M; Wakabayashi, T; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 62 巻 ( 1 ) 頁： 45 - 55 2022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：Neurologia Medico-Chirurgica

Resting-state functional MRI (rs-fMRI) has been utilized to visualize large-scale brain networks. We evaluated the usefulness of multitier network analysis using rs-fMRI in patients with focal epilepsy. Structural and rs-fMRI data were retrospectively evaluated in 20 cases with medically refractory focal epilepsy, who subsequently underwent surgery. First, structural changes were examined using voxel-based morphometry analysis. Second, alterations in large-scale networks were evaluated using dual-regression analysis. Third, changes in cortical hubs were analyzed and the relationship between aberrant hubs and the epileptogenic zone (EZ) was evaluated. Finally, the relationship between the hubs and the default mode network (DMN) was examined using spectral dynamic causal modeling (spDCM). Dual-regression analysis revealed significant decrease in functional connectivity in several networks including DMN in patients, although no structural difference was seen between groups. Aberrant cortical hubs were observed in and around the EZ (EZ hubs) in 85% of the patients, and a strong degree of EZ hubs correlated to good seizure outcomes postoperatively. In spDCM analysis, facilitation was often seen from the EZ hub to the contralateral side, while inhibition was seen from the EZ hub to nodes of the DMN. Some cognition-related networks were impaired in patients with focal epilepsy. The EZ hub appeared in the vicinity of EZ facilitating connections to distant regions in the early phase, which may eventually generate secondary focus, while inhibiting connections to the DMN, which may cause cognitive deterioration. Our results demonstrate pathological network alterations in epilepsy and suggest that earlier surgical intervention may be more effective.

DOI： 10.2176/nmc.oa.2021-0173

[Diffuse midline glioma].

Saito R

No shinkei geka. Neurological surgery 50 巻 ( 1 ) 頁： 29 - 38 2022年1月

胸部大動脈ステントグラフト治療の既往がある急性主幹動脈閉塞症に対しsurgical embolectomyが奏功した1例

村松佑亮, 布施佑太郎, 太田慎次, 中村茂和, 栗本太志, 渡邉和彦, 齋藤竜太

脳卒中 44 巻 ( 6 ) 頁： 664 - 669 2022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学会

症例は83歳男性．突然の右半身麻痺および失語を呈し，当院に救急搬送された．来院時，全失語，右半身完全麻痺の状態であった．頭部造影CTと脳MRIで左MCA急性閉塞を認めた．機械的血栓回収療法を検討したが，胸部大動脈瘤に対するステントグラフト留置（thoracic endovascular aortic repair: TEVAR）の既往があり，経大動脈的アプローチは困難と予測された．そのため，緊急で顕微鏡下のsurgical embolectomyを施行した．術後症状は著明に改善し，NIHSS 3点，mRS 2点で自宅退院となった．発症から来院までの時間が短いMCA急性閉塞症に対して，機械的血栓回収療法のリスクが高い場合にsurgical embolectomyを行い，良好な転帰を得た．急性期脳主幹動脈閉塞に対して，大動脈アプローチが困難と予想される場合には，surgical embolectomyをはじめから治療の選択肢に加えることを検討してもよいかもしれない．

DOI： 10.3995/jstroke.11028

Delayed Recurrence of Choroid Plexus Carcinoma in the Sacral Spinal Cord 17 Years after Its Initial Presentation.

Nagai A, Kanamori M, Shimoda Y, Watanabe M, Saito R, Kumabe T, Aizawa T, Tominaga T

NMC case report journal 9 巻 ( 0 ) 頁： 301 - 306 2022年

Diagnosis and Treatment Strategies for Arachnoiditis Ossificans Following Subarachnoid Hemorrhage: A Case Report.

Nagashima Y, Nishimura Y, Ito H, Nishii T, Oyama T, Saito R

NMC case report journal 9 巻 ( 0 ) 頁： 295 - 299 2022年

Dural Arteriovenous Fistula Mimicking a Brain Tumor on Methionine-positron Emission Tomography: A Case Report.

Hanyu T, Nishihori M, Izumi T, Motomura K, Ohka F, Goto S, Araki Y, Yokoyama K, Uda K, Saito R

NMC case report journal 9 巻 ( 0 ) 頁： 289 - 294 2022年

Contrast-Enhanced Magnetic Resonance Imaging Suggested a Possibility of Transvenous Embolization in the Superior Petrosal Sinus Dural Arteriovenous Fistula: A Case Report Open Access

Nishihori, M; Izumi, T; Tsukada, T; Kato, Y; Uda, K; Yokoyama, K; Araki, Y; Saito, R

JOURNAL OF NEUROENDOVASCULAR THERAPY 16 巻 ( 3 ) 頁： 163 - 169 2022年

Atypical Incomplete Detachment Following PulseRider Deployment Open Access

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

JOURNAL OF NEUROENDOVASCULAR THERAPY 16 巻 ( 8 ) 頁： 409 - 412 2022年

頚椎症性脊髄症が疑われたACTH単独欠損症の1例

齋藤剛, 吉田光宏, 中林規容, 相見有理, 石田衛, 濱﨑一, 寺尾和一, 中嶋祥子, 苗代朋樹, 齋藤竜太

脊髄外科 36 巻 ( 1 ) 頁： 88 - 93 2022年

Laminectomy triggers symptomatic growth of spinal schwannoma in a patient with schwannomatosis. 国際誌 Open Access

Oyama T, Nishimura Y, Nagashima Y, Nishii T, Hara M, Takayasu M, Sakakibara A, Saito R

Surgical neurology international 13 巻頁： 261 - 261 2022年

記述言語：英語出版者・発行元：Surgical Neurology International

Background: Schwannomatosis (SWN) is genetically similar to neurofibromatosis type 2 (NF2) and represents a NF2 gene mutation. Previous studies have shown that these mutations in both neurons and Schwann cells can lead to the development of schwannomas after nerve crush injuries. Here, we reviewed the potential pathoanatomical mechanisms for the development of a trauma-induced spinal schwannomas in a 55-year-old male with SWN. Case Description: A 49-year-old male had originally undergone a L3-L5 lumbar laminectomy for stenosis; the schwannomas seen on the preoperative magnetic resonance imaging (MRI) were not resected. Now at age 55, he newly presented with low back pain and numbness in the left L5 dermatome, and he was diagnosed with an L4 vertebral level cauda equina tumor on MRI. Following gross-total resection, the histopathological assessment revealed a Ki-67 labeling index 5-10% in hotspots (i.e., slightly higher than the normal range of schwannomas) and a 20% mosaic loss of SMARCB1. Based on these criteria, he was diagnosed as having SWN. Conclusion: In this patient with SWN, compression/physical trauma to nerves of the cauda equina during the L3-L5 laminectomy 6 years ago likely caused the progression of schwannoma.

DOI： 10.25259/SNI_453_2022

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease. 査読有り Open Access

Araki Y, Yokoyama K, Uda K, Kanamori F, Mamiya T, Takayanagi K, Ishii K, Shintai K, Nishihori M, Tsukada T, Takeuchi K, Tanahashi K, Nagata Y, Nishimura Y, Tanei T, Nagashima Y, Muraoka S, Izumi T, Seki Y, Saito R

Surgical neurology international 13 巻頁： 511 2022年

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

Background: The aim of this study was to investigate the association between early postoperative slow flow in bypass grafts and preoperative focal cerebral blood flow (CBF) in patients who underwent combined surgery for moyamoya disease (MMD). Methods: The subjects were 18 patients (22 surgeries) who underwent single photon emission computed tomography (SPECT) before surgery. The CBF value of the middle cerebral artery territory was extracted from the SPECT data, and the value relative to the ipsilateral cerebellar CBF (relative CBF, or RCBF) was calculated. The association between RCBF and early postoperative slow flow in the bypass graft was investigated. In addition, the correlation between the revascularization effect and preoperative RCBF was analyzed. Results: In four of 22 surgeries (18.2%), slow flow in the bypass graft was identified in the early postoperative period. Preoperative RCBF in the slow flow and patent groups was 0.86 ± 0.15 and 0.87 ± 0.15, respectively, with no significant difference (P = 0.72). The signal intensity of four slow-flowed bypasses was improved in all cases on magnetic resonance angiography images captured during the chronic phase (mean of 3.3 months postoperatively). The revascularization scores were 2 ± 0.82 and 2.1 ± 0.68 in the slow flow and patent groups, respectively, and did not differ significantly (P = 0.78). A significant correlation was not observed between preoperative RCBF and the revascularization effect. Conclusion: No significant association was observed between preoperative RCBF and early postoperative slow flow in bypass grafts in patients with MMD undergoing combined surgery. Given the high rate of improved depiction of slow-flowed bypass in the chronic postoperative phase, the conceptual significance of an opportune surgical intervention is to maintain CBF by supporting the patient's own intracranial-extracranial conversion function.

DOI： 10.25259/SNI_772_2022

Downward penetrating endplate screw technique under O-arm navigation posterior fusion in patients with osteoporotic vertebral body fractures associated with diffuse idiopathic skeletal hyperostosis. 国際誌 Open Access

Shiraishi D, Yamamoto Y, Motonori I, Nishimura Y, Hara M, Saito R, Takayasu M

Surgical neurology international 13 巻頁： 436 - 436 2022年

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

Background: A downward penetrating endplate screw (PES) technique combined with caudal anchor screws inserted in the upward direction under O-arm navigation (i.e., crossing screw technique) avoided screw backout and proximal junctional kyphosis (PJK) in three patients with osteoporotic vertebral body fractures and diffuse idiopathic skeletal hyperostosis (DISH). Methods: The PES techniques were utilized for patients with T12 (one patient) and L1 (two patients) spontaneous fusion across the targeted vertebrae, with minimal damage to the involved endplates/intervertebral discs. The average number of instrumented vertebrae was 5.3. Results: There were no perioperative complications over the mean follow-up period of 28.7 months; no screw loosening, and no PJK. Conclusion: The PES technique prevented screw backout, and PJK in three patients with lumbar osteoporotic vertebral fractures and DISH.

DOI： 10.25259/SNI_762_2022

覚醒下手術中痙攣発作コントロールにおけるレベチラセタム・ペランパネル併用療法の有効性について

本村和也, 齋藤竜太

神経治療学 39 巻 ( 4 ) 頁： 655 - 655 2022年

Unilateral laminotomy for bilateral decompression and balloon kyphoplasty to decompress lumber canal stenosis aggravated by osteoporotic vertebral compression fractures: A technical note. 国際誌 Open Access

Nagashima Y, Nishimura Y, Ishii M, Nishii T, Fukaya N, Oyama T, Abe T, Kato H, Tsukamoto E, Tanei T, Saito R

Surgical neurology international 13 巻頁： 538 - 538 2022年

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

Background: The optimal treatment of lumbar canal stenosis (LCS) associated with osteoporotic vertebral fractures (OVFs) remains unclear. Here, we have combined a minimally invasive unilateral laminotomy for bilateral decompression (ULBD) alone with balloon kyphoplasty (BKP) for LCS aggravated by OVF. Methods: ULBD with BKP was performed in three patients who showed LCS associated with OVFs on MR images with progressive lower extremity neurological deficits. Clinical outcomes were assessed using the numerical rating scale (NRS) and the Japanese Orthopaedic Association (JOA) score. Radiological outcomes were evaluated using multiple parameters (i.e., fractured vertebral body height, lumbar lordosis [LL], and focal angle of the fractured vertebral body). Results: Over 6 postoperative months, the NRS and JOA scores were clearly improved while radiological parameters remained maintained (i.e., loss of fractured vertebral body height was only 0.3-1.4 mm in all cases). Two of the three cases showed restoration of LL and focal angle postoperatively. Conclusion: The combination of ULBD with BKP is an effective option for LCS aggravated by OVF.

DOI： 10.25259/SNI_971_2022

壊血病により非外傷性硬膜外血腫に至った1例

滝戸悠平, 長倉正宗, 加藤美穂子, 齋藤竜太

小児の脳神経 47 巻 ( 3 ) 頁： 309 - 313 2022年

記述言語：日本語出版者・発行元：一般社団法人日本小児神経外科学会

壊血病はVit.C欠乏により易出血性を呈する疾患であるが，先進国では食料事情の改善でほとんど認められなくなった．症例は4歳女児，下肢の疼痛症状で歩行困難となり骨髄炎や歯肉腫脹を来していた．頭痛が出現し外傷歴のない硬膜外血腫を指摘され手術を施行した．入院経過中に極度の偏食であることが判明し，Vit.C欠乏が示唆され壊血病の診断に至った．Vit.Cの補充により急速に症状は改善し良好な転帰を得た．本疾患は多彩な症状を呈し診断困難な場合があるが，偏食などの病歴を把握し診断・治療へつなげることが重要である．

DOI： 10.34544/jspn.47.3_309

脊椎脊髄疾患における3Dプリンター活用の実際と現状

永島吉孝, 西村由介, 赤堀翔, 竹内和人, 宇田憲司, 伊藤洋, 齋藤竜太

脊髄外科 36 巻 ( 3 ) 頁： 296 - 301 2022年

Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series Open Access

Araki Y, Mamiya T, Fujita N, Yokoyama K, Uda K, Kanamori F, Takayanagi K, Ishii K, Nishihori M, Takeuchi K, Tanahashi K, Nagata Y, Nishimura Y, Tanei T, Muraoka S, Izumi T, Kato K, Saito R

Journal of Neurosurgery: Case Lessons 3 巻 ( 19 ) 2022年

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

BACKGROUND Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (DRCBF) (to ipsilateral cerebellar ratio (denoted DRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the DRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke.

DOI： 10.3171/CASE2274

Spinal Cord Stimulation for Neuropathic Pain following a Spinal Cord Lesion with Past Spinal Surgical Histories Using a Paddle Lead Placed on the Rostral Side of the Lesion: Report of Three Cases.

(11)C-methionine- and (18)F-FDG-PET double-negative metastatic brain tumor from lung adenocarcinoma with paradoxical high (18)F-FDG uptake: A case report. 国際誌 Open Access

Tanahashi K, Hirano M, Chalise L, Tsugawa T, Okumura Y, Hase T, Ohka F, Motomura K, Takeuchi K, Nagata Y, Nakahara N, Hashimoto N, Saito R

Surgical neurology international 13 巻頁： 372 - 372 2022年

記述言語：英語出版者・発行元：Surgical Neurology International

Background: Imaging with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and 11C-methionine (MET)-PET can delineate primary and metastatic brain tumors. Lesion size affects the sensitivity of both scans and histopathological features can also influence FDG-PET, but the effects on MET-PET have not been elucidated. Case Description: We report an unusual case of metastatic brain tumors without accumulation of FDG or MET, contrasting with high FDG uptake in the primary lung lesion. The brain lesions were identified as adenocarcinoma with a more mucus-rich background, contributing to the indistinct accumulation of both FDG and MET. Conclusion: Histopathological characteristics can affect both MET and FDG accumulation, leading to findings contradicting those of the primary lesion.

DOI： 10.25259/SNI_264_2022

Atypical radiographic case of arachnoid web without scalpel sign. 国際誌 Open Access

Nagashima Y, Nishimura Y, Ito H, Oyama T, Nishii T, Gonda T, Kato H, Saito R

Surgical neurology international 13 巻頁： 108 - 108 2022年

記述言語：英語出版者・発行元：Surgical Neurology International

Background: Spinal arachnoid webs (SAW) occur when abnormally thickened bands of arachnoid membranes commonly located dorsal to the thoracic spine cause blockage of normal cerebrospinal fluid (CSF) flow, resulting in focal cord compression and myelopathy. The pathognomonic MR finding for SAW is the "positive scalpel sign"comprised of an enlarged dorsal CSF space with a normal ventral subarachnoid space. The main differential diagnostic consideration for SAW is idiopathic spinal cord herniation (ISCH); however, for ISCH, MR studies classically demonstrate ventral displacement of the spinal cord through an anterior dural defect. Here, we describe a 60-year-old female with an atypical SAW at the T3-T4 level (i.e., the preoperative MR failed to demonstrate the "positive scalpel sign"). Nevertheless, at surgery, intraoperative ultrasonography confirmed that SAW was present and was decompressed/marsupialized/removed. Case Description: A 60-year-old female presented with sensory impairment to both lower extremities. The thoracic MR images showed an enlarged dorsal CSF space at the T3-T4 level but without the "scalpel sign"suggesting "interruption"of CSF flow by thickened bands of focal dorsal arachnoidal tissues. Although the initial preoperative diagnosis was ISCH, intraoperative ultrasound (IOUS) confirmed the presence of a thickened arachnoid band, confirming the diagnosis of a SAW that was appropriately decompressed/resected. Conclusion: Correctly, establishing the preoperative diagnosis of a SAW based on MR imaging may sometimes be difficult as the typical "scalpel sign"may not be present in all patients. Notably, in cases like this one, IOUS may critically confirm the diagnosis of SAW thus leading to appropriate SAW decompression/removal.

DOI： 10.25259/SNI_179_2022

Fukaya N, Tanei T, Nishimura Y, Hara M, Hata N, Nagashima Y, Maesawa S, Araki Y, Saito R

NMC case report journal 9 巻 ( 0 ) 頁： 349 - 355 2022年

Clinical and Radiological Clues of Traumatic Craniocervical Junction Injuries Requiring Occipitocervical Fusion to Early Diagnosis 国際誌 Open Access

Shiraishi, D; Nishimura, Y; Aguirre-Carreno, I; Hara, M; Yoshikawa, S; Eguchi, K; Nagashima, Y; Ito, H; Haimoto, S; Yamamoto, Y; Ginsberg, HJ; Takayasu, M; Saito, R

NEUROSPINE 18 巻 ( 4 ) 頁： 741 - 748 2021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：Neurospine

Objective: The purpose of this study is to find the clinical and radiographic characteristics of traumatic craniocervical junction (CCJ) injuries requiring occipitocervical fusion (OC fusion) for early diagnosis and surgical intervention. Methods: We retrospectively reviewed 12 patients with CCJ injuries presenting to St. Mi-chaels Hospital in Toronto who underwent OC fusion and looked into the following vari-ables; (1) initial trauma data on emergency room arrival, (2) associated injuries, (3) imaging characteristics of computed tomography (CT) scan and magnetic resonance imaging (MRI), (4) surgical procedures, surgical complications, and neurological outcome. Results: All patients were treated as acute spinal injuries and underwent OC fusion on an emergency basis. Patients consisted of 10 males and 2 females with an average age of 47 years (range, 18–82 years). All patients sustained high-energy injuries. Three patients out of 6 patients with normal BAI (basion-axial interval) and BDI (basion-dens interval) values showed visible CCJ injuries on CT scans. However, the remaining 3 patients had no clear evidence of occipitoatlantal instability on CT scans. MRI clearly described several findings indicating occipitoatlantal instability. The 8 patients with normal values of ADI (atlanto-dens interval interval) demonstrated atlantoaxial instability on CT scan, however, all MRI more clearly and reliably demonstrated C1/2 facet injury and/or cruciate ligament injury. Conclusion: We advocate measures to help recognize CCJ injury at an early stage in the present study. Occipitoatlantal instability needs to be carefully investigated on MRI in addition to CT scan with special attention to facet joint and ligament integrity.

DOI： 10.14245/ns.2142860.430

Two cases of solitary fibrous tumor/hemangiopericytoma with different clinical features according to the World Health Organization classification: case report and review of the literature. 国際誌 Open Access

Nishii T, Nagashima Y, Nishimura Y, Ito H, Oyama T, Matsuo M, Sakakibara A, Shimada S, Saito R

Journal of spine surgery (Hong Kong) 7 巻 ( 4 ) 頁： 532 - 539 2021年12月

記述言語：英語出版者・発行元：Journal of Spine Surgery

Solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) have been classified as one entity by the World Health Organization in 2016 due to gene fusion between NAB2 and STAT6. In the Central Nervous System (CNS), a hypocellular, collagenized tumor with a classic SFT phenotype is considered grade I, whereas more densely cellular tumors mostly corresponding to the HPC phenotype are classified as grade II or III (anaplastic) depending in mitotic count (<5 vs. >5 mitoses per 10 high-power fields). Herein, we report two cases of targeted SFT/HPC in which pathological differences and WHO grading affect clinical features. A 75-year-old woman presented with headache and had an intradural extramedullary tumor at the C1 to C2 level. The tumor was well-circumscribed and attached only to the dura mater. It was totally removed and diagnosed SFT/HPC grade I. In contrast, a 68-year-old woman presented with numbness in the right upper limb and had an intradural extramedullary tumor at the medulla to C3 levels The tumor was irregularly marginated and strongly adherent to the spinal cord and involved the vertebral artery. It was sub totally removed and diagnosed SFT/HPC grade II. To the best of our knowledge, there are only 12 cases of SFT/HPC at the craniocervical junction, including the present two cases, of which four that were adherent to the spinal cord or involved the vertebral artery were grade II or III. Although the location of the tumor was almost the same, there were significant differences in the intraoperative findings according to the WHO grading.

DOI： 10.21037/jss-21-83

Resting State Networks Related to the Maintenance of Good Cognitive Performance During Healthy Aging 国際誌 Open Access

Maesawa, S; Mizuno, S; Bagarinao, E; Watanabe, H; Kawabata, K; Hara, K; Ohdake, R; Ogura, A; Mori, D; Nakatsubo, D; Isoda, H; Hoshiyama, M; Katsuno, M; Saito, R; Ozaki, N; Sobue, G

FRONTIERS IN HUMAN NEUROSCIENCE 15 巻頁： 753836 - 753836 2021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：Frontiers in Human Neuroscience

Purpose: Maintenance of cognitive performance is important for healthy aging. This study aims to elucidate the relationship between brain networks and cognitive function in subjects maintaining relatively good cognitive performance. Methods: A total of 120 subjects, with equal number of participants from each age group between 20 and 70 years, were included in this study. Only participants with Addenbrooke’s Cognitive Examination – Revised (ACE-R) total score greater than 83 were included. Anatomical T1-weighted MR images and resting-state functional MR images (rsfMRIs) were taken from all participants using a 3-tesla MRI scanner. After preprocessing, several factors associated with age including the ACE-R total score, scores of five domains, sub-scores of ACE-R, and brain volumes were tested. Morphometric changes associated with age were analyzed using voxel based morphometry (VBM) and changes in resting state networks (RSNs) were examined using dual regression analysis. Results: Significant negative correlations with age were seen in the total gray matter volume (GMV, r = −0.58), and in the memory, attention, and visuospatial domains. Among the different sub-scores, the score of the delayed recall (DR) showed the highest negative correlation with age (r = −0.55, p < 0.001). In VBM analysis, widespread regions demonstrated negative correlation with age, but none with any of the cognitive scores. Quadratic approximations of cognitive scores as functions of age showed relatively delayed decline compared to total GMV loss. In dual regression analysis, some cognitive networks, including the dorsal default mode network, the lateral dorsal attention network, the right / left executive control network, the posterior salience network, and the language network, did not demonstrate negative correlation with age. Some regions in the sensorimotor networks showed positive correlation with the DR, memory, and fluency scores. Conclusion: Some domains of the cognitive test did not correlate with age, and even the highly correlated sub-scores such as the DR score, showed delayed decline compared to the loss of total GMV. Some RSNs, especially involving cognitive control regions, were relatively maintained with age. Furthermore, the scores of memory, fluency, and the DR were correlated with the within-network functional connectivity values of the sensorimotor network, which supported the importance of exercise for maintenance of cognition.

DOI： 10.3389/fnhum.2021.753836

Aphasic status epilepticus after glioma resection: two case reports. 国際誌

Shimoda Y, Kanamori M, Saito R, Osawa S, Mugikura S, Tominaga T

Acta neurochirurgica 163 巻 ( 11 ) 頁： 3109 - 3113 2021年11月

Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor Open Access

Maesawa, S; Nakatsubo, D; Tsugawa, T; Kato, S; Shibata, M; Takai, S; Torii, J; Ishizaki, T; Wakabayashi, T; Saito, R

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 11 ) 頁： 629 - 639 2021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：Neurologia Medico-Chirurgica

Magnetic resonance (MR)-guided focused ultrasound surgery (MRgFUS) is the latest minimally invasive stereotactic procedure, and thalamotomy using this novel modality has demonstrated its effectiveness and safety, especially for patients with essential tremor (ET) and Parkinson’s disease (PD). In Japan, the application of MRgFUS to treat ET and PD has recently been covered by health insurance. Technically, the transducer with 1024 elements emits ultrasound beams, which are then focused on the target with a phase control, resulting in optimal ablation by thermal coagulation. The technical advantages of MRgFUS are continuous intraoperative monitoring of clinical symptoms and MR images and fine adjustment of the target by the steering function. Postoperative tremor control is compatible with other modalities, although long-term follow-up is necessary. The adverse effects are usually transient and acceptable. Prognostic factors for good tremor control include high temperature and large lesion size. A high skull density ratio is a factor to achieve high temperature and large lesioning, but it may not be necessary and sufficient for clinical outcomes. For patients with advanced symptoms such as bilateral tremor or head/neck tremor, deep brain stimulation may be recommended because of the adjustability of stimulation and the possibility of bilateral treatment. Patients have high expectations of MRgFUS because of its non-invasiveness. To perform this treatment safely and effectively, physicians need to understand the technological aspects, the physiological principles. To choose the appropriate modality, physicians also should recognize the clinical advantages and disadvantages of MRgFUS compared to other modalities.

DOI： 10.2176/nmc.ra.2021-0187

Newly established patient-derived organoid model of intracranial meningioma 国際誌 Open Access

Yamazaki, S; Ohka, F; Hirano, M; Shiraki, Y; Motomura, K; Tanahashi, K; Tsujiuchi, T; Motomura, A; Aoki, K; Shinjo, K; Murofushi, Y; Kitano, Y; Maeda, S; Kato, A; Shimizu, H; Yamaguchi, J; Adilijiang, A; Wakabayashi, T; Saito, R; Enomoto, A; Kondo, Y; Natsume, A

NEURO-ONCOLOGY 23 巻 ( 11 ) 頁： 1936 - 1948 2021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：Neuro-Oncology

Background: Recent comprehensive studies have revealed several molecular alterations that are frequently found in meningiomas. However, effective treatment reagents targeting specific molecular alterations have not yet been identified because of the limited number of representative research models of meningiomas. Methods: We performed organoid cultures using meningioma cells and meningioma tumor tissues. Using immunohistochemistry and molecular analyses consisting of whole-exome sequencing, RNA-seq, and DNA methylation analyses, we compared the histological findings and molecular profiling of organoid models with those of parental tumors. Further, using these organoid models together with a public database of meningiomas, we explored molecular alterations, which are a potent treatment target for meningioma. Results: We established 18 organoid models comprising of two malignant meningioma cells (HKBMM and IOMM-Lee), 10 benign meningiomas, four malignant meningiomas, and two solitary fibrous tumors (SFTs). The organoids exhibited consistent histological features and molecular profiles with those of the parental tumors. Using a public database, we identified that upregulated forkhead box M1 (FOXM1) was correlated with increased tumor proliferation. Overexpression of FOXM1 in benign meningioma organoids increased organoid proliferation; depletion of FOXM1 in malignant organoids decreased proliferation. Additionally, thiostrepton, a FOXM1 inhibitor combined with radiation therapy, significantly inhibited the proliferation of malignant meningioma organoid models. Conclusions: An organoid model for meningioma enabled us to elucidate the tumor biology of meningioma along with potent treatment targets for meningioma.

DOI： 10.1093/neuonc/noab155

Effects of oxytocin on responses to nociceptive and non-nociceptive stimulation in the upper central nervous system 国際誌 Open Access

Saito, H; Hidema, S; Otsuka, A; Suzuki, J; Kumagai, M; Kanaya, A; Murakami, T; Takei, Y; Saito, K; Sugino, S; Toyama, H; Saito, R; Tominaga, T; Nishimori, K; Yamauchi, M

BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS 574 巻頁： 8 - 13 2021年10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：Biochemical and Biophysical Research Communications

Oxytocin is known as a social bonding hormone, but it also functions as an anxiolytic or analgesic neurotransmitter. When oxytocin regulates pain or anxiousness centrally as a neurotransmitter, it is secreted by neurons and directly projected to targeted regions. Although the function of oxytocin at the spinal level is well studied, its effects at the supraspinal level are poorly understood. We aimed to investigate the effect of oxytocin at the supraspinal level in vivo using C57BL/6J (wild-type [WT]), oxytocin-deficient (Oxt−/−), oxytocin receptor-deficient (Oxtr−/−), and oxytocin receptor-Venus (OxtrVenus/+) mice lines. Response thresholds in Oxtr−/− mice in Hargreaves and von-Frey tests were significantly lower than those in WT mice, whereas open field and light/dark tests showed no significant differences. Moreover, response thresholds in Oxt−/− mice were raised to those in WT mice after oxytocin administration. Following the Hargreaves test, we observed the co-localisation of c-fos with Venus or the oxytocin receptor in the periaqueductal gray (PAG), medial amygdala (MeA), and nucleus accumbens (NAc) regions in OxtrVenus/+ mice. Furthermore, in the PAG, MeA, and NAc regions, the co-localisation of oxytocin with c-fos and gamma-aminobutyric acid was much stronger in Oxtr−/− mice than in WT mice. However, following von-Frey test, the same findings were observed only in the MeA and NAc regions. Our results suggest that oxytocin exerts its analgesic effect on painful stimulation via the PAG region and a self-protective effect on unpleasant stimulation via the MeA and NAc regions.

DOI： 10.1016/j.bbrc.2021.08.042

Triggering of Carotid Sinus Reflex during Deployment the Flow-diverter Device Open Access

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

NEUROLOGIA MEDICO-CHIRURGICA 61 巻 ( 10 ) 頁： 583 - 590 2021年10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

The carotid sinus reflex (CSR) is a rare complication of the Pipeline Embolization Device (PED) deployment. No study has assessed the potential risk factors in a case series. The purpose of this study was to examine CSR triggering during PED deployment. Thirty-seven consecutive patients who underwent PED deployment were included. All procedures were performed under local anesthesia with mild sedation. We retrospectively analyzed patient characteristics, PED deployment time, and vital signs during the procedure. The vital signs included the pulse rate (PR) and systolic blood pressure (SBP) obtained at three timepoints (pre-deployment, during deployment, post-deployment). We examined the triggering of the CSR during PED deployment by comparing the vital signs at the three timepoints. Moreover, risk factors for CSR were analyzed with univar-iate analysis. The patients’ average age was 66.3 years. The average size of the aneurysm was 18.0 mm. Six patients (16.2%) showed a decline in the SBP or PR defined as CSR. One patient had a transient cardiac arrest and two had severe transient bradycardia. Deployment into the ophthalmic segment of the internal carotid artery (C2 segment) aneurysm (p = 0.022), prolonged PED deployment time more than 14.5 minutes (p = 0.005), and an acute angle of the anterior genu less than 51.5 degrees (p = 0.005) were risk factors in triggering CSR. CSR may be triggered during PED deployment under local anesthesia with mild sedation. Deployment to the C2 segment aneu-rysm, prolonged PED deployment time, and an acute angle of the anterior genu were associated with CSR triggering.

DOI： 10.2176/nmc.oa.2021-0049

Sellar arachnoid cystに対する経鼻内視鏡手術

永田雄一, 竹内和人, 山本太樹, 水野晃宏, 永谷哲也, 齋藤竜太

日本内分泌学会雑誌 97 巻 ( S.HPT ) 頁： 49 - 51 2021年9月

内視鏡下経鼻頭蓋底手術後の再建戦略

竹内和人, 永田雄一, 山本太樹, 原田英幸, 齋藤竜太

日本内分泌学会雑誌 97 巻 ( S.HPT ) 頁： 16 - 18 2021年9月

Mathematical Modeling and Mutational Analysis Reveal Optimal Therapy to Prevent Malignant Transformation in Grade II IDH-Mutant Gliomas 国際誌 Open Access

Aoki, K; Suzuki, H; Yamamoto, T; Yamamoto, KN; Maeda, S; Okuno, Y; Ranjit, M; Motomura, K; Ohka, F; Tanahashi, K; Hirano, M; Nishikawa, T; Shimizu, H; Kitano, Y; Yamaguchi, J; Yamazaki, S; Nakamura, H; Takahashi, M; Narita, Y; Nakada, M; Deguchi, S; Mizoguchi, M; Momii, Y; Muragaki, Y; Abe, T; Akimoto, J; Wakabayashi, T; Saito, R; Ogawa, S; Haeno, H; Natsume, A

CANCER RESEARCH 81 巻 ( 18 ) 頁： 4861 - 4873 2021年9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：Cancer Research

Isocitrate dehydrogenase-mutant low-grade gliomas (IDHmut- LGG) grow slowly but frequently undergo malignant transformation, which eventually leads to premature death. Chemotherapy and radiotherapy treatments prolong survival, but can also induce genetic (or epigenetic) alterations involved in transformation. Here, we developed a mathematical model of tumor progression based on serial tumor volume data and treatment history of 276 IDHmut- LGGs classified by chromosome 1p/19q codeletion (IDHmut/ 1p19qcodel and IDHmut/1p19qnoncodel) and performed genomewide mutational analyses, including targeted sequencing and longitudinal whole-exome sequencing data. These analyses showed that tumor mutational burden correlated positively with malignant transformation rate, and chemotherapy and radiotherapy significantly suppressed tumor growth but increased malignant transformation rate per cell by 1.8 to 2.8 times compared with before treatment. This model revealed that prompt adjuvant chemoradiotherapy prolonged malignant transformation-free survival in small IDHmut-LGGs (≤ 50 cm3). Furthermore, optimal treatment differed according to genetic alterations for large IDHmut-LGGs (> 50 cm3); adjuvant therapies delayed malignant transformation in IDHmut/1p19qnoncodel but often accelerated it in IDHmut/1p19qcodel. Notably, PI3K mutation was not associated with malignant transformation but increased net postoperative proliferation rate and decreased malignant transformation-free survival, prompting the need for adjuvant therapy in IDHmut/1p19qcodel. Overall, this model uncovered therapeutic strategies that could prevent malignant transformation and, consequently, improve overall survival in patients with IDHmut-LGGs.

DOI： 10.1158/0008-5472.CAN-21-0985

A Super-selective Wada Test Successfully Detected an Artery That Supplied Broca's Area in a Case of Left Frontal Lobe Glioblastoma: Technical Case Report.

Yamashita S, Saito R, Osawa SI, Niizuma K, Ukishiro K, Kanamori M, Kakinuma K, Suzuki K, Tominaga T

Neurologia medico-chirurgica 61 巻 ( 11 ) 頁： 661 - 666 2021年8月

[Magnetic Resonance-guided Focused Ultrasound Ablation:Techniques and Neurological Applications].

Maesawa S, Nakatsubo D, Tsugawa T, Kato S, Shibata M, Takai S, Torii J, Wakabayashi T, Saito R

No shinkei geka. Neurological surgery 49 巻 ( 4 ) 頁： 847 - 856 2021年7月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：株式会社医学書院

Magnetic resonance(MR)-guided focused ultrasound ablation(FUS)is a minimally invasive technique for targeted tissue thermo-ablation and is promising for neuromodulation in various neurological disorders. The effectiveness and safety of this technique have been recognized worldwide. In Japan, the applications of FUS for the treatment of essential tremors and Parkinson's disease have recently been covered under health insurance. The FUS system is composed of a phased-array transducer with 1024 elements, with a beam of ultrasound emerging from each element. The phase and amplitude of the beam are computed and controlled to focus on the target with the calculation of computed tomography(CT)profiles, resulting in optimal thermo-ablation. To utilize FUS safely and effectively, a deep understanding of the physics of this technology is necessary. Furthermore, the technique should be compared with other options including deep brain stimulation(DBS)and radiofrequency thermo-ablation. Although FUS has received attention because of minimally invasive characteristics and a possibility of procedural target refinement, DBS has some advantages on bilateral implantation, a potential of postoperative adjustment, and control of head/leg tremors. In this article, we first reviewed the physics of FUS and demonstrated the typical treatment protocols. Second, we reviewed the outcomes from the existing literature, and revealed the advantages and disadvantages of this procedure, with the evaluation of the optimal condition for FUS.

DOI： 10.11477/mf.1436204463

Association between IDH mutational status and tumor-associated epilepsy or venous thromboembolism in patients with grade II and III astrocytoma.

Osada Y, Saito R, Miyata S, Shoji T, Shibahara I, Kanamori M, Sonoda Y, Kumabe T, Watanabe M, Tominaga T

Brain tumor pathology 38 巻 ( 3 ) 頁： 218 - 227 2021年7月

頭蓋内胚腫治療後にてんかんを発症した症例群の検討

下田由輝, 金森政之, 大沢伸一郎, 齋藤竜太, 園田順彦, 隈部俊宏, 中里信和, 冨永悌二

てんかん研究 39 巻 ( 2 ) 頁： 305 - 305 2021年7月

Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping 国際誌

Motomura, K; Chalise, L; Ohka, F; Aoki, K; Tanahashi, K; Hirano, M; Nishikawa, T; Yamaguchi, J; Shimizu, H; Wakabayashi, T; Saito, R

JOURNAL OF NEURO-ONCOLOGY 153 巻 ( 2 ) 頁： 361 - 372 2021年6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 Neuro-Oncology

Purpose: The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping. Methods: We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. Results: EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of ≥ 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR ≥ 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7–48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR ≥ 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9–51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3–59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. Conclusions: The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was ≥ 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.

DOI： 10.1007/s11060-021-03776-w

Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway. 国際誌

Shibahara I, Sato S, Hide T, Saito R, Kanamori M, Sonoda Y, Tominaga T, Kumabe T

Acta neurochirurgica 163 巻 ( 5 ) 頁： 1269 - 1278 2021年5月

[Chemotherapy for Glioma].

Saito R

No shinkei geka. Neurological surgery 49 巻 ( 3 ) 頁： 588 - 596 2021年5月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：株式会社医学書院

Chemotherapeutic treatment of malignant gliomas is extremely challenging. Tumor accumulation of systemically-administrated chemotherapy is always hindered by the blood-brain barrier(BBB). Although temozolomide administered orally or intravenously represents the standard of care for malignant gliomas, its efficacy is unsatisfactory. Local chemotherapy bypasses the BBB and, therefore, achieves a high drug concentration at the site the drug is administered. Carmustine wafers are clinically available local chemotherapeutic agents. However, their efficacy is limited because of limited drug penetration into the tumor. Combined with the highly chemoresistant features of glioma itself, ongoing chemotherapy is far from satisfactory in terms of efficacy. This review covers several important issues regarding temozolomide chemotherapy, including the reactivation of hepatitis B virus, assessment of

DOI： 10.11477/mf.1436204432

側脳室下角に存在する脈絡叢腫瘍に対する島下境界溝を介した摘出術

高速リアルタイムPCR法を用いた迅速IDH1、H3F3A、BRAF遺伝子変異解析

大岡史治, 北野詳太郎, 本村和也, 清水浩之, 棚橋邦明, 青木恒介, 平野雅規, 山口純矢, 夏目敦至, 齋藤竜太

Brain Tumor Pathology 38 巻 ( Suppl. ) 頁： 075 - 075 2021年5月

柴原一陽, 百武佑理, 豊田茉梨子, 半田肇, 猿田和貴子, 犬飼円, 佐藤澄人, 秀拓一郎, 齋藤竜太, 金森政之, 園田順彦, 冨永悌二, 隈部俊宏

小児の脳神経 46 巻 ( 2 ) 頁： 179 - 179 2021年4月

Effect of endoscope flexibility on tissue dissection profile assessed with pulsed water jet device: ensuring safety, efficacy, and handling of thin devices for neuroendoscopic surgery. 国際誌

Kusunoki T, Kawaguchi T, Nakagawa A, Noguchi Y, Osawa SI, Endo H, Endo T, Saito R, Kanamori M, Niizuma K, Tominaga T

BMC research notes 14 巻 ( 1 ) 頁： 64 - 64 2021年2月

Hepatitis B virus reactivation during temozolomide administration for malignant glioma.

Shoji T, Kanamori M, Inoue J, Saito R, Osada Y, Shimoda Y, Chonan M, Uenohara H, Masamune A, Tominaga T

International journal of clinical oncology 26 巻 ( 2 ) 頁： 305 - 315 2021年2月

H3K27M and TERT promoter mutations are poor prognostic factors in surgical cases of adult thalamic high-grade glioma. 国際誌

Osada Y, Saito R, Shibahara I, Sasaki K, Shoji T, Kanamori M, Sonoda Y, Kumabe T, Watanabe M, Tominaga T

Neuro-oncology advances 3 巻 ( 1 ) 頁： vdab038 2021年1月

覚醒下手術中痙攣発作コントロールにおけるレベチラセタム・ペランパネル併用療法の有効性について

本村和也, 齋藤竜太

神経治療学 38 巻 ( 6 ) 頁： S211 - S211 2021年

アクセス困難な硬膜動静脈瘻症例における，対側上錐体静脈洞を経由する上錐体静脈洞へのアプローチ

鈴木啓太, 西堀正洋, 泉孝嗣, 鈴木宰, 武藤学, 荒木芳生, 宇田憲司, 横山欣也, 齋藤竜太

脳血管内治療 6 巻 ( 3 ) 頁： 161 - 168 2021年

記述言語：日本語出版者・発行元：特定非営利活動法人日本脳神経血管内治療学会

【目的】多発硬膜動静脈瘻（dural arteriovenous fistula: DAVF）の症例において，左上錐体静脈洞部（superior petrosal sinus: SPS）のシャントを右 SPS 経由で塞栓した症例を報告する．【症例】60 歳女性，意識障害の精査にて深部静脈逆流を伴う多発 DAVF を認めた．逆流に最も関与する左横静脈洞部 DAVF に対して経静脈的塞栓術を施行した．術後症状改善が乏しく，再度DSA を行うと，左 SPS へのシャントと深部静脈への逆流が明らかとなった．左横静脈洞と両側下錐体静脈洞は閉塞していたため，右 SPS と両側海綿静脈洞を経由してマイクロカテーテルをシャント部へ誘導し，左 SPS を塞栓し，逆流の消失を得た．【結論】対側 SPS を経由した SPS へのアクセスは，同側からのアクセスが困難な症例において，有効な選択肢になり得る．

DOI： 10.20626/nkc.tn.2021-0009

Survival Benefit of Supratotal Resection in a Long-term Survivor of IDH-wildtype Glioblastoma: A Case Report and Literature Review.

Corpus Callosum Swelling after Resection of Intraventricular Central Neurocytoma.

Aburakawa D, Kanamori M, Akashi T, Sato S, Saito R, Tominaga T

NMC case report journal 8 巻 ( 1 ) 頁： 535 - 543 2021年

Yamaguchi J, Motomura K, Ohka F, Aoki K, Tanahashi K, Hirano M, Chalise L, Nishikawa T, Shimizu H, Natsume A, Wakabayashi T, Saito R

NMC case report journal 8 巻 ( 1 ) 頁： 747 - 753 2021年

Postoperative Cervicothoracic Kyphosis Following Infantile Intramedullary Tumor Resection Accelerates Neurological Deterioration.

Gonda T, Nagashima Y, Nishimura Y, Ito H, Nisii T, Oyama T, Hara M, Saito R

NMC case report journal 8 巻 ( 1 ) 頁： 705 - 711 2021年

Management of Asymptomatic Vertebral Artery Injury Caused by a Cervical Pedicle Screw Malposition: Two Case Reports.

Otsuka T, Izumi T, Nishihori M, Tsukada T, Araki Y, Yokoyama K, Uda K, Goto S, Ikezawa M, Kato N, Nakano M, Saito R

NMC case report journal 8 巻 ( 1 ) 頁： 713 - 717 2021年

TERT promoter mutation confers favorable prognosis regardless of 1p/19q status in adult diffuse gliomas with IDH1/2 mutations 国際誌

Hideyuki Arita, Yuko Matsushita, Ryunosuke Machida, Kai Yamasaki, Nobuhiro Hata, Makoto Ohno, Shigeru Yamaguchi, Takashi Sasayama, Shota Tanaka, Fumi Higuchi, Toshihiko Iuchi, Kuniaki Saito, Masayuki Kanamori, Ken ichiro Matsuda, Yohei Miyake, Kaoru Tamura, Sho Tamai, Taishi Nakamura, Takehiro Uda, Yoshiko Okita, Junya Fukai, Daisuke Sakamoto, Yasuhiko Hattori, Eriel Sandika Pareira, Ryusuke Hatae, Yukitomo Ishi, Yasuji Miyakita, Kazuhiro Tanaka, Shunsaku Takayanagi, Ryohei Otani, Tsukasa Sakaida, Keiichi Kobayashi, Ryuta Saito, Kazuhiko Kurozumi, Tomoko Shofuda, Masahiro Nonaka, Hiroyoshi Suzuki, Makoto Shibuya, Takashi Komori, Hikaru Sasaki, Masahiro Mizoguchi, Haruhiko Kishima, Mitsutoshi Nakada, Yukihiko Sonoda, Teiji Tominaga, Motoo Nagane, Ryo Nishikawa, Yonehiro Kanemura, Aya Kuchiba, Yoshitaka Narita, Koichi Ichimura

Acta Neuropathologica Communications 8 巻 ( 1 ) 頁： 201 - 201 2020年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

TERT promoter mutations are commonly associated with 1p/19q codeletion in IDH-mutated gliomas. However, whether these mutations have an impact on patient survival independent of 1p/19q codeletion is unknown. In this study, we investigated the impact of TERT promoter mutations on survival in IDH-mutated glioma cases. Detailed clinical information and molecular status data were collected for a cohort of 560 adult patients with IDH-mutated gliomas. Among these patients, 279 had both TERT promoter mutation and 1p/19q codeletion, while 30 had either TERT promoter mutation (n = 24) or 1p/19q codeletion (n = 6) alone. A univariable Cox proportional hazard analysis for survival using clinical and genetic factors indicated that a Karnofsky performance status score (KPS) of 90 or 100, WHO grade II or III, TERT promoter mutation, 1p/19q codeletion, radiation therapy, and extent of resection (90–100%) were associated with favorable prognosis (p < 0.05). A multivariable Cox regression model revealed that TERT promoter mutation had a significantly favorable prognostic impact (hazard ratio = 0.421, p = 0.049), while 1p/19q codeletion did not have a significant impact (hazard ratio = 0.648, p = 0.349). Analyses incorporating patient clinical and genetic information were further conducted to identify subgroups showing the favorable prognostic impact of TERT promoter mutation. Among the grade II-III glioma patients with a KPS score of 90 or 100, those with IDH-TERT co-mutation and intact 1p/19q (n = 17) showed significantly longer survival than those with IDH mutation, wild-type TERT, and intact 1p/19q (n = 185) (5-year overall survival, 94% and 77%, respectively; p = 0.032). Our results demonstrate that TERT promoter mutation predicts favorable prognosis independent of 1p/19q codeletion in IDH-mutated gliomas. Combined with its adverse effect on survival among IDH-wild glioma cases, the bivalent prognostic impact of TERT promoter mutation may help further refine the molecular diagnosis and prognostication of diffuse gliomas.

DOI： 10.1186/s40478-020-01078-2

A multinodular and vacuolating neuronal tumor in the right temporal lobe with positive methionine uptake: A case report

Taketo Nishizawa, Ryuta Saito, Masashi Chonan, Masayuki Kanamori, Kentaro Takanami, Mika Watanabe, Teiji Tominaga

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 22 巻 2020年12月

掲載種別：研究論文（学術雑誌）

Multinodular and vacuolating neuronal tumor (MVNT) is a recently recognized type of neural tumor that was first documented in 2013. This tumor type is characterized by multiple nodules of neuronal cells with vacuolar degeneration localized in the subcortical white matter. Here, we report a case of MVNT in the right temporal lobe of a 26-year-old female. Magnetic resonance imaging (MRI) revealed a high-intensity lesion on a T2- weighted image of the right temporal lobe without contrast enhancement. Positron emission tomography revealed increased 11C-methionine uptake in the lesion, which was pathologically diagnosed as MVNT.

DOI： 10.1016/j.inat.2020.100861

Phase I trial of convection-enhanced delivery of nimustine hydrochloride (ACNU) for brainstem recurrent glioma. 国際誌

がん遺伝子パネル検査でSMARCB1変異を認め、INI-1蛋白陽性のAT/RTと考えられた一例(Clinical sequencing revealed two distinct mutations in SMARCB1, in an INI-1 positive AT/RT)

Kaino Akira, Niizuma Hidetaka, Moriya Kunihiko, Katayama Saori, Irie Masahiro, Rikiishi Takeshi, Saito Ryuta, Kanamori Masayuki, Sasahara Yoji, Kure Shigeo

日本小児血液・がん学会雑誌 57 巻 ( 4 ) 頁： 245 - 245 2020年10月

Orengedokuto and shosaikoto for intractable intracranial carmustine implant-induced fever in a patient with brain tumor: A case report. 国際誌

Suzuki S, Takayama S, Kikuchi A, Arita R, Abe M, Saito R, Kanamori M, Tominaga T, Ishii T

Explore (New York, N.Y.) 17 巻 ( 3 ) 頁： 236 - 238 2020年8月

視床高悪性度神経膠腫におけるヒストン変異と予後についての検討

長田佳整, 齋藤竜太, 庄司拓大, 長南雅志, 柴原一陽, 金森政之, 園田順彦, 隈部俊宏, 渡邉みか, 冨永悌二

Brain Tumor Pathology 37 巻 ( Suppl. ) 頁： 130 - 130 2020年8月

IDH変異型膠芽腫自験連続9例の検討

齋藤竜太, 長田佳整, 柴原一陽, 金森政之, 園田順彦, 隈部俊宏, 渡辺みか, 冨永悌二

Brain Tumor Pathology 37 巻 ( Suppl. ) 頁： 092 - 092 2020年8月

Frequent Clinical and Radiological Progression of Optic Pathway/Hypothalamic Pilocytic Astrocytoma in Adolescents and Young Adults. 査読有り

Shoji T, Kanamori M, Saito R, Watanabe Y, Watanabe M, Fujimura M, Ogawa Y, Sonoda Y, Kumabe T, Kure S, Tominaga T

Neurologia medico-chirurgica 60 巻 ( 6 ) 頁： 277 - 285 2020年5月

Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review. 国際誌

Endo T, Inoue T, Sugiyama S, Saito R, Tominaga T

Operative neurosurgery (Hagerstown, Md.) 18 巻 ( 4 ) 頁： 451 - 459 2020年4月

髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

戒能明, 新妻秀剛, 入江正寛, 片山紗乙莉, 森谷邦彦, 力石健, 齋藤竜太, 金森政之, 笹原洋二, 呉繁夫

日本小児科学会雑誌 124 巻 ( 2 ) 頁： 321 - 321 2020年2月

髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

戒能明, 新妻秀剛, 入江正寛, 片山紗乙莉, 森谷邦彦, 力石健, 齋藤竜太, 金森政之, 笹原洋二, 呉繁夫

日本小児科学会雑誌 124 巻 ( 2 ) 頁： 321 - 321 2020年2月

Saito R, Kanamori M, Sonoda Y, Yamashita Y, Nagamatsu K, Murata T, Mugikura S, Kumabe T, Wembacher-Schröder E, Thomson R, Tominaga T

Neuro-oncology advances 2 巻 ( 1 ) 頁： vdaa033 2020年1月

TERT promoter mutation associated with multifocal phenotype and poor prognosis in patients with IDH wild-type glioblastoma. 国際誌

Kikuchi Z, Shibahara I, Yamaki T, Yoshioka E, Shofuda T, Ohe R, Matsuda KI, Saito R, Kanamori M, Kanemura Y, Kumabe T, Tominaga T, Sonoda Y

Neuro-oncology advances 2 巻 ( 1 ) 頁： vdaa114 2020年1月

Cystic Glioblastoma Rupturing into the Ventricle.

Yoshimichi Sato, Ryuta Saito, Masayuki Kanamori, Teiji Tominaga

NMC case report journal 7 巻 ( 1 ) 頁： 39 - 41 2020年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Cystic tumors, such as craniopharyngiomas and Rathke's cleft cysts, as well as arachnoid cysts have been reported to rupture occasionally. Approximately 8-10% of glioblastomas (GBMs) are known to have a significant cystic component; however, to the best of our knowledge, no studies have reported cystic rupturing of GBMs. Here, we describe a unique case of cystic GBM rupturing and penetrating into the cerebral ventricle. A 77-year-old man with a right frontal lobe lesion suspected as GBM with a large cyst was referred to our hospital. At admission, disorientation and left facial weakness were detected. Consciousness disturbance worsened on the 8th day of hospitalization. Computed tomography (CT) revealed prominent shrinkage of the tumor and intratumoral cyst. Signs of meningeal irritation were observed, and chemical meningitis due to cystic tumor rupture and leakage of necrotic components into the ventricle was highly suspected. Surgical resection of the right frontal lobe tumor was performed on the 10th day of hospitalization. During the surgery, clear and colorless cerebrospinal fluid was obtained upon penetration of the tumoral cyst, suggesting traffic of tumor cysts and cerebral ventricle. Adjuvant chemoradiation therapy was initiated postoperatively. Local recurrence was noted at the corpus callosum 7 months postoperatively and was treated with a gamma knife. Further therapy was performed after this recurrence. However, his condition gradually deteriorated 15 months postoperatively, and he was subjected to terminal care. To the best of our knowledge, this is the first report on a cystic GBM rupture.

DOI： 10.2176/nmccrj.cr.2019-0043