記述言語：英語   掲載種別：研究論文（学術雑誌）  

Acromegaly most commonly results from excess growth hormone (GH) produced by pituitary neuroendocrine tumors (PitNETs). Craniopharyngioma (CP) is an uncommon suprasellar tumor characterized by cystic change and calcification. The true coexistence of PitNET and CP is rare and poses diagnostic and operative challenges, particularly when lesions are spatially separated. A 72-year-old man was referred for a pituitary mass and clinical features suggestive of acromegaly (enlarged extremities, prominent supraorbital ridge, and jaw enlargement) without headache or visual complaints. MRI demonstrated two distinct lesions: a heterogeneous, mainly cystic suprasellar mass measuring 2.2×1.2×1.2 cm compressing the optic chiasm and extending toward the third ventricle, and a separate 1.7×1.2×1.1 cm intrasellar lesion extending into the sphenoid sinus. CT showed calcification within the suprasellar lesion. Baseline hormones revealed elevated GH (7.60 ng/mL) and IGF-1 (388 ng/mL; +5.7 SD) with inadequate GH suppression on oral glucose tolerance testing (nadir GH 2.68 ng/mL). An endoscopic endonasal transsphenoidal approach was undertaken. Intraoperatively, a white, soft intrasellar tumor breaching the dura and protruding into the sphenoid sinus was removed, and a separate, highly calcified suprasellar tumor was internally decompressed and dissected free; no macroscopic continuity was identified. Histopathology showed a densely granulated mixed somatotroph-lactotroph PitNET (immunoreactive for GH, prolactin, Pit-1, and alpha subunit; CAM5.2 perinuclear pattern <70%; Ki-67 <1%) and an adamantinomatous CP with wet keratin and calcified nests. Postoperatively, GH fell to 0.36 ng/mL and IGF-1 to 166 ng/mL (+1.2 SD). Transient diabetes insipidus occurred and was controlled with desmopressin. The patient was discharged without new neurological deficits, and an MRI at four months showed no recurrence. This case underscores the value of recognizing "separated" coexistence of CP and PitNET, in which discrepant imaging features (calcified, cystic suprasellar mass versus enhancing intrasellar lesion) can suggest dual pathology before surgery. Clear preoperative identification facilitates tailored resection strategies, allows focused manipulation of each lesion, and helps balance the competing priorities of gross-total removal and preservation of pituitary-hypothalamic function. Early biochemical remission of acromegaly and an uncomplicated radiographic course support the efficacy and safety of an endoscopic endonasal approach in selected patients. When intra- and suprasellar lesions demonstrate discordant radiologic characteristics in a patient with biochemical acromegaly, concomitant CP and PitNET should be considered. Distinguishing separated from admixed disease preoperatively can guide operative planning and reduce morbidity. Targeted endoscopic resection achieved prompt hormonal normalization and radiographic disease control in this patient, emphasizing the importance of individualized, anatomy-driven management and vigilant postoperative endocrine and imaging follow-up.

DOI： 10.7759/cureus.93606

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because of ischemic symptoms, intracranial internal carotid artery (IICA) dissection has no established treatment guidelines. The authors report a case of IICA dissection in which an emergency superficial temporal artery-middle cerebral artery (STA-MCA) bypass was performed. OBSERVATIONS: A 46-year-old woman presented with a headache and left hemiplegia. Her cortical symptoms appeared on day 10, and an STA-MCA bypass was performed because of cerebral hypoperfusion. Her postoperative patency was good, and cortical symptoms improved. Contrast-enhanced magnetic resonance imaging (MRI) was performed in the acute phase with wall contrast. From day 18, the internal carotid artery delineation improved, and the patient was transferred for rehabilitation without worsening symptoms. A literature review of spontaneous IICA dissection with revascularization procedures was conducted to discuss the indications, timing, treatment modalities, and surgical outcomes. LESSONS: The STA-MCA bypass provides supplemental cerebral blood flow and can prevent critical complications. Contrast-enhanced MRI in the acute phase of dissection can show a wall contrast effect and assist in predicting disease progression. https://thejns.org/doi/10.3171/CASE24332.

DOI： 10.3171/CASE24332

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND:  Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. In this study, we compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and formation of microvascular thrombosis in anastomosis were compared. METHODS:  We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink. RESULTS:  The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4. CONCLUSION:  BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced when BV4 was used.

DOI： 10.1055/a-2175-3295

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Infarction of the posterior inferior cerebellar artery (PICA) can lead to ischemic stroke in the lateral medullary oblongata. PICA dissection can also elicit an ischemic event in this region, but its detection on radiological images is difficult because of the small diameter of the vessel. We report a case of Wallenberg syndrome due to PICA dissection in a 48-year-old man, which was difficult to diagnose on first admission. He reported sudden onset of sensory disturbance on the right side of his face, ataxic gait, and headache. Brain magnetic resonance imaging (MRI) revealed a fresh cerebral infarct in the right lateral medulla oblongata. Magnetic resonance angiography (MRA) performed at the time of his admission showed no cerebral vessel abnormalities. An MRI study 18 months after the event revealed a fusiform aneurysm on the lateral medullary segment of the PICA, which was extremely close to the cerebral infarct. We concluded that the infarct was due to PICA dissection because of the sudden onset of symptoms and because the infarcted territory of the occluded penetrating branch of the dissecting aneurysm was consistent with Wallenberg syndrome. The aneurysm was trapped and an occipital artery-PICA bypass was placed. At the latest follow-up, 1 year after the procedure, he had no neurological symptoms. Imaging findings at the time of his first admission indicated that the PICA was intact. However, 18 months later, MRI revealed enlargement of an aneurysm at the site of the dissection. A cerebral infarct with headache may indicate PICA dissection.

DOI： 10.1272/jnms.JNMS.2024_91-101

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Fat is commonly used for preventing cerebrospinal fluid (CSF) leakage during endoscopic transsphenoidal surgery (ETSS). However, fat is soft, slippery, and sometimes not easy to handle. The present study aimed to examine the efficacy of our Surgicel® wrapping method, which allows for better fat handling, in preventing the occurrence of CSF leakage among patients undergoing ETSS. METHODS: We used fat tissues removed from the abdomen. The fat was cut with scissors into pieces that were approximately 5 mm in size. Surgicel® was also cut into 2.5 cm2. The fat tissues were encased with these Surgicel® squares and slightly moistened with a saline solution. RESULTS: Between January 2023 and August 2024, 34 patients aged 18-86 years (average 54.9 years) underwent ETSS. Among these patients, 20 had pituitary tumors, 6 had Rathke's cysts, and 8 had other conditions. None of the patients had CSF leakage postoperatively. The use of Surgicel®-wrapped fat during ETSS is better than the use of fat alone. CONCLUSION: The Surgicel® wrapping method allows for better fat handling during ETSS.

DOI： 10.25259/SNI_626_2024

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(一社)日本意識障害学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

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