記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Some patients develop immunoglobulin G4 (IgG4)-related hypophysitis associated with systemic diseases. More than 30 cases of IgG4-related hypophysitis have been reported. However, biopsy has rarely been performed in these patients, and none have had an associated pituitary neuroendocrine tumor (PitNET). We present a case of concurrent IgG4-related hypophysitis and PitNET. CASE PRESENTATION: A 56-year-old Japanese man arrived at the hospital with visual impairment, bitemporal hemianopia, and right abducens nerve palsy. Magnetic resonance imaging revealed pituitary body and stalk swelling as well as a small poorly enhanced right anterior lobe mass. Laboratory and loading test results suggested hypopituitarism. Because IgG4 level was elevated, a systemic examination was performed; multiple nodules were found in both lung fields. The diagnosis was based on an endoscopic transnasal biopsy of the pituitary gland. A histopathological examination revealed a marked infiltration of plasma cells into the pituitary gland, which was strongly positive for IgG4. The histological features of the resected tumor were consistent with those of gonadotroph PitNET, which was immunohistochemically positive for follicle-stimulating hormone-β and steroidogenic factor-1, and no plasma cell infiltration was observed. Based on the histopathological examination results, steroid therapy was initiated, which reduced pituitary gland size and serum IgG4 levels. DISCUSSION AND CONCLUSIONS: This is the first reported case of IgG4-related hypophysitis with PitNET. Although no pathological findings indicating a relationship between the two conditions were found, we were able to preoperatively differentiate multiple lesions via detailed diagnostic imaging.

DOI： 10.1186/s12902-023-01353-y

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Training kits for laparoscopes for deep suturing under endoscopes are commercially available; however, previously reported training kits for endoscopic transnasal transsphenoidal pituitary/skull base surgery (eTSS) were not available in the market. Moreover, the previously reported low cost, self-made kit has the drawback of being unrealistic. This study aimed to create a low cost training kit for eTSS dura mater suturing that was as close to real as possible. Most necessary items were obtained from the 100-yen store ($1 store) or from everyday supplies. As an alternative to the endoscope, a stick-type camera was used. Through the assembly of the materials, a simple and easy-to-use training kit was created, which is almost identical to the actual dural suturing situation. In eTSS, a simple and easy-to-use training kit for dural suturing was successfully created at a low cost. This kit is expected to be used for deep suture operations and the development of surgical instruments for training.

DOI： 10.1038/s41598-023-32311-2

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本医療安全学会  

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Pituitary incidentalomas are tumors or mass lesions of the pituitary gland. These are incidentally discovered during imaging studies for symptoms that are not causally related to pituitary diseases. The most common symptom that triggers an examination is headache, and the most common type of pituitary incidentalomas are pituitary neuroendocrine tumors (PitNETs) and Rathke cleft cysts. The existing treatment strategy is controversial; however, surgical resection is recommended in cases of clinically non-functioning PitNETs with optic chiasm compression. In contrast, cystic lesions, such as Rathke cleft cysts, should be followed if the patients are asymptomatic. In this case, MRI and pituitary function tests are recommended every six months to one year; if there is no change, the follow-up period should be extended. The natural history of PitNET is partially known, and the management of pituitary incidentalomas is determined by this history. However, the pathogenesis of PitNET has significantly changed with the new World Health Organization classification, and follow-up is important based on this new classification. Therefore, a high level of evidence-based research is needed to consider treatment guidelines for pituitary incidentalomas in the future.

DOI： 10.3390/cancers14174324

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Maintaining the patency of extracranial-to-intracranial (EC-IC) bypass is critical for long-term stroke prevention. However, reports on the factors influencing long-term bypass patency and quantitative assessments of bypass patency are limited. OBJECTIVE: To quantitatively evaluate blood flow in EC-IC bypass using four-dimensional (4D) flow magnetic resonance imaging (MRI) and investigate factors influencing the long-term patency of EC-IC bypass. METHODS: Thirty-six adult Japanese patients who underwent EC-IC bypass for symptomatic internal carotid or middle cerebral artery occlusive disease were included. We examined the relationships between decreased superficial temporal artery (STA) blood flow volume and perioperative complications, long-term ischemic complications, patient background, and postoperative antithrombotic medications in patients for whom STA flow could be quantitatively assessed for at least 5 months using 4D flow MRI. RESULTS: The mean follow-up time was 54.7 ± 6.1 months. One patient presented with a stroke during the acute postoperative period that affected postoperative outcomes. No recurrent strokes were recorded during long-term follow-up. Two patients died of malignant disease. Seven cases of reduced flow occurred in the STA, which were correlated with single bypass (P = .0294) and nonuse of cilostazol (P = .0294). STA occlusion was observed in 1 patient during the follow-up period. Hypertension, age, smoking, dyslipidemia, and diabetes mellitus were not correlated with reduced blood flow in the STA. CONCLUSION: Double anastomoses and cilostazol resulted in long-term STA blood flow preservation. No recurrence of cerebral infarction was noted in either STA hypoperfusion or occlusion cases.

DOI： 10.1227/NEU.0000000000001846

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：日本脳神経CI学会  

researchmap

記述言語：日本語   出版者・発行元：日本脳神経CI学会  

これまでに進められた研究プロジェクトのコンセプトと現況、課題をまとめた。プロジェクトIの脳神経外科領域robotic system(Smart Arm)の開発では、1)深部狭小術野操作を可能とするシステムと、2)浅術野の超微細手術を可能とするシステムを構築した。今回、1)において特に経鼻内視鏡手術支援用robotic systemの構築を企画した。プロジェクトIIでは外科技術のデジタル評価、プロジェクトIIIでは自動化手術を試みた。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Considering the lack of studies on the long-term evaluation of improvements in microsurgical techniques using simulation models, we determined whether technical improvements in surgical techniques could be assessed based on an increase in the score of contest-style continuous and objective evaluation systems involving the same microsurgical task. METHODS: Since 2014, neurosurgeons with 1-10 years of experience participated in a biannual competition-style test. The task involved suturing as many times as possible within 5 min after arteriotomy of 1-mm artificial vessels. A modified version of the Objective Structured Assessment of Technical Skills examination was created and used. Changes and differences in scoring results over time were examined for each evaluator. RESULTS: Overall, 103 neurosurgeons participated in the study at least once, and those who participated more than once were divided into two groups: those who obtained the highest score in each contest and those who obtained the lowest score. The linear regression equations for the highest and lowest scorer groups were y=7.62x+81.56 (R2=0.628) and y=1.94x+67.93 (R2=0.0433), respectively. The high-scoring group had high scores from the first time they participated, and their scores tended to increase further, while the low-scoring group did not show any tendency of score increases after gaining experience. No significant differences were found in scores according to four evaluators. CONCLUSIONS: Our study showed the possibility of assessing technical improvements in surgery through long-term and continuous microsurgical technique evaluation. A surgical technique evaluation system was established, and its potential to contribute to surgical safety was demonstrated.

DOI： 10.1272/jnms.JNMS.2022_89-407

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

Robotic surgery, which has been introduced to the field of neurosurgery, has the potential to improve the safety, accuracy, and dexterity of surgery compared to conventional methods. Currently, accuracy‒ enhancing robotic systems for stereotactic and spinal neurosurgery are used. In particular, stereotactic depth electrode placement using a robotic system has shown clinical benefits over conventional frame‒ based placements. Several microsurgery systems for dexterity‒enhancing systems are available. Our trials aimed to develop the following two systems：1）a deep endonasal robotic system that supports endonasal procedures, including dural suturing at the anterior cranial base and complicated vascular procedures and 2）a super‒microsurgery system that enables anastomosis of 0.3 mm diameter vessels. Our systems showed a rapid learning curve for surgical beginners and enhanced the accuracy of left‒hand procedures. In future, we aim to improve the user‒friendly control and durability of these systems. At the same time, robotics engineering can enhance surgical science by digitalizing all dimensions of surgical procedures and introducing artificial intelligence for sensor‒ and image‒guided automated surgical developments. In the near future, robotic surgery will be routinely applied in complex and daily surgical procedures to improve surgical outcomes without significant variance between occasions and surgical or hospital experiences.

DOI： 10.7887/jcns.31.500

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The ring finger protein 213 (RNF213) susceptibility gene has been detected in more than 80% of Japanese and Korean patients with moyamoya disease (MMD), a bilateral internal carotid artery (ICA) occlusion. Furthermore, RNF213 has been detected in more than 20% of East Asians with atherosclerotic ICA stenosis. In this study, we evaluated the frequency of RNF213 mutations in congenital occlusive lesions of the ICA system. This case series was conducted jointly at four university hospitals. Patients with a family history of MMD, quasi-MMD, or related diseases were excluded. Ten patients were diagnosed with abnormal ICA or middle cerebral artery (MCA) angiogenesis. Patients with neurofibromatosis were excluded. Finally, nine patients with congenital vascular abnormalities were selected; of these, five had ICA deficiency and four had twig-like MCA. The RNF213 c.14576G > A mutation was absent in all patients. Therefore, the RNF213 c.14576G > A mutation may not be associated with ICA and MCA congenital dysplasia-rare vascular anomalies making it difficult to study a large number of cases. However, an accumulation of cases is required for accurate determination. The results of this study may help differentiate congenital vascular diseases from MMD.

DOI： 10.1038/s41598-021-01623-6

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

A mutation in RNF213 (c.14576G>A), a gene associated with moyamoya disease (>80%), plays a role in terminal internal carotid artery (ICA) stenosis (>15%) (ICS). Studies on RNF213 and cerebral aneurysms (AN), which did not focus on the site of origin or morphology, could not elucidate the relationship between the two. However, a report suggested a relationship between RNF213 and AN in French-Canadians. Here, we investigated the relationship between ICA saccular aneurysm (ICA-AN) and RNF213. We analyzed RNF213 expression in subjects with ICA-AN and atherosclerotic ICS. Cases with a family history of moyamoya disease were excluded. AN smaller than 4 mm were confirmed as AN only by surgical or angiographic findings. RNF213 was detected in 12.2% of patients with ICA-AN and 13.6% of patients with ICS; patients with ICA-AN and ICS had a similar risk of RNF213 mutation expression (odds ratio, 0.884; 95% confidence interval, 0.199–3.91; p = 0.871). The relationship between ICA-AN and RNF213 (c.14576G>A) was not correlated with the location of the ICA and bifurcation, presence of rupture, or multiplicity. When the etiology and location of AN were more restricted, the incidence of RNF213 mutations in ICA-AN was higher than that reported in previous studies. Our results suggest that strict maternal vessel selection and pathological selection of AN morphology may reveal an association between genetic mutations and ICA-AN development. The results of this study may form a basis for further research on systemic vascular diseases, in which the RNF213 (c.14576G>A) mutation has been implicated.

DOI： 10.3390/genes12101468

Scopus

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

DOI： 10.1507/endocrine.97.s.hpt_32

CiNii Research

researchmap

その他リンク： https://search.jamas.or.jp/link/ui/2022074895

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Quasi-moyamoya disease (QMMD) is moyamoya disease (MMD) associated with additional underlying diseases. Although the ring finger protein 213 (RNF213) c.14576G>A mutation is highly correlated with MMD in the Asian population, its relationship to QMMD is unclear. Therefore, in this study the authors sought to investigate the RNF213 c.14576G>A mutation in the genetic diagnosis and classification of QMMD. METHODS: This case-control study was conducted among four core hospitals. A screening system for the RNF213 c.14576G>A mutation based on high-resolution melting curve analysis was designed. The prevalence of RNF213 c.14576G>A was investigated in 76 patients with MMD and 10 patients with QMMD. RESULTS: There were no significant differences in age, sex, family history, and mode of onset between the two groups. Underlying diseases presenting in patients with QMMD were hyperthyroidism (n = 6), neurofibromatosis type 1 (n = 2), Sjögren's syndrome (n = 1), and meningitis (n =1). The RNF213 c.14576G>A mutation was found in 64 patients (84.2%) with MMD and 8 patients (80%) with QMMD; no significant difference in mutation frequency was observed between cohorts. CONCLUSIONS: There are two forms of QMMD, one in which the vascular abnormality is associated with an underlying disease, and the other in which MMD is coincidentally complicated by an unrelated underlying disease. It has been suggested that the presence or absence of the RNF213 c.14576G>A mutation may be useful in distinguishing between these disease types.

DOI： 10.3171/2021.5.FOCUS21182

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本レーザー医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

経鼻的生検術を行った自己免疫性下垂体炎3症例を提示し、生検術の方法と注意点について報告した。視床下部下垂体に限局した病変で、診断が絞れないケース対して下垂体部の生検術を行う場合には術中髄液漏のリスクを考慮して、トルコ鞍を後方まで十分に削除し、下垂体硬膜を大きく切開した後、後葉の方向から行っている。各種検査で診断を絞ることができなかった症例1(79歳男性)と症例2(64歳女性)は、生検にてそれぞれ頭蓋咽頭腫、リンパ球汎下垂体炎と診断された。症例3(56歳男性)はIgG4関連下垂体炎が最も疑われたが、MRI所見が非典型的であり、生検にて下垂体腺腫を合併したIgG4関連下垂体炎と診断された。正常組織を一部摘出する生検術は最小限の侵襲で行う必要があり、下垂体および周辺の解剖を理解して正確な生検術を行い、下垂体機能を悪化させないことも極めて重要である。

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01160&link_issn=&doc_id=20210929320010&doc_link_id=%2Fcs6hypop%2F2021%2F0097s1%2F011%2F0032-0035%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcs6hypop%2F2021%2F0097s1%2F011%2F0032-0035%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Recent reports regarding endoscopic third ventriculostomy (ETV) for pediatric hydrocephalus revealed that ETV could avoid cerebrospinal fluid (CSF) shunting in certain types of hydrocephalus. However, the effectiveness of ETV for "pure" communicating hydrocephalus that has no obstruction through CSF pathway is still unknown. In this study, we report clinical outcome of ETV and CSF shunting for communicating hydrocephalus and discuss the efficacy of ETV for pure communicating hydrocephalus. METHODS: Children less than 15 years old who underwent ETV or CSF shunting for communicating hydrocephalus were retrospectively reviewed. The absence of obstruction through CSF circulation was confirmed by CT cisternography or cine-contrast image in MRI. RESULTS: Sixty-three patients (45 CSF shunting and 18 ETV) were included. The mean follow-up period was 6.1 years. The success rate was 60% in CSF shunting and 67% in ETV at the last visit (p = 0.867). Normal development was observed in 24 patients (53%) in CSF shunting and 12 patients (67%) in ETV (p = 0.334). There was a significant difference in the mean time to failure (CSF shunting: 51.1 months, ETV 3.6 months, p = 0.004). The factor that affected success rate in ETV was the age at surgery (success 21.6 months, failure 4.4 months, p = 0.024) and ETV success score (success 66.7, failure 50.0, p = 0.047). CONCLUSION: Clinical outcomes of ETV were not inferior to those of CSF shunting in patients with communicating hydrocephalus. Further studies is required to elucidate to establish the consensus of ETV as a treatment option for communicating hydrocephalus.

DOI： 10.1007/s00381-021-05242-4

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: It was reported that the XYZ/2 technique (using length, width and height of hematoma) is a simple and reliable method of estimation of chronic subdural hematoma volume. Two subtypes of techniques enable to adequately estimate, it is unclear which is more accurate. Computer-assisted volumetric analysis is widely considered the gold standard for CSDH volumetric analysis. It is important to consider the stability of analyses between examiners, because individual, decision-making differences may be relevant to the analysis, as hematoma margin and length are hand-operated. In this study, we investigated potential measurement biases of three neurosurgeons and analyzed the validity of the XYZ/2 technique by comparing it to the gold standard method. METHOD: We retrospectively analyzed CT scans that indicated the need for an operation in 50 patients with CSDH in our department. Three neurosurgeons measured and calculated CSDH volumes independent of one another. We investigated potential measurement biases of three neurosurgeons and analyzed the validity of the XYZ/2 technique by comparing it to the gold standard method. The XYZ/2 technique includes the "maximal method" that uses the maximum length and maximum width of a slice to determine volume, and the "central method" that uses only the central slice to measure length and width. RESULTS: ICCs for the gold standard, central method, and maximal method were 0.945, 0.916, and 0.844, respectively, all of which indicated excellent reliability. For all examiners, the differences in calculation from gold standard and central method were not statistically significant (P>0.05). The estimations of CSDH volume calculated by the maximal method were significantly greater than the estimates calculated by the gold standard (P<0.05). CONCLUSIONS: This study proves that the XYZ/2 technique is a simple and reliable method of estimating CSDH volume. The "central method" in particular yielded similar results to that of the gold standard method.

DOI： 10.1016/j.neuchi.2021.04.009

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We reported a 7-month-old female with intraorbital Ewing's sarcoma. Infantile Ewing's sarcoma is rare and its prognosis is poor. Ewing's sarcoma of orbital origin is even rare. There has been only 1 case of infantile intraorbital Ewing's sarcoma reported, and only 5 infantile primary orbital ESFTs (Ewing's sarcoma family of tumors) have been reported. Among these 5 cases, 2 infants who did not receive multimodal therapy died, whereas 3 who received multimodal therapy demonstrated long-term survival. The present case was also treated with multimodal therapy consisting of surgery, chemotherapy, and proton beam radiotherapy. There is no recurrence at 15 months follow-up. No specific treatment strategies have been established yet, and accumulation of cases is necessary. Ewing's sarcoma should be included in the differential diagnosis of infantile intraorbital tumors.

DOI： 10.1007/s00381-020-04606-6

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although terminal syringomyelia suggests a tethered spinal cord, a consensus has still not been established for surgical indications, when there are no associated abnormalities or only minor associated abnormalities. We analyzed surgical outcomes of sectioning a filum terminale in patients with terminal syringomyelia to elucidate the significance of untethering surgery. METHODS: Fifty-seven pediatric patients with terminal syringomyelia who underwent untethering via sectioning the filum terminale between 2007 and 2018 were retrospectively analyzed. Postoperative outcomes of symptoms and MRI findings were evaluated. RESULTS: Of 57 patients, 40 had other associated abnormalities (25 with filar lipoma and 29 with low conus medullaris) that could be responsible for tethered cord. Nineteen patients had symptoms. The mean age at the time of surgery was 18 months (3-96 months). The mean follow-up period was 3.3 years (1-9 years). Preoperative symptoms improved in 9 patients (47%) after surgery. At 1 year after the surgery, the size of syringomyelia decreased in 19 (33%), increased in 4 (8%), and did not change in 34 (69%) patients. Of 28 patients who were followed up for more than 3 years, the size decreased in 17 (61%), increased in 1 (4%), and did not change in 10 (35%). CONCLUSION: When untethering was performed by sectioning a filum terminale, the size of terminal syringomyelia decreased in more than half of patients in the long term. Sectioning the filum terminale demonstrated the possibility of radiological and clinical improvement in patients with terminal syringomyelia.

DOI： 10.1007/s00381-020-04615-5

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本シミュレーション医療教育学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report the unusual case of a 7-month-old girl presenting with congenital cervical dermal sinus tract in which the intradural tract was not detected on preoperative imaging and was identified intraoperatively. Considering possible devastating sequelae of infection, excision of dermal sinus tract might be justified even in the case with radiologically undetected intradural tract.

DOI： 10.1007/s00381-020-04673-9

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: There have been reports on postoperative ischemic complications with vascular reconstructive surgery. However, various factors, such as lesions, operative technique, and perioperative treatment, prevent analyzing the causes of ischemic complications in vascular reconstruction surgeries. In the present study, we analyzed the cause of ischemic complications for vascular reconstruction surgeries with the same operator, surgical procedure, and perioperative treatment and without focusing on the lesions. PATIENTS AND METHODS: We retrospectively reviewed 66 patients, including 24 aneurysm cases and 42 ischemic disease cases, between 2008 and 2018. The patient group comprised 35 males and 31 females, and the patient mean age was 63.3 (23-87) years. We investigated the postoperative presence of symptomatic and asymptomatic cerebral ischemia on MRIDWI performed within 4 postoperative days. We conducted a statistical analysis of the ischemic complications and clinical and treatment factors. RESULTS: Symptomatic cerebral ischemia was detected in 3 cases, whereas asymptomatic ischemic findings were identified in 8 cases. All cases of symptomatic cerebral ischemia involved cerebral aneurysms. Results of a univariate analysis revealed an association between symptomatic cerebral ischemia and preoperative antithrombotic therapy (OR, 0.07; p =  0.049 (95 %CI; 0.007-0.8794)), clipping (OR, 4.8; p =  0.0501 (95 %CI; 1.641-342.9)), and aneurysm (OR, 14.16; p =  0.0423 (95 %CI; 0.6991-286.9)). Significant associations were found between asymptomatic cerebral ischemia and preoperative antithrombotic therapy [OR, 0.2941; p =  0.0514 (95 %CI; 0.08335-1.038)], aneurysms [OR, 7.8; p =  0.0146 (95 %CI; 1.414-43.04)] and radial artery grafts (RAGs) [OR, 6.8; p =  0.0192 (95 %CI; 1.410-32.98)]. Multivariate analysis identified clipping [OR, 5.462; p =  0.045 (95 %CI; 1.01-78.25] and preoperative antithrombotic therapy [OR, 0.187; p =  0.037 (95 %CI; 0.004-0.813)] as the risk factors for symptomatic cerebral ischemia. Further, a correlation was found between asymptomatic cerebral ischemia and RAGs [OR, 9.244; p =  0.00013 (95 %CI; 2.34-29.44)]. CONCLUSION: Ischemic complications associated with combined vascular reconstruction surgeries for cerebral aneurysms are possibly associated with procedures related to aneurysmal occlusions. Thus, vascular reconstruction surgeries can be performed relatively safely. Further, preoperative antithrombotic treatment should be considered, and caution is required for asymptomatic cerebral ischemia in RAG cases.

DOI： 10.1016/j.clineuro.2020.105768

PubMed

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Atypical teratoid rhabdoid tumor (AT/RT) is a rare, clinically highly malignant tumor. The extent of the surgical resection may affect survival. However, it is often difficult to perform gross total resection (GTR) at an initial surgery because of the large tumor size and high vascularity. Neoadjuvant chemotherapy may reduce not only the size but also the vascularity. We report our experience, review the literature, and analyze its effectiveness. METHODS: A retrospective chart review of patients who underwent neoadjuvant chemotherapy and second-look surgery was performed. Demographic data, treatment courses, changes in tumor after the chemotherapy, extent of resection and estimated blood loss (EBL) during the second-look surgery, and outcome of each children were evaluated. RESULTS: There are 4 cases. The average age at diagnosis was 13.3 months (2-30 months). Two to 4 courses of neoadjuvant chemotherapy were performed. MRI after the chemotherapy showed reduction of tumor volume, and tumor vascularity at the second-look surgery decreased in all cases. GTR was achieved in 3 cases, and NTR in 1 case. The mean EBL/estimated blood volume (EBL/EBV) was 21.3% (1.5-39%). The mean follow-up period was 23 months (2-48 months). At the last follow-up, 2 patients were alive without recurrence of the tumor (the follow-up periods were 48 and 16 months). CONCLUSIONS: Neoadjuvant chemotherapy for AT/RTs might reduce both tumor size and vascularity, which enabled the maximal tumor resection. It may contribute to improve the prognosis of AT/RT through facilitating the tumor resection.

DOI： 10.1007/s00381-019-04422-7

PubMed

researchmap

記述言語：英語  

DOI： 10.1507/endocrj.EJ19-0288

PubMed

J-GLOBAL

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a 3-year-old girl with decreased visual acuity of the left eye. Radiological studies revealed a mass lesion at the roof of the left optic canal with bony erosion, which compressed the left optic nerve. Gross total resection of the mass and decompression of the optic canal were performed. Histopathological study was consistent with nodular fasciitis. This is the first report of nodular fasciitis at the roof of the optic canal in a young child. Nodular fasciitis compressing the optic nerve should be included in differential diagnoses of optic neuropathy in young children.

DOI： 10.1007/s00381-019-04057-8

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

下垂体細胞腫(pituicytoma)の手術6例を対象に、臨床的検討を行った。全例が男性で、手術時年齢は平均58.6歳であった。症状は視野障害、副腎不全、性欲減退、偶発腫など多様であった。下垂体前葉ホルモンの3種(LH、FSH、GH)の低下を1例に認めた他は、いずれも汎下垂体機能低下を呈していた。MRI画像上の特徴は全例に腫瘍ないし腫瘍内にflow voidを認め、強いガドリニウム造影効果を示した。術前診断として、手術経験順に並べた時の前半2例は下垂体腺腫を考えて手術を行い、後半4例はpituicytomaも鑑別に挙げた上で手術を行った。前半2例は術中に予期せぬ出血に苦慮し、腫瘍は部分摘出に留まった。術中出血量は平均1350mlで、1例が術中輸血を必要とした。後半4例はワーキングスペースを広く確保する工夫を行い、術中出血量を平均212mlに抑えることができた。4例とも肉眼的に全摘出が可能で、その後の再発を認めていない。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01160&link_issn=&doc_id=20190708500001&doc_link_id=10.1507%2Fendocrine.95.S.HPT_5&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.95.S.HPT_5&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.

DOI： 10.1272/jnms.JNMS.2019_86-406

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although it is well-known that vertebrobasilar insufficiency (VBI) because of atherothrombosis with bilateral vertebral artery (VA) occlusion is resistant to medical treatment from the acute to subacute stages, the most appropriate treatment for progressive infarction at these stages remains unclear. Here, we described a patient with VBI who underwent emergency superficial temporal artery-superior cerebellar artery (STA-SCA) bypass under partial mastoidectomy after confirming mismatch between diffusion-weighted imaging (DWI) findings and clinical symptoms. The patient showed a good outcome with this approach. To our knowledge, our surgical strategy has not been previously reported. CASE DESCRIPTION: The patient was a 71-year-old woman with progressive infarction because of atherothrombosis with bilateral VA occlusions resistant to maximum medical treatment. Emergency STA-SCA bypass under partial mastoidectomy was performed after confirming DWI findings and symptom mismatch. A good outcome was archived, and no additional cerebral infarctions were noted. CONCLUSIONS: Emergency bypass should be considered as a treatment option for VBI that is resistant to maximal medical treatment after confirming DWI findings and symptom mismatch. Our approach involving partial mastoidectomy provides a wide and shallow operative field for STA-SCA bypass, which allows accurate bypass with good outcomes.

DOI： 10.1016/j.wneu.2018.07.032

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本職業・災害医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hemangioblastomas usually occur in the cerebellum and are often a component of von Hippel-Lindau disease. Edema-like changes along the optic tract are commonly observed in association with tumors in the sellar and suprasellar regions, such as craniopharyngiomas and pituitary adenomas. Here, we describe a case of sporadic suprasellar hemangioblastoma with edema-like changes along the optic tract that completely resolved after surgery. CASE DESCRIPTION: The patient was a 28-year-old woman with failing vision and a bitemporal hemianopia. Magnetic resonance imaging revealed a tumor accompanied by a 10-mm cyst. Fluid-attenuated inversion recovery axial magnetic resonance imaging revealed a hyperintense region along the optic tract. Other regions of the central nervous system were normal. Endoscopic transsphenoidal surgery was performed, and the histopathologic findings confirmed hemangioblastoma. Six months after surgery, the edema-like change along the optic tract had disappeared. The patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In addition, the genetic test was negative for von Hippel-Lindau mutations. CONCLUSIONS: When examining a patient with suprasellar tumor, clinicians must consider the possibility of hemangioblastoma. Adequate treatment can improve the edematous change and visual disturbance.

DOI： 10.1016/j.wneu.2018.03.114

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In vascular reconstructive surgery, intraoperative confirmation of patency is performed by angiography, Doppler, or indocyanine videoangiography, but it is sometimes insufficient. OBJECTIVE: Using the FLOW 800 system (Carl Zeiss, Oberkochen, Germany), we confirmed patency in a quantitative relative evaluation of the timing of the luminance change of the regions of interest (ROIs) on the donor and recipient. METHODS: Thirty-seven patients (58 anastomoses) were divided into 2 groups: those with arteriosclerotic ischemic disease (CI group; n = 23) and those with cerebral aneurysm (AN group; n = 14). Four ROIs were set: the donor, proximal, and distal sides of the recipient middle cerebral artery (MCA) and cortical MCA (control MCA). The half-life for fluorescence intensity was calculated by using the FLOW 800 system. A delay map analysis was also performed. RESULTS: In the CI group, there were statistically significant differences (P < 0.05) between the donor vessel and control MCA, proximal MCA and MCA control, and distal MCA and control MCA. The investigation with the delay map showed red tones in 20/22 patients in the CI group and in 2/17 patients in the AN group. CONCLUSIONS: In the CI group, the transit time of the donor vessel was shown relatively early as red T. When good patency has been achieved, the FLOW 800 system can be used to confirm patency more reliably, especially in ischemic regions. The unique point of this research is that the patency of anastomotic vessels was evaluated as a quantitative value of its rendering time rather than as a change in fluorescence intensity.

DOI： 10.1016/j.wneu.2017.11.072

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Giant thrombosed aneurysms of the vertebral artery (VA) are difficult to treat. Moreover, marked tortuosity of the parent VA complicates determination of the surgical approach. We report the case of a 71-year-old male patient who presented with gait disturbance. Magnetic resonance imaging revealed a giant thrombosed aneurysm of approximately 4cm in diameter located in the ventral region and to the right of the medulla oblongata. Computed tomography angiography showed that the right VA had extreme tortuosity, and that the VA union was in contact with the left 7th and 8th cranial nerves. Given that the aneurysm was thrombosed and causing a mass effect, we sought to trap it. In this case, because of the tortuous VA, intravascular team considered intravascular therapy to be too difficult. We made a question mark-shaped skin incision and used a wide bilateral suboccipital approach. The VA proximal to the aneurysm was occluded with an aneurysm clip using an approach from the right of the brainstem, while the VA distal to the aneurysm was occluded using a lateral suboccipital approach. When the VA and basilar artery are atherosclerotic and extremely tortuous, the distal and proximal aspects of the aneurysm can exist on both sides of the midline. In difficult cases such as that reported here, in which a giant VA aneurysm exceeded the midline of the anterior surface of the medulla, we believe that it is useful to employ a bilateral approach from both sides of the brainstem.

DOI： 10.1016/j.jocn.2017.08.019

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

In penetrating injuries, woods are known to be difficult to detect with radiological imaging studies, because the wood density are known to be extremely close to the value of air on CT. Adjustment of CT window and reconstruction of a 3D image from CT images allowed us to more accurately distinguish wood from air and to find the fragment of the wooden chopstick. It is particularly useful in transorbital penetrating injury.

DOI： 10.1007/s00381-017-3510-2

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chiasmapexy is used to treat empty sella syndrome, and various materials are used for the elevation of the optic chiasm. However, the use of artificial substances may have the risk of graft infection, and fat and muscle may be absorbed over the long term after surgery. In addition, bone and cartilage may be unavailable in adequate amounts. Here, we describe a new technique for chiasmapexy using an iliac crest bone graft. CASE DESCRIPTION: The first patient was a 71-year-old woman who had undergone transsphenoidal surgery twice for the treatment of pituitary adenoma and Rathke cleft cyst. The optic chiasm collapsed after the second surgery and her visual field worsened gradually. We performed chiasmapexy using fat, fascia, and a septal mucosal flap, but the optic chiasm did not remain in the normal position because of graft shrinkage. Finally, we used an iliac crest bone graft, which resulted in good visual function. The second patient was a 58-year-old man who was incidentally diagnosed with empty sella syndrome. The patient's bitemporal hemianopia gradually progressed. As in the first case, we used an iliac crest bone graft, which halted the deterioration of visual function after chiasmapexy. CONCLUSIONS: The advantages of iliac bone are that it is less likely to absorb and become infected than synthetic materials. This method may be suitable for reoperative cases, especially those wherein the septal cartilage has been removed in a previous surgery. This method will halt visual deterioration and may be one of the considerable options for chiasmapexy operations.

DOI： 10.1016/j.wneu.2017.08.080

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

65歳女。食欲低下、倦怠感を主訴とした。MRIで下垂体後葉の前方に8mm大の境界明瞭、低信号域の腫瘤様陰影を認め、ホルモン基礎値と負荷試験の結果から中枢性甲状腺低下症、中枢性性腺機能低下症、重症成人成長ホルモン分泌不全症、高PRL血症と診断した。画像上、下垂体の病変は後葉の前方に位置していたが、尿崩症は認めなかった。腫瘍性病変が否定できないため、経蝶形骨洞的下垂体手術を施行した。手術時、下垂体硬膜は非常に厚く線維化し、下垂体後葉の前方に白色調の線維に富む腫瘤を認め摘出した。病理組織学的に切除した病変部は線維化に富み、正常下垂体前葉にCD68陽性の泡沫状の組織球浸潤を認め、Xanthomatous hypophysitisが疑われた。CD1a、S-100、Grocotto、Ziehl-Neelsenは陰性で、Ki-67は1%未満であった。術後に頭痛が出現し、CTにて気脳症を認めたため髄液漏閉鎖術を行った。術後の負荷試験では成長ホルモン分泌低下のみを認め、中枢性甲状腺機能低下症、高PRL血症は改善していた。

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It can be difficult to make complete burr holes using a perforator with automatic releasing systems in cases of a soft diploe or thick calvarial bone. OBJECTIVE: To demonstrate the utility of a flipped "bone pad" (BP) in recovery of penetration failure when using an automatic releasing perforator. METHODS: For craniotomy or ventricular drainage, the first step is to make 1 or more burr holes using a craniotome. Neurosurgeons sometimes incompletely penetrate the skull using the latest tools. As a countermeasure for such cases, we have developed a simple and practical method. When making a perforation using a high-speed perforator, a round bone piece we call the BP is formed just above the dura. We pulled the BP from a completed burr hole, and placed the reversed BP in position at the bottom of the incompletely perforated burr hole. The BP acted as a new hard surface, preventing the automatic releasing system from activating, and allowed the burr hole to be completed by the craniotome without the need for additional tools. RESULTS: With this technique, we have successfully completed 6 out of 7 imperfectly perforated burr holes using a perforator with an automatic releasing system. There were no technique-related complications, such as plunging or dural laceration. CONCLUSIONS: The method has the advantage that the BP can be obtained without drilling an additional burr hole, and can be completed without the need for increasing cost, time, or instrument usage.

DOI： 10.1093/ons/opw043

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We report a case of an internal carotid artery (ICA) aneurysm anomalously originating from the posterior communicating artery (PComA). CASE DESCRIPTION: Preoperative radiologic findings revealed a paraclinoid carotid artery aneurysm at the level of the distal dural ring. Because of the low rupture risk, there are no treatment indications for small paraclinoid or ICA-superior hypophyseal artery unruptured aneurysms. In this case, because of the patient's age and the irregular shape of the aneurysm, treatment was considered necessary. Intraoperative findings using microscopic and endoscopic angiography showed that the aneurysm originated from the proximal branched PComA. The PComA originated from the same level as the ophthalmic artery, and the superior hypophyseal artery originated from the distal side of the PComA. CONCLUSIONS: According to numerous reports, small incidental paraclinoid aneurysms have a lower risk of rupture and growth than PComA aneurysms. Preoperative radiologic examination of unruptured small aneurysms was performed using magnetic resonance angiography and three-dimensional computed tomography angiography. Because the ability of magnetic resonance angiography and three-dimensional computed tomography angiography to detect small branches of the ICA is inferior to digital subtraction angiography, the location of an unruptured ICA aneurysm should be evaluated with other diagnostic modalities besides magnetic resonance angiography and three-dimensional computed tomography angiography.

DOI： 10.1016/j.wneu.2015.08.026

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20200624390009&doc_link_id=%2Fab8gtkrc%2F2020%2F004706%2F010%2F0908-0912%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004706%2F010%2F0908-0912%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

症例1(69歳女性)。左内頸動脈瘤に対する左前頭側頭開頭によるクリッピング術後5日頃より左側の聴力低下を自覚した。症例2(69歳女性)。左中大脳動脈瘤に対する左前頭側頭開頭によるクリッピング術後3日目より左聴力の低下を自覚した。いずれも耳鼻咽喉科を受診し、鼓室内血腫による伝音性難聴と診断され、カルボシステイン、アンブロキソール塩酸塩内服による保存的加療を行ったところ、20〜30日で自覚症状や聴力検査所見が改善した。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02079&link_issn=&doc_id=20160614290010&doc_link_id=%2Fcp4strok%2F2016%2F004403%2F010%2F0229-0234%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2016%2F004403%2F010%2F0229-0234%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

40歳女。約3年前に複視を自覚し、頭部CTを行ったところ、頭蓋内腫瘍を指摘され紹介となった。頭部MRIにて左錐体骨尖腫瘤性病変を認めたが、自然軽快していた。今回、複視が再出現したため手術治療目的に入院した。頭部MRIでは、腫瘤性病変は軽度増大し、内部に信号強度が二層性に分かれ、T2強調像では病変周囲にhypointense rimを認めた。コレステリン肉芽腫と判断し、経蝶形骨洞アプローチを選択した。左側病変に右鼻腔内から内視鏡を挿入し、蝶形骨洞内に進むと斜台のやや左側で頸動脈隆起の内側に病変部隆起を確認し、嚢胞壁を切開すると緑褐色の泥状のギラギラした排液を認めた。液体の所見よりコレステリン肉芽腫が強く疑われ、内腔を生理食塩水で十分洗浄した。術後、耳鼻咽喉科外来にて、右中鼻甲介の下端部を切除して右鼻腔から開窓部が直接的に観察可能となった。病理所見より、血液や変性壊死、Foamy細胞の出現やコレステリン結晶、ヘモジデリン沈着や小円形細胞浸潤を認め、コレステリン肉芽腫と診断した。術後、嚢胞は著明に縮小し、左外転神経麻痺は徐々に改善し術後4週間でほぼ消失し、嚢胞開窓部は再閉塞なく順調に経過している。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02632&link_issn=&doc_id=20121106230008&doc_link_id=10.7887%2Fjcns.21.890&url=https%3A%2F%2Fdoi.org%2F10.7887%2Fjcns.21.890&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

researchmap